Pseudohipoparatiroidismo 1b de diagnóstico tardío / Late diagnosis of 1b pseudohypoparathyroidism

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Comentarios a «Hipercarotinemia tras cirugía bariátrica» / Comments on «Hipercarotinemia after bariatric surgery»

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Hipercarotinemia tras cirugía bariátrica / Hypercarotinemia after bariatric surgery

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Impacto de la cirugía bariátrica a medio plazo en la estructura y la función del corazón / Mid-term impact of bariatric surgery on cardiac structure and function

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Hyperuricemia and metabolic syndrome in children with overweight and obesity

Objetivo: Estudiar la prevalencia de hiperuricemia en niños con sobrepeso u obesidad y analizarla relación con el síndrome metabólico y las enfermedades que lo definen. Materiales y métodos: Se realizó un estudio de prevalencia transversal en 148 niños con sobrepeso u obesidad (12 ± 3 años, 48% chicos, IMC 31,8 ± 6,1) reclutados de una consulta de endocrinología pediátrica. Se determinaron el IMC, la cintura-talla, el perímetro de la cintura, la presión arterial con el equipo habitual y la glucosa (en ayunas y tras sobrecarga con 75 g), la resistencia a la insulina, el colesterol HDL, los triglicéridos y el ácido úrico. Resultados: La prevalencia de hiperuricemia era del 53%. Los pacientes con hiperuricemia tenían valores superiores de IMC (33,9 frente a 30,6; p = 0,003), perímetro de cintura (101,4frente a 91,1 cm; p < 0,001) y presión arterial sistólica (123,4 frente a 111,9 mmHg; p < 0,001)y diastólica (78,2 frente a 68,7 mmHg; p < 0,001). Mostraban además una glucemia más alta después de la sobrecarga oral de glucosa (107,5 frente a 100,7 mg/dl; p = 0,03), valores superiores de insulina (29,2 frente a 20,7 mg/dl; p = 0,001) y HOMA IR (6,5 frente a 4,4; p < 0,001) y concentraciones más bajas de HDL (49,5 frente a 54,4 mg/dl; p = 0,02).El valor de ácido úrico correspondiente con mayor probabilidad al diagnóstico de síndrome metabólico en nuestra muestra era de 5,4 mg/dl (sensibilidad del 64% y especificidad del 62%).Conclusión: La prevalencia de hiperuricemia en niños con sobrepeso y obesidad es alta. En el grupo de pacientes con obesidad e hiperuricemia hallamos que los parámetros determinados para diagnosticar el síndrome metabólico eran menos favorables. La concentración de ácido úrico a partir de la cual existe una mayor posibilidad de encontrar síndrome metabólico es de5,4 mg/dl (AU)

Objective: To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it. Materials and methods This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12±3 years, 48% boys, BMI 31.8±6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75g), insulin resistance, cholesterol HDL, triglycerides and uric acid. Results The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p=0.003), plus waist circumference (101.4 vs 91.1cm, p<0.001), higher blood pressure: systolic (123.4 vs 111.9mm Hg, p<0.001), diastolic (78.2 vs 68.7mm Hg, p<0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7mg/dl, p=0.03), insulin was higher (29.2 vs 20.7mg/dl, p=0.001) as well as HOMA IR (6.5 vs 4.4, p<0.001) and HDL levels were lower (49.5 vs 54.4mg/dl, p=0.02).Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4mg/dl in our sample (sensitivity: 64% and specificity 62%).Conclusion The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4mg/dl (AU)

Hyperuricemia and metabolic syndrome in children with overweight and obesity.

OBJECTIVE: To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it. MATERIALS AND METHODS: This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12±3 years, 48% boys, BMI 31.8±6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75 g), insulin resistance, cholesterol HDL, triglycerides and uric acid. RESULTS: The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p=0.003), plus waist circumference (101.4 vs 91.1cm, p<0.001), higher blood pressure: systolic (123.4 vs 111.9 mm Hg, p<0.001), diastolic (78.2 vs 68.7 mm Hg, p<0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7 mg/dl, p=0.03), insulin was higher (29.2 vs 20.7 mg/dl, p=0.001) as well as HOMA IR (6.5 vs 4.4, p<0.001) and HDL levels were lower (49.5 vs 54.4 mg/dl, p=0.02). Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4 mg/dl in our sample (sensitivity: 64% and specificity 62%). CONCLUSION: The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4 mg/dl.

[Prevalence of metabolic syndrome in a population of obese children and adolescents]. / Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad.

INTRODUCTION: Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. OBJECTIVES: 1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity. and 2). To compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. PATIENTS AND METHODS: A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight>p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI),waist circumference(WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (TG), HDL, and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007. RESULTS: A total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17 ± 3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97 h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥ 90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥ 150 mg/dL, 15.94%; HDL <40 mg/dL, 10.86%; fasting blood glucose levels ≥ 100mg/dL, 7.97%. The overall prevalence of metabolic syndrome was 19.6%. A comparison of different anthropometric and biochemical parameters in patients with 1 or 2 MS criteria to those with 3 or more criteria showed that obesity and insulin resistance were significantly greater the greater the number of MS criteria met. CONCLUSIONS: 1.) Prevalence of MS in obese children and adolescents is high, 2). Arterial hypertension and hypertriglyceridemia are the most prevalent metabolic changes in the population studied and 3). Early intervention to control childhood obesity is essential to prevent cardiovascular morbidity and mortality in the future.

Complicated osteoporosis in progeroid syndrome: treatment with teriparatide.

Human progeroid syndromes (PSs) include a group of genetic "premature aging" diseases that affect a variety of organ systems. Bone diseases are common sequelae of patients diagnosed with PSs. Teriparatide therapy is recommended for elderly men with low bone mineral density (BMD; T-score <-2.5) and at least 1 fragility fracture who are unable to tolerate bisphosphonates. We describe a 20-yr-old patient affected by PS and severe osteoporosis complicated with femoral fracture. The patient experienced a significant improvement in lumbar spine BMD after treatment with teriparatide.

Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave / Prevalence of carbohydrate metabolism disturbances in a population of children and adolescents with severe obesity

Introducción La obesidad infanto-juvenil está sufriendo un incremento desmesurado en todo el mundo. Junto con ella, también se encuentran otras alteraciones que conllevan un importante riesgo cardiometabólico en la edad adulta, como son las alteraciones en el metabolismo de los hidratos de carbono. Objetivo Consistió en establecer la prevalencia de prediabetes, definida como glucemia basal alterada (GBA) y/o intolerancia a hidratos de carbono (IHC) tras sobrecarga oral de glucosa, así como la prevalencia de diabetes mellitus tipo 2 (DM-2) en una población infanto-juvenil con obesidad grave. Asimismo, se evaluaron las diferencias clínico-metabólicas entre pacientes prediabéticos frente a sujetos obesos sin prediabetes. Material y métodos Estudio transversal descriptivo en niños y adolescentes con obesidad grave (> percentil 97). Las variables estudiadas fueron: edad, sexo, talla, peso, índice de masa corporal, circunferencia de cintura (CC), glucemia basal y tras sobrecarga oral de glucosa, insulinemia, resistencia a la insulina medida mediante el índice homeostasis model assessment (HOMA), hemoglobina glucosilada (HbA1c), triglicéridos, colesterol de las lipoproteínas de alta densidad (HDL), tensión arterial sistólica y tensión arterial diastólica. Resultados Se reclutaron 133 pacientes, 67 varones (50,4%) y 66 mujeres (49,6%), con edad (..) (AU)

Introduction There is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism. Objective To establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes. Material and methods A cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA1c), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure. Results A total of 133 patients were included: 67 boys (50.4%) and 66 girls (..) (AU)

[Prevalence of carbohydrate metabolism disturbances in a population of children and adolescents with severe obesity]. / Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave.

INTRODUCTION: There is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism. OBJECTIVE: To establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes. MATERIAL AND METHODS: A cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA(1c)), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure. RESULTS: A total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30µU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA(1c), triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant. CONCLUSIONS: The prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.

Efectos del tratamiento con ácido zoledrónico en pacientes adultos con osteogénesis imperfecta / Effects of zoledronic acid in adults with osteogenesis imperfecta

Antecedentes y objetivo La osteogénesis imperfecta (OI) es una enfermedad genética que cursa con fragilidad ósea. Varios trabajos han demostrado la eficacia de los bisfosfonatos. El objetivo de este estudio es evaluar la evolución de la densidad mineral ósea (DMO) y parámetros bioquímicos de metabolismo óseo, en pacientes adultos con OI tratados con ácido zoledrónico iv. Material y métodos Estudio prospectivo no aleatorizado con pacientes adultos con OI con osteoporosis u osteopenia, con T-score <2, e intolerancia o contraindicación de bisfosfonatos orales, a los que se administró ácido zoledrónico iv cada 6 meses. Material y metodosSe realizó densitometría basal y cada año. Se determinaron basal y anualmente calcio total (Ca), fósforo (P), paratirina intacta (PTHi), 25 hidroxivitamina D (Vit D) y marcadores de remodelado óseo: fosfatasa alcalina ósea (FAO), telopéptido carboxiterminal del colágeno tipo I (ß cross-laps [CTX] y deoxipiridolina urinaria (DOP). Se registraron los efectos secundarios y la aparición de nuevas fracturas.ResultadosSe trataron 10 pacientes, 2 hombres y 8 mujeres. Resultados La DMO medida en columna lumbar mostró un aumento significativo a los 24 (0,738±0,141 vs 0,788±0,144g/cm2; p=0,048) y a los 36 meses (0,720±0,139 vs 0,820±0,128) con respecto a la basal. En cuello femoral se evidenció un incremento significativo de la DMO a los 24 meses: 0,677±0,121 vs 0,703±0,122g/cm2; p<0,016.ResultadosNo se evidenciaron cambios significativos en las concentraciones de Ca, P, FAO y CTX a lo largo de seguimiento. La concentración de PTHi aumentó y la de Vit D descendió a los 36 meses. La excreción de DOP disminuyó significativamente a los 24 meses. Siete pacientes presentaron un cuadro pseudogripal leve en las primeras 24h tras la primera infusión. No se evidenciaron efectos secundarios graves.(..) (AU)

Effects of zoledronic acid in adults with osteogenesis imperfectajueves, 01 jul 2010Background and objective Osteogenesis imperfecta (OI) is a genetic disorder that results in bone fragility. Several studies have demonstrated the effectiveness of bisphosphonate therapy. The aim of this study was to evaluate the effects of intravenous zoledronic acid on bone mineral density (BMD) and biochemical markers of bone turnover in adults with OI.Material and methodsWe carried out a prospective non-randomized study in patients with osteoporosis or severe osteopenia (T score (..) (AU)

[Effects of zoledronic acid in adults with osteogenesis imperfecta]. / Efectos del tratamiento con ácido zoledrónico en pacientes adultos con osteogénesis imperfecta.

BACKGROUND AND OBJECTIVE: Osteogenesis imperfecta (OI) is a genetic disorder that results in bone fragility. Several studies have demonstrated the effectiveness of bisphosphonate therapy. The aim of this study was to evaluate the effects of intravenous zoledronic acid on bone mineral density (BMD) and biochemical markers of bone turnover in adults with OI. MATERIAL AND METHODS: We carried out a prospective non-randomized study in patients with osteoporosis or severe osteopenia (T score < -2) related to OI and intolerance or contraindication to oral bisphosphonates. The patients were treated with a zoledronic acid infusion every 6 months. Densitometry was carried out annually. Calcium (Ca), phosphate (P), intact parathormone (PTH), 25 hydroxyvitamin D and biochemical markers of bone turnover [bone alkaline phosphatase (BAP), beta-cross-laps (CTX) and urinary deoxypyridoxine (DOP)] were measured every year. Adverse events and new fractures were registered. RESULTS: Ten patients (2 men and 8 women) were treated. Treatment increased BMD measured in the lumbar spine after 24 (0.738+/-0.141 vs 0.788+/-0.144 g/cm(2); p=0.048) and 36 months (0.720+/-0.139 vs 0.820+/-0.128; p=0.01). Significant increases in BMD were also observed after 24 months in the femoral neck (0.677+/-0.121 vs 0.703+/-0.122 g/cm(2); p<0.016). Serum Ca, P, BAP and CTX concentrations remained unchanged. PTH concentrations increased and vitamin D concentrations decreased after 36 months of treatment. DOP excretion decreased significantly after 24 months. Seven patients had mild influenza-like symptoms occurring within the first 24 h after the first infusion. No severe adverse events were observed. None of the patients had new fractures. CONCLUSION: Zoledronic acid seems to be a safe and effective treatment option in adults with osteoporosis related to OI.

Importancia de la lactancia materna en la prevalencia de síndrome metabólico y en el grado de obesidad infantil / Importance of breastfeeding in the prevalence of metabolic syndrome and degree of childhood obesity

Objetivos: El objetivo de nuestro estudio es evaluar la relación entre lactancia materna (LM) y prevalencia de obesidad y síndrome metabólico, en un grupo de niños y adolescentes obesos. Material y métodos: Se realizó un estudio retrospectivo en niños y adolescentes con obesidad tratados en el Servicio de Endocrinología y Nutrición del Hospital de Getafe (Madrid). Las variables estudiadas fueron edad, sexo, talla, peso, índice de masa corporal (IMC), circunferencia de cintura (CC), índice cintura-talla (ICT), presión arterial (PA), triglicéridos, lipoproteínas de alta densidad y glucemia basal. Asimismo, se recogió información sobre la alimentación recibida en los primeros meses de vida, considerando LM positiva la recibida durante al menos 3 meses. El programa estadístico utilizado fue SPSS v.15. Resultados: Se reclutó a 126 pacientes obesos (71 niños y 55 niñas), con una media de edad de 11,94 ± 3,12 años; 117 (92,86%) de ellos presentaron obesidad mórbida (IMC > P97 para edad y sexo). Todos los pacientes presentaban CC > P90 para edad y sexo. De los 126 pacientes evaluados, el 36,8% recibió LM durante más de 3 meses, y el 63,2%, sólo lactancia artificial (LA). Frente a los pacientes alimentados con LA, aquellos que recibieron LM presentaban menor IMC (31,53 ± 5,77 frente a 32,08 ± 6,78) y menor CC (95,02 ± 3,4 frente a 95,69 ± 3,2 cm), aunque no se alcanzó la significación estadística. La prevalencia de síndrome metabólico en la población estudiada fue del 19,8%. Dentro de este grupo, el 64% no había recibido LM frente a un 36% alimentado con LA. Conclusiones: Haber recibido LM durante al menos 3 meses conllevó un menor grado de obesidad, menor CC y menos complicaciones relacionadas con el síndrome metabólico durante la infancia y la adolescencia. El 64% de los niños con síndrome metabólico completo habían sido alimentados con LA. Son necesarios más estudios para conocer el impacto de la LM en el desarrollo de obesidad y riesgo cardiometabólico (AU)

Objectives: To evaluate the relationship between breastfeeding and the prevalence of obesity and metabolic syndrome in a group of obese children and adolescents. Material and methods: We performed a retrospective study in obese children and adolescents treated at the Endocrinology and Nutrition Service of the Hospital de Getafe (Madrid). The variables studied were age, sex, height, weight, body mass index (BMI), waist circumference, waist-height ratio, blood pressure, triglycerides, high-density lipoprotein and fasting glucose. Information was also collected on food received in the first months of life. Breastfeeding was defined as feeding with maternal milk for at least 3 months. The SPSS v.15 statistical package was used. Results: A total of 126 patients with obesity were recruited (71 boys and 55 girls) with a mean age of 11.94 ± 3.12 years. Of these, 117 (92.86%) were morbidly obese (BMI > 97th percentile for age and sex). All patients had a waist circumference > 90th percentile for age and sex. Of the 126 patients evaluated, 36.8% were breastfed for more than 3 months and 63.2% were fed with artificial milk only. Compared with patients fed with artificial milk, those who were breast fed had a lower BMI (31.53 ± 5.77 vs 32.08 ± 6.78) and lower waist circumference (95.02 ± 3.4 vs. 95.69 ± 3.2 cm), although this difference was not statistically significant. The prevalence of metabolic syndrome in the study population was 19.8%. Within this group, 64% had not been breast fed compared with 36% who had been fed with artificial milk. (..) (AU)

[Effect of abdominal obesity on size of myocardial infarction]. / Impacto de la obesidad central en la extensión del área de necrosis miocárdica.

OBJECTIVE: Metabolic syndrome consists of a group of factors that predict the risk of having an acute cardiovascular event. Some of these factors increase the risk of myocardial infarction and are also associated with the severity of cardiovascular events. The objective was to determine the influence of factors associated with metabolic syndrome, and especially abdominal obesity, on the size of coronary events, estimated by the concentration of total creatine phosphokinase (CPK) and CPK-MB isoenzyme (CPK-MB). SUBJECTS AND METHOD: We performed a cross-sectional study of 40 men diagnosed with acute coronary syndrome. We collected clinical data (age, history of diabetes, dyslipidemia and hypertension ) and anthropometric data [body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR)]. CPK and CPK-MB concentrations were measured to determine the maximum concentration reached in order to estimate the size of the myocardial infarction area. RESULTS: The prevalence of metabolic syndrome was 30%. Approximately 84% of the patients were overweight and 42% had abdominal obesity. A positive association was found between myocardial enzymes and anthropometric parameters (BMI, WC, WHR). The variable showing the closest association with the size of myocardial infarction was central obesity [total CPK, r (Pearson) = 0.47; p<0.003] and (CPK-MB, r= 0.4; p<0.01). Metabolic syndrome was not a predictive factor for the size of myocardial necrosis (beta=-0.29; p<0.1). Multiple regression analysis showed that WC predicted maximal total CPK (beta=37.15; 95% CI, 9.16-65.15; p<0.01) and CPK-MB concentrations (beta=5.7; 95% CI, -0.4-11.9; p< 0.06) after an acute coronary event. CONCLUSIONS: The presence of abdominal obesity was associated with greater myocardial necrosis size after an acute coronary event.