Liraglutide vs. lixisenatide in obese type 2 diabetes mellitus patients: What effect should we expect in routine clinical practice?

AIM: Liraglutide and lixisenatide improved glycemic control, weight and cardiovascular risk factors (CVRF) in type 2 diabetes mellitus (T2DM) patients. Our objective was to analyze clinical efficacy and safety differences in routine clinical practice. METHODS: A 24-week prospective observational study to compare the effect of liraglutide versus lixisenatide in obese T2DM patients in routine clinical practice. The main objective was to analyze between-group glycosylated hemoglobin (HbA1c) differences at the end of the study. Secondary objectives included differences in body weight, other CVRF, changes in medication, side effects, satisfaction and safety. RESULTS: A total of 100 patients (50 liraglutide, 50 lixisenatide) were included. Both groups experienced a decrease in HbA1c values (liraglutide, -1.4%, CI 95% -2, -0.8, P < 0.001 vs. lixisenatide, -0.8%, 95% CI -1.2, -0.5, P < 0.001). No differences were found in final HbA1c values between both groups (liraglutide 7.3 ±â€¯0.9% vs. lixisenatide 7.2 ±â€¯1.5%, P = 0.7). We did not detect between groups differences in anthropometric variables or CVRF at the study end. A lower proportion of patients received treatment with a maximum dose of liraglutide compared with lixisenatide (27% vs. 95%, P < 0.001). In contrast, a greater percentage of patients in the lixisenatide group than in liraglutide group (29% vs. 9%, P = 0.026) intensified treatment by the addition of sodium-glucose transporter type 2 inhibitors. Adverse events were less frequently reported in liraglutide treated patients compared with lixisentatide (80% vs. 96%, P = 0.014). No serious adverse events were detected. CONCLUSIONS: These results confirm the efficacy and safety of liraglutide and lixisenatide in routine clinical practice. Moreover, a different therapeutic effect between liraglutide and lixisenatide was detected.

Linfomas primarios tiroideos. Experiencia en hospitales de Castilla-La Mancha / Primary thyroid lymphomas. Experience in hospitals of Castilla-La Mancha

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Recommendations for somatic and germline genetic testing of single pheochromocytoma and paraganglioma based on findings from a series of 329 patients.

BACKGROUND: Nowadays, 65-80% of pheochromocytoma and paraganglioma (PPGL) cases are explained by germline or somatic mutations in one of 22 genes. Several genetic testing algorithms have been proposed, but they usually exclude sporadic-PPGLs (S-PPGLs) and none include somatic testing. We aimed to genetically characterise S-PPGL cases and propose an evidence-based algorithm for genetic testing, prioritising DNA source. METHODS: The study included 329 probands fitting three criteria: single PPGL, no syndromic and no PPGL family history. Germline DNA was tested for point mutations in RET and for both point mutation and gross deletions in VHL, the SDH genes, TMEM127, MAX and FH. 99 tumours from patients negative for germline screening were available and tested for RET, VHL, HRAS, EPAS1, MAX and SDHB. RESULTS: Germline mutations were found in 46 (14.0%) patients, being more prevalent in paragangliomas (PGLs) (28.7%) than in pheochromocytomas (PCCs) (4.5%) (p=6.62×10(-10)). Somatic mutations were found in 43% of those tested, being more prevalent in PCCs (48.5%) than in PGLs (32.3%) (p=0.13). A quarter of S-PPGLs had a somatic mutation, regardless of age at presentation. Head and neck PGLs (HN-PGLs) and thoracic-PGLs (T-PGLs) more commonly had germline mutations (p=2.0×10(-4) and p=0.027, respectively). Five of the 29 metastatic cases harboured a somatic mutation, one in HRAS. CONCLUSIONS: We recommend prioritising testing for germline mutations in patients with HN-PGLs and T-PGLs, and for somatic mutations in those with PCC. Biochemical secretion and SDHB-immunohistochemistry should guide genetic screening in abdominal-PGLs. Paediatric and metastatic cases should not be excluded from somatic screening.

Utilidad de la creación de una consulta monográfica de nuevas tecnologías en el tratamiento de pacientes con diabetes mellitus tipo 1 mediante infusión subcutánea continua de insulina / Usefulness of a New Technology Unit creation for continuous subcutaneous insulin infusion treated type 1 diabetes patients

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Valoración de la satisfación y calidad de vida en pacientes con diabetes mellitus tipo 1 en tratamiento con infusión subcutánea continua de insulina comparado con multidosis de insulina / Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections

Valorar la calidad de vida ( CV ) y satisfacción (SF) de los pacientes con diabetes mellitus tipo 1 (DM1) en terapia con infusión subcutánea continua de insulina (ISCI) comparado con los pacientes tratados con multidosis diarias de insulina (MDI). Método Estudio descriptivo valorando la CV y SF de 68 pacientes en tratamiento con ISCI o MDI (1:2). Los instrumentos utilizados fueron la versión española del cuestionario de CV relacionado con diabetes (Diabetes Quality of Life [EsDQOL]) y el cuestionario general de CV SF-36, junto con el test de SF con el tratamiento recibido (Diabetes Treatment Satisfaction Questionnaire [DTSQ]). Resultado sLos pacientes en terapia ISCI obtuvieron una puntuación similar a los tratados con MDI en el cuestionario EsDQOL (87,20 ± 21,11 y 86,83 ± 20,78, p = 0,86, respectivamente), aunque mostraron resultados menores en el test SF-36 (66,91 ± 15,76 y 75,90 ± 14,56 p = 0,03, respectivamente) salvo en el apartado transición de salud de este último, que resultó mayor (68,75 ± 19,66 y 57,93 ± 17,18 p = 0,02, respectivamente). Los valores conseguidos en el cuestionario DTSQ fueron mayores en el grupo ISCI frente a MDI en las últimas semanas (31,50 ± 4,66 y 27,83 ± 6,06, p = 0,01, respectivamente) y en los últimos 3 meses (13,20 ± 6,73 y 8,77 ± 7,40, p = 0,01, respectivamente). Conclusiones Los pacientes con DM1 en terapia ISCI mostraron peor CV general aunque se sienten más satisfechos con su tratamiento que los tratados con MDI. No detectamos diferencias en la CV relacionada con diabetes entre ambos grupos de tratamiento (AU)

Objective To assess the quality of life (QOL) and satisfaction (SF) in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI).MethodA descriptive study was conducted to assess the QOL and SF of 68 patients on CSII or MDI treatment (1:2). The instruments used were, the Spanish version of the Diabetes Quality of Life (EsDQOL) specific for diabetes related QOL, SF-36 for general QOL, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for SF evaluation. Results The Es DQOL scores for patients on CSII therapy were similar to those treated with MDI (87.20 ± 21.11 vs 86.83 ± 20.7, P = .86), with lower scores in the SF-36 questionnaire (66.91 ± 15.76 vs 75.90 ± 14.56, P = .03) except in Health Transition section, where patients treated with CSII showed higher scores (68.75 ± 19.66 vs 57.93 ± 17.18, p = .02). The values obtained in the DTSQ questionnaire were higher in CSII patients compared with the MDI group in last weeks (31.50 ± 4.66 vs 27.83 ± 6.06, p = .01) and last three months periods (13.2 ± 6.73 vs 8.77 ± 7.40, p = .01). Conclusions Patients with T1DM on CSII therapy showed a poorer global QOL, although they felt more satisfied with their treatment than those treated with MDI. No differences in diabetes related QOL were detected between groups (AU)

Manejo clínico del incidentaloma suprarrenal: resultados de una encuesta / Clinical management of adrenal incidentalomas: results of a survey

Introducción: El incidentaloma suprarrenal (IS) es una masa adrenal clínicamente silente que se descubre por casualidad en una prueba de imagen durante el estudio de una situación clínica no relacionada con la adrenal. Existen diversos protocolos de actuación ante el IS. Evaluamos la aplicación habitual de estos algoritmos mediante una encuesta de actividad clínica. Material y método: La encuesta incluía centro de trabajo, evaluación hormonal y radiológica inicial, pruebas de imagen y de función hormonal para completar el estudio, indicaciones de cirugía y seguimiento clínico. Resultados: Se encuestó a 33 endocrinólogos (el 79% de los asistentes al congreso anual de la Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes). El 46% de los entrevistados considera el tamaño tumoral como el factor más importante que orienta a malignidad en la valoración inicial del IS; este límite se sitúa en 4 cm para el 78% de los endocrinólogos. El 39% suele llevar a cabo una resonancia magnética para completar el estudio de imagen. En el análisis hormonal todos realizan siempre cribado de hipercortisolismo y feocromocitoma. Otras valoraciones efectuadas siempre en todos los IS incluyen: hiperaldosteronismo (76%), tumor productor de hormonas sexuales (51%) e hiperplasia suprarrenal congénita (30%). El 79% de los encuestados comienza (..) (AU)

Introduction: Incidentalomas are clinically silent adrenal masses that are discovered incidentally during diagnostic testing for clinical conditions unrelated to suspicion of adrenal disease. Several decision algorithms are used in the management of adrenal masses. We evaluated the routine use of these algorithms through a clinical activity questionnaire. Material and method: The questionnaire included data on the work center, initial hormonal and radiological study, imaging and hormonal tests performed to complete the study, surgical indications and clinical follow-up. Results: Thirty-three endocrinologists (79%) attending the annual congress of the Castilla-La Mancha Society of Endocrinology, Nutrition and Diabetes completed the questionnaire. Forty-six percent considered tumoral size to be the most important factor suggesting malignancy in the initial evaluation of adrenal incidentalomas, the limit being 4 cm for 78% of the endocrinologists. Imaging study was completed by magnetic resonance imaging by 39%. All the physicians always performed screening for hypercortisolism and pheochromocytoma. Other assessments always conducted in all incidentalomas included hyperaldosteronism (76%), sex hormone-producing tumor (51%) and congenital adrenal hyperplasia (30%). Seventy-nine percent of respondents began to refer incidentalomas larger than 4 cm for surgical treatment, and 46% referred all tumors larger than 6 cm for surgical treatment. With regard to hormonal (..) (AU)

Bocio amiloide secundario a enfermedad de Crohn / Amyloid goiter secondary to Crohn’s disease

La amiloidosis secundaria, en la mayoría de los casos, tiene un origen neoplásico o es secundaria a enfermedades inflamatorias crónicas. La mayoría de las amiloidosis secundarias son descubiertas por proteinuria o síndrome nefrótico, debido a amiloidosis renal. Sólo en un pequeño porcentaje hay afección clínicamente significativa de la glándula tiroidea, aunque no es infrecuente encontrar depósito de amiloide en autopsias. Describimos a continuación un caso de bocio amiloide. La paciente había sido diagnosticada de enfermedad de Crohn hacía 7 años y presentaba insuficiencia renal de causa no filiada. Fue remitida a nuestro servicio para estudio de bocio descubierto casualmente. La paciente fue sometida a tiroidectomía por un crecimiento progresivo de la glándula tiroidea con síntomas compresivos. La anatomía patológica se correspondió con bocio amiloide (AU)

Hipertiroidismo y captaciones de yodo bajas en una paciente con enfermedad de Graves / Thyrotoxicosis and low iodine uptake in a woman with Grave´s disease

La tirotoxicosis facticia se define como la causada por ingestión de hormona tiroidea exógena, normalmente en pacientes con trastornos psiquiátricos. El diagnóstico puede ser difícil y debemos sospecharla con concentraciones de tiroxina (T4) libre elevadas, tiroglobulina baja osuprimida, yoduria normal y gammagrafía con captación de 131I baja. Hay que hacer diagnóstico diferencial con otras causas de hipertiroidismo con gammagrafía con hipocaptación de 131I, como enfermedad de Graves, tiroiditis subagudas, struma ovarii, metástasis de cáncer de tiroides ehipertiroidismo inducido por yodo. El tratamiento se basa en bloqueadores beta para aminorar los síntomas y evitar riesgos iatrogénicos. Presentamos un caso de tirotoxicosis facticia atendida en nuestro servicio (AU)

Thyrotoxicosis factitia is defined as thyrotoxicosis resulting from exogenous ingestion of thyroid hormone, usually inpatients with a psychiatric disorder. Diagnosis can be difficult and this entity should be suspected in patients with highfree tiroxine (T4) concentrations, low or suppressed thyroglobulin concentrations, normal urinary iodide excretion and low or suppressed 131I uptake. To establish the differential diagnosis, thyrotoxicosisfactitia must be distinguished from several diseases with low 131I uptake, such as Graves’ disease, subacute thyroiditis, hyperthyroidism due to excessive iodineintake, struma ovarii and metastasis from thyroid cancer. Treatment is based on b blockers to reduce symptoms and avoidiatrogeny. We present a case of thyrotoxicosis factitia treated in our outpatient clinic (AU)

Thyrotoxicosis and low iodine uptake in a woman with graves' disease.

Thyrotoxicosis factitia is defined as thyrotoxicosis resulting from exogenous ingestion of thyroid hormone, usually in patients with a psychiatric disorder. Diagnosis can be difficult and this entity should be suspected in patients with high free tiroxine (T4) concentrations, low or suppressed thyroglobulin concentrations, normal urinary iodide excretion and low or suppressed (131)I uptake. To establish the differential diagnosis, thyrotoxicosis factitia must be distinguished from several diseases with low (131)I uptake, such as Graves' disease, subacute thyroiditis, hyperthyroidism due to excessive iodine intake, struma ovarii and metastasis from thyroid cancer. Treatment is based on b-blockers to reduce symptoms and avoid iatrogeny. We present a case of thyrotoxicosis factitia treated in our outpatient clinic.

Tratamiento de la oftalmopatía tiroidea / Treatment of Graves’ ophthalmopathy

La oftalmopatía tiroidea, que constituye la principal manifestación extratiroidea de la enfermedad de Graves-Basedow, es una enfermedad de naturaleza autoinmunitaria. En la mayoría de los casos suele ser leve, no precisándose más que medidas de apoyo, pero si la enfermedad es moderada o grave, la elección del tratamiento sigue siendo un tema controvertido. El desconocimiento de distintos aspectos de la etiopatogenia dificulta el desarrollo de tratamientos etiopatogénicos específicos. Los tratamientos inmunodepresores sólo consiguen resultados en dos tercios de los pacientes. Con todo ello, hoy por hoy el tratamiento de la oftalmopatía tiroidea sigue basándose en el uso de los glucocorticoides, la radioterapia orbitaria, la combinación de ambos y la cirugía de la órbita. La elección de una de estas modalidades de tratamiento dependerá en cada caso de la actividad y de la intensidad de la oftalmopatía

Graves' ophthalmopathy, the main extrathyroidal feature of Graves' disease, is an autoimmune condition. In most patients, ophthalmopathy is mild and only supportive measures are needed, but if the disease is moderate or severe the appropriate treatment remains controversial. Several aspects of the pathogenesis are not elucidated and this makes it difficult the design of specific treatments. Immunosuppressive therapies are only effective in two thirds of the cases. Anyway, the current treatment of Graves' ophthalmopathy relies on the use of glucocorticoids, orbital irradiation and surgery. The choice of the therapeutical approach will depend on the activity and the severity of the ophthalmopathy