Evaluación endocrinológica del paciente con enfermedad nodular tiroidea / Endocrinologic approach to the patient with thyroid nodules

Llamamos nódulo tiroideo a aquella lesión concreta palpable o radiológicamente distinguible del parénquima tiroideo. La enfermedad nodular tiroidea tiene una prevalencia progresivamente creciente a medida que ha mejorado la calidad de las técnicas de imagen, principalmente la ecografía. El objetivo de la presente revisión es señalar cuales son los pasos en la evaluación endocrinológica del paciente con enfermedad nodular tiroidea. Más concretamente, cual es la mejor estrategia coste/efectiva para diagnosticar los nódulos tiroideos malignos. Tras una buena anamnesis y exploración clínica, el estudio se completa con una determinación de TSH y la realización de una ecografía tiroidea, que es la prueba diagnóstica que más criterios aporta para poder hacer la indicación de PAAF. La muestra obtenida se estudiará según el sistema Bethesda

Thyroid nodule is defined as a palpable lesion o radiologically distinguishable from thyroid parenchyma. Its prevalence is increasing with the improvement of the imagine techniques, mainly the ultrasonography. The aim of this review is to indicate the steps for the endocrinology evaluation of the patient with thyroid nodules, particularly to choose the best cost/effective strategy to diagnose the malignant thyroid nodules. After having the anamnesis and physical examination done, a TSH determination and an thyroid ultrasound are needed. The sample obtained will be studied according to the Bethesda system

Deleción en el gen STX16 asociada a pseudohipoparatiroidismo / STX16 deletion associated to pseudohypoparathyroidism

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Molecular alterations in hereditary and sporadic thyroid and parathyroid diseases.

Thyroid and parathyroid diseases are fairly common and can be either hereditary or sporadic in nature. Tumors and tumor-like processes account for the majority of surgical pathology specimens in both of these endocrine organs. Molecular alterations are well known to occur in both the hereditary and the sporadic settings, and include alterations in tumor suppressor genes and oncogenes. The genetic pathways of tumors of parathyroid and thyroid are beginning to be well understood and are proving to be useful diagnostic, prognostic, and potential therapeutic targets. The molecular alterations in parathyroid and thyroid tumors and tumor-like processes are reviewed, with a focus on the potentially clinically useful diagnostic markers.

Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease.

BACKGROUND: The risk of dying from primary hyperparathyroidism (pHPT) is controversial and has been explored mainly in single parathyroid gland disease. The present study investigates mortality in pHPT due to multiple parathyroid gland disease. METHODS: We used the nationwide Swedish In-patient Register and Cause-of-Death Registry to compare the mortality in 3485 Swedish patients subjected to parathyroidectomy during 1964 to 1999 with that of the Swedish population (standardized for age, gender, and calendar year). The patient cohort includes 36,596 person years. RESULTS: Increased risk of death beyond the first postoperative year (standardized mortality ratio, 1.4; 95% CI, 1.37-1.52) was found in both sexes and for all age intervals below 80 years. The increased risk persisted more than 15 years postoperatively and related to cardiovascular diseases, diabetes mellitus, urogenital diseases, and malignant disorders. The increased risk of dying in cardiovascular diseases normalized during 1990 to 1999. CONCLUSIONS: pHPT caused by multiple parathyroid gland enlargement is associated with an excessive mortality similar to pHPT of single parathyroid adenoma. The findings substantiate that modern modes of surgical treatment for pHPT normalize the risk of dying from cardiovascular complications and that the hyperpararthyroid state per se is the possible cause of the premature death.

[Current status and problems in the classification of parathyroid diseases].

Abnormalities in serum calcium level usually lead to the diagnosis of parathyroid diseases. Therefore, parathyroid diseases can be classified according to serum calcium levels of the patients. However, the present classification of the diseases have several problems. First, the existence of some of the historically wellknown parathyroid diseases is still under controversy at present. Second, recent studies using molecular and cellular biological approaches have uncovered several genetic abnormalities in some parathyroid tumors, suggesting that parathyroid adenoma or cancer is not a homogeneous disease entity. Third, there remain many unanswered problems to explain the pathogenesis of various parathyroid diseases including pseudohypoparathyroidism. Further elucidation of the pathogenesis of parathyroid diseases should enable us to establish a better classification of these diseases.

[Various technical diagnosis problems in the early diagnosis of parathyroid dysfunctions]. / Uber einige methodisch-diagnostische Probleme zur Früherfassung parathyreoidaler Dysfunktionen.

During the last years the functional diagnostics of the parathyroid glands has been considerably enlarged. Nevertheless, the results concerning an early recognition of conditions of hypofunction and hyperfunction are up to now unsatisfying. Despite of the increasing diagnostic importance of the direct determination of the parathormone which is at first available only in special institutions in these cases methodical problems play a less important part than the still not infrequent appearing misunderstanding of the adequate basic disease. The without doubt great variability of the clinical phenomenology of the parathyreogenic dysfunctions is particularly to be established in their initial stages. The demonstrated processes of investigation apart from the description of complexes of diagnostic problems summarize the experiences of many years of a treatment of outpatients directed to the forms of disturbances of the parathyroid glands.