Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.

Multidisciplinary Panel Consensus for the Management of Patients with Type 2 Diabetes: A Delphi Study.

AIM: To reach a multidisciplinary consensus on managing patients with type 2 diabetes among specialists in family medicine, cardiology, endocrinology, internal medicine, and nephrology. METHODS: A two-round Delphi study was conducted using a questionnaire with 68 positive/negative statements distributed in four thematic blocks on diabetes management: early diagnosis and prediabetes, referral criteria, treatment and comorbidities, and clinical management. The expert panel was composed of 105 physicians from different specialties (family medicine, cardiology, endocrinology, internal medicine, and nephrology) with experience in managing patients with diabetes and who were members of a diabetes-related society. RESULTS: Response rates for the first and second rounds were 86.7 and 75.2%, respectively. After both rounds, a consensus was reached on 52 (76.5%) items. The recommendations with the highest degree of consensus (median = 10, IQR = 0.00) were related to anti-smoking education, cardiovascular risk factor target control, and diabetic kidney disease. There were significant differences between family physicians and other specialties for some items. CONCLUSIONS: This study provides a set of recommendations for diabetes management agreed upon by specialists from different healthcare settings.

Inhibin B and antiMüllerian hormone as surrogate markers of fertility in male and female Crohn's disease patients: a case-control study.

Background: Several studies suggest that women with Crohn disease (CD) have reduced fertility due to decreased ovarian reserve, among other causes. On the other hand, male CD patients could have difficulties conceiving. The present study aimed to test the effect of CD on both male and female fertility potential, Sertoli cell function and ovarian reserve, assessed by inhibin-B (IB) plus IB:FSH ratio (IFR) and antiMüllerian hormone (AMH), respectively. Sexual dysfunction (SD) was studied as secondary endpoint. Methods: We performed a cross-sectional, case-control study. Serum IB levels plus IFR were measured in 58 men with CD and compared to 25 age-matched healthy controls (HC). Serum AMH levels were measured in 50 women with CD and in 30 HC matched by age. SD was assessed by means of the International Index of Erectile Function (IIFE-15) in males and the Index of Female Sexual Function (IFSF) in women. Results: A total of 108 CD patients and 55 HC were included. IB serum levels were significantly lower in CD men than in HC (177 ± 58 vs. 234 ± 75 pg./mL, p = 0.001). IFR was also decreased in CD patients compared to HC (58.27 ± 59.5 vs. 91.35 ± 60.04, p = 0.014). Women with CD > 30 years had lower serum AMH levels compared to HC (1.15 ± 0.74 vs. 2.14 ± 1.68 ng/mL, p = 0.033). In addition, CD women >30 years presented a serum AMH < 2 ng/mL more frequently than HC (90% vs. 40%, p = 0.004). The prevalence of SD was significantly higher among both male and female CD patients compared to HC, without association to fertility potential. Age was the only predictor of low ovarian reserve. Conclusion: Testicular Sertoli cell function assessed through serum IB levels and IFR is decreased in CD male patients compared to HC, regardless of age. Age > 30 years is the single independent predictor of reduced ovarian reserve in women with CD. These results should be confirmed in further studies in order to properly counsel patients with CD and desire for offspring.

Modelo asistencial ambulatorio de alta resolución COVID-A2R: una solución efectiva en el servicio de urgencias para pacientes con COVID-19 y riesgo de evolución desfavorable / Effective fast-track ambulatory care pathway for patients with COVID-19 at risk for poor outcome: the COVID-A2R model in a hospital emergency department

Objetivo. Evaluar la efectividad de un modelo asistencial basado en la derivación desde el servicio de urgencias hospitalarios (SUH) a una consulta presencial precoz de alta resolución (COVID-A2R), para pacientes con infección por SARS-CoV-2 sin insuficiencia respiratoria, pero con factor de riesgo de complicación/deterioro clínico. Método. Cohorte retrospectiva de pacientes remitidos por COVID-19 (RT-PCR) desde el SUH de un hospital terciario a COVID-A2R (7 de enero - 17 de febrero de 2021). Los criterios de inclusión son presencia de alta comorbilidad y elevación de biomarcadores inflamatorios en pacientes sin neumonía, o la presencia de neumonía con elevación de biomarcadores inflamatorios sin insuficiencia respiratoria. La variable de resultado principal fue el no requerimiento de revisita en el SUH con ingreso hospitalario y su distribución temporal. Los objetivos secundarios son la frecuentación en COVID-A2R y el impacto económico potencial. Resultados. Se incluyeron 278 pacientes, edad mediana de 57 años, 57,9% hombres e índice de Charlson de 1. Consultaron en el SUH tras 7 (4-11) días de clínica y un 71,8% de los casos presentaban neumonía. El 64,7% de los pacientes requirió una visita única en COVID-A2R. No se produjo una revisita a urgencias con ingreso en el 87,8% (83,4-91,1) de los pacientes. De los 34 pacientes que ingresaron, el 88,2% lo hizo en menos de 5 días. El ahorro potencial del modelo fue de 1.708 días de ingreso hospitalario. Conclusiones. Un modelo asistencial ambulatorio con una consulta de alta resolución tras el alta de urgencias es efectivo para pacientes con COVID-19 sin insuficiencia respiratoria con marcadores clínicos o analíticos de evolución desfavorable.

Objective. To evaluate the effectiveness of a care pathway (Spanish acronym, COVID-A2R) through which patients with SARS-CoV-2 infection were referred by a hospital emergency department (ED) for fast-track in-person outpatient clinic care if they did not have respiratory insufficiency but were at high risk for complications and poor outcome. Methods. Retrospective cohort of patients referred to the COVID-A2R pathway after being diagnosed with COVID-19 by reverse transcription polymerase chain reaction assay in a tertiary care hospital ED between January 7 and February 17, 2021. The inclusion criteria were 1) absence of pneumonia but presence of serious comorbidity and/or elevated biomarkers of inflammation, and 2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an emergency department revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the potential economic impact. Results. We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4–11 days). Pneumonia was diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%–91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization. Conclusion. The fast-track ambulatory care model was effective after emergency department discharge of patients with COVID-19 without respiratory insufficiency but with clinical or laboratory indicators of risk for poor outcome.

Utilidad y seguridad de la automonitorización electrocardiográfica durante el tratamiento con hidroxicloroquina y azitromicina en pacientes con COVID-19 / Usefulness and safety of self-electrocardiographic monitoring during treatment with hydroxychloroquine and azithromycin in COVID-19 patients

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Reference ranges for serum and salivary testosterone in young men of Mediterranean region / Valores de referencia de testosterona sérica y salivar en varones jóvenes del área Mediterránea

BACKGROUND AND AIMS: The interassay variability found in the measurement of testosterone (T) levels warrants the need for laboratories to validate their methods to establish trustworthy cut-off points for diagnosis of male hypogonadism. The aims of this study were to validate measurement of total T (TT) at our laboratory in order to obtain reference ranges for TT, calculated free T (CFT), calculated bioavailable T (CBT), and salivary T (ST) in healthy young men from the Mediterranean region, and to evaluate the potential clinical value of ST by establishing its correlation with serum T. METHODS: An observational, cross-sectional study with sequential sampling. Inclusion criteria: men aged 18-30 years with body mass index (BMI) < 30. Exclusion criteria: chronic diseases, hepatic insufficiency or use of drugs altering circulating T levels. Main outcome measures TT (chemiluminescent immunoassay UniCell DXI 800 [Access T Beckman Coulter]), CFT and CBT (Vermeulen's formula), and ST (radioimmunoassay for serum TT modified for saliva [Coat-A-Count, Siemens]). Descriptive statistical analyses and correlation by Spearman's rho (SPSS 19.0 Inc., Chicago) were used. RESULTS: One hundred and twenty-one subjects aged 24 ± 3.6 years with BMI 24 ± 2.5 kg/m2 were enrolled. Hormone study: TT, 19 ± 5.5 nmol/L (reference range [rr.] 9.7-33.3); CFT, 0.38 nmol/L (rr. 0.22-0.79); CBT, 9.7 nmol/L (rr. 4.9-19.2); and ST, 0.35 nmol/L (rr. 0.19-0.68). Correlation between ST and CFT was 0.46. CONCLUSIONS: In men from the Mediterranean region, values of TT > 9.7 nmol/L, CFT > 0.22 nmol/L, and/or CBT > 4.9 nmol/L make the presence of biochemical hypogonadism unlikely. According to the correlation between serum and ST, the clinical value of ST remains to be established

ANTECEDENTES Y OBJETIVOS: La variabilidad interensayo existente en la determinación de testosterona (T) justifica la necesidad de que cada laboratorio valide su método y establezca puntos de corte fiables para el diagnóstico del hipogonadismo masculino. Los objetivos del estudio fueron validar la determinación de T total (TT) en nuestro laboratorio para obtener los valores de referencia de TT, T libre calculada (TLC), T biodisponible calculada (TBC) y T salivar (TS) en varones jóvenes sanos del área mediterránea y evaluar la posible utilidad clínica de la TS. MATERIAL Y MÉTODOS: Estudio observacional transversal. Muestreo secuencial. CRITERIOS DE INCLUSIÓN: varones, 18-30 años de edad, índice de masa corporal (IMC) < 30. Criterios de exclusión: enfermedades crónicas, insuficiencia hepática o uso de medicamentos que alteran las concentraciones circulantes de T. METODOLOGÍA: TT (inmunoanálisis de quimioluminiscencia UniCell DXI800 [Acces T Beckman Coulter]), TLC y TBC (fórmula de Vermeulen), TS (radioinmunoensayo para TT sérica modificado para la saliva [Coat-A-Count, Siemens]). Análisis estadísticos: descriptivos y correlación rho de Spearman (SPSS 19,0 Inc.,Chicago). RESULTADOS: Se incluyeron 121 individuos de 24 ± 3,6 años e IMC 24 ± 2,5 kg/m2. Estudio hormonal TT, 19 ± 5,5 nmol/L (intervalo de confianza 95% 9,7-33,3); TLC, 0,38 nmol/L ([P2,5-P97,5] 0,22-0,79); TBC, 9,7 nmol/L ([P2,5-P97,5] 4,9-19,2); y TS, 0,35 nmol/L ([P2,5-P97,5] 0,19-0,68). La correlación entre TS y TLC fue 0,46. CONCLUSIONES: En varones de la región mediterránea, concentraciones de TT > 9,7 nmol/L, TLC > 0,22 nmol/L y/o TBC > 4,9 nmol/L hacen improbable la presencia de hipogonadismo bioquímico. De acuerdo a la correlación entre la testosterona sérica y salivar, la utilidad clínica de la ST está aún por establecerse

Documento de posicionamiento: disforia de género en la infancia y la adolescencia. Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN) / Position statement: Gender dysphoria in childhood and adolescence. Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN)

La disforia de género (DG) en la infancia y adolescencia es una condición compleja, siendo importante la detección precoz y el tratamiento integral, ya que con ello se mejora la calidad de vida, disminuye la comorbilidad mental y la propia DG. En este documento de posicionamiento, el Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN), integrado por especialistas de Endocrinología, Psicología, Psiquiatría, Pediatría y Sociología, establece unas recomendaciones sobre la evaluación y tratamiento de la DG en niños y adolescentes. El manejo interdisciplinar de la DG debe llevarse a cabo en unidades con equipos especializados (UTIG) y considerando que cualquier intervención sanitaria debe seguir los principios del rigor científico, la experiencia acumulada, los principios éticos y deontológicos y la prudencia necesaria ante tratamientos crónicos, agresivos e irreversibles

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments

Respuesta a: Comentarios sobre las «Guías de práctica clínica para la valoración y tratamiento de la transexualidad», emitidas por el Grupo de identidad y diferenciación sexual de la SEEN (GIDSEEN) / Reply to: Comments on the «Clinical practice guidelines for assessment and treatment of transsexuality» issued by the sexual identity and differentiation group of the SEEN (GIDSEEN)

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Documento de abordaje integral de la diabetes tipo 2 / Document on a comprehensive approach to type 2 diabetes mellitus

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2

Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists

Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente concon diabetes mellitus. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición / Position statement: Hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y el manejo de la hipoglucemia en pacientes con diabetes mellitus. Participantes Miembros del Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición (SEEN).Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en MEDLINE (PubMed) de la evidencia disponible para cada tema, y se revisaron artículos escritos en inglés y castellano con fecha de inclusión hasta el 15 de febrero de 2013. Para las recomendaciones acerca del uso de fármacos, se consideraron tratamientos aprobados por la Agencia Europea de Medicamentos con esa misma fecha. Tras la formulación de las recomendaciones estas se discutieron conjuntamente por el Grupo de trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y manejo de la hipoglucemia en pacientes con diabetes mellitus (AU)

Objective To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus (AU)

Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 2 (tratamiento) / No disponible

La pancreatitis crónica (PC) es una enfermedad compleja, con un amplio espectro de manifestaciones clínicas, que abarca desde pacientes asintomáticos a pacientes con síntomas inhabilitantes o con complicaciones serias. El manejo de la PC frecuentemente difiere entre áreas geográficas e incluso entre centros. Ello se debe a la escasez de estudios de calidad y guías de práctica clínica que aborden el diagnóstico y tratamiento de esta enfermedad. El objetivo del Club Español Pancreático fue elaborar recomendaciones basadas en la evidencia para el manejo de la PC. Dos coordinadores eligieron un panel multidisciplinario de 24 expertos en esta enfermedad. Estos expertos se seleccionaron por su experiencia clínica e investigadora en PC. Se elaboró una lista de preguntas, cada una de las cuales se revisó por 2 panelistas. Con ello se produjo un borrador que se discutió en una reunión presencial por todos los participantes. Los niveles de evidencia se basaron en la clasificación del Oxford Centre for Evidence-Based Medicine. En la segunda parte del consenso se dieron recomendaciones para el manejo del dolor, seudoquistes, estenosis biliar y duodenal, fístula pancreática y ascitis, hipertensión portal izquierda, diabetes mellitus, insuficiencia pancreática exocrina y soporte nutricional en PC (AU)

Chronic pancreatitis (CP) is a complex disease with a wide spectrum of clinical manifestations ranging from asymptomatic disease to disabling forms or serious complications. The management of CP frequently differs among geographical areas and even among centers. These differences are due to the scarcity of high-quality studies and clinical practice guidelines that focus on the diagnosis and treatment of this disease. The aim of the Spanish Pancreatic Club was to create evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. These experts were selected on the basis of their clinical and research experience in CP. A list of questions was drawn up and each question was then reviewed by two panelists. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. Levels of evidence were based on the classification of the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus process, recommendations were established for the management of pain, pseudocysts, biliary and duodenal stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP (AU)

Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 1 (diagnóstico) / Recommendations of the Spanish pancreatic club on the diagnosis and treatment of chronic pancreatitis: part 1 (diagnosis)

La pancreatitis crónica (PC) es una enfermedad relativamente infrecuente, compleja y muy heterogénea. La ausencia de un patrón oro aplicable a las fases iniciales de la PC hace que su diagnóstico precoz sea difícil. Algunas de sus complicaciones, en particular el dolor crónico, pueden ser difíciles de manejar. Hay mucha variedad en el diagnóstico y tratamiento de la PC y de sus complicaciones entre los diferentes centros y profesionales. El Club Español Pancreático ha desarrollado un consenso sobre el manejo de la PC. Dos coordinadores eligieron un panel multidisciplinario de 24 expertos en esta enfermedad. Se elaboró una lista de preguntas. Cada pregunta fue revisada por 2 expertos. Con ello se elaboró un borrador compartido con todo el panel de expertos y discutido en una reunión presencial. En la primera parte del consenso se aborda el diagnóstico de la PC y de sus complicaciones (AU)

Chronic pancreatitis (CP) is a relatively uncommon, complex and highly heterogeneous disease. There is no clear pattern applicable to the initial stages of CP, which hampers its early diagnosis. Some of the complications of CP, especially chronic pain, can be difficult to manage. There is wide variation in the diagnosis and treatment of CP and its complications among centers and health professionals. The Spanish Pancreatic Club has developed a consensus document on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. A list of questions was drawn up. Each question was reviewed by two experts. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. The first part of the consensus document focusses on the diagnosis of CP and its complications (AU)

Guías de práctica clínica para la valoración y tratamiento de la transexualidad. Grupo de Identidad y Diferenciación Sexual de la SEEN (GIDSEEN)*(anexo 1) / Clinical Practice Guidelines for Assessment and Treatment of Transsexualism. SEEN Identity and Sexual Differentiation Groupd (GIDSEEN)

El abordaje diagnóstico-terapéutico de los pacientes transexuales solo puede desarrollarse en unidades funcionales de Identidad de Género, con la provisión de servicios de alta calidad asistencial, desarrollo de guías de práctica clínica y grupos de trabajo interdisciplinarios. El proceso terapéutico consta de 3 pilares fundamentales: evaluación diagnóstica psicológica inicial y psicoterapia, evaluación endocrinológica y terapia hormonal y cirugías de reasignación sexual. El tratamiento hormonal cruzado es un elemento importante en el proceso de transición anatómica y psicológica de los pacientes apropiadamente seleccionados. Las hormonas contribuyen a optimizar el proceso de vida real en el sexo identitario, mejoran la calidad de vida y limitan las comorbilidades psiquiátricas que muchas veces se asocian a la falta de este tratamiento. La elaboración de esta guía de práctica clínica responde a la necesidad de implantación de un protocolo de actuación coordinado para la atención sanitaria integral a las personas transexuales en el Sistema Nacional de Salud (AU)

Transsexual patients can only be diagnosed and treated at functional gender identity Units with provision of high quality care, development of clinical practice guidelines, and interdisciplinary working groups. The therapeutic process has three mainstays: initial psychological diagnostic evaluation and psychotherapy, endocrinological evaluation and hormone therapy, and sex reassignment surgery. Cross-sex hormone therapy is essential for the anatomical and psychological transition process in duly selected patients. Hormones help optimize real-life sex identity, improve quality of life, and limit psychiatric co-morbidities often associated to lack of treatment. Development of this clinical practice guideline addresses the need for implementing a coordinated action protocol for comprehensive health care for transgender people in the National Health System (AU)

A propósito de tres casos. Respuesta a la terapia adyuvante con perclorato potásico en la tirotoxicosis inducida por amiodarona / Response to adjuvant therapy with potassium perchlorate in amiodarone-induced

Introducción La tiroiditis inducida por amiodarona (TIA) es una entidad clínica frecuente, con distintas formas de presentación, respuesta variable al tratamiento, y que puede ser potencialmente fatal. Métodos Se presentan tres pacientes con fibrilación auricular, que desarrollaron una TIA tras al menos 36 meses de exposición al fármaco. El hipertiroidismo asociado no respondió a la terapia farmacológica convencional, conllevando un empeoramiento franco de la cardiopatía de los pacientes, lo que motivó la indicación de tiroidectomía total, previa instauración de una terapia basada en la combinación de dexametasona 8-12mg/día iv, tionamidas 45mg/día vo, beta-bloqueantes, junto perclorato potásico 0,8-1g/día vo. Dos pacientes normalizaron las hormonas tiroideas periféricas tras 12 y 32 días de terapia combinada. Conclusión La combinación de tionamidas y perclorato potásico es una alternativa terapéutica eficaz en la TIA tipo I en pacientes refractarios a terapia convencional. Debe valorarse su empleo en pacientes con TIA mixta o etiología no aclarada (AU)

Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a common clinical disorder that maybe life threatening and whose clinical manifestations and response to treatment may vary among patients. Methods: We present three patients treated with amiodarone for atrial fibrillation who developed AIT at least 36 months after beginning the treatment. Thyrotoxicosis worsened the underlying cardiac disorders and was resistant to treatment based on the combination of dexamethasone 8-12 mg/day i.v., thioamides 45 mg/day p.o., beta blockers and potassium perchlorate at doses of 800 to 1000 mg per day p.o. Two of the patients attained sustained euthyroidism after 12 and 32 days of combined treatment, while the third required total thyroidectomy. Conclusion: The combination of thioamides with potassium perchlorate is an appropriate formof therapy for AIT in patients resistant to thioamides. The use of this combination should be evaluated in patients with mixed AIT or AIT of unclear etiology (AU)

Papel de pituitary tumour-transforming gene (PTTG) en los adenomas hipofisarios / Rol of Pituitary Tumour-Transforming Gene (PTTG) in the pituitary adenomas

El pituitary transforming tumour gene (PTTG) está involucrado en una gran variedad de mecanismos fisiológicos. Se ha descrito sobreexpresión proteínica de PTTG en múltiples neoplasias, como los tumores hipofisarios, la cual favorece la aneuploidía, la inestabilidad genética, la proliferación celular y la angiogénesis, todos ellos procesos clave en la transformación neoplásica. Los estudios llevados a cabo en adenomas hipofisarios indican su asociación con un mayor grado de infiltración y de recidivas. Actualmente se plantea su función potencial como diana terapéutica (AU)

The pathogenesis of pituitary tumours is far to be understood. Pituitary transforming tumour gene (PTTG), a gen that induces aneuploidy, genetic instability, cellular proliferation and to stimulate angiogenesis, has been involved in neoplasic transformation and shown overexpressed in many neoplasm as lung, breast, endometrium, thyroid and colon malignant tumours. On the other hand, PTTG has been inconsistently studied in pituitary tumours. The majority of studies have been performed in animals and there is a great variability in the methods used in its determination. The goal of this review is to resume the role of PTTG in tumourogenesis and critically to revise the studies published in humans in order to advance in the knowledge of the pathogenesis of pituitary adenomas and to find clinical useful predictors of the behavior of these tumours (AU)

Insuficiencia renal aguda en una adolescente como presentación de hipotiroidismo primario autoinmune / Acute renal failure in a teenager as presentation of primary autoinmune hypothyroidism

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Cefalea secundaria a hipertiroidismo / Headache secondary to hyperthyroidism

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Hipogonadismo, disfunción eréctil y disfunción endotelial en varones con infección por el virus de la inmunodeficiencia humana / Hypogonadism, erectile dysfunction and endothelial dysfunction among HIV-infected men

El hipogonadismo es una alteración endocrina frecuente en varones con infección por el virus de la inmunodeficiencia humana (VIH), y conlleva reducción de la funcionalidad y la cantidad de masa muscular, pérdida de masa ósea, disfunción eréctil y depresión. El efecto combinado de hipogonadismo, lipodistrofia y alteraciones en la síntesis de adipocitocinas favorece la aparición de resistencia insulínica, alteraciones en el metabolismo hidrocarbonado, disfunción endotelial y arteriosclerosis. La clínica del hipogonadismo es inespecífica y los cuestionarios de cribado no son útiles para su diagnóstico. La determinación de testosterona libre calculada (TLc) es la prueba de elección para detectar hipogonadismo en varones infectados por el VIH y dada sus implicaciones clínicas debería determinarse de forma periódica en estos pacientes. El tratamiento hormonal sustitutivo debe ofrecerse sólo a pacientes con valores de TLc por debajo de la normalidad y una vez descartadas causas reversibles (AU)

HIV-associated hypogonadism is known to be a prevalent endocrine disorder, with a multifactorial etiology. Low testosterone levels are associated with decreased muscle mass, exercise capacity loss, erectile dysfunction, cognitive impairment, depression and decreased quality of life. In the same way, hypogonadism in HIV-infected men is associated with decreased muscle mass quantity and function, changes in corporal fat mass distribution and quantity, secretion of adipocytokines and endothelial dysfunction. This combined effect renders the entire body less sensitive to insulin, promoting development of atherosclerosis and glucose metabolism disorders. The clinical presentation is non-specific and hypogonadism screening scales are not useful in this population. Diagnostic procedures must include determination of free testosterone (FTc) in any HIV-infected men at the time of first HIV diagnosis and periodically, because of the clinical implications and the absence of specific predictive disease factors. Substitutive hormonal treatment must be offered only for HIV-infected men with FTc under reference levels and when reversible causes have been ruled out. Metabolic impact of hypogonadism suggests the incorporation of low testosterone levels to the list of cardiovascular risk factor in HIV-infected men (AU)

Glioblastoma multiforme y neoplasia endocrina múltiple tipo 2 A / Glioblastoma multiforme and multiple endocrine neoplasic type 2A

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