Laboratorio de función tiroidea en pediatría. Ventajas y limitaciones de los métodos indirectos para la obtención de intervalos de referencia / Thyroid function laboratory in pediatrics. Advantages and limitations of indirect methods to obtain reference intervals

Obtener intervalos de referencia (IRs) confiables para pruebas de laboratorio en pediatría es particularmente complejo y costoso. Una alternativa a este problema es el uso de métodos indirectos, donde se usan grandes bases de datos preexistentes de pacientes. Nuestros objetivos fueron: calcular IR para TSH y hormonas tiroideas (Perfil tiroideo, PT) en población pediátrica que asiste al Hospital de Pediatría Juan P. Garrahan, por método indirecto y verificar la confiabilidad de los mismos para su aplicación. Se recolectaron datos de 19.842 pacientes entre enero de 2020 y diciembre de 2021. Se aplicaron filtros para eliminar los pacientes que pudieran tener afectado el PT. Los 4.861 pacientes incorporados al análisis fueron divididos en 3 grupos: G1: 0-12 meses (n: 551), G2:13 meses- 7 años (n: 1347) y G3: 8 -18 años (n: 2963). Los IR fueron calculados por 2 métodos: el de Hoffman adaptado y el de CLSI EP28A3, para cada grupo de edad. TSH, TT3 y T4L se analizaron con Architect i4000-Abbott y TT4 con Immulite 2000XPi-Siemens. Para la primera etapa de verificación se utilizaron 20 sueros de pacientes provenientes de análisis prequirúrgicos. Los outliers se detectaron aplicando el método de Tukey. Los datos fueron procesados según CLSI EP28A3c. Los IR obtenidos fueron similares a los previamente publicados obtenidos por método directo. Los resultados de la verificación fueron en su mayoría aceptados. Por lo tanto, los métodos indirectos son una buena alternativa de cálculo de IR en pediatría (AU)

Obtaining reliable reference ranges (RRs) for laboratory tests in pediatrics is particularly complex and costly. An alternative to this problem is to use of indirect methods, where large pre-existing patient databases are used. Our aims were to calculate RRs for TSH and thyroid hormones (thyroid profile, PT) in children seen at Hospital de Pediatría Juan P. Garrahan by indirect methods and to verify their reliability for their application. Data were collected from 19,842 patients seen between January 2020 and December 2021. Filters were applied to eliminate patients in whom the PT was potentially affected. The remaining 4,861 patients included in the analysis were divided into 3 groups: G1: 0-12 months (n: 551), G2: 13 months-7 years (n: 1347) and G3: 8-18 years (n: 2963). RRs were calculated by 2 methods: the adapted Hoffman method and the CLSI EP28A3 method, for each age group. TSH, TT3, and FT4 were analyzed with Architect i4000-Abbott and TT4 with Immulite 2000XPi-Siemens. For the first stage of verification, 20 patient sera from pre-surgical analysis were used. Outliers were detected by applying the Tukey method. The data were processed according to CLSI EP28A3c. The RRs obtained were similar to those previously published using the direct method. The verification results were mostly acceptable. Therefore, indirect methods are a good option for calculating RRs in children (AU)

Uso adecuado de las pruebas de laboratorio para la evaluación de la función tiroidea en pediatría / Appropriate use of laboratory tests for evaluation of thyroid function in pediatrics

Las pruebas de función tiroidea (PFT) son esenciales para el diagnóstico preciso y el seguimiento eficaz de la disfunción tiroidea. Existe un incremento progresivo y estable de los pedidos de PFT, incluso se han incorporado las mismas a los exámenes de salud anuales en niños sanos. Representan más del 60% de las pruebas realizadas en el laboratorio de endocrinología, tanto en adultos como en los laboratorios especializados en pediatría. Para hacer un uso eficiente de las PFT, antes de solicitarlas debemos preguntarnos… ¿Para quién? ¿Cuándo solicitarlas? ¿Qué pruebas solicitar? ¿Cómo solicitarlas? y ¿Cómo interpretar correctamente los resultados? Un resultado anormal en las PFT no siempre implica patología tiroidea asociada. Las PFT tienen importante variabilidad intra e interindividual lo que hace más compleja su correcta interpretación. La pesquisa de enfermedad tiroidea neonatal es un importante aporte a la prevención de la deficiencia mental en la infancia, su aplicación obligatoria posibilita un diagnóstico temprano, para asegurar su éxito debe considerarse en el marco de un programa integral de detección con estrategias de confirmación, tratamiento temprano y seguimiento a corto, mediano y largo plazo. No debe hacerse un uso indiscriminado de la prueba de estímulo con TRH en el diagnóstico de la patología tiroidea. En pediatría la estrategia de tamiz de enfermedad tiroidea es conveniente realizarla mediante la medición de por lo menos TSH y T4 libre e incluir la determinación de ATPO en grupos de riesgo, a diferencia de la determinación aislada de TSH como es recomendado en adultos. (AU)

Thyroid function tests (TFTs) are essential for accurate diagnosis and effective monitoring of thyroid dysfunction. There is a progressive and steady increase in requests for TFTs, and they have even been incorporated into annual health examinations in healthy children. They represent more than 60% of the tests performed in the endocrinology laboratory, both in adults and in specialized pediatric laboratories. To efficiently use TFTs, before requesting them we should ask ourselves... For whom? When to request them? Which tests to request? How to request them? and How to correctly interpret the results? An abnormal TFT result does not always imply thyroid disease. TFTs have significant intra- and inter-individual variability, which makes their correct interpretation more complex. Screening for newborn thyroid disease is an important contribution to the prevention of intellectual disability in childhood and its mandatory use enables early diagnosis; however, to ensure the test to be successful, it should be considered within the framework of a comprehensive screening program with strategies for confirmation, early treatment, and short-, medium-, and long-term follow-up. The TRH stimulation test in the diagnosis of thyroid disease should not be used indiscriminately. In children, the screening strategy for thyroid disease should be performed by measuring at least TSH and free T4 and include the measurement of TPO-ab in risk groups, as opposed to the isolated measurement of TSH as recommended in adults. (AU)

Avaliação termográfica do desenvolvimento mamário de búfalas e sua regulação endócrina em distintos estágios fisiológicos / Thermographic evaluation of the mammary development of buffaloes and their endocrine regulation in different physiological stages

O conhecimento do desenvolvimento mamário de um rebanho leiteiro é fundamental, pois relaciona-se à eficiência produtiva. Objetivou-se avaliar a associação dos parâmetros térmicos mamários com concentrações hormonais de búfalas em distintos estágios fisiológicos. Foram utilizadas 24 búfalas mestiças Murrah, em quatro grupos (n= 6): grupo 1 (bezerras), grupo 2 (novilhas), grupo 3 (gestantes) e grupo 4 (lactantes). A cada 28 dias, durante 4 meses, realizaram-se exames de termografia digital por infravermelho para verificar temperatura superficial dos corpos mamários craniais (CMCr) e caudais (CMC), das cisternas craniais (CGMCr) e caudais (CGMC) e tetas craniais (TGMCr) e caudais (TGMC). Foi aferida temperatura retal (TR) e colhido sangue para mensuração das concentrações plasmáticas do fator semelhante a insulina tipo-I, insulina (INS), hormônio do crescimento (GH), progesterona (P4) e estradiol. Grupos 1 e 2 apresentaram correlação de TR com CGMCr. No grupo 3, TR correlacionou-se com TGMCr, TGMC e concentrações plasmáticas de P4. No grupo 4, houve correlação de TR com CGMC, TGMCr e concentrações plasmáticas de INS e GH, e de TGMC com concentrações plasmáticas de GH. Nos quatro grupos, CGMCr correlacionou-se com CMCr e TGMCr, semelhantemente ao observado na porção caudal. Variações térmicas mamárias refletiram alterações fisiológicas aguardadas nos períodos avaliados.(AU)

The knowledge of the mammary development of a dairy herd is key, since it is related to its productive efficiency. The objective of this study was to evaluate the association of mammary thermal parameters with hormonal concentrations of buffaloes at different physiological stages. Twenty-four Murrah crossbred buffaloes were used in four groups (n= 6): group 1 (calves), group 2 (heifers), group 3 (pregnant animals) and group 4 (lactating animals). Every 28 days, for 4 months, infrared digital thermography was performed to check the surface temperature of cranial (CrCM) and caudal (CCM) corpus mammae, cranial (CrC) and caudal (CC) cisterns and cranial (CrT) and caudal teats (CT). Rectal temperature (RT) was measured and blood was collected to measure plasma concentrations of insulin-like factor I, insulin (INS), growth hormone (GH), progesterone (P4) and estradiol. Groups 1 and 2 presented correlation of RT with CrC. In group 3, RT correlated with CrT, CT and plasma P4 concentrations. In group 4, there was correlation of RT with CC, CrT and plasma concentrations of INS and GH, and CT with plasma GH concentrations. In all four groups, CrC correlated with CrCM and CrT, similar to that observed in the caudal portion. The thermal changes in the mammary glands reflected the expected physiological changes in the evaluated periods.(AU)

Resposta endócrina à contenção física e isolamento em papagaios-verdadeiros / Endocrine response to physical restraint and isolation in blue-fronted parrots

O objetivo deste trabalho foi analisar a resposta dos papagaios-verdadeiros aos procedimentos de contenção e separação física por método não invasivo, como a dosagem das concentrações de metabólitos de glicocorticoides nas excretas. Para tanto, foram utilizadas 24 aves, 17 machos e sete fêmeas, inicialmente mantidas em viveiros amplos e adjacentes, separadas por sexo. Após captura e contenção de três minutos, 13 aves voltaram para os viveiros coletivos e 11 foram alojadas em gaiolas individuais no mesmo recinto dos viveiros, de modo a permitir que as aves isoladas mantivessem contato visual e auditivo com as demais. Para avaliar se os animais responderiam de maneira diferente quando fisicamente isolados ou em grupo, amostras de excretas foram coletadas sequencialmente em intervalos de três horas durante 24 horas para avaliação dos metabólitos de glicocorticoides por enzimaimunoensaio. Não houve efeito significativo de sexo (P=0,5850), tratamento (P=0,6805) e tempo (P=0,2293), e as concentrações de metabólitos de glicocorticoides mantiveram-se dentro da variação diurna esperada para esta espécie. Portanto, ambos os grupos responderam endocrinologicamente de forma semelhante e o estresse de captura e separação física não foi significativo para as aves.(AU)

The aim of this study was to evaluate the response of blue-fronted parrots to restraint procedures and separation by non-invasive methods such as measurement of glucocorticoid metabolites in droppings. For this, we utilized 24 birds, 17 males and 7 females, initially kept in large adjacent aviaries, separated by sex. After capture and 3 minutes of manual contention, by random, 13 birds returned to the aviary and 11 animals were housed in individual cages in the same facility of the aviaries allowing the maintenance of auditory and visual contact between them. In order to evaluate if the physically isolated birds isolated or in groups would react in different ways, all droppings samples were collected at 3-hours intervals during 24 hours to evaluation of excreted glucocorticoid metabolites by enzimeimmunoassay. There were no significant effects of sex (P=0.5850), treatment (P=0.6805) and time (P=0.2293) and the glucocorticoid metabolites concentrations were within the diurnal range expected for this specie. Therefore, the endocrine response of both groups was similar and stress of capture and physical separation was not significant for the birds.(AU)

Características clínicas y epidemiológicas de los pacientes con diagnóstico de pubertad precoz central controlados en la consulta externa de endocrinología pediátrica del Hospital Nacional de Niños Benjamín Bloom en el período de 2004 al 2014 / Clinical and epidemiological characteristics of patients with a diagnosis of central precocious puberty controlled in the pediatric endocrinology outpatient clinic of the Benjamín Bloom National Children's Hospital in the period from 2004 to 2014

Pubertad precoz central (PPC) se caracteriza por la aparición de un desarrollo mamario progresivo en las niñas antes de los 8 años con posterior aparición de vello pubiano y axilar seis meses más tarde del inicio de la telarquia. La administración de análogos de la Hormona liberadora de la Gonadotropina (aGnRH) ha sido el tratamiento de elección. Estudio observacional, transversal, retrospectivo. Muestra comprendida por 61 pacientes controlados en consulta externa de Endocrinología del Hospital Nacional de Niños Benjamín Bloom en período de 2004 al 2014. Se realizó una descripción de las variables obtenidas a través de un instrumento, recolección de datos, utilizando como fuente de información el expediente clínico. El 100% de los pacientes fueron femeninos. El 95% provino de áreas urbanas. La media de edad de diagnóstico fue de 7.0 años, la edad media de inicio de síntomas 6.4 años. Todos los casos fueron idiopáticos. El síntoma inicial más frecuente fue la telarquia (n= 43, 70.4%). Recibieron tratamiento con aGnRh 29 (47.5%) pacientes, de los cuales (n=8 27.5%) lo obtuvieron por menos de un año. Talla adulta final media con tratamiento 150.5 cm, mientras que los que no recibieron 150.9. Todos los pacientes pertenecieron al sexo femenino. La mayoría (95%) son de origen urbano. La edad de diagnóstico de la enfermedad en la población estudiada concuerda con la sugerida para el manejo en guías internacionales. Todos los casos fueron idiopáticos. La talla adulta final es inferior a las obtenidas en estudios diferentes. Menos de la mitad de los pacientes recibieron tratamiento con aGnRh. Los pacientes tratados presentaron mayor velocidad de crecimiento

Maniobra digital para localización del nervio recurrente descripción de la técnica Montezuma y Wilper / Digital maneuver for the localization of recurrent nerve Wilper and Montezuma technique description

En el siguiente trabajo tratamos de dar a conocer una maniobra que desde hace varios años venimos utilizando en el servicio de cabeza y cuello, con lo que respecta a la localización del nervio laríngeo recurrente en la cirugía del tiroides tanto en los casos malignos como benigno y en aquellos casos de bocio grado II, III o bocios voluminosos, y carcinoma tiroideos, lo cuales cambian la localización anatómica en el trayecto del nervio de igual manera la disposición anatómica de no recurrir. Se realiza un estudio en una muestra descriptiva tomada para este trabajo de 80 casos solamente, durante 10 años en lo que venimos practicamos la técnica, con pacientes de ambos sexos y diferentes edades. Se procedió a realizar la incisión clásica de cervicotomía anterior, se hace la diéresis hasta liberar los lóbulos tiroideos luego se localiza con palpación digital la escotadura crico tiroidea de cada lado de la laringe donde se encuentra el ligamento suspensorio tiroideo de Berry y membrana cricotiroidea, se diseca una área de 2 cm x 2 cm dicha zona y se ve la penetración de una o dos ramas del nervio recurrentelaríngeo tanto en los casos que recurre como en los no recurrentes. Concluimos que en todos los casos fueron encontrados el nervio ya sea como único o varias de sus ramas en este punto anatómico de reparo

The damage to the recurrent laryngeal nerve is most feared complication by the surgeon of all those that can affect patients undergoing surgery for thyroid and the parathyroid glands. In this paper we try to give a maneuver known that for several years we have been using the service head and neck, with regard to the location of laryngeal recurrent nerve thyroid surgery in both malignant and benign cases most important in cases of goiter grade II, III or bulky goiter and thyroid carcinoma, which changes the anatomical location on the route of laryngeal recurrent nerve, just as the anatomical disposition of non-use. We were studied in a sample descriptive taken for this study of 80 cases only, for 10 years in what we have practiced the technique, patients of both sexes and different ages. We preceded to perform a cervical incision anterior classic, the umlaut is to release the lobes, then located with palpation cricothyroid notch on each side of the larynx where the suspensor ligament of Berry thyroid and cricothyroid membrane is dissected an area of 2 cm x 2 cm that area and is the penetration of one or two branches of recurrent laryngeal nerve, both in the case used as non-recurring. We conclude that in all cases were found either as single recurrent laryngeal nerve or more of its branches at this point anatomical repair

Síndrome metabólica em adolescentes obesos: comparação entre três diferentes critérios diagnósticos / Metabolic syndrome in obese adolescents: a comparison of three different diagnostic criteria

OBJETIVO: Verificar a diferença na proporção de adolescentes com síndrome metabólica, diagnosticados por três diferentes critérios, bem como com a utilização da resistência à insulina no lugar da glicemia de jejum. MÉTODOS: Estudo transversal com 121 adolescentes obesos, de 10 a 14 anos de idade, da rede municipal de ensino de Porto Alegre, em 2011. Foram realizadas avaliações antropométricas, de pressão arterial e bioquímicas. A síndrome metabólica foi definida por três critérios diagnósticos diferentes: International Diabetes Federation, Cook e de Ferranti. Todos eles incluem cinco componentes: perímetro abdominal, pressão arterial, lipoproteína de alta densidade (HDL) colesterol, triglicerídeos e glicemia em jejum, sendo necessária a alteração de pelo menos três para o diagnóstico da síndrome. Para a caracterização da resistência à insulina, foi utilizado o índice Homeostasis Model Assessment - Insulin Resistance. A análise de concordância entre os critérios foi realizada pela estatística de Kappa. RESULTADOS: A síndrome metabólica foi observada em 39,7, 51,2 e 74,4% dos adolescentes, de acordo com as definições da International Diabetes Federation, Cook e de Ferranti, respectivamente. Houve concordância do diagnóstico para os três critérios, simultaneamente, em 60,3% da amostra. O componente mais prevalente foi o perímetro abdominal elevado (81,0, 81,0 e 96,7%), e o menos prevalente foi a glicemia em jejum elevada (7,4, 1,7 e 1,7%). A utilização do Homeostasis Model Assessment - Insulin Resistance aumentou significativamente a proporção de diagnósticos positivos para a síndrome. CONCLUSÃO: Os resultados mostraram considerável diferença entre os três critérios diagnósticos. Enquanto não houver consenso em relação aos critérios da síndrome metabólica, serão frequentes as divergências quanto à prevalência da doença em populações pediátricas.

OBJECTIVE: To investigate the difference in the proportion of adolescents with metabolic syndrome diagnosed based on three different criteria, as well as the use of insulin resistance instead of fasting glucose. METHODS: Cross-sectional study with 121 obese adolescents, between 10 and 14 years old, from public schools of the city of Porto Alegre, Brazil, in 2011. Anthropometric, blood pressure, and biochemical variables were assessed. Metabolic syndrome was defined using three different diagnostic criteria: the International Diabetes Federation (IDF), Cook and de Ferranti. All of them include five components: waist circumference, blood pressure, high-density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose, and there should be at least three abnormal results for the diagnosis of the syndrome. The Homeostasis Model Assessment - Insuline Resistance (HOMA-IR) was used for the characterization of insulin resistance. The analysis of agreement among the criteria was performed using Kappa statistics. RESULTS: Metabolic syndrome was diagnosed in 39.7, 51.2, and 74.4% of adolescents, according to the IDF, Cook and de Ferranti criteria, respectively. There was agreement for the three diagnostic criteria in 60.3% of the sample. Waist circumference was the most prevalent component (81.0, 81.0, and 96.7%), whereas high fasting glucose was the least prevalent (7.4, 1.7, and 1.7%). The use of HOMA-IR significantly increased the proportion of positive diagnoses for the syndrome. CONCLUSION: The results showed significant differences between the three diagnostic criteria. While there is no consensus on the diagnostic criteria for metabolic syndrome, differences in the prevalence of the disease in pediatric population will be frequent.

Caracterización clínica y epidemiológica de los pacientes menores de 15 años de edad con diabetes mellitus tipo 1 / Clinical-epidemiologic characterization of patients aged under 15 presenting with type 1 diabetes mellitus

Objetivo: identificar las características clínico epidemiológicas de los pacientes menores de 15 años de edad, diagnosticados con diabetes mellitus tipo 1 durante el período comprendido entre el 1º de enero de 2000 y el 31 de diciembre de 2008 de la provincia Ciudad de La Habana. Métodos: se realizó un estudio descriptivo-retrospectivo con los pacientes menores de 15 años de edad, diagnosticados con diabetes mellitus tipo 1 durante el período ya mencionado. El grupo de estudio estuvo constituido por 293 pacientes, a los que se realizó la revisión de la historia clínica. Las variables estudiadas fueron: sexo, edad al diagnóstico, color de la piel, duración de lactancia materna exclusiva, forma clínica al diagnóstico y factores ambientales. Se realizó el análisis estadístico mediante cálculo de por cientos y de tasas de incidencia por grupo de edad y sexo durante el período estudiado. Resultados: los resultados más importantes mostraron un predominio de los pacientes que recibieron lactancia materna exclusiva por un tiempo menor de 3 meses. Las formas clínicas menos graves al diagnóstico de la enfermedad fueron las más frecuentes. Entre los factores ambientales predominaron las enfermedades respiratorias agudas. La tasa de incidencia media del período fue de 8,4 x 100 000 habitantes. Conclusiones: la incidencia de la enfermedad durante el período fue más alta en relación con los estudios previos realizados en el país, con un desplazamiento hacia edades tempranas(AU)

Objective: to identify the clinical-epidemiologic features of the patients aged under 15, diagnosed with type 1 diabetes mellitus from January 1, 2000 to December 31, 2008 from Ciudad de La Habana province. Methods: a descriptive-retrospective study was conducted in patients aged under 15 diagnosed with type 1 diabetes mellitus over above mentioned period. The study group included 293 patients and the review of medical record. Study variables were: sex, age at diagnosis, skin color, length of exclusive breast feeding, clinical way at diagnosis and environmental factors. A statistic analysis was carried out by means of percentage calculation and the incidence rates by age group and sex over the study period. Results: the more important results showed predominance of patients received exclusive breastfeeding over a period less than three months. The less severe clinical ways at disease's diagnosis were the more frequent ones. Among the environmental factors there was predominance of acute respiratory diseases. The mean incidence rate of the period was of 8.4 x 100 000 inhabitants. Conclusions: the disease's incidence over the period was higher in relation to the previous studies conducted in our country with a displacement towards early ages(AU)

Does undetectable basal Tg measured with a highly sensitive assay in the absence of antibodies and combined with normal ultrasonography ensure the absence of disease in patients treated for thyroid carcinoma? / Tireoglobulina basal indetectável medida com ensaio ultrassensível na ausência de anticorpos e combinada com ultrassonografia normal assegura ausência de doença em pacientes tratados de câncer de tireoide?

It has been proposed that, in patients treated for well-differentiated thyroid carcinoma, undetectable basal thyroglobulin (Tg) levels measured with a highly sensitive assay in the absence of anti-thyroglobulin antibodies (TgAb) and combined with negative neck ultrasonography (US) ensured the absence of disease. We report a series of five patients with well-differentiated (papillary) carcinoma submitted to total thyroidectomy with apparently complete tumor resection, followed by remnant ablation with 131I (100-150 mCi), who had no distant metastases upon initial post-therapy whole-body scanning. When tumor recurrence or persistence was detected, these patients presented undetectable basal Tg (0.1 ng/mL) in the absence of TgAb, and US showed no anomalies. Two patients had lymph node metastases, one had mediastinal metastases, bone involvement was observed in one patient, and local recurrence in one. We conclude that further studies are needed to define in which patients undetectable basal Tg (negative TgAb) combined with negative US is sufficient, and no additional tests are required.

Tem sido proposto que em pacientes tratados de carcinoma bem diferenciado da tireoide o encontro de valores basais indetectáveis de tireoglobulina (Tg), dosada por ensaios ultrassensíveis, na ausência de anticorpos antitireoglobulina (TgAc), e combinado à ultrassonografia (US) cervical negativa, asseguraria ausência de doença. Reportamos aqui uma série de cinco pacientes com carcinoma bem diferenciado (papilífero), submetidos à tireoidectomia total, com ressecção tumoral aparentemente completa, seguida da ablação de remanescentes com 131I (100-150 mCi), sem metástases distantes na pesquisa de corpo inteiro pós-dose inicial, que, na ocasião em que a recorrência ou persistência tumoral foi detectada, apresentavam Tg basal indetectável (0.1 ng/ml), TgAc negativos e US sem anormalidades. Dois pacientes tinham metástases linfonodais, um tinha mediastinal, outro acometimento ósseo e um recorrência local. Concluímos que mais estudos são necessários para a definição de que pacientes com Tg basal indetectável (sem TgAc) combinada à US sem anormalidades seria suficiente, dispensando testes adicionais.

Evaluación de parámetros endócrino metabólicos en los nuevos fenotipos diagnósticos de pacientes con síndrome de ovario poliquístico / Evaluation of endocrine metabolic parameters in new phenotypes diagnoses of patients with polycystic ovary syndrome

Introducción: el síndrome de ovario poliquístico (SOP), la endocrinopatía ginecológica mßs frecuentes en mujeres en edad fértil, se caracteriza por hiperandrogenismo, anovulación crónica y/u ovarios poliquísticos. Debido a su asociación con la insulino resistencia las pacientes tienen mayor riesgo de padecer alteraciones metabólicas. En la actualidad no existe un único criterio diagnóstico universalmente aceptado para definir SOP, estando en vigencia dos: los formulados en 1990 por el Instituto Nacional de Salud de Estados Unidos (Criterios NIH) y el mßs reciente, publicado en 2004 por la Sociedad Americana de Medicina Reproductiva y la Sociedad Europea de Reproducción Humana y Embriología (Criterios de Rotterdam). El hiperandrogenismo y la anovulación crónica son los elementos cardinales de ambas definiciones, siendo el patrón ecogrßfico de ovario poliquístico el tercer elemento incorporado en el último consenso. Así, aplicando los Criterios de Rotterdam, el diagnóstico se realiza con dos de los tres elementos mencionados; generando cuatro fenotipos de mujeres con SOP: 1- hiperandrogenismo, disfunción ovulatoria y morfología de ovario poliquístico [SOP clßsico tipo I con ovarios poliquísticos], 2- hiperandrogenismo y disfunción ovulatoria pero con ecografía normal [SOP clßsico tipo II con ovarios normales], 3- hiperandrogenismo y ovario poliquístico pero con ciclos ovulatorios [SOP ovulador] y 4- disfunción ovulatoria y ovario poliquístico pero sin hiperandrogenismo [SOP normoandrogénico]. Los nuevos criterios han incrementado la prevalencia, la heterogeneidad y también la controversia; siendo prematuro asumir que todos los fenotipos tienen el mismo riesgo de desarrollar complicaciones metabólicas...

ABSTRACT: Background: Polycystic ovary syndrome (PCOS), the most common gynecological endocrinopathy in women of childbearing age, is characterized by hyperandrogenism, chronic anovulation and / or polycystic ovaries. Because of its association with insulin resistance patients have increased risk of metabolic disorders. At present there is no single universally accepted diagnostic criteria to define PCOS, being in effect two: those made in 1990 by the National Institute of Health USA (NIH criteria) and the most recent, published in 2004 by the American Society of Reproductive Medicine and European Society of Human Reproduction and Embryology (Rotterdam criteria). Hyperandrogenism and chronic anovulation are the cardinal elements of both definitions, with the ultrasonographic pattern of polycystic ovary the third element incorporated in the last consensus. Thus, using the Rotterdam criteria, the diagnosis is made with two of the three elements, generating four phenotypes of women with PCOS: 1- hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology [PCOS classic type I with polycystic ovaries], 2- hyperandrogenism and ovulatory dysfunction but with normal ultrasound [PCOS classic type II with normal ovaries], 3- and polycystic ovarian hyperandrogenism but with ovulatory cycles [PCOS ovulating] and 4- ovulatory dysfunction and polycystic ovaries without hyperandrogenism [PCOS normoandrogenic]. The new criteria have increased the prevalence, diversity and controversy. It is still premature to assume that all phenotypes have the same risk of developing metabolic complications...

El método clínico en las enfermedades tiroideas / The clinical method in thyroid diseases

Se analizan algunos aspectos del método clínico en relación con las enfermedades de la glándula tiroidea, que provocan una mayor concurrencia de los pacientes a las consultas de endocrinología en todo el país, donde se carece en ocasiones de reactivos hormonales, así como también de la posibilidad de realizar estudios y terapéuticas con iodo I 131, entre los medios más importantes para diagnosticar y tratar adecuadamente a quienes padecen esas afecciones.

Some aspects of the clinical method related to the diseases of thyroid gland are analyzed, leading to an increase of patients attending the endocrinology departments throughout the country, where sometimes hormonal reagents are not available, and there is not a possibility for studies or treatment with iodine I 131, among the most important ways to diagnose and adequately treat those suffering from these conditions.

Estudio del paciente con talla baja: [revisión] / Study of patients with short stature: [review]

La talla baja se define como la condición en la cual la altura de un niño o niña es más de dos desviaciones esténdar por debajo del promedio poblacional esperado para su edad y sexo, o por debajo del percentil 3. La talla baja es una de las principales causas por las cuales se consulta al pediatra endocrinólogo; sin embargo, hay que tener presente que existen variaciones normales en el crecimiento que deben ser diferenciadas de las patológicas. Es necesario que la evaluación del paciente con talla baja incluya una historia clínica completa y detallada, un cuidadoso examen clínico, auxología y pruebas diagnósticas, incluyendo evaluaciones radiológicas, con el fin de diferenciar...

Análise de diferentes medidas antropométricas na identificação de síndrome metabólica, com ou sem alteração do metabolismo glicídico / Analysis of several anthropometric measurements for the identification of metabolic syndrome, with or without disturbance of glucose metabolism

OBJETIVO: Este estudo comparou parâmetros antropométricos e de resistência à insulina de indivíduos sem e com síndrome metabólica (SM), subestratificados pela presença de anormalidades glicêmicas. SUJEITOS E MÉTODOS: Foram incluídos 454 indivíduos (66 por cento mulheres, 54 por cento brancos), sendo 155 alocados para o grupo 1 (sem SM, sem anormalidade glicêmica), 32 para o grupo 2 (sem SM, com anormalidade glicêmica), 104 no grupo 3 (com SM, sem anormalidade glicêmica) e 163 no grupo 4 (com SM e anormalidade glicêmica). Os grupos foram comparados por ANOVA. RESULTADOS: Os grupos com SM (3 e 4) apresentaram os piores perfis antropométrico e lipídico; no grupo 2, apesar de glicemias significantemente mais elevadas, as médias das variáveis antropométricas e lipídicas não diferiram do grupo 1. Os maiores valores médios de HOMA-IR foram encontrados nos grupos com SM, enquanto o grupo 2 apresentou o menor HOMA-β. A trigliceridemia foi a variável metabólica com coeficientes de correlação mais elevados com a antropometria. Porém, as correlações mais fortes foram da circunferência da cintura (r = 0,503) e da razão cintura-altura (r = 0,513) com o HOMA-IR (p < 0,01). CONCLUSÃO: Nossos achados revelam que, em amostra da população brasileira, qualquer das medidas antropométricas identifica indivíduos com SM, mas não parece capaz de diferenciar aqueles com distúrbio glicêmico. Reforçamos a relação mais forte das medidas de adiposidade central com resistência à insulina, sugerindo utilidade da razão cintura-altura. É possível que componente autoimune contribua para o comprometimento do metabolismo glicídico dos indivíduos do grupo 2.

OBJECTIVE: This study compared anthropometric measurements and insulin resistance indexes of individuals with or without metabolic syndrome (MS), stratified by the presence of glycemic abnormalities. SUBJECTS AND METHODS: 454 individuals (66 percent women, 54 percent Caucasians) were included, being 155 allocated to group 1 (without MS, without glycemic abnormality), 32 to group 2 (without MS, with glycemic abnormality), 104 to group 3 (with MS, without glycemic abnormality), and 163 to group 4 (with MS, with glycemic abnormality). Groups were compared by ANOVA. RESULTS: Those with MS (3 e 4) showed the worst anthropometric and lipid profiles; in group 2, despite higher plasma glucose levels, the mean values of anthropometric variables and lipids did not differ from group 1. The highest mean values of HOMA-IR were found in the groups with MS, while group 2 showed the lowest HOMA-β. Triglyceride was the metabolic variable with the highest correlation coefficients with anthropometry. However, the strongest correlations were those of waist circumference (r = 0.503) and waist-to-height ratio (r = 0.513) with HOMA-IR (p < 0.01). CONCLUSION: Our findings indicate that, in a sample of the Brazilian population, any anthropometric measure identifies individuals with MS, but such measurements seem to be unable to differentiate those with glycemic disturbance. We reinforce the strongest relationship of measures of central adiposity with insulin resistance, suggesting utility for the waist-to-height. An autoimmune component may be contributing to the deterioration of glucose metabolism of individuals from group 2.

Ultrassonografia e histopatologia renal em cães / Renal ultrasonography and histopathology in dogs

The kidneys are the organs responsible for maintaining the hydro-electrolytic equilibrium of the organism. There are several diseases that can affect these organs, causing changes and may be one of the causes of death in clinical routine. The ultrasound is the main diagnostic method to detect changes in the kidneys because it is noninvasive and allow the assessment of the size and the renal parenchyma. The histopathology is essential for confirmation of the diagnosis, and it was performed and compared with the ultrasound examination, so the degree of compatibility between ultrasound and pathological diagnostic methods could be analyzed. Twenty-one dogs were used in the experiment. After the ultrasound, the animals were autopsied for removal of the kidneys. The kidneys were fixed in 10% formalin, processed and observed by light microscopy. The findings were 52% in ultrasound examination and 81% in histological examination. The index of compatibility between the two tests was 66%, which confirmed the literature data that describe the ultrasound examination as the best method of non-invasive diagnosis for renal disorders.

Evaluación de sensibilidad-especificidad de valores de 170H progesterona sérica, basales y post estímulo con ACTH, en función del análisis molecular del gen CYP21A2 en la deficiencia de 21-hidroxilasa no clásica / Evaluation of sensitivity and specificity of serum 170H progesterone values at baseline and post ACTH stimulation in the function of molecular analysis of the CYP21A2 gene in non-classic 21-hydroxilase deficiency

La forma no clásica, post natal, de la hiperplasia suprarrenal congénita tiene una incidencia de 1 en 1000 en la población general y afecta al 6% de las mujeres hirsutas. En este estudio se estableció la sensibilidad y la especificidad de la respuesta de los niveles séricos de 17-hidroxiprogesterona (17OHP4) al estímulo agudo con ACTH en 203 pacientes de ambos sexos, pre y post puberales, con hiperandrogenismo, en los cuales se analizó si tenían una alteración molecular del gen CYP21A2. Posteriormente al estudio molecular, los pacientes fueron clasificados en tres grupos de acuerdo al genotipo: Gr0, n=61: ningún alelo mutado (no portadores de mutación); Gr1, n=55: un alelo mutado (portadores) y Gr2, n=87: dos alelos mutados (afectados). Por análisis de regresión logística (curvas ROC) se compararon los valores basales del Gr2 vs Gr0 y se obtuvo un valor de 17OHP4 de 7,2 ng/ml con una sensibilidad del 83% y una especificidad del 85%. Se sugiere entonces que en los pacientes con este nivel basal no se debería realizar el test de ACTH, y habría que confirmar el diagnóstico con el estudio molecular. Los niveles 17OHP4 a los 60 minutos post estímulo con ACTH mayores a 20 ng/ml son confirmatorios del diagnóstico con 84% de sensibilidad y 88% de especificidad. No sería necesario entonces realizar estudios moleculares. Un valor de 15,6 ng/ml diferencia Gr2 de Gr0 con una sensibilidad del 89% y una especificidad del 95%. Este es un buen valor predictivo, pero el análisis molecular no debería obviarse en aquellos casos en los que exista una fuerte sospecha clínica. (AU)

The incidence of non classic congenital adrenal hyperplasia is 1:1000 in the general population and it is present in 6% of hirsute women. In this study, the sensitivity and specificity of serum 17-hydroxyprogesterone (17OHP4) response to acute ACTH stimulation was evaluated in 203 prepubertal and pubertal patients of the two sexes with hyperandrogenism, in whom the CYP21A2 gene was analyzed. After molecular analysis patients were divided in 3 groups according to genotype: Gr0, n=61, no mutated allele (no mutation carrier); Gr1, n=55, one mutated allele (carrier); and Gr2, n=81, two mutated alleles (affected patient). Using logistic regression analysis (ROC curves), basal values in Gr2 vs. Gr0 were compared and a cutoff value of 7.2 ng/ml was defined to separate groups, with 83% sensitivity and 85% specificity. It is suggested then that in patients with levels higher than 7,2 no ACTH test is necessary and molecular analysis is required to confirm diagnosis. Serum 17OHP4 values above 20 ng/ml 60 minutes after ACTH are confirmatory of diagnosis, with 84% sensitivity and 88% specificity. No molecular studies should be necessary. A 15.6 ng/ml cutoff value is able to differentiate Gr2 from Gr0, with 89% sensitivity and 95% specificity. It is a good predictive value, but carrying out molecular analysis is only advisable if clinical evidence is strong (AU)

A comparison of applicability in three diagnostic criteria of metabolic syndrome in Jiangsu population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To compare the applicability of the three diagnostic criteria for metabolic syndrome (MS) proposed by the International Diabetes Federation (IDF) in 2005, Adult Treatment Panel III of National Cholesterol Education Program (NCEP-ATP III) in 2005 and Chinese Diabetes Socie (CDS) in 2004.</p><p><b>METHODS</b>Based on the findings of cohort study of multiple metabolic disorders and metabolic syndrome (1971 cases) in Jiangsu province, MS was diagnosed according to these three definitions respectively, and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases (CVD) and type 2 diabetes mellitus (T2DM). While, through Cox regression analysis, to compare their relative risk (RR) and 95% confidential interval (CI) was wade.</p><p><b>RESULTS</b>Among three diagnostic criteria, the specificity by CDS of MS was higher than the other criteria (83.52%, 76.36%, 89.57%; 85.02%, 78.67%, 92.28%), however the sensitivity of CDS of MS was low (40.82%, 29.47%). When using CDS, over 50 percent of diagnosis might be missed. ATP III definition corresponded to the shortest distance in ROC curve, namely, at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum (0.4369; 0.5777). The incidence of CVD [5.59 (2.62 - 11.92) vs 2.90 (1.41 - 5.93)], T2DM [3.36 (1.92 - 5.79) vs 1.97 (1.16 - 3.34)] was significantly higher in cases of ATP III+/IDF-than ATP III+/IDF+, as compared with ATP III-/IDF-.</p><p><b>CONCLUSION</b>Among three diagnostic criteria, the ATP III definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.</p>