Long-term remission following antithyroid drug withdrawal in patients with Graves' hyperthyroidism: parameters with prognostic value.

OBJECTIVE: To assess the predictive value of some clinical and biochemical parameters, and of the +49 A/G polymorphism of the CTLA-4 gene, for long-term remission following the withdrawal of antithyroid drugs before starting antithyroid drug therapy. STUDY DESIGN: Observational, prospective and longitudinal study. METHODS: Seventy-two patients (11 of whom were men) with newly diagnosed Graves' hyperthyroidism who had been attended consecutively at a University Clinic in a population with sufficient iodine intake were included in the study. EXCLUSION CRITERIA: patients under the age of 18, pregnant women and non-Caucasian patients. All subjects were treated following a well-defined protocol. Long-term remission was calculated at 12 and 36 months following withdrawal of the antithyroid drug. RESULTS: Thirty-six of the 72 study subjects experienced a remission of at least 12 months following withdrawal of methimazole, with no differences according to their age or sex. A comparison made between the remission rates seen in both groups yielded significant differences regarding the presence of Graves' orbitopathy, the duration of the treatment with methimazole and the absence of the CTLA-4 G/G genotype. In the univariate and multivariate analyses performed, only lower frequencies of Graves' orbitopathy and an absence of the CTLA-4 G/G genotype were considered independent predictors of long-term remission. CONCLUSIONS: The absence of Graves' orbitopathy and of the CTLA-4 G/G genotype are independent predictors of long-term remission following a first course of antithyroid drugs.

Long-term outcome of multimodal therapy for giant prolactinomas.

Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.

[Malnutrition in patients with cancer; four years experience]. / Desnutrición en pacientes con cáncer; una experiencia de cuatro años.

OBJECTIVE: To analyze the prevalence and degree of malnutrition among patients with cancer who were sent to an Oncological Nutrition visit. MATERIAL AND METHODS: It is an observational crosssectional descriptive study. First nutrition visit data of all patientes aged ≥ 18 with cancer who were evaluated from march of 2008 to february of 2012 were used. A total of 997 patients were studied using the Patient-Generated Subjective Global Assessment. RESULTS: 69% of the patients had lost more than 5% of their usual weight within the previous 3 months, the patients with the highest frequency of weight loss were those with digestive cancer. Eating problems were encountered by the 81.2% of the patients, the most frequent problem being anorexia (53.3%) and the median number of symptoms was 3. Patient-Generated Subjective Global Assessment shows a malnutrition prevalence of 72.9% (29.9% with moderate malnutrition and 43% with severe malnutrition). Malnutrition was related to the type of cancer and the stage of the disease and was not related to age, gender neither usual body mass index. CONCLUSIONS: Malnutrition prevalence among patients who were evaluated in our consulting-room is high. Nutritional evaluation is very important to detect patients at risk of malnutrition or with malnutrition and helps to choose the nutritional treatment.

Objetivo: Analizar la prevalencia y el grado de desnutrición de los pacientes con cáncer remitidos a una consulta específica de Nutrición Oncológica. Material y métodos: Se trata de un estudio transversal, observacional y descriptivo basado en los datos recogidos en la primera consulta de nutrición de todos los pacientes mayores de edad con cáncer evaluados en el período comprendido entre el 1 de marzo de 2008 y el 29 de febrero de 2012. Se incluyeron 997 pacientes, a los que se les realizó la Valoración Global Subjetiva Generada por el Paciente. Resultados: El 69% de los pacientes habían perdido más de un 5% de su peso habitual en los 3 meses previos, siendo esto más frecuente entre los portadores de tumores digestivos. El 81,2% de los pacientes tenían dificultades para alimentarse, el síntoma más frecuente era la anorexia (53,3%) y la mediana de síntomas por paciente 3. La Valoración Global Subjetiva Generada por el Paciente muestra una prevalencia de desnutrición del 72,9% (29,9% desnutrición moderada y 43% desnutrición severa). La desnutrición se relacionó con el tipo de tumor y con el estadío, pero no con la edad, el sexo ni con el Índice de Masa Corporal habitual. Conclusiones: La prevalencia de desnutrición en los pacientes con cáncer evaluados en nuestra consulta es elevada. La valoración nutricional es básica para identificar a aquellos pacientes con desnutrición o riesgo de desnutrición y orientar la necesidad de tratamiento nutricional.

Acromegaloidism with normal growth hormone secretion associated with X-tetrasomy.

We reported a case of a 26-year-old female who was referred to our clinic with the diagnosis of possible acromegaly. She was born from a term pregnancy by forceps delivery. The patient was diagnosed as having hip luxation at one month and spoke her first word at 15 months. She had been diagnosed at the age of 9 years old as having perinatal encephalopathy with intellectual and motor affectation. Since this period of time she has undergone an insidious change in her appearance, mainly comprising progressive coarsening of the face. For this reason she was submitted to our clinic with presumed acromegaly. Dynamic tests of growth hormone secretion ruled out such a diagnosis. The Patient was considered as having "acromegaloidism", a term used for patients whom manifest clinical features of acromegaly but do not present a demonstrable growth hormone hypersecretion. Subsequently cytogenetic evaluation revealed an infrequent chromosome pattern: X-Tetrasomy. In the present article a differential diagnosis of acromegaloidism and the potential role of genes present on X-chromosome involved in human growth such as SHOX gene are discussed. Overdosification of SHOX gene might explain tall stature of girls with X-tetrasomy. Our observation suggested that X-tetrasomy should be considered in the differential diagnosis of acromegaloidism. Furthermore, this may lead to the identification of new genes in the X-chromosome that are important for growth of facial structures.