Clínica de la acromegalia: presentación, cuadro clínico y comorbilidades / Clinical features of acromegaly: presentation, clinical picture and comorbidities

La acromegalia es un síndrome clínico producido por la secreción excesiva de hormona del crecimiento que afecta a prácticamente todo los órganos y tejidos. Se caracteriza por la desfiguración progresiva de los rasgos somáticos debido a las complicaciones metabólicas, endocrinas, cardiovasculares, respiratorias y articulares, así como por un aumento de la prevalencia de cáncer, sobre todo gastrointestinal. Conlleva una gran morbilidad y un aumento significativo de la mortalidad (AU)

Acromegaly is a clinical syndrome produced by excess growth hormone secretion affecting practically all organs and tissues. It is characterized by progressive enlargement of parts of the body due to metabolic, endocrine, respiratory and joint complications, as well as by an increase in the prevalence of cancer, especially gastrointestinal forms. This disorder produces high morbidity and a significant increase in mortality (AU)

Synthesis and structure determination of kahalalide F (1,2).

Kahalalide F, the only member of the family of peptides called kahalalides, isolated from the sacoglossan mollusc Elysia rufescens and the green alga Bryopsis sp., with important bioactivity, is in clinical trials for treatment of prostate cancer. An efficient solid-phase synthetic approach is reported. Kahalalide F presents several synthetic difficulties: (i) an ester bond between two beta-branched and sterically hindered amino acids; (ii) a didehydroamino acid; and (iii) a rather hydrophobic sequence with two fragments containing several beta-branched amino acids in a row, one of them terminated with a saturated aliphatic acid. The cornerstones of our strategy were (i) a quasiorthogonal protecting system with allyl, tert-butyl, fluorenyl, and trityl-based groups, (ii) azabenzotriazole coupling reagents, (iii) formation of the didehydroamino acid residue on the solid phase, and (iv) cyclization and final purification in solution. HPLC, high-field NMR, and biological activity studies showed that the correct stereochemistry of the natural product is that proposed by Rinehart et al. whereas the stereochemistry proposed by Scheuer et al. is that of a biologically less active diastereoisomer.

Serum LH, FSH and testosterone response to the administration of a new LH-RH analog, D-Trp6-LH-RH, in normal men.

A long-acting superactive analog of LH-RH, D-Trp6-LH-RH was given to 23 normal men by several routes of administration (iv, im, sc, continuous infusion) and in increasing doses of 1 to 50 microgram. LH and FSH responses were obtained at doses as low as 2.5 microgram. The maximal absolute LH and FSH increment in response to a 10 microgram iv bolus injection of this analog was similar to 100 microgram of LH-RH. In addition, after administration of the analog the LH and FSH level was maintained at a higher than basal level for at least 8 hours. With a 50 microgram iv bolus injection, from 30 minutes onwards the increases in LH levels were significantly greater (P less than 0.05) than those elicited by the 10 microgram dose for at least 8 hours. Maximum release of LH and RSH was observed when this same dose was given as continuous infusion for 8 hours (P less than 0.05). There seemed to be no significant differences between the im and sc routes. Following the administration of the D-Trp6-LH-RH, testosterone levels were maintained above the normal values (P less than 0.02). The high potency and prolonged duration of action of this compound suggest its potential usefulness for increasing testosterone levels and for stimulation of spermatogenesis in men.

[Current study of Cushing's syndrome, apropos of 3 cases]. / Exploración actual del síndrome de Cushing; a propósito de tres casos

The authors describe three cases of Cushing' syndrome, due to nodular hyperplasia, simple hyperplasia and adenocarcinoma respectively, and the most useful approaches (dexamethasone, metopirona, insulinic hypoglycemia, cortisol rhythm, catheterism and assessment of urinary free cortisol) for diagnosis and etiology of Cushing's syndrome.