RESUMEN
The differential diagnosis of sellar masses may be complex. Metastatic disease constitutes 1% of all pituitary lesions and sometimes mimics the clinical-radiological presentation of pituitary adenoma. The definitive diagnosis usually relies on histology, but occasionally even histological features of pituitary metastasis may resemble those of adenomas. We present a patient initially diagnosed with pituitary adenoma, but whose clinical course finally revealed pituitary metastasis of a hepatocellular carcinoma. The existing literature on this topic is reviewed.
Asunto(s)
Adenoma/patología , Carcinoma Hepatocelular/secundario , Neoplasias Hepáticas/patología , Neoplasias Hipofisarias/secundario , Anciano , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
OBJECTIVE: To evaluate the cost-effectiveness and safety of two distinct low calorie diets (LCD). DESIGN: Prospective controlled study. METHODS: 67 obese patients [body mass index (BMI) 40 kg/m2] were included in two study groups. Group A: 26 patients followed a 458 kcal diet given in three meals for 1 month. Group B: 41 patients followed a 800 kcal diet for 3 months and with outpatient control. MEASUREMENTS: Anthropometric, cardiovascular risk and nutritional profile changes were evaluated, as well as total direct and indirect costs, and the incidence of complications. RESULTS: No significant initial differences were observed between the two study groups. Eighty-six point two per cent of the patients completed the therapy correctly. After treatment a significant decrease was observed in the following variables for both groups, but no differences were detected between Groups A and B: mean weight loss (A= 9.28 kg, B= 8.7 kg), ponderal loss percentage (A/B= 7.2/6.8%), glycemia (A/B= 18.6/12.1 mg/dl), systolic blood pressure (SBP) (A/B= 11.8/6.5 mmHg), diastolic blood pressure (DBP) (A/B 5.9/6.8 mmHg), and final insulin-resistance (IR) index (A= 4.4, B= 4.3). Group A had the highest drop in total cholesterol (37.7 vs 8.1 mg/dl) and triglycerides (54.4 vs 2.5 mg/dl). No changes were observed in ureic acid, renal function and serum albumin. Thirty-six patients (55.3%) suffered trivial complications associated to the VLCD (16.9% gastrointestinal, 20% anxiety), with no differences between groups. Group A patients were on sick leave due to asthenia, and two patients in this group had serious complications (transient ischemic attack and atrial fibrillation). The total cost of Group A treatment was 3018.9 against 582.6 euros for Group B. CONCLUSIONS: The 3-month 800 kcal/day VLCD was more cost-effective and safer than the 1-month 458 kcal/day diet.
Asunto(s)
Dieta Reductora , Obesidad/dietoterapia , Adulto , Glucemia , Presión Sanguínea , Composición Corporal , Índice de Masa Corporal , Restricción Calórica , Dieta Reductora/efectos adversos , Dieta Reductora/economía , Femenino , Humanos , Resistencia a la Insulina , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Pérdida de PesoAsunto(s)
Autoanticuerpos/sangre , Enfermedad Celíaca/diagnóstico , Diabetes Mellitus Tipo 1/complicaciones , Transglutaminasas/inmunología , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Enfermedad Celíaca/etiología , Niño , Preescolar , Humanos , Inmunoglobulina A , Tamizaje Masivo/métodos , Persona de Mediana EdadRESUMEN
Los adenomas hipofisarios secretores de TSH son muy infrecuentes. Los pacientes presentan concentraciones elevadas de TSH, clínica de hipertiroidismo y tumor hipofisario, habitualmente un macroadenoma. El presente trabajo describe el caso de un microadenoma hipofisario secretor de TSH tratado con análogos de somatostatina (lanreótido) y posteriormente con cirugía transesfenoidal. El estudio patológico confirmó un adenoma hipofisario con positividad inmunohistoquímica para TSH y subunidad alfa. Un hallazgo relevante fue la presencia de abundante fibrosis tumoral. La fibrosis es un fenómeno frecuente en los tirotropinomas, por lo que resulta difícil establecer su relación con el tratamiento con lanreótido (AU)