[Thymic hyperplasia in a patient with Graves' disease]. / Hiperplasia tímica en una paciente con enfermedad de Graves.

Benign thymic hyperplasia (TH) is a known feature of hyperthyroidism. In most cases, thymic enlargement is minimal; however, this syndrome may occasionally appear as an appreciable anterior mediastinal mass. Recognition of the benign nature of TH and its regression following treatment of the hyperthyroidism is important to prevent unnecessary surgical procedures. We present a case of TH associated with hyperthyroidism due to Graves' disease.

Hiperplasia tímica en una paciente con enfermedad de Graves / Thymic hyperplasia in a patient with Graves¿ disease

Existe una relación conocida entre hiperplasia tímica (HT) e hipertiroidismo. En la mayor parte de los casos el agrandamiento del timo es mínimo; sin embargo, de forma infrecuente se puede presentar como una masa mediastínica anterior. Es importante conocer la naturaleza benigna de la HT en este contexto y su regresión tras tratar el hipertiroidismo para evitar una intervención quirúrgica innecesaria. Presentamos el caso de una paciente con HT e hipertiroidismo por enfermedad de Graves (AU)

Benign thymic hyperplasia (TH) is a known feature of hyperthyroidism. In most cases, thymic enlargement is minimal; however, this syndrome may occasionally appear as an appreciable anterior mediastinal mass. Recognition of the benign nature of TH and its regression following treatment of the hyperthyroidism is important to prevent unnecessary surgical procedures. We present a case of TH associated with hyperthyroidism due to Graves¿ disease (AU)

Hiperandrogenismo en una mujer posmenopáusica / Hyperandrogenism in a postmenopausal woman

La hipersecreción ovárica de andrógenos es una causa conocida de hirsutismo y virilización en la posmenopausia. La hipertecosis ovárica posmenopáusica es una alteración funcional originada por una regulación anormal de la esteroidogénesis ovárica. Presentamos a una paciente con hiperandrogenismo posmenopáusico ocasionado por una hipertecosisovárica (AU)

Ovarian androgen hypersecretion is a wellrecognized cause of hirsutism and virilization in postmenopausal women. Postmenopausal ovarian hyperthecosis is anonneoplastic functional disorder, which results from abnormal regulation of ovarian steroidogenesis. We present a patient with postmenopausal hyperandrogenism due to ovarian hyperthecosis (AU)

Hyperandrogenism in a postmenopausal woman.

Ovarian androgen hypersecretion is a wellrecognized cause of hirsutism and virilization in postmenopausal women. Postmenopausal ovarian hyperthecosis is a nonneoplastic functional disorder, which results from abnormal regulation of ovarian steroidogenesis. We present a patient with postmenopausal hyperandrogenism due to ovarian hyperthecosis.

Pancreatitis aguda grave en una embarazada con hiperparatiroidismo primario / Severe acute pancreatitis in a pregnant woman with primary hyperparathyroidism

La incidencia del hiperparatiroidismo primario en el embarazo es muy baja. El 80% de las pacientes están asintomáticas, y es extremadamente infrecuente su asociación a pancreatitis aguda. Cuando se diagnostica durante la gestación, el manejo depende de la gravedad de la hipercalcemia, la edad gestacional y la aparición de complicaciones. Presentamos el caso de una mujer embarazada que desarrolló fallo multiorgánico secundario a pancreatitis aguda grave por hiperparatiroidismo primario (AU)

The incidence of primary hyperparathyroidism during pregnancy is very low. Eighty percent of patients area symptomatic and an association with acute pancreatitis is fairly uncommon. When hyperparathyroidism is discovered during pregnancy, management is influenced by the degree of hypercalcemia, gestational age, and the presence of complications. We present a pregnant woman who developed multiorgan failure with severe acute pancreatitis due to primary hyperparathyroidism (AU)

Hipoglucemias por síndrome de hiperinsulinismo-hiperamonemia: a propósito de un caso diagnosticado en la edad adulta / Hypoglycemia due to hyperinsulinism-hyperammonemia syndrome: apropos of a case

El diagnóstico diferencial de las hipoglucemias relacionadas con hiperinsulinismo en adultos incluye tanto los insulinomas como otras causas menos habituales, como el hiperinsulinismo congénito (HC), causa más frecuente de hipoglucemia hiperinsulínica en niños descrita cada vez más en adultos. Adulto diagnosticado de hipoglucemias de ayuno por hiperinsulinismo endógeno con concentraciones de amonio anormalmente elevadas, por lo que se sospechó un síndrome de hiperinsulinismo-hiperamonemia (HI/HA). El análisis del material genético mostró una mutación heterocigota en el gen de la glutamatodeshidrogenasa (GDH), con un cambio en el aminoácido 445 (serina por leucina) de la GDH, que confirmó el diagnóstico. A la vista de los resultados, es recomendable la inclusión en el espectro diagnóstico de las hipoglucemias en adultos tanto del síndrome HI/HA como de otros cuadros del HC

The differential diagnosis of hypoglycemias associated with hyperinsulinism in adults includes both insulinomas and other more unusual causes such as congenital hyperinsulinism (CH). CH is the most frequent cause of hyperinsulinemic hypoglycemia in children and is increasingly being described in adults. An adult diagnosed with fasting hypoglycemias due to endogenous hyperinsulinism with abnormally high plasma ammonium concentrations, possibly indicating a hyperinsulinism-hyperammonemia syndrome (HI/HA). Genetic analysis showed a heterozygote mutation in amino acid 445 (serine for leucine) of the glutamate dehydrogenase gene, confirming the diagnosis. In view of these results and the information found in the literature, the differential diagnosis of hypoglycemias in adults should include both HI/HA syndrome and CH clinical syndromes

Oxidative stress and fibrosis in incipient myocardial dysfunction in type 2 diabetic patients.

BACKGROUND: The existence of a diabetic cardiomyopathy has been recently supported by epidemiological studies. Increased oxidative stress and myocardial fibrosis has been hypothesized as etiopathogenic mechanisms. We sought to demonstrate the existence of incipient myocardial dysfunction in type 2 diabetes and its relation with markers of oxidative stress and myocardial fibrosis. METHODS: We studied by echocardiography 25 uncomplicated type 2 diabetic patients and 12 sex- and age-matched control subjects. Stress-corrected endocardial and midwall shortening and systolic and early diastolic velocity of the lateral mitral annulus (Doppler tissue) were used as parameters of myocardial function. Serum levels of glutathione peroxidase and procollagen type I carboxy-terminal peptide were used as markers of oxidative stress and myocardial fibrosis, respectively. RESULTS: Diabetics had significant lower values of corrected endocardial shortening than control subjects (P = 0.029). Both systolic and early diastolic mitral annulus velocities were significantly reduced in diabetics as compared to control subjects (P = 0.008 and P = 0.003, respectively). In diabetic patients, corrected endocardial (r = -0.56) and midwall shortening (r = -0.38) correlated with procollagen type I carboxy-terminal peptide, whereas systolic and early diastolic velocities of the mitral annulus correlated with glutathione peroxidase (both r = 0.44). CONCLUSIONS: In a highly selected group of uncomplicated type 2 diabetic patients, we found evidence of systolic and diastolic myocardial dysfunction, especially with the use of pulsed Doppler tissue imaging. The correlations between parameters of myocardial function and glutathione peroxidase and procollagen type I carboxy-terminal peptide support a mechanistic role for the increased oxidative stress and myocardial fibrosis in the myocardial dysfunction of type 2 diabetes.