Obesidad secundaria a síndrome endocrinológico en paciente pluripatológica / Obesity secondary to endocrinology syndrome in a polymorbid patient

Presentamos el caso de una paciente de 64 años, natural de Rumanía, con antecedentes médicos de síndrome de apnea-hipopnea, cirrosis hepática, EPOC y artrosis. Fumadora activa de un paquete de cigarrillos/día. La paciente es remitida desde la consulta de neumología para estudio ambulatorio por presentar como hallazgo incidental adenomas suprarrenales bilaterales y aumento progresivo de peso en los últimos 5 años. En el estudio de adenomas suprarrenales y obesidad se objetiva la presencia de un síndrome de Cushing. Es importante estudiar la aparición de la obesidad reciente en una paciente pluripatológica dado que puede haber otras causas secundarias además de las enfermedades subyacentes que presenta. Durante la presentación del caso clínico se realiza un abordaje esencial y práctico de la enfermedad adrenal. (AU)

We present the case of a 64-year-old woman from Romania with a medical history of obstructive sleep apnea-hypopnea syndrome, hepatic cirrhosis, COPD, and osteoarthritis. She smokes one pack of cigarettes per day. The patient is referred from the pulmonology department for an outpatient evaluation for an incidental finding of bilateral adrenal adenomas and progressive weight gain over the last five years. Cushing syndrome is detected during study of the adrenal adenomas and obesity. It is important to study recent-onset obesity in multimorbid patients as there could be other secondary causes in addition to the underlying diseases they present with. During the presentation of this clinical case, an essential, practical approach to the adrenal pathology is made. (AU)

Obesity secondary to endocrinology syndrome in a polymorbid patient.

We present the case of a 64-year-old woman from Romania with a medical history of obstructive sleep apnea-hypopnea syndrome, hepatic cirrhosis, COPD, and osteoarthritis. She smokes one pack of cigarettes per day. The patient is referred from the pulmonology department for an outpatient evaluation for an incidental finding of bilateral adrenal adenomas and progressive weight gain over the last five years. Cushing syndrome is detected during study of the adrenal adenomas and obesity. It is important to study recent-onset obesity in multimorbid patients as there could be other secondary causes in addition to the underlying diseases they present with. During the presentation of this clinical case, an essential, practical approach to the adrenal pathology is made.

[Comparison of two nutritional screening tools for predicting the development of complications in hospitalized patients]. / Comparación de dos herramientas de cribado nutricional para predecir la aparición de complicaciones en pacientes hospitalizados.

BACKGROUND: The prevalence of malnutrition in hospitalized patients is high and has been associated with higher morbimortality. Currently no nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate the prevalence of nutritional risk in hospitalized patients using the nutritional screening tools Mini Nutritional Assessment (MNA) and Nutrition Risk Screenig 2002 (NRS 2002) and to identify the ability for predicting development of complications. METHODS: We evaluated 57 patients admitted within the first 48 h in different medical or surgical wards of the hospital. The patients were assessed by MNA and NRS 2002 and using anthropometric and laboratory parameters. Agreement between MNA and NRS 2002 was analyzed with the kappa index. ROC curves were used for assessing the validity of the both tools in predicting complications with determination of the area under the curve (AUC). RESULTS: The prevalence of patients at nutritional risk was 38.6% with the NRS-2002 and 49.1% with the MNA. The agreement between two tools was moderate (κ = 0.436, p = 0.001). The incidence of complications was significantly higher in patients at nutritional risk defined by the NRS 0,002) but not according to the MNA (28.6% vs. = 2002 (40.9% vs. 5.7%; p 0.08). Sensitivity for predicting complications was 81.8% with = 10.3%, p the NRS 2002 and 72.7% with the MNA and specificity was 71.7% and 56.5% respectively. By ROC curve, both tests were valid to identify the risk of complications: NRS 2002 AUC = 0.768 (confidence interval (IC) 95%: 0.637-0.869) and MNA AUC = 0.646 (IC 95%: 0.508-0.768), but the AUC was significantly higher with the NRS 2002 (p = 0.047). CONCLUSIONS: The prevalence of nutritional risk in hospitalized patients is high. NRS 2002 is a screening tool more valid than MNA to predict the development of complications.