Comparison of different systems of ultrasound (US) risk stratification for malignancy in elderly patients with thyroid nodules. Real world experience.

PURPOSE: To comparatively assess the performance of three sonographic classification systems, American Thyroid Association (ATA), the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), and American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)/Associazione Medici Endocrinologi (AME) in identifying malignant nodules in an elderly population. METHODS: Cross-sectional study of patients referred for fine needle aspiration biopsy in an academic center for the elderly. One nodule/patient was considered. Nodules classified Bethesda V/VI were considered malignant. Receiver operating characteristics (ROC) curves were established and compared to evaluate diagnostic performance. Malignancy among biopsies below the size cutoff for each ultrasound classification was also compared. RESULTS: One thousand, eight hundred sixty-seven patients (92% females); median (Q1-Q3), age 71 (67-76) years, were studied showing 82.8% benign (Bethesda II) and 2.6% malignant cytology. The three classifications correctly identified malignancy (P < 0.01). Nonetheless, in the ATA and AACE/ACE/AME 16 and 2 malignant nodules, respectively, were unclassifiable. Including unclassified malignant nodules (n = 1234, malignant = 50), comparison of the ROC curves showed lower performance of ATA [area under the curve (AUC) = ATA (0.49) vs. ACR TI-RADS (0.62), p = 0.008 and ATA vs. AACE/ACE/AME (0.59), p = 0.022]. Proportion of below size cutoff biopsies for ATA, ACR TI-RADS, and AACE/ACE/AME was different [16, 42, and 29% (all p < 0.001)], but no differences in malignancy rate were observed in these nodules. CONCLUSION: The present study is the first to validate in elderly patients these classifications showing that AACE/ACE/AME and ACR TI-RADS can predict thyroid malignancy more accurately than the ATA when unclassifiable malignant nodules are considered. Moreover, in this aged segment of the population, the use of ACR TI-RADS avoided more invasive procedures.

Clinical and Etiological Aspects of Gynecomastia in Adult Males: A Multicenter Study.

OBJECTIVES: To evaluate the characteristics of presentation, biochemical profile, and etiology of gynecomastia in adults. METHODS: Medical records of 237 men aged 18-85 years with gynecomastia were evaluated. RESULTS: Highest prevalence of gynecomastia was observed between 21 and 30 years (n = 74; 31.2%). The most common presenting complaints were aesthetic concerns (62.8%) and breast pain (51.2%). 25.3% of the subjects had a history of pubertal gynecomastia. 56.5% had bilateral gynecomastia. 39.9% were overweight and 22.8% were obese. The etiology could not be identified in 45.1% of the cases; the most frequent identified causes were anabolic steroids consumption (13.9%), hypogonadism (11.1%), and use of pharmaceutical drugs (7.8%). Patients with bilateral gynecomastia had a longer history of disease, higher BMI, and lower testosterone levels. CONCLUSIONS: Patients with gynecomastia presented more often with aesthetic concerns and secondarily with breast pain. The most frequent final diagnosis was idiopathic gynecomastia, whereas the most frequent identified etiologies were anabolic steroids consumption, hypogonadism, and use of pharmaceutical drugs. Despite the low frequency of etiologies such as thyroid dysfunction or adrenal carcinoma, we emphasize the importance of a thorough assessment of the patient, as gynecomastia may be the tip of the iceberg for the diagnosis of treatable diseases.

Clinical Presentation of Klinefelter's Syndrome: Differences According to Age.

The aim of the study was to establish the characteristics of presentation of 94 patients with Kinelfelter's syndrome (KS) referred to the endocrinologist at different ages. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8%). Most of the patients (83.7%) showed the classic 47,XXY karyotype and 7.1% showed a 47,XXY/46,XY mosaicism. Half of the patients younger than 18 years presented mild neurodevelopmental disorders. The most frequent clinical findings were cryptorchidism in prepubertal patients, and small testes, cryptorchidism, and gynecomastia in pubertal patients. FSH, LH, AMH, and inhibin B levels were normal in prepubertal patients and became abnormal from midpuberty. Most adults were referred for small testes, infertility, and gynecomastia; 43.6% had sexual dysfunction. Testosterone levels were low in 45%. Mean stature was above the 50th percentile, and 62.5% had BMI ≥25.0 kg/m(2). In conclusion, the diagnosis of Klinefelter syndrome seems to be made earlier nowadays probably because pediatricians are more aware that boys and adolescents with neuro-developmental disorders and cryptorchidism are at increased risk. The increasing use of prenatal diagnosis has also decreased the mean age at diagnosis and allowed to get insight into the evolution of previously undiagnosed cases, which probably represent the mildest forms. In adults average height and weight are slightly higher than those in the normal population. Bone mineral density is mildly affected, more at the spine than at the femoral neck level, in less than half of cases.

Hipogonadismo masculino / Male hypogonadism

El hipogonadismo masculino es un síndrome que involucra la falla testicular en cuanto a la producción de andrógenos y de una espermatogénesis adecuada. En este Consenso se discutirán, exclusivamente, los aspectos vinculados al déficit de andrógenos. La deficiencia androgénica es una situación clínica frecuente. El síndrome de Klinefelter tiene una prevalencia de 1 en 500 recién nacidos vivos y si se suman otras causas congénitas o adquiridas de lesiones testiculares e hipotálamo-hipofisarias, se estima que alrededor de 1 en 200 hombres presentan reducción de los niveles circulantes de testosterona (T). Si, además, se considera la deficiencia androgénica asociada al envejecimiento, esta prevalencia aumenta significativamente. El hipogonadismo en su presentación clínica clásica es de fácil diagnóstico, pero las formas menos severas presentan dificultades para su reconocimiento. Sin embargo, es de fundamental importancia establecer con certeza la deficiencia androgénica antes de iniciar cualquier terapia de sustitución debido a los riesgos potenciales

Utilidad de la versión abreviada del Indice Internacional de Función Eréctil (IIEF-5) pra la evaluación de la severidad de la disfunción eréctil y de la respuesta al tratamiento con sildenafil / Utility of the 5-Item version of the International Index of Erectile function as a diagnostic tool for erectile dysfunction. Evaluation of the efficacy and safety of sildenafil

Desde el año 1997 se cuenta con un método semicuantitativo que permite obtener información del grado de severidad y compromiso psicosexual de los pacientes con disfunción eréctil (D.E.), mediante un cuestionario de 15 ítems: el Indice Internacional de Función Eréctil (IIEF). A partir de este índice, en 1999 se desarrolló una versión acotada de 5 preguntas, que permite una rápida y eficaz orientación diagnóstica de severidad de la D.E. (IIEF-5). Por otro lado, el ingreso en los últimos años del sildenafil, inhibidor de la fosfodiesterasa tipo 5, al arsenal farmacológico del tratamiento de la D.E., ha cambiado el pronóstico y el abordaje terapéutico de dicha disfunción. Los objetivos del presente trabajo fue 1) determinar la utilidad del IIEF-5 en el diagnóstico y seguimiento de la D.E. y 2) determinar la eficacia y seguridad del sildenafil en el tratamiento de los pacientes con D.E