Tumor de Merkel en atención primaria / Merkel cell carcinoma in primary care

El tumor de células de Merkel es una neoplasia maligna cutánea de origen neuroendocrino muy poco frecuente. Afecta principalmente a mujeres mayores de cincuenta años, se localiza por lo general en zonas fotoexpuestas, suele ser asintomático y de rápido crecimiento, presenta un elevado porcentaje de recurrencias y metástasis, siendo el lugar más frecuente de diseminación la piel, seguido por los ganglios regionales. Su tratamiento está aún en controversia. Presentamos el caso clínico de una mujer de 76 años con un nódulo eritematoso en antebrazo derecho que presenta una evolución tórpida siendo el diagnóstico final un tumor de Merkel y que tras el tratamiento mantiene una buena evolución (AU)

Merkel cell tumour is a rare malignant cutaneous neoplasm of neuroendocrine origin. It mainly affects women over 50, is generally located in photo-exposed areas, is normally asymptomatic and of rapid growth. It has a high percentage of recurrences and metastasis, with the most frequent sites of dissemination being the skin, followed by the regional lymph nodes. Its treatment is still controversial. We report a clinical case of a 76-year-old woman with erythematous nodule in the right forearm that was not responding to treatment. The final diagnosis was a Merkel tumour and after the treatment it shows good progress (AU)

[Merkel cell carcinoma in primary care]. / Tumor de Merkel en atención primaria.

Merkel cell tumour is a rare malignant cutaneous neoplasm of neuroendocrine origin. It mainly affects women over 50, is generally located in photo-exposed areas, is normally asymptomatic and of rapid growth. It has a high percentage of recurrences and metastasis, with the most frequent sites of dissemination being the skin, followed by the regional lymph nodes. Its treatment is still controversial. We report a clinical case of a 76-year-old woman with erythematous nodule in the right forearm that was not responding to treatment. The final diagnosis was a Merkel tumour and after the treatment it shows good progress.

Hipertensión secundaria y síndrome metabólico / Secondary hypertension and metabolic syndrome

Mujer de 67 años en programa de obesidad desde hace 5 años. Se detecta hipercolesterolemia hace dos años, con colesterol total: 245 mg/dl, colesterol ligado a lipoproteínas de alta densidad (c-HDL): 50 mg/dl, colesterol ligado a lipoproteínas de baja densidad (c-LDL): 165 mg/dl, y triglicéridos: 149 mg/dl, en tratamiento con dieta. Ingresa por cuadro de abdomen agudo en el servicio de Cirugía General, siendo sometida a apendicectomía incidental tras analítica, ecografía y tomografía computarizada (TC) abdominal sugerentes de apendicitis aguda. Reingresa dos días después en Medicina Interna por persistencia del dolor abdominal y febrícula. Se detecta hipertensión arterial (HTA) y tras estudio exhaustivo el diagnóstico es dolor de origen genitourinario con buena resolución. En el informe de alta, aunque descartan la HTA secundaria vásculo-renal, no se valoran alteraciones analíticas: glucemia: 140 mg/dl, fósforo: 2,4 mg/dl, calcio en orina de 24 horas: 333,2 mg/24 horas y microalbuminuria que podrían sugerir otro origen. Ante la persistencia de alteraciones del metabolismo fosfocálcico se solicitan valores de hormona parotiroidea (PTH) que resultan elevados: 310 pg/ml. Se diagnostica de HTA secundaria a hiperparatiroidismo y síndrome metabólico

A 67 year old woman who has been included in an obesity program for 5 years with hypercholesterolemia detected 2 years ago. Total cholesterol is: 245 mg/dl, HDL-C: 50 mg/dl, LDL-c: 165 mg/dl and triglycerides: 149 mg/dl. She was following a treatment with diet. She was admitted in the General Surgery Department due to acute abdomen and underwent an appendectomy as a result of a blood test, abdominal ultrasonography and abdominal CT suggesting acute appendicitis. She was readmitted two days later in the Internal Medicine Department due to persistence of abdominal pain and low fever. High blood pressure was detected. After a thorough study, genitourinary pain with good outcome was diagnosed. In the discharge report, no blood tests abnormalities were assessed, although vasculo-renal secondary hypertension was ruled out: glycemia: 140 mg/dl, phosphorus: 2.4 mg/dl, 24 hour urine calcium: 333.2 mg/24 h and positive microalbuminuria that could suggest a different etiology. Given the persistence of phosphorus-calcium metabolism disorders, PTH values, which were elevated, were assessed: 310 pg/ml. The diagnosis was hyperparathyroidism with secondary hypertension and metabolic syndrome