Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

Calidad de los antecedentes personales en la historia clínica electrónica hospitalaria / Quality of individual health history in in-patient electronic medical records

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Hallazgo incidental de un tumor carcinoide bronquial en gammagrafía de receptores de somatostatina de paciente con síndrome de neoplasia endocrina múltiple tipo 1 e hipergastrinemia / Unsuspected bronchial carcinoid tumor detected in a somatostatin receptor scintigraphy in a patient with multiple endocrine neoplasia syndrome type 1 and hypergastrinemia

El síndrome de neoplasia endocrina múltiple tipo 1 (MEN 1) se caracteriza por la presencia de neoplasias en glándulas paratiroides, hipófisis anterior, páncreas endocrino y duodeno. Sin embargo, otro tipo de tumores también se pueden presentar. Uno de ellos es el tumor carcinoide, que en este contexto, se localiza más frecuentemente en el tracto gastrointestinal. Menos frecuente es la aparición de tumores carcinoides de origen bronquial que, con confirmación histológica se pueden presentar en el 5-8% de los casos y que se han encontrado con más frecuencia en pacientes que cursan con hipergastrinemia. Presentamos el caso de un paciente con antecedente de síndrome MEN 1, hipergastrinemia y el hallazgo incidental en un estudio gammagráfico de receptores de somatostatina de un tumor carcinoide bronquial confirmado histológicamente (AU)

Multiple Endocrine Neoplasia type 1 syndrome (MEN1) is characterized by the presence of tumors in parathyroid glands, anterior pituitary gland, endocrine pancreas and duodenum. However, other tumors may also occur. One of them is the carcinoid tumor, which in this context, is more common in the gastrointestinal tract. Less common is the presence of carcinoid tumors of bronchial origin, which with histologic confirmation, may occur in 5-8% of cases and that appears more frequently in patients with hypergastrinemia. We report a patient with MEN1 syndrome, hypergastrinemia and an incidental finding in a somatostatin receptor scintigraphy of an unsuspected bronchial carcinoid tumor that was confirmed histologically (AU)

[Unsuspected bronchial carcinoid tumor detected in a somatostatin receptor scintigraphy in a patient with multiple endocrine neoplasia syndrome type 1 and hypergastrinemia]. / Hallazgo incidental de un tumor carcinoide bronquial en gammagrafía de receptores de somatostatina de paciente con síndrome de neoplasia endocrina múltiple tipo 1 e hipergastrinemia.

Multiple Endocrine Neoplasia type 1 syndrome (MEN1) is characterized by the presence of tumors in parathyroid glands, anterior pituitary gland, endocrine pancreas and duodenum. However, other tumors may also occur. One of them is the carcinoid tumor, which in this context, is more common in the gastrointestinal tract. Less common is the presence of carcinoid tumors of bronchial origin, which with histologic confirmation, may occur in 5-8% of cases and that appears more frequently in patients with hypergastrinemia. We report a patient with MEN1 syndrome, hypergastrinemia and an incidental finding in a somatostatin receptor scintigraphy of an unsuspected bronchial carcinoid tumor that was confirmed histologically.

Self-limited acute hepatotoxicity caused by pegvisomant.

We present a case of acute severe hepatitis in a patient with acromegaly receiving combination therapy with somatostatin analogs and pegvisomant. Hepatitis resolved completely 18 weeks after diagnosis of hypertransaminasemia without discontinuation of therapy and with a close clinical and biochemical follow-up. In this case, despite the severity of the hepatitis, therapy could be continued as hypertransaminasemia was gradually decreasing after the maximum peak. We also review the literature on toxic hepatitis associated to pegvisomant therapy analyzing the etiology, clinical predisposing factors and natural evolution.

Nutrición en anorexia nerviosa / Nutrition in anorexia nervosa

La anorexia nerviosa es la enfermedad psiquiátrica más frecuente entre las mujeres jóvenes, y se caracteriza por la realización de dietas estrictas con pérdida significativa de peso y un miedo desproporcionado a su ganancia. Esta enfermedad conlleva múltiples complicaciones derivadas tanto de la desnutrición que origina como de los métodos empleados para la pérdida de peso. El tratamiento de esta afección exige un abordaje multidisciplinario y especializado, que se puede efectuar en distintos niveles asistenciales tanto ambulatorio como hospitalario, dependiendo de la situación clínica de los pacientes. Durante el proceso de renutrición, en cualquiera de los niveles asistenciales, se pretende la recuperación de un peso mínimo saludable, la normalización de la conducta alimentaria así como la corrección de las secuelas físicas y psicológicas de la malnutrición. El tratamiento inicial debe enfocarse hacia la restauración del peso, y para alcanzar los objetivos propuestos se seleccionará la vía de acceso de alimentación más apropiada; la vía oral siempre será la de elección, y se optará por la nutrición artificial sólo en situaciones de falta de cooperación o de incorrecta progresión ponderal durante el tratamiento. Si es preciso puede recurrirse a la nutrición artificial, y la nutrición enteral es preferible a la parenteral. Una vez iniciada la realimentación, la progresión en la alimentación se realizará de manera individualizada, y se incrementará progresivamente el aporte calórico hasta alcanzar los objetivos de peso propuestos. Es imprescindible el estricto control hidroelectrolítico, metabólico y físico durante la fase inicial de la realimentación para evitar y diagnosticar complicaciones que pueden aparecer, como el síndrome de renutrición

Anorexia nervosa is the most frequent psychiatric disorder among young women and is characterized by strict dieting with significant weight loss accompanied by a inordinate fear of weight gain. The disorder produces multiple complications arising from both malnutrition and from the methods used to lose weight. Treatment involves a multidisciplinary and specialized approach, which can be carried out in distinct health care levels, both inpatient and outpatient, depending on the patient's clinical status. In all levels of healthcare, during the renutrition process the aim is to recover a minimum healthy weight, achieve normal eating behavior in the patient, and correct the physical and psychological sequelae of malnutrition. Initial treatment should focus on weight gain. To achieve this goal, the most appropriate route of feeding should be selected; the route of choice is always oral, while artificial nutrition is reserved when the patient is uncooperative or there is insufficient weight gain during treatment. If artificial nutrition is unavoidable, enteral nutrition should always be preferred over parenteral nutrition. Once refeeding has been initiated, feeding progression should be individualized, progressively increasing calorie intake until the target weight has been achieved. Strict monitoring of hydroelectrolyte, metabolic and physical status is essential during the initial refeeding phase to prevent or diagnose possible complications, such as refeeding syndrome