Carcinoma medular de tiroides estadio IV y gestación / Medullary thyroid carcinoma stage IV and pregnancy

El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, con relativa agresividad debido a la existencia de metástasis a distancia en el momento del diagnóstico. Se considera como tratamiento de primera línea la cirugía, aunque existen otras opciones de tratamiento en los casos de recurrencia o enfermedad persistente, como los inhibidores de la tirosin-kinasa. El impacto del embarazo en mujeres con CMT es desconocido. Presentamos un caso inédito de una paciente diagnosticada de CMT con gestación posterior exitosa

Medullary thyroid carcinoma is an uncommon malignant tumour that behaves aggressively due to frequent distant metastases at the time of diagnosis. Surgery is considered as first-line treatment, although other treatment options are available for patients with recurrent or residual disease, such as a tyrosine kinase inhibitors. The impact of pregnancy on women with medullary thyroid carcinoma is unknown. We present the case of a woman with medullary thyroid carcinoma whose subsequent pregnancy was successful

Postpartum development of endothelial dysfunction and oxidative stress markers in women with previous gestational diabetes mellitus.

BACKGROUND: Relationships between adhesion molecules (AM), oxidative stress, gestational diabetes mellitus (GDM) and future development of type 2 diabetes mellitus are unclear. AIM: We investigated AM and oxidant/antioxidant markers in women with previous history of GDM. SUBJECTS AND METHODS: Postpartum women with GDM (cases; n = 41) and healthy women (controls; n = 21) had clinical and laboratory variables measured, including indicators of vascular damage (ICAM-1, VCAM-1 and E-selectin), oxidative stress (LPO, GSH and GST) and antioxidant markers (catalase, SOD, GPX and TAC). RESULTS: Previous GDM versus control women presented higher body mass index: 27.4 ± 5.6 versus 23.9 ± 3.6 (p = 0.013); waist circumference: 85.2 ± 12.9 versus 77.5 ± 9.0 (p = 0.017); MetS (WHO definition): 14.6 versus 0 % (p = 0.012); MetS (NCEP-ATPIII definition): 22 versus 0 % (p = 0.002); low HDL: 36.6 versus 9.5 % (p = 0.024); fasting glucose (mmol/L): 5.4 ± 0.6 versus 4.9 ± 0.2 (p < 0.001); glucose 120 min (mg/dL): 105.0 ± 30.2 versus 85.1 ± 14.2 (p = 0.007); fasting insulin (µU/mL): 13.4 ± 8.1 versus 8.4 ± 4.3 (p = 0.004); HOMA index: 3.3 ± 2.3 versus 1.8 ± 1.0 (p = 0.002); HbA1c (%/mmol/mol): 5.4 ± 0.2 versus 5.2 ± 0.2/36 ± 1.4 versus 33 ± 1.4 (p = 0.021); uric acid (mg/dL): 4.1 ± 1 versus 3.5 ± 0.6 (p = 0.009); catalase (nmol/min/mL): 38.7 ± 15.6 versus 28.9 ± 11.1 (p = 0.013). There were no significant differences in hypertension prevalence, lipid fractions, albumin/creatinine ratio and AM. CONCLUSIONS: Women with previous GDM have high catalase levels which correlate positively with glucose intolerance, indicating the potential effect of oxidative stress on postpartum dysglycemic status.

Cytokine profile, metabolic syndrome and cardiovascular disease risk in women with late-onset gestational diabetes mellitus.

Inflammation is an important component of the metabolic syndrome (MetS) which could be the link between the metabolic and the cardiovascular consequences of this condition. Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for MetS and an inflammation component has been described in this disease. The aim of the study was to evaluate the relationships between cytokine concentrations, components of MetS and cardiovascular risk markers in women with late-onset GDM. Women (n=63) with late-onset GDM and 63 controls were enrolled. Clinical variables, and obstetrics and perinatal outcomes were recorded. Relationships between cytokines (TNF-α, leptin, IL6, adiponectin) and endothelial injury markers (VCAM, ICAM and selectine) were analyzed. Control vs. patient data indicated: pre-gestational body mass index (BMI) 23.46±3.73 vs. 26.97±5.07kg/m(2) (p=0.001); TNF-α 2.2±0.8 vs. 3.1±1.5pg/mL (p=0.002); leptin 18714.78±8859.08 vs. 27365.79±16209.67pg/mL (p=0.001); adiponectin 162.42±34.19 vs. 141.54±41.33ng/mL (p=0.04). Multivariate analyses showed that adiponectin had a protective effect (OR=0.9; p=0.02) and BMI carried a significant risk (OR=8.4; p=0.01) for GDM. No differences were found in endothelial injury markers. In conclusion, the cytokine profile in women with late-onset GDM is characterized by high concentrations of TNF-α and leptin and low adiponectin. This profile is related, in large extent, to an increased pregravid BMI which, potentially, may be linked to the future development of both metabolic and cardiovascular disease.

Hipertiroidismo transitorio tras la curación de una enfermedad de Cushing / Transient hyperthyroidism after curing a Cushing disease

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[Papilar thyroid carcinoma. An unusual clinic]. / Carcinoma papilar de tiroides de localizacion inusual.

The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years.

Carcinoma papilar de tiroides de localización inusual / Papilar thyroid carcinoma. An unusual clinic

El carcinoma papilar es el tumor más frecuente de la glándula tiroides, con una frecuencia del 70-75% de todos los cánceres tiroideos. En el 80-90% de los casos se manifesta como un nódulo tiroideo único de crecimiento lento. Sin embargo, en el 10-26%; la forma de presentación es de una tumoración laterocervical aislada en ausencia de una masa tiroidea palpable. Presentamos el caso de un paciente de 67 años de edad que acudió a consulta por tumoración laterocervical de varios años de evolución

The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years