Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

[Adrenal incidentalomas: clinical experience in the hospitals of Castilla-La Mancha (Spain)]. / Incidentalomas suprarrenales: experiencia clínica en los hospitales de Castilla-La Mancha.

OBJECTIVE: The management of incidentally discovered adrenal masses (incidentalomas) remains controversial. Our objective was to describe the demographic and clinical characteristics of a series of patients with adrenal incidentalomas attended in several hospitals of Castilla-La Mancha, and their diagnostic and therapeutic management. MATERIAL AND METHODS: Data were obtained by reviewing the patients' medical charts. RESULTS: A total of 270 patients were included (28.1% from Toledo, 25.9% from Albacete, 24.1% from Ciudad Real, 15.9% from Cuenca and 5.9% from Guadalajara). The mean age was 60.3 +/- 12 and 53.3% were women. Overweight or obesity were found in 80.6%, hypertension in 55.8%, diabetes mellitus in 25.6%, impaired fasting glucose or impaired glucose tolerance in 15.6%, osteopenia in 31.5% and osteoporosis in 20.4%. These percentages were similar in patients with subclinical Cushing's syndrome. Diameter was less than 3 cm in 66% of the tumors, and more than 4 cm in 14.3%. Eighty-five percent of the tumors were detected by computed tomography. After a median follow-up of 28.8 months, 6% of nonfunctioning adenomas progressed to subclinical Cushing's syndrome, tumoral enlargement of more than 1 cm was found in 9.4% and a contralateral mass developed in 8.9%. Surgical adrenalectomy was performed in 14.4% of the patients. CONCLUSIONS: Our study confirms the favorable outcome in most patients with adrenal incidentalomas and contributes to a better understanding of this clinical entity.