Change of the melanocortin system caused by bilateral subthalamic nucleus stimulation in Parkinson's disease.

OBJECTIVES - Determine whether bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) is associated with an increase in neuropeptide Y (NPY) and/or resistance to inhibition by leptin in relation to post-surgery weight gain. MATERIALS AND METHODS - This prospective study included 20 patients who underwent bilateral STN-DBS and 17 who refused surgery. Data were obtained at baseline, 3 and 6 months on neurological and nutritional status, including determination of body mass index (BMI) and serum NPY and leptin levels. RESULTS - NPY and leptin levels changed over time, with a distinct pattern. The BMI increase at 6 months was greater in the surgical group (5.5 ± 6.3% vs 0.5 ± 3.5%; P = 0.035). Medical group exhibited a reduction in leptin level (-2.0 ± 4.3 ng/ml) and a consequent increase in NPY level (72.4 ± 58.7 pmol/ml). However, STN-DBS patients showed an increase in leptin (3.1 ± 5.0 ng/ml; P = 0.001 vs medical group) and also in NPY (12.1 ± 53.6 pmol/ml; P = 0.022 vs medical group) levels, which suggests resistance to inhibition by leptin. Rise in NPY level correlated with higher stimulation voltages. CONCLUSIONS - Bilateral STN-DBS causes disruption of the melanocortin system, probably related to diffusion of the electric current to the hypothalamus. This mechanism may in part explain the weight gain of patients with PD after surgery.

Manifestaciones psiquiátricas secundarias a las principales enfermedades endocrinológicas / Psychiatric manifestations due to most common endocrine diseases

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[Usefulness of the clonidine test for the diagnosis of pheochromocytoma]. / Utilidad de la prueba de clonidina en el diagnóstico de feocromocitoma.

BACKGROUND: The clonidine test has been proposed as diagnostic biochemical test for patients with clinical suspicion of pheochromocytoma. METHODS: The clonidine test was used in 80 patients with suspicion of pheochromocytoma (on account of suggestive clinical findings, increased levels of metanephrines, increased plasma or urinary levels of catecholamines, or suggestive images by ultrasonography or CT). RESULTS: Surgery confirmed the diagnosis of pheochromocytoma in 16 patients. The highest sensitivity (62%) and specificity (46%) of the clonidine test corresponded to a brake degree of 5%, with a predictive negative value of 83%. The test was most useful in patients with increased basal plasma values of catecholamines (sensitivity, 62%; specificity, 66%). CONCLUSIONS: The clonidine test can be useful for the diagnosis of pheochromocytoma in patients with increased basal plasma levels of catecholamines and a brake degree lower than 5% at 180 minutes.

Utilidad de la prueba de clonidina en el diagnóstico de feocromocitoma / Utility of the clonidine test for the diagnosis of pheochromocytoma

Fundamento. La prueba de clonidina se ha propuesto como prueba bioquímica diagnóstica en pacientes con sospecha clínica de feocromocitoma. Método. Hemos realizado dicha prueba a 80 pacientes con sospecha de feocromocitoma (por datos clínicos sugestivos, metanefrinas elevadas, catecolaminas plasmáticas o urinarias elevadas, imágenes en eco o tomografía axial computarizada sugerentes del mismo).Resultados. Se confirmó quirúrgicamente el diagnóstico de feocromocitoma en 16 pacientes. La prueba de clonidina mostró la mayor sensibilidad (S = 62 por ciento) y especificidad (E = 46 por ciento) para un punto de corte de frenación del 5 por ciento, con un valor predictivo negativo del 83 por ciento. La prueba mostró mayor utilidad en los pacientes con valores plasmáticos basales elevados de catecolaminas (S, 62 por ciento; E, 66 por ciento).Conclusiones. La prueba de clonidina puede ser útil en el diagnóstico de feocromocitoma en pacientes que presentan catecolaminas plasmáticas basales elevadas y una frenación a los 180 minutos menor del 5 por ciento (AU)

[Morbidity in transsexual patients with cross-gender hormone self-treatment]. / Morbilidad en pacientes transexuales con autotratamiento hormonal para cambio de sexo.

BACKGROUND: The demand for sex reassignment in transsexual patients has increased as have the number of treatments. However, these patients run into troubles to be treated in Spanish public hospitals and the patients usually make use of self-therapy, without medical control, by suffering frequent side effects. In this paper, we have analysed these effects. PATIENTS AND METHODS: Cross-sectional and descriptive study of the side effects of cross-gender hormone self-administration in 57 transsexuals, aged (median [SD]) 30(7) years. RESULTS: Combined treatment with estrogen and cyproterone acetate in 31 male-to-female transsexuals was associated with hyperprolactinemia in 24/31 patients (77.4%) and elevation of liver enzymes in 4/31 (12.9%). Androgen treatment in 26 female-to-male transsexuals was associated with hyperprolactinemia in 10/26 patients (38.5%), elevation of liver enzymes in 5/26 (19.2%). The levels of total cholesterol, LDL-cholesterol and triglycerides were higher in female-to-male that in male-to-female transsexuals (197.3 [40.2] vs 160.6 [38.0] mg/dl, p = 0.033; 131.4 [29.4] vs 104.8 [26.4] mg/dl, p = 0.049; and 131.3 [62.7] vs 67.4 [25.6], p = 0.001, respectively). Total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios were higher in female-to-male that in male-to-female transsexuals, too (4.94 [1.20] vs 3.32 [0.71], p = 0.006; and 3.20 [0.87] vs 2.04 [0.63], p = 0.003, respectively). CONCLUSIONS: The alteration of the cardiovascular risk, the presence of hyperprolactinemia and the elevation of liver enzymes must be taken into account in transsexual patients with hormone treatment.

[Primary adrenal lymphoma: review and report of a case]. / Linfoma suprarrenal primario: revisión a propósito de un caso.

We present a case of non-Hodgkins lymphoma located in both adrenal glands, with diminished adrenal reserve and fatal evolution with serious metabolic complications, with hypoglycemia, severe lactic acidosis, hyperuricemia, acute renal failure, hepatic affectation and hemogram alterations. Much of these complications can be explained by tumoral lysis syndrome probably prompted by the use of high doses of corticosteroids. Primary adrenal lymphoma is exceptional with only 14 cases described in the literature. In spite of its rarity it should be included in the differential diagnosis of uni or bilateral adrenal masses and an early diagnosis is necessary in order to avoid serious and potentially lethal complications. Percutaneous aspiration biopsy can be a valid method of diagnosis because it can identify specific tumoral antigens. The literature concerning this unusual tumour is reviewed.

Scintigraphic diagnosis of subclinical Cushing's syndrome in patients with adrenal incidentalomas.

Adrenal scintigraphy has been shown to be a useful procedure for the characterization of incidentally discovered adrenal tumours. The functional evaluation of these patients is controversial. This paper describes the biochemical and pathological findings in five patients with asymptomatic adrenal masses and unilateral concordant adrenocortical scintigraphic uptake. All the patients were diagnosed as having subclinical Cushing's Syndrome, without clinical or biochemical adrenocortical dysfunction. Scintigraphy is the most sensitive method for detecting an adrenal adenoma in the subclinical setting when the disease is not yet demonstrable by biochemical methods.