[The potential dangers of endocrinal disorders].

The symptoms of most endocrine system diseases are usually clearly recognizable and most of the times are accompanied by a rich medical history. Many general practitioners are reluctant to treat such cases and prefer to refer these patients to specialists who are trained in management of the medically compromised thus increasing the chances of dental treatment without complications. However, sometimes endocrinal diseases develop slowly and their clinical manifestations are hidden or subclinical in nature. In these cases, neither the patient nor the dentist are aware of the condition and there is the potential of life threatening, emergency situations in what at first seem as simple, straightforward dental procedures. Therefore, the dentist must be able to recognize the clinical problem, differentiate between the different symptoms and initiate the proper management protocol. The most unstable endocrinal disorders that should be treated with great care are diabetes mellitus, mainly hypoglycemia, hyperthyroidism and adrenal insufficiency. The general practitioner dentist can treat patients suffering from these disorders providing the disease is well controlled and balanced and that the dental treatment is not very traumatic.

[Hyperthyroidism and dental treatment]. / Hyperthyreoïdie en de tandheelkundige behandeling.

In this contribution the cause, consequences, and treatment of hyperthyroidism are discussed. The consequences in relation to dental treatment are given special attention. A patient with a properly treated hyperthyroidism can safely undergo dental treatment, although periods of stress are to be avoided.

Erythrocyte metabolism in hyperthyroidism: a microcalorimetric study on changes in the Embden-Meyerhof and the hexose monophosphate pathways.

Erythrocyte metabolism was studied in vitro by microcalorimetry in 10 hyperthyroid subjects before and after treatment. By inhibiting the enzyme enolase in the Embden-Meyerhof pathway with sodium fluoride (NaF) we have recorded the anaerobic and aerobic contributions in erythrocyte thermogenesis. The decrease in heat production rate in samples with NaF corresponds to the anaerobic contribution, whereas the values from samples with NaF reflect aerobic processes. Before treatment, total heat production rate was 120 +/- 2 mW/l erythrocytes which was higher than the post-treatment value of 99 +/- 2 (P less than 0.001) as well as the value for 14 euthyroid subjects, 108 +/- 2 mW/l (P less than 0.001). The NaF inhibitable rate was 73 +/- 2 before and 63 +/- 1 mW/l after therapy (P less than 0.01). These values correspond to 61 +/- 1 and 64 +/- 1% (n.s.) of the total heat production rate, and were similar to that of 61 +/- 2% for the controls. Heat production rates in the presence of NaF were 47 +/- 1 before and 36 +/- 1 mW/l after therapy (P less than 0.001), representing 39 +/- 1 and 36 +/- 1% of total values, respectively. The present results show that overall metabolism is increased in erythrocytes from hyperthyroid subjects before treatment and returns to normal after normalization of the thyroid function. Moreover, by using microcalorimetry we found that the metabolic activity along the Embden-Meyerhof anaerobic pathway as well as along the hexose monophosphate aerobic pathway in erythrocytes is stimulated by thyroid hormones.

Experiencia de 10 años en el tratamiento quirúrgico del hiperparatiroidismo primario en el Hospital de Especialidades del Centro Médico Nacional de Occidente / Ten-year experience in the surgical treatment of primary hyperparathyroidism in the Hospital de Especialidades del Cedntro Médico Nacional de Occidente

Se analizaron 91 expedientes de pacientes con diagnóstico de hiperparatiroidismo primario (HPTP), que recibieron tratamiento quirúrgico en el periodo comprendido de enero de 1980 a marzo de 1990. Del total de pacientes, 17 fueron hombres (18 por ciento) y 74 mujeres (82 por ciento) con una relación H/M de 1 a 4. Las edades extremas fueron de 17 a 72 años con una media de 47.1. La sintomatología que con mayor frecuencia se observó fue la siguiente: litiasis renoureteral recidivanate 75 por ciento, fraturas óseas patológicas en 7.5 por ciento, mialgias y artralgias en 7.5 por cinto. A todos los pacientes se les realizó determinación de calcio y fósforo sérico, se encontró calcio por arriba de 12 mgs en 89 por ciento y fósforo bajo en 63.7 pacientes. Se realizaron un total de 91 procedimientos quirúrgicos, cinco de ellos requirieron re-intervención por permanecer con el calcio sérico elevado. El resultado histopatológico de las piezas resecadas fue de adenoma en 93 por ciento de los enfermos, hiperplasia en 4.2 por ciento y carcinoma en 2.8 por ciento; la localización más frecuente de los adenomas encontrados fue en la glándula inferior izquierda (34.8 por ciento, seguida de la inferior derecha (30.3 por ciento). Las complicaciones registradas en el post-operatorio fueron: hipocalcemia transitoria en 6 pacientes y lesion del nervo laringeo recurrente en uno. La mortalidad operatoria fue de cero.