Carcinoma medular de tiroides estadio IV y gestación / Medullary thyroid carcinoma stage IV and pregnancy

El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, con relativa agresividad debido a la existencia de metástasis a distancia en el momento del diagnóstico. Se considera como tratamiento de primera línea la cirugía, aunque existen otras opciones de tratamiento en los casos de recurrencia o enfermedad persistente, como los inhibidores de la tirosin-kinasa. El impacto del embarazo en mujeres con CMT es desconocido. Presentamos un caso inédito de una paciente diagnosticada de CMT con gestación posterior exitosa

Medullary thyroid carcinoma is an uncommon malignant tumour that behaves aggressively due to frequent distant metastases at the time of diagnosis. Surgery is considered as first-line treatment, although other treatment options are available for patients with recurrent or residual disease, such as a tyrosine kinase inhibitors. The impact of pregnancy on women with medullary thyroid carcinoma is unknown. We present the case of a woman with medullary thyroid carcinoma whose subsequent pregnancy was successful

Evaluación de la calidad asistencial en pacientes con diabetes tipo 2 del Área Sanitaria Cádiz-San Fernando / Evaluation of the quality of care of type 2 diabetic patients from the Health Area 2 Cádiz-San Fernando

Objetivo: Evaluar la calidad de la prestación de atención sanitaria al paciente con diabetes tipo 2 en un área básica de salud. Pacientes y métodos: Estudio observacional descriptivo de una muestra de 517 pacientes con diabetes tipo 2 conocida (intervalo de confianza 95%, nivel de riesgo alfa 0,05) atendidos en Atención Primaria y Endocrinología del área básica de salud Cádiz-San Fernando (228.000 habitantes). Se evalúa la calidad de la atención sanitaria aplicando los criterios de calidad propuestos por el Grupo Europeo de la Federación Internacional de Diabetes. Resultados: Se estudian 517 pacientes con diabetes tipo 2de 63,4 ± 12 años de edad media (59,4% mujeres) y 9,7 ± 8 años de evolución conocida de la diabetes. A pesar de la elevada prevalencia de factores de riesgo cardiovascular (HTA: 58%, dislipemia53%, obesidad: 40%, tabaquismo activo: 19%) y complicaciones crónicas de la diabetes (retinopatía 29%, nefropatía: 20%). El grado de cumplimiento en la realización de autoanálisis de glucemia capilar (35%), exploración anual de los pies (44%), determinación anual de albuminuria (47%) y de un perfil lipídico completo(51%) y participación en actividades educacionales (53%) fue insuficiente. Sin embargo, el porcentaje de determinación anual dehemoglobina glicosilada fue aceptable (81%).Conclusiones: Los pacientes con diabetes tipo 2 del área Cádiz-San Fernando presentan una elevada prevalencia de comorbilidades y complicaciones crónicas, evidenciándose la necesidad de mejora en el cumplimiento de las recomendaciones básicas para el cuidado y control de la enfermedad

Objective: The objective of our study was to evaluate the quality of health care in patients with type 2 in a health care area. Patients and methods: Observational descriptive study of a sample of 517 type 2 diabetes patients (confidence interval at 95% and sensibility at 5%) attended by Primary Care and Endocrinology of a Cádiz-San Fernando health care area (228,000 inhabitants). The quality of health care was evaluated applying the Guidelines of Diabetes Care of European Diabetes Policy Group of International Diabetes Federation. Results: A total of 517 patients with type 2 diabetes, with a mean age of 63.4 ± 12 years (59.4% women) and a mean period of disease evolution of 9.7 ± 8 years were assessed. Despite of great prevalence of cardiovascular risk factors (58% hypertension, 53% dislipemia, 40% obesity, 19% smoker) and chronic diabetes complications (29% retinopathy, 20% nephropathy), it was observed inadequate percentages in self-monitoring of blood glucose (35%), foot examination (44%) and yearly measure of urinary albumin excretion (47%) and blood lipid profile (51%) and patient education programme participation (53%). However, it was observed an adequate percentage of patients with at least one glycated haemoglobin determination at year (81%). Conclusion: Type 2 diabetes patients of Cádiz-San Fernando health care area present a great prevalence of comorbidities and chronic diabetes complications. It is necessary to improve the implementation of diabetes basic care recommendations and control of illness

Características clínicas y grado de control metabólico de paicentes hospitalizados con diabetes

El objetivo del estudio fue describir las principales características y el grado de control metabólico de los pacientes con diabetes mellitus que ingresan en nuestro hospital. Se diseñó un estudio descriptivo transversal que incluyese a toda la población diabética ingresada durante el período de una semana. A partir de encuestas individuales se evaluaron los antecedentes médicos, tratamientos realizados y diversos aspectos sobre los hábitos de vida y autocuidados de la enfermedad. EL nivel de control metabólico se evaluó a àrtir de la medición del nivel de hemoglobina glicosilada (HbA1c). Se estudiaron 158 pacientes con diabetes conocida (54 por ciento mujeres) con edad media de 65 +/- 13,7 años y tiempo medio de evolución de 13,5 +/-10 años. El 65,8 por ciento presentaba hipertensión arterial (HTA), el 41,7 por ciento dislipemia y el 9,5 por ciento era fumador. El 23,4 por ciento de los pacientes habían presentado úlcera o amputación distal y el 24,6 por ciento habían recibido láserterapia retiniana. La HbA1c media fue de 7,5 +/- 2,7 por ciento, no existiendo diferencias significativas entre los pacientes en seguimiento por atención primaria o especializada. En conclusión, los pacientes con diabetes mellitus ingresados en nuestro hospital presentan una elevada prevalencia de factores de riesgo cardiovascular y de complicaciones crónicas de la diabetes. Sin embargo, los porcentajes obtenidos probablemente infravaloran la prevalencia real entre la población hospitalizada con diabetes (AU)

Apoplejía hipofisaria. Protocolo de actuación diagnóstica y terapéutica en urgencias / Pituitary apoplexy. Diagnostic and therapeutic management in emergency department

La apoplejía hipofisaria es un síndrome clínico agudo caracterizado por cefalea de inicio rápido, vómitos, disminución de la agudeza y/o campo visual, oftalmoplejía y disminución del nivel de conciencia. Este síndrome está causado por el infarto isquémico o hemorrágico de la glándula hipofisaria, lo cual ocurre casi invariablemente en presencia de un adenoma hipofisario. El hipopituitarismo, transitorio o permanente, es frecuente tras la apoplejía pituitaria. La resonancia magnética hipofisaria es el método diagnóstico de elección. Ante la sospecha de apoplejía hipofisaria debe instaurarse urgentemente tratamiento sustitutivo con corticoesteroides, monitorizando estrechamente el balance hídrico y electrolítico. La descompresión quirúrgica transesfenoidal precoz del contenido selar se asocia a una mejoría de las complicaciones neurológicas presentes en estos pacientes, teniendo una baja morbilidad y mortalidad (AU)

[Pituitary apoplexy: retrospective study of 9 patients with hypophyseal adenoma]. / Apoplejía pituitaria: análisis retrospectivo en 9 pacientes con adenomas hipofisarios.

Pituitary apoplexy is an acute hemorrhage or ischemia infarction of the pituitary gland, almost invariably occurring in the presence of an pituitary adenoma. Although intratumoral bleeding occur in about 9.5 to 25% of pituitary adenomas, various series suggest that clinical apoplexy may be diagnosed in about 2% to 10% of the adenomas. In a retrospective study from 1988 to 1998 of 110 patients with hypophyseal adenomas, there were 9 cases with pituitary apoplexy, yielding an incidence of 8.2%. Their mean age was 52.4 +/- 12.8 años years, with a male to female ratio of 7:2. Symptoms observed were headache (89%), sudden visual deterioration (78%), vomiting (78%) and oculomotor nerves paresis (33%). The diagnosis of pituitary apoplexy was established by computerized tomographic scans, and hypophyseal macroadenoma with intratumoral bleeding was observed in every patient. Five patients underwent transphenoidal surgery. Improvement of visual deficit was observed in 3/4 (75%) and ocular paresis in 3/3 (100%) of affected patients. Four patients were treated conservatively with steroids. Two patients who had visual deficit recovered it completely without surgery. Two hypophyseal adenomas were resolved spontaneously after bleeding, one stayed unchanged and another presented recurrence of bleeding at six years of follow-up. Steroid and thyroid hormone replacement therapy was required in 62.5% of patients.

[Thyrotoxic periodic paralysis: an exceptional case report in Spanish population]. / Parálisis periódica tirotóxica: una observación excepcional en nuestro medio.

Thyrotoxic periodic paralysis is a rare clinical manifestation of thyrotoxicosis in spanish population. Patients show weakness and frecuently, paralysis and low levels of potassium in serum. The episode can be triggered by eating high carbohydrate diet, exercise, stress and some drugs. We present a new case of thyrotoxic periodic paralysis in a Grave's disease patient. Only four cases have been reported in the spanish literature. We conclude that a functional evaluation of thyroid gland is necessary in thyrotoxic periodic paralysis patients.

Male pseudohermaphroditism with 5-alpha-reductase deficiency: report of two new familial cases. The importance of early diagnosis.

We report two new familial cases of male pseudohermaphroditism due to 5-alpha-reductase deficiency, from the south of Spain. They were born with ambiguous genitalia and were reared as females. At the time of puberty, both brothers virilized partially and underwent a change of gender role from female to male with a stormy psychic readjustment period. We stress the value of the prolonged chorionic gonadotropin test for an early diagnosis.

[Anatomoclinical and diagnostic characteristics of thyroid carcinoma. Study of 126 cases]. / Características anatomoclínicas y diagnósticas del carcinoma tiroideo. Estudio de 126 casos.

A retrospective review was conducted among 126 patients treated for thyroidal carcinoma--86 papillary, 31 follicular, 4 anaplastic, 1 lymphoma, and 4 non-familiar medullary--in our area between 1979 and 1992. Diagnostic and clinical findings obtained were evaluated along with those from physical examinations, imaging techniques (i.e., echography and gamma spectrometry), and histological study (i.e., fine needle puncture-aspiration and intra-operatory biopsy). The majority (88 cases) presented a hard node or one of elastic consistency, while in 34 cases, there was a diffuse or nodular increase. Only four patients manifested a normal thyroid in the physical examination. A 2.4% had a normal gammagraphy, 70% presented a cold node, 1.6% an alient node, and there was evidence of heterogeneous uptake in 23.7%. In the echography study, 63.3% were noted as being solid nodes, 11.4% as cysts, and 24% as mixed. The sensitivity of the fine needle puncture-aspiration was 76.4% and 66.6% for intraoperative biopsy.

[Treatment of hyperthyroidism from Graves-Basedow's disease]. / Tratamiento del hipertiroidismo por enfermedad de Graves-Basedow.

The Graves's Disease is the most frequent cause of hyperthyroidism. Currently, there is a lack of consensus with respect to the therapeutical role played by synthetic antithyroids, radioactive iodine and surgery. In order to study in depth this issue, we have analyzed the results of the therapy administered to 217 patients with Graves's Disease: 96 were treated with synthetical anti-thyroids, 46 with surgery and 75 with radioactive iodine. After twelve months of therapy with synthetic antithyroids, remission of the disease was observed in 64 patients (67%); the only factor predicting such remission was the absence of ophthalmopathy (p < 0.05); all 64 patients were followed-up during 12 months, detecting the recurrence of hyperthyroidism in 33 of them. Such recurrence is predicted by the serum levels of thyroid hormones before the administration of the therapy (p < 0.001). On the contrary, in patients treated with surgery or radioactive iodine, hyperthyroidism was controlled in 91% and 100% of them, respectively. Given the evolution of patients with Graves's Disease treated with synthetic antithyroids, we suggest the use of a more aggressive approach for the management of these patients.