Densitometría ósea y tamaño uterino: una relación de utilidad práctica en mujeres climatéricas / Bone mineral density and uterine size: a practical relationship for climacteric women

Background: Double beam bone densitometry allows to select climacteric women who will benefit from hormone replacement. However, it is not always affordable in clinical practice. Aim: To study possible alternative markers of bone mineral density. Patients and methods: A retrospective survey of climacteric women in whom bone mineral density was measured when hormone replacement therapy was started. Eighty one women were studied and in 27, uterine size index was obtained from pelvic ultrasound examinations. Women with and without uterine size index measurements were analyzed separately. Relationships of bone mineral density with age, lapse from menopause, body mass index and uterine size index were sought. Results: There was a significant regression between the lapse in years from menopause and lumbar bone mineral density in the group without uterine size index measurements (r2=0.228, ANOVA p=0.014). There was also a significant regression of lumbar bone mineral density with the uterine size index (r2=0.236, ANOVA p=0.01) in those women in whom this measurement was available. No other variables were associated with bone mineral density. Conclusion: In this group of patients, the lapse after menopause and uterine size index are predictors of lumbar bone mineral density

Tumores de hipófisis: presentación clínica y evaluación del tratamiento por cirugía transfenoidal / Pituitary tumors: clinical presentation and assesment of transphenoidal surgical treatment

The clinical manifestations and the surgical treatment results of 280 patients (179 female), undergoing a total of 319 operations at the Asenjo Institute of Neurosurgery were retrospectively analyzed. The surgical approach for the first operation was transphenoidal in 89.3 per cent of patients and transcraneal in the rest. Tumors were non secretory in 169 (60.4 per cent)patients, prolactinomas in 75 (27.8 per cent) and produced acromegalia in 29 (10.4 per cent) and Cushing syndrome in 7 (2.5 per cent) patients. There was extraselar extension in 42 per cent of women and 71 per cent of men. The surgical treatment of prolactinomas corrected endocrine alterations in 25 of 29 and visual alterations in 18 of 27 patients assessed. Surgical treatment of acromegalia improved endocrine alterations in 11 of 13 and visual alterations in 4 of 10 patients assessed. Treatment of non secretory tumors corrected visual alterations in 38 of 64 patients assessed. The principal complication of transphenoidal surgery was transient diabetes insipidus in 6.8 per cent of patients. Overall mortality was 2.3 per cent for transphenoidal surgery and 5.6 per cent for transcraneal surgery. It is concluded that transphenoidal surgery is effective for the management extraselar complications of pituitary tumors and endocrine management of selected cases

Hirsutismo en mujeres chilenas: importancia de la deficiencia congénita de 21-hidroxilasa de manifestación tardía / Hirsutism in Chilean women: importance of 21-hydroxylase congenital deficiency of late onset

The prevalence of steroid 21-hydroxylase (21-O Hase) deficiency of late onset was investigated in a Chilean population of hirsute women. In 33 hirsute patients, not family related, plasma 17-alpha hydroxyprogesterone (170H-P) was measured under basal conditions and after ACTH stimulation. Three cases of complete deficiency of late onset or post menarchia type were found, a prevalence of 91% similar to that reported by others. Affected patients were indistinguishable from other hirsute women, except in 170H-P concentrations after ACTH. Plasma testosterone and dihydroepiandrosterone sulphate were significantly higher in hirsute women, either deficiet of without enzyme deficiency, compared with a control group of 19 normal women. The 170H-P post ACTH levels of hirsute women who did not comply with criteria for enzyme deficiency were similar to control's. However, in these patients there was a significant correlation between hirsutism and 170H-P post ACTH, suggesting the presence of patients with mild enzyme deficiency, perhaps heterozygous for the defective gene. In conclusion, measurement of basal and post ACTH 170H-P during diagnostic work up in hirsute patients allows the detection of a significant number of cases with enzyme deficiency

Tratamiento de la anovulación en el síndrome de ovarios poliquísticos con citrato de clomifeno en períodos de 10 días / Treatment of anovulation in polycystic ovary syndrome with clomiphene citrate during 10 days

Se informa sobre la eficacia de un esquema novedoso de uso del citrato de Clomifeno (50 mg al día, los primeros diez días de cada ciclo), sobre la ovulación y la fertilidad, en 41 pacientes con Síndrome de ovarios poliquísticos anovulantes y que deseaban fertilidad. En 35 se obtuvo ovulaciones (85,4%). Se logró embarazos en 28 pacientes (68,3%). El (87,5% de los embarazos se consiguió antes de 6 meses de tratamiento. Los resultados son iguales o mejores que los informados en la literatura con el tratamiento tradicional. Los embarazos fueron normales. No se observaron malformaciones en los recién nacidos. Hubo solamente 2 abortos espontáneos. No hubo ningún caso de hiperestimulación ovárica. Con el esquema propuesto no es necesario aumentar progresivamente las dosis de citrato de clomifeno. Se le recomienda por su eficacia, además que parece producir menos complicaciones