Ectopic insulinoma: a systematic review.

Knowledge of ectopic insulinomas comes from single cases. We performed a systematic review through PubMed, Web of Science, Embase, eLibrary and ScienceDirect of all cases reported in the last four decades. We also describe one unreported patient. From 28 patients with ectopic insulinoma, 78.6% were female and mean age was 55.7 ± 19.2 years. Hypoglycaemia was the first symptom in 85.7% while 14.3% complained of abdominal pain or genital symptoms. Median tumour diameter was 27.5 [15-52.5] mm and it was localised by CT (73.1%), MRI (88.9%), [68Ga]Ga-DOTA-exedin-4 PET/CT (100%), 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC (100%), somatostatin receptor scintigraphy (40%) and endoscopic ultrasound (50%). Ectopic insulinomas were located at duodenum (n = 3), jejunum (n = 2), and one respectively at stomach, liver, appendix, rectum, mesentery, ligament of Treitz, gastrosplenic ligament, hepatoduodenal ligament and splenic hilum. Seven insulinomas were affecting the female reproductive organs: ovary (n = 5), cervix (n = 2) and remaining tumours were at retroperitoneum (n = 3), kidney (n = 2), spleen (n = 1) and pelvis (n = 1). 89.3% underwent surgery (66.7% surgery vs. 33.3% laparoscopy) and 16% underwent an ineffective pancreatectomy. 85.7% had localized disease at diagnosis and 14.3% developed distant metastasis. Median follow-up time was 14.5 [4.5-35.5] months and mortality was reported in 28.6% with median time until death of 60 [5-144] months. In conclusion, ectopic insulinomas are presented as hypoglycaemia with female preponderance. Functional imaging [68Ga]Ga-DOTA-exedin-4 PET/CT and 68Ga-labelled-DOTA-conjugated somatostatin analogue PET/TC have very high sensitivity. Clinicians should be alert to the possibility of extra-pancreatic insulinomas when classic diagnostic tests and intraoperative pancreas exploration failed to locate the tumour.

Estudi de la relació entre el nivell d'activitat física i el control de la diabetis mellitus tipus 1 determinat pels valors d'hemoglobina glicosilada / Relación entre nivel de actividad física y control de la Diabetes Mellitus tipo 1 / Evaluation of the association of physical activity with metabolic control of type 1 Diabetes Mellitus

Fonament: els principals beneficis que l'activitat física aporta a la salut dels pacients diabètics tipus 1 s'han estudiat en diverses publicacions prèvies. Tot i això, l'evidència que l'exercici físic millora els controls metabòlics dels pacients no ha estat totalment demostrada i hi ha resultats controvertits. Objectiu: l'objectiu del treball és conèixer la relació entre el nivell d'activitat física dels pacients amb diabetis mellitus tipus 1 (DM1) i el control metabòlic de la malaltia, definit pels valors de l'hemoglobina glicosilada (HbA1c). Mètode: en l'estudi s'han inclòs 44 pacients diagnosticats de DM1 nascuts entre els anys 1998 i 2009, i que, per tant, tenen una edat compresa entre 7 i 18 anys. Les dades dels pacients s'han extret de la revisió de les històries clíniques. Tots els pacients de l'estudi han omplert els qüestionaris PAQ-C o PAQ-A (Physical Activity Questionnaire) per tal de registrar l'activitat física setmanal. Resultats: tant en l'anàlisi univariable com en l'anàlisi multivariable ajustada per factors de confusió, s'ha obtingut una relació estadísticament significativa entre el nivell d'activitat física i els valors d'HbA1c (Beta -0,510, p<0,01). Conclusió: l'activitat física millora el control glicèmic dels pacients diabètics tipus 1

Fundamento. Los principales beneficios que la actividad física aporta a la salud de los pacientes con diabetes tipo 1 se han estudiado previamente. Aún así, la evidencia de que el ejercicio físico mejora los controles metabólicos no se ha demostrado totalmente y existen resultados controvertidos. Objetivo. El objetivo de este trabajo es conocer la relación entre el nivel de actividad física de los pacientes con diabetes mellitus tipo 1 y el control metabólico de la enfermedad, definido por los valores de HbA1c. Método. En el estudio se han incluido 44 pacientes diagnosticados de diabetes mellitus tipo1 nacidos entre los años 1998 i 2009. Los datos se han obtenido de la revisión de las historias clínicas. Todos los pacientes del estudio han rellenado el cuestionario PAQ-C o PAQ-A para registrar la actividad física semanal. Resultados. El análisis univariable y el multivariable ajustado por factores de confusión muestran de manera estadísticamente significativa el efecto beneficioso del nivel de actividad física sobre los valores de HbA1c (Beta -0,510, p>0,01). Conclusión. La actividad física mejora el control metabólico de los pacientes diabéticos tipo 1 (AU)

Background. The benefits of physical activity in patients with type 1 diabetes mellitus have been previously reported. However, the association between physical activity and HbA1c levels is controversial, and studies have not shown consistent results. Objective. The aim of this study was to evaluate the association between the level of physical activity and the metabolic control of the disease, as defined by HbA1c levels. Method. Forty-four patients with type 1 diabetes mellitus and born between 1998 and 2009 were included in the study. Patient data were extracted from clinical records, and all patients completed the PAQ-C or PAQ-A questionnaire to document the weekly physical activity. Results. The analysis adjusted for possible confounding factors (Beta -0.510, p<0.01) showed that physical activity had a significant effect on the metabolic control of the HbA1c levels. Conclusion. Physical activity improves metabolic control of type 1 diabetes mellitus (AU)

Afectación tiroidea por enfermedad de Rosai-Dorfman / Thyroid involvement by Rosai-Dorfman disease

No disponible

Recommended vitamin D levels in the general population. / Recomendaciones de vitamina D para la población general.

OBJECTIVE: To provide recommendations based on evidence on the management of vitaminD deficiency in the general population. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS: Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the term VitaminD and the name of each issue. Papers in English and Spanish with publication date before 17 March 2016 were included. Recommendations were jointly discussed by the Working Group. CONCLUSIONS: This document summarizes the data about vitaminD deficiency in terms of prevalence, etiology, screening indications, adequate levels and effects of supplementation on bone and non-skeletal health outcomes.

Recomendaciones de vitamina D para la población general / Recommended vitamin D levels in the general population

Objetivo: Proporcionar recomendaciones basadas en la evidencia sobre el manejo del déficit de vitaminaD en población general. Participantes: Miembros del Grupo de Trabajo de Osteoporosis y Metabolismo Mineral de la SEEN. Métodos: Se empleó el sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en Medline de la evidencia disponible para vitaminaD y el título de cada capítulo. Se revisaron artículos escritos en inglés con fecha de inclusión hasta 17 de marzo del 2016. Tras la formulación de las recomendaciones, estas se discutieron de manera conjunta en el grupo de trabajo. Conclusiones: Este documento resume los datos acerca del déficit de vitaminaD en lo que respecta a su prevalencia, etiología, indicaciones de cribado, niveles adecuados y efectos de la suplementación a nivel óseo y extraóseo (AU)

Objective: To provide recommendations based on evidence on the management of vitaminD deficiency in the general population. Participants: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. Methods: Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the term VitaminD and the name of each issue. Papers in English and Spanish with publication date before 17 March 2016 were included. Recommendations were jointly discussed by the Working Group. Conclusions: This document summarizes the data about vitaminD deficiency in terms of prevalence, etiology, screening indications, adequate levels and effects of supplementation on bone and non-skeletal health outcomes (AU)