Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital.

INTRODUCTION: Endocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. MATERIAL AND METHODS: Longitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. RESULTS: A total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. CONCLUSIONS: The EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.

Importance of clinical variables in the diagnosis of MODY2 and MODY3.

AIMS: MODY (maturity onset diabetes of the young) is a group of well-defined diseases clinically characterised by onset before age 25 years that does not require insulin treatment (at least initially) to prevent the formation of ketone bodies and autosomal dominant inheritance. Despite the importance of accurate classification, it is not always simple to catalogue the diagnosis of a young patient with diabetes, and genetic studies are often improperly used. METHODS: We describe the clinical features of patients negative for MODY2 and MODY3 and compared them to patients positive for these subtypes. RESULTS: All patients with MODY3 had been diagnosed before age 25 years and required drug therapy for blood glucose control. MODY2 patients were diagnosed at the first laboratory workup either incidentally or as part of gestational diabetes screening. The clinical description of the 19 patients negative for MODY2 and MODY3 showed that only two patients presented a clinical picture consistent with MODY3 and one patient with MODY2. CONCLUSIONS: Clinical features can be used for early exclusion of a MODY2 or MODY3 diagnosis and may reduce the need for genetic testing.

Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1alpha gene.

OBJECTIVE: The aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1alpha gene. METHODS: The study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1alpha gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed. RESULTS: No differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1alpha gene (p < 0.05). CONCLUSIONS: Occasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1alpha gene.

[Variations in the concentration of the sex hormone binding globulin is a major factor causing a variation in total testosterone values]. / Variaciones en las concentraciones de globulina transportadora de hormonas sexuales como causa importante de alteraciones en las concentraciones de testosterona total.

Measurement of total testosterone concentrations is the initial test for the diagnosis of androgen deficiency or excess in men. However, total testosterone concentrations may be affected by alterations in sex hormone binding globulin (SHBG) concentrations. Most circulating testosterone is bound to SHBG and to albumin and only 0.5-3% of circulating testosterone is unbound or free. The free fraction can be measured by equilibrium dialysis or calculated using published algorithms. The term bioavailable testosterone refers to unbound testosterone plus albumin-bound testosterone; this term reflects the view that, in addition to unbound testosterone, albumin-bound testosterone is readily dissociable and thus bioavailable. Bioavailable testosterone can be measured by precipitation methods or calculated from total testosterone, SHBG, albumin concentrations and their affinity constants. Free testosterone measurements by analog methods are frequently available, but these measurements are affected by alterations in SHBG and are inaccurate. We report the cases of a 42-year-old man with testosterone excess and a 29-year-old man with testosterone deficiency, in whom total testosterone concentrations were affected by SHBG alterations.

Primary hyperparathyroidism due to parathyroid carcinoma associated with pulmonary embolism.

Parathyroid carcinoma (PC) is an uncommon disease affecting 0.5-5% of all patients with primary hyperparathyroidism. PC is characterized by the association of severe symptoms of hypercalcemia, high serum calcium and parathyroid hormone (PTH) concentrations and a palpable neck mass. Definitive diagnosis can only be made by histological study after surgery. We report the case of a 77-year-old man admitted to our hospital due to pulmonary embolism and hypercalcemia. The patient was initially diagnosed with primary hyperparathyroidism, but displayed the atypical clinical features described above. Due to clinical suspicion of PC, a surgical procedure was carried out. Diagnosis of parathyroid carcinoma was confirmed by histopathologic study.

Silent corticotroph adenomas of the pituitary gland: apropos of two cases.

Clinically silent corticotroph adenomas are rare. The clinical course of these tumors varies: while some have an insidious course, others behave aggressively, especially during tumoral recurrence. Given the absence of clinical and biochemical features of hypercortisolism, the definitive diagnosis is histological.