Indicación, realización y resultado del cateterismo de venas adrenales en pacientes con hiperaldosteronismo primario / Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism

El hiperaldosteronismo primario (HAP) es una causa importante de hipertensión arterial (HTA) secundaria. El estudio del mismo precisa de una alta sospecha clínica, además de un estudio hormonal que confirme la hipersecreción hormonal. Es importante iniciar el tratamiento adecuado una vez se confirma el diagnóstico, y para ello es preciso demostrar si la hipersecreción hormonal es unilateral (pacientes que podrían ser tributarios a tratamiento quirúrgico) o bilateral (pacientes que son tributarios a tratamiento únicamente farmacológico). En el Hospital del Mar desde el año 2016 existe un equipo de trabajo multidisciplinar en el que participan nefrólogos, endocrinólogos, radiólogos y cirujanos para evaluar los casos con sospecha de hiperaldosteronismo y consensuar el mejor abordaje diagnóstico-terapéutico de estos pacientes, incluyendo la necesidad de cateterismo venoso adrenal, que es una técnica que en los últimos años se ha erigido como gold standard para el estudio del HAP. En el presente estudio recogemos la experiencia de nuestro centro en la realización de cateterismo venoso adrenal y en la utilidad de este para el manejo de tales pacientes (AU)

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our center in performing adrenal vein catheterization and its usefulness for the management of these patients (AU)

Cardiovascular disease risk in the transgender population.

This review summarizes the impact of gender affirming hormone therapy used in the transgendered population and the classic and emerging risk factors on cardiovascular outcomes and surrogate markers of cardiovascular health. There is a growing body of evidence that people who are transgender and gender diverse are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Previously, disparities have been reported in cardiovascular morbidity and mortality across this group as a result of a higher prevalence of non-healthy life style. However, recent research suggests that there are additional factors playing a role in this differences: there is the hypothesis that the excess of cardiovascular morbility and mortality has been driven by psychosocial stressors across the lifespan at multiple levels, as structural violence (e.g., discrimination, lack of affordable housing, lack of access to health care, etc.). Lack of information and research in this population is an important limitation; therefore, a multifaceted approach that integrates best practice into research, health promotion and cardiovascular care for this understudied and growing population is clearly needed.

Este artículo resume la literatura existente hasta este momento sobre el impacto de la terapia hormonal para la asignación de género utilizada en la población transgénero, y de los factores de riesgo tradicionales y emergentes, en los desenlaces cardiovasculares o los marcadores subrogados de enfermedad cardiovascular. Actualmente se reconoce la evidencia creciente de que las personas transgénero o con género diverso son víctimas de disparidades en una gran variedad de factores de riesgo cardiovascular comparadas con sus pares cisgénero. Se ha reportado disparidad en morbilidad y mortalidad como resultado de una alta prevalencia en estilos de vida no saludables. Sin embargo, recientemente se ha incorporado la interpretación de que no solo la disparidad en factores de riesgo cardiovascular es lo que incrementa el riesgo en la salud cardiovascular de la población transgénero. Existe la hipótesis de que el exceso en morbilidad y mortalidad cardiovascular está relacionado con estresores psicosociales a lo largo de la vida de este grupo en múltiples niveles, incluyendo violencia estructurada (p. ej., discriminación, falta de acceso a los servicios de salud, falta de vivienda digna, etc.). La falta de información y de investigación en este grupo son limitantes importantes que requieren un abordaje multifacético para mejorar aspectos como la promoción de la salud y el mejor cuidado cardiovascular.

Particularities of physical training and control of risk factors in the transgender and gender-diverse population.

The transgender and gender-diverse (TGD) population holds significant relevance concerning exercise and sports practices. Specific challenges are highlighted, such as physical inactivity driven by internal and external reasons, including discrimination in sports environments. Psychological aspects and hormonal therapy effects create implications for hindering participation in sports competitions. Disparities in cardiovascular risk factors are also mentioned, emphasizing the need for inclusive sports policies based on scientific evidence. The article underscores the importance of addressing social, psychological, and medical aspects to promote the physical and mental health of the TGD population, particularly in the professional sports area.

La población trans y de género diverso (TGD) tiene una gran relevancia en relación con la práctica de ejercicio y deporte. Se destacan desafíos específicos, como la inactividad física motivada por razones internas y externas, incluida la discriminación en entornos deportivos. Existen aspectos psicológicos y efectos de la terapia hormonal que generan implicaciones para la dificultar participación en competiciones deportivas. También se menciona la disparidad en los factores de riesgo cardiovascular y se plantea la necesidad de políticas deportivas inclusivas basadas en evidencia científica. El artículo enfatiza la importancia de abordar los aspectos sociales, psicológicos y médicos para promover la salud física y mental de la población TGD, especialmente en el ámbito deportivo profesional.

Manejo del paciente con Hipertiroidismo en consulta externa de la Unidad Técnica de Endocrinología del Hospital Carlos Andrade Marín / Management of the patient with hyperthyroidism in the outpatient clinic of the Technical Unit of Endocrinology of the Endocrinology Technical Unit of the Carlos Andrade Marín Hospital

El hipertiroidismo es un trastorno caracterizado por el exceso de hormonas tiroideas. El déficit de yodo es un factor clave en dicha patología y en lugares con suficiencia del mismo se asocian a au-toinmunidad tiroidea. La prevalencia de hipertiroidismo mani-fiesto varía del 0,2% al 1,3% en áreas con suficiencia de yodo, sin embargo, esto puede variar en cada país por diferencias en umbrales de diagnóstico, sensibilidad de ensayo y población se-leccionada. Un reporte de The Third National Health and Nutri-tion Examination Survey (NHANES III) mostró que el hiperti-roidismo manifiesto se presenta en 0,7% de la población general e hipertiroidismo subclínico en el 1,7%1,2.En incidencia, la patología se asocia con la suplementación de yodo, con la mayor frecuencia en áreas de deficiencias, por au-mento de nódulos tiroideos en la población anciana, teniendo a regiones de áreas montañosas como América del Sur, África Central y suroeste de Asia dentro de este grupo. Un meta aná-lisis de estudios europeos mostró una incidencia general de 50 casos por 100000 personas/años1. En Ecuador, según los datos del Instituto Nacional de Estadísticas y Censos (INEC) del 2017, se reportaron 157 casos de hipertiroidismo, de los cuales la En-fermedad de Graves (EG) fue la causa más común, seguida por el bocio multinodular tóxico (BMNT) y finalmente el adenoma tóxico (AT) con una incidencia de 61 %, 24 % y 14 % respecti-vamente3.Los pacientes con esta patología tienen aumento de riesgo com-plicaciones cardiovasculares y mortalidad por todas las causas, siendo falla cardíaca uno de sus principales desenlaces, así el diagnóstico precoz evita estos eventos, principalmente en pobla-ción de edad avanzada.El presente protocolo se ha realizado para un correcto trata-miento de esta patología en el Hospital de Especialidades Carlos Andrade Marín (HECAM).

Hyperthyroidism is a disorder characterized by an excess of thyroid hormones. Iodine deficiency is a key factor in this pa-thology and in places with iodine deficiency it is associated with thyroid autoimmunity. The prevalence of overt hyperthyroidism varies from 0,2% to 1,3% in iodine-sufficient areas; however, this may vary from country to country due to differences in diag-nostic thresholds, assay sensitivity, and selected population. A report from The Third National Health and Nutrition Examina-tion Survey (NHANES III) showed that overt hyperthyroidism occurs in 0,7% of the general population and subclinical hyper-thyroidism in 1,7%1,2.In incidence, the pathology is associated with iodine supplemen-tation, with the highest frequency in areas of deficiencies, due to increased thyroid nodules in the elderly population, having regions of mountainous areas such as South America, Central Africa and Southwest Asia within this group. A meta-analysis of European studies showed an overall incidence of 50 cases per 100000 person/years1. In Ecuador, according to data from the National Institute of Statistics and Census (INEC) in 2017, 157 cases of hyperthyroidism were reported, of which, Graves' di-sease (GD) was the most common cause, followed by toxic mul-tinodular goiter (BMNT) and finally toxic adenoma (TA) with an incidence of 61 %, 24 % and 14 % respectively3.Patients with this pathology have an increased risk of cardiovas-cular complications and all-cause mortality, with heart failure being one of the main outcomes, so early diagnosis avoids these events, mainly in the elderly population.The present protocol has been carried out for the correct treat-ment of this pathology at the Carlos Andrade Marín Specialties Hospital (HECAM).

Survey on Endocrinology and Nutrition undergraduate teaching in Spain-2021.

OBJECTIVES: Advances in endocrinology and nutrition (E&N) and the importance of its associated disorders require that its teaching within the medical degree meets adequate standards of quality and homogeneity Our objective was to expand the data on E&N undergraduate teaching in Spain. METHODS: We designed an observational, cross-sectional web-based study addressed to the coordinators of E&N teaching at the 42 faculties of medicine that had taught the subject during the 2020-2021 academic year. RESULTS: One in three faculties had a professor who was an E&N specialist, but less than half had a full professor of E&N. There is great variability in teaching programmes, although most of them dedicate 6 ECTS credits to the subject. Over two-thirds of the faculties maintain theoretical lessons with over 50 students per class. Most programmes dedicate between four and six hours to hypothalamic pituitary disorders, thyroid diseases and adrenal gland disorders. However, there is great variability in the time dedicated to diabetes and nutrition. In one-third of the faculties, students are not required to do a rotation in the E&N department. Teachers at the universities widely participate in undergraduate/master's students' final projects and master's degree studies. CONCLUSIONS: The E&N specialty maintains a good position within universities, but there is still great heterogeneity in the teaching structure of the subject.

RECALSEEN 2021. Resources and quality in the Endocrinology and Nutrition units of the National Health System of Spain.

OBJECTIVES: RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U_EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented. MATERIAL AND METHODS: Cross-sectional descriptive study of the S-U_EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U_EyN' consultants; and 2. analysing the acute general hospital discharges from S-U_EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS. RESULTS: 112 responses from S-U_EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U_EyN sample includes 24 more centers than in 2017. 54% of the S-U_EyN were endocrinology departments. The median number of endocrinologists per S-U_EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U_EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U_EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management. CONCLUSIONS: RECALSEEN is a useful project for the analysis of S-U_EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement.

Tiroiditis subaguda asociada a COVID-19: revisión narrativa / Subacute thyroiditis associated with COVID-19: A narrative review

La infección por SARS-CoV-2 podría gatillar la ocurrencia de numerosas patologías, algunas de ellas de tipo endocrinológico. Se presenta una revisión narrativa sobre la asociación entre COVID-19 y tiroiditis subaguda, en la que se describen aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas y de laboratorio, tratamiento y pronóstico. La prevalencia de alguna disfunción tiroidea en pacientes COVID-19 fluctúa entre 13 y 64%, específicamente en relación con tiroiditis subaguda se describe un cambio en la prevalencia de 0,5% a 10% entre los años 2019 y 2020. La tiroiditis subaguda se produce por la unión del virus SARS-CoV-2 con la enzima convertidora de angiotensina 2 (ACE-2) ampliamente expresada en la glándula tiroides, generando manifestaciones clínicas tipo tirotoxicosis, aunque la presentación de la tiroiditis subaguda asociada a COVID-19 puede ser atípica. Los elementos centrales del tratamiento son similares a los empleados ante cualquier tiroiditis subaguda. Se concluye la necesidad de considerar esta entidad en el diagnóstico diferencial de pacientes actual o previamente infectados por SARS-CoV-2 que presenten síndrome febril, elevación de parámetros inflamatorios o taquicardia persistente, sin etiología precisada.

SARS-CoV-2 infection can trigger the occurrence of numerous pathologies, some of them endocrinological. The present narrative review works on the association between COVID-19 and subacute thyroiditis, which describes epidemiological and pathophysiological aspects, clinical and laboratory manifestations, treatment, and prognosis. The prevalence of thyroid dysfunction in COVID-19 patients fluctuates between 13 and 64%, explicitly concerning subacute thyroiditis; it has been described as a change in prevalence from 0.5% to 10% between 2019 and 2020. The binding of the SARS-CoV-2 virus with the angiotensin-converting enzyme 2 receptor (ACE-2) widely expressed in the thyroid gland causes subacute thyroiditis, generating thyrotoxicosis-like clinical manifestations. However, the presentation of subacute thyroiditis associated with COVID-19 may be atypical. The central elements of the treatment are similar to those used in any subacute thyroiditis. We conclude that this entity must be considered in differential diagnoses of patients currently or previously infected with SARS-CoV-2 that present a febrile syndrome, elevated inflammatory parameters, or persistent tachycardia without a specified aetiology.

Variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey

Fundamento: la infertilidad femenina es un término utilizado para referirse a una mujer que no ha podido quedar embarazada después de haberlo intentado por lo menos en un año al mantener relaciones sexuales desprotegidas. Objetivo: caracterizar algunas variables socio-epidemiológicas de la infertilidad femenina en la provincia Camagüey. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en el Hospital Docente Ginecobstétrico Provincial Ana Betancourt Mora de Camagüey durante el año 2021. El universo estuvo constituido por 304 pacientes con diagnóstico de infertilidad. Las variables estudiadas incluyeron: grupo etáreo, tipo de infertilidad, municipio de origen, tasa de incidencia, nivel educacional, hábitos tóxicos, factores de riesgo y antecedentes personales. Los datos se expresaron en números y porcientos. Resultados: el 30,9 % correspondió al grupo etáreo de 30 a 34 años, procedentes en su mayoría del municipio Camagüey (43,5 %), mientras Céspedes alcanzó la mayor tasa de incidencia (13,8 %) por cada 1000 mujeres con rango de edad que pudieran ser admitidas en el programa. Un porciento elevado tenía estudios universitarios (45,4 %) y preuniversitarios (24,3 %), predominó el consumo de café (24,0 %) y tabaco (14,5 %) como hábitos tóxicos; así como enfermedades de trasmisión sexual (24,7 %) y el uso de anticonceptivo (21,1 %). La obesidad (13,5 %) resultó ser el principal antecedente personal. Conclusiones: la infertilidad femenina está determinada por varios factores, incluidos los epidemiológicos, como los hábitos tóxicos, el estado nutricional, los antecedentes personales, entre otros, en su mayoría modificables, que pueden ser tratados desde la Atención Primaria de Salud.

Background: female infertility is a term used to refer to a woman who has not been able to get pregnant after trying for at least a year by having unprotected sexual intercourse. Objective: to characterize some socio-epidemiological variables of female infertility in Camagüey province. Methods: a descriptive, cross-sectional study was carried out at the Ana Betancourt Mora Camagüey Provincial Gynecobstetric Teaching Hospital during the year 2021. The universe consisted of 304 patients diagnosed with infertility. The variables studied included: age group, type of infertility, municipality of origin, incidence rate, educational level, toxic habits, risk factors, and personal history. Data were expressed in numbers and percentages. Results: 30.9 % corresponded to the age group of 30 to 34 years, coming mostly from the Camagüey municipality (43.5 %), while Cespedes reached the highest incidence rate (13.8 %) per 1000 women with age range that could be admitted to the program. A high percentage had university studies (45.4 %) and pre-university studies (24.3 %), the consumption of coffee (24.0 %) and tobacco (14.5 %) predominated as toxic habits; as well as sexually transmitted diseases (24.7 %) and the use of contraception (21.1 %). Obesity (13.5 %) turned out to be the main personal history. Conclusions: female infertility is determined by several factors, including epidemiological ones, such as toxic habits, nutritional status, personal history, among others, mostly modifiable, which can be treated from Primary Health

Indication, performance and outcomes of adrenal vein sampling in patients with primary hyperaldosteronism.

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only). At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH. In the present study we collect the experience of our centre in performing AVC and its usefulness for the management of these patients.

A survey on the perception of the specialty of Endocrinology and Nutrition among students preparing for the entrance exam for medical specialty training in Spain.

INTRODUCTION AND AIMS: Previous studies have shown that there is decreasing interest in E&N among medical students. The aim of our study was to evaluate the perception of E&N among a sample of medical students. MATERIAL AND METHODS: We surveyed 2252 students prior to taking the exam that allows access to specialised training in Spain. RESULTS: Overall, 9.9% (222 participants) would probably choose E&N. The most positive aspects in includes of the specialty are its logical pathophysiological basis (54%) and that the work is dynamic and varied (27%), while the least attractive aspects are the few interventional techniques. The parts of the specialty that most attract students are hypothalamic-pituitary disease and diabetes mellitus. CONCLUSIONS: The proportion of candidates who want to study E&N as their first choice is adequate in relation to the number of places available.

PET/TC en endocrinología nuclear. Resultados de la encuesta difundida por las distintas redes sociales de la SEMNIM en España / PET/CT in nuclear endocrinology: Results of the survey diffused through different social networks of the SEMNIM in Spain

Objetivo Desde el Grupo de Trabajo de Endocrinología de la SEMNIM, se planteó la necesidad de conocer el uso actual de la tecnología PET/TC aplicada en el campo de la endocrinología. El objetivo de la encuesta era obtener una fotografía instantánea del uso de la PET/TC en endocrinología nuclear, con el fin de conocer si está siendo adecuadamente utilizada y detectar posibles necesidades. Material y métodos Durante el primer trimestre del 2022, se analizaron los datos obtenidos de una encuesta que se difundió a través de distintas redes sociales a lo largo de la segunda mitad del 2021. Se recogieron datos sobre el uso de las distintas técnicas PET/TC en el carcinoma diferenciado de tiroides, el carcinoma medular de tiroides, los tumores neuroendocrinos y el hiperparatiroidismo. Resultados Un total de 15 centros respondieron la encuesta. El 79% de los hospitales utilizan la 18F-FDG PET/TC en el diagnóstico y/o seguimiento del carcinoma diferenciado de tiroides (media de exploraciones anuales: 36,9; rango 10-100). El 85% utilizan la 18F-DOPA PET/TC para el estudio de recidiva bioquímica de carcinoma medular de tiroides (media estudios anuales: 7,8; rango 2-20). El 77% utilizan la 18F-DOPA PET/TC para el estudio de los tumores neuroendocrinos: el 77% utilizan la 18F-DOPA PET/TC (media de 10 exploraciones anuales; rango 2-30) y el 69% utilizan el 68Ga-DOTA-SA (media de 24,7 exploraciones anuales; rango 2-127). El 79% utilizan la 18F-colina PET/TC para el estudio del hiperparatiroidismo (media de 30,1 exploraciones anuales; rango 10-120). Conclusiones El uso de la técnica PET/TC en endocrinología aún no está generalizado, sin embargo, vimos que las indicaciones en las cuales se utiliza son, en general, las reportadas en los distintos consensos (AU)

Aim To know the current use of the PET/CT technology applied in the field of endocrinology, the Endocrinology Working Group of SEMNIM proposed conducting a survey. The objective was to obtain a snapshot of the use of PET/CT in nuclear endocrinology, to know if it is being used properly and detect possible needs. Material and methods During the first quarter of 2022, we analyzed the data obtained from a survey that was distributed through different social networks throughout the second half of 2021. The survey asked for the use of the different PET/CT techniques available in Spain in different endocrinological pathologies like differentiated thyroid carcinoma, medullary thyroid carcinoma, neuroendocrine tumors and hyperparathyroidism. Results A total of 15 centers responded to the survey. A percentage of 79 of hospitals used 18F-FDG PET/CT in the diagnosis and/or follow-up of differentiated thyroid carcinoma (mean annual studies: 36.9; range 10–100); 85% used 18F-DOPA PET/CT for the study of biochemical recurrence of medullary thyroid carcinoma (mean annual studies: 7.8; range 2–20); 77% used 18F-DOPA PET/CT for the study of neuroendocrine tumors: 77% used 18F-DOPA PET/CT (mean of 10 scans per year; range 2–30) and 69% used 68Ga-DOTA-SA (mean of 24.7 studies per year; range 2–127); 79% used 18F-choline PET/CT for the study of hyperparathyroidism (mean of 30.1 annual studies; range 10–120). Conclusions We detected that the use of the PET/CT technique in endocrinology is not yet widespread, however, we saw that the indications in which it is used are, in general, those reported in the different consensus (AU)

Evolution of the choice of places in Endocrinology and Nutrition in the Spanish exam for accessing to the resident physicians training program 2001-2022 measured with the quotation index.

INTRODUCTION: The comparison between specialties or the analysis of evolution over time of a speciality in the Spanish exam for accessing to the resident physicians training programme (RPTP) is difficult due to the changing of the number of places offered. In this paper we describe two parameters (quotation index and quotation order) that objectify the relationship between supply and demand for places in a given medical speciality in a RPTP call and analyse the evolution of the speciality of Endocrinology and Nutrition (E&N). MATERIAL AND METHODS: We analysed the evolution of the supply/demand ratio for the speciality of E&N in the 2001-2022 RPTP calls using the quotation index and quotation order. An increase in the quotation order implies a worsening of the supply/demand ratio. Robust correlation analysis between year and quoatation orden is used. RESULTS: E&N shows a worsening in the RPTP choice, both in relation to all specialties offered and in relation to specialties of medical area (robust correlation coefficient year-quotation order 0.72 (p=0.0002) if all specialties are considered and 0.80 (p<0.0001) if only medical area specialties are considered). CONCLUSIONS: The specialty E&N has shown a negative evolution in the choice of RPTP, objectified through the quotation index and the quotation order, both in relation to all the specialties offered and in relation to all the specialties of the medical area, although it is still among the most sought-after medical specialties in the medical area.

Perception of training and job perspectives among final-year residents in the specialty of Endocrinology and Nutrition.

INTRODUCTION: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19. MATERIALS AND METHODS: Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021. RESULTS: 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology. CONCLUSION: The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility.

PET/CT in nuclear endocrinology: Results of the survey diffused through different social networks of the SEMNIM in Spain.

AIM: To know the current use of the PET/CT technology applied in the field of endocrinology, the Endocrinology Working Group of SEMNIM proposed conducting a survey. The objective was to obtain a snapshot of the use of PET/CT in nuclear endocrinology, to know if it is being used properly and detect possible needs. MATERIAL AND METHODS: During the first quarter of 2022, we analyzed the data obtained from a survey that was distributed through different social networks throughout the second half of 2021. The survey asked for the use of the different PET/CT techniques available in Spain in different endocrinological pathologies like differentiated thyroid carcinoma, medullary thyroid carcinoma, neuroendocrine tumors and hyperparathyroidism. RESULTS: A total of 15 centers responded to the survey. A percentage of 79 of hospitals used 18F-FDG PET/CT in the diagnosis and/or follow-up of differentiated thyroid carcinoma (mean annual studies: 36.9; range 10-100); 85% used 18F-DOPA PET/CT for the study of biochemical recurrence of medullary thyroid carcinoma (mean annual studies: 7.8; range 2-20); 77% used 18F-DOPA PET/CT for the study of neuroendocrine tumors: 77% used 18F-DOPA PET/CT (mean of 10 scans per year; range 2-30) and 69% used 68Ga-DOTA-SA (mean of 24.7 studies per year; range 2-127); 79% used 18F-choline PET/CT for the study of hyperparathyroidism (mean of 30.1 annual studies; range 10-120). CONCLUSIONS: We detected that the use of the PET/CT technique in endocrinology is not yet widespread, however, we saw that the indications in which it is used are, in general, those reported in the different consensus.

Particularidades del entrenamiento físico y el control de los factores de riesgo en la población trans y de género diverso / Particularities of physical training and control of risk factors in the transgender and gender-diverse population

Resumen La población trans y de género diverso (TGD) tiene una gran relevancia en relación con la práctica de ejercicio y deporte. Se destacan desafíos específicos, como la inactividad física motivada por razones internas y externas, incluida la discriminación en entornos deportivos. Existen aspectos psicológicos y efectos de la terapia hormonal que generan implicaciones para la dificultar participación en competiciones deportivas. También se menciona la disparidad en los factores de riesgo cardiovascular y se plantea la necesidad de políticas deportivas inclusivas basadas en evidencia científica. El artículo enfatiza la importancia de abordar los aspectos sociales, psicológicos y médicos para promover la salud física y mental de la población TGD, especialmente en el ámbito deportivo profesional.

Abstract The transgender and gender-diverse (TGD) population holds significant relevance concerning exercise and sports practices. Specific challenges are highlighted, such as physical inactivity driven by internal and external reasons, including discrimination in sports environments. Psychological aspects and hormonal therapy effects create implications for hindering participation in sports competitions. Disparities in cardiovascular risk factors are also mentioned, emphasizing the need for inclusive sports policies based on scientific evidence. The article underscores the importance of addressing social, psychological, and medical aspects to promote the physical and mental health of the TGD population, particularly in the professional sports area.

Riesgo de enfermedad cardiovascular en la población transgénero / Cardiovascular disease risk in the transgender population

Resumen Este artículo resume la literatura existente hasta este momento sobre el impacto de la terapia hormonal para la asignación de género utilizada en la población transgénero, y de los factores de riesgo tradicionales y emergentes, en los desenlaces cardiovasculares o los marcadores subrogados de enfermedad cardiovascular. Actualmente se reconoce la evidencia creciente de que las personas transgénero o con género diverso son víctimas de disparidades en una gran variedad de factores de riesgo cardiovascular comparadas con sus pares cisgénero. Se ha reportado disparidad en morbilidad y mortalidad como resultado de una alta prevalencia en estilos de vida no saludables. Sin embargo, recientemente se ha incorporado la interpretación de que no solo la disparidad en factores de riesgo cardiovascular es lo que incrementa el riesgo en la salud cardiovascular de la población transgénero. Existe la hipótesis de que el exceso en morbilidad y mortalidad cardiovascular está relacionado con estresores psicosociales a lo largo de la vida de este grupo en múltiples niveles, incluyendo violencia estructurada (p. ej., discriminación, falta de acceso a los servicios de salud, falta de vivienda digna, etc.). La falta de información y de investigación en este grupo son limitantes importantes que requieren un abordaje multifacético para mejorar aspectos como la promoción de la salud y el mejor cuidado cardiovascular.

Abstract This review summarizes the impact of gender affirming hormone therapy used in the transgendered population and the classic and emerging risk factors on cardiovascular outcomes and surrogate markers of cardiovascular health. There is a growing body of evidence that people who are transgender and gender diverse are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Previously, disparities have been reported in cardiovascular morbidity and mortality across this group as a result of a higher prevalence of non-healthy life style. However, recent research suggests that there are additional factors playing a role in this differences: there is the hypothesis that the excess of cardiovascular morbility and mortality has been driven by psychosocial stressors across the lifespan at multiple levels, as structural violence (e.g., discrimination, lack of affordable housing, lack of access to health care, etc.). Lack of information and research in this population is an important limitation; therefore, a multifaceted approach that integrates best practice into research, health promotion and cardiovascular care for this understudied and growing population is clearly needed.

Malignant hypercalcemia at a national referral center. A retrospective analysis

Malignant hypercalcemia is the most frequent endocrinological emergency in cancer. The factors related to its occurrence have not been evaluated, nor are there any related studies in Colombia. Objective: to determine the factors associated with the onset of malignant hypercalcemia (MH) in patients hospitalized at Instituto Nacional de Cancerología (2014-2019). Design: a retrospective analytical case-control study Population: 230 cases of adults with cancer and calcium corrected for albumin equal to or greater than 10.5 mg/dL and 223 controls of cancer patients with normal corrected calcium (8.5 to 10.4 mg/ dL) were included. Squamous cell carcinoma was used as the pairing variable. Analysis: univariate and bivariate analyses between the variables and the occurrence of MH were conducted to determine association, and raw ORs were calculated. Depending on their statis tical significance (p<0.05), they were included in the logistic regression for multivariate analysis and to rule out bias. Results: the median calcium for cases: 12.98 mg/dL (11.64-14.42) vs. 9.4 mg/dL (9.02-9.74) (p < 0.0001). The two groups were similar in age and sex. There was more metastasis in the cases (60.0% vs. 39.91%) (p< 0.0001). Altogether, 54.34% of the cases developed neurological symp toms. The median hospital stay was 16 days (IQR 9-27) vs. 9 days (IQR 6-17) for the controls (p< 0.0001), and inpatient deaths occurred in 48.70% vs. 16.59% (p < 0.0001). The following showed an association with MH: normal albumin, OR 0.41 (95% CI 0.29-0.55); a Karnofsky Index greater than or equal to 70, OR 0.98 (95% CI 0.97-0.99); and metastasis, OR 1.87 (95% CI 1.23-2.84). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2555).

La hipercalcemia maligna es la urgencia endocrinológica en cáncer más frecuente, los factores relacionados a su presentación no han sido evaluados, ni hay estudios relacionados en Colombia. Objetivo: determinar los factores asociados a la presentación de hipercalcemia maligna (HM), en pacientes hospitalizados en el Instituto Nacional de Cancerología (2014-2019). Diseño: estudio analítico retrospectivo de casos y controles. Población: se incluyeron 230 casos de adultos con cáncer y calcio corregido por albúmina mayor e igual a 10.5 mg/dL y 223 controles de pacientes oncológicos con calcio corregido normal (8.5 a 10.4 mg/dL), se usó el carcinoma escamocelular como variable pareadora. Análisis: para establecer asociación se realizó el análisis univariado y bivariado entre las variables y la presentación de HM, se calcularon OR crudos, según significancia estadística (p<0.05) fueron incluidas en regresión logística para el análisis multivariado y excluir sesgos. Resultados: mediana de calcio en los casos: 12.98 mg/dL (11.64-14.42) vs. 9.4 mg/dL (9.02-9.74) (p < 0.0001). Los dos grupos presentaron edad y sexo similares. Hubo mayor proporción de metástasis en los casos (60.0% vs. 39.91%) (p < 0.0001). El 54.34% de los casos desarrolló síntomas neuro lógicos. La mediana de estancia hospitalaria fue de 16 días (RIC 9-27) vs. nueve días (RIC 6-17) para los controles (p < 0.0001) y la muerte intrahospitalaria se presentó en el 48.70% vs. 16.59% (p < 0.0001). Demostraron asociación con HM: albúmina normal OR 0.41 (IC 95% 0.29-0.55), índice de Karnofsky mayor o igual 70 OR 0.98 (IC95% 0.97-0.99) y presencia de metástasis OR 1.87 (IC 95% 1.23-2.84). (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2555).

Impacto de la pandemia por COVID-19 en la consulta ambulatoria endocrinológica y teleconsulta en un hospital Peruano

Introducción: La pandemia por COVID-19 afectó la continuidad de las consultas médicas presenciales, así se implementaron estrategias, como las teleconsultas, para cerrar brechas de atención. El objetivo del estudio fue describir el impacto de la pandemia en la consulta endocrinológica en el Hospital Nacional Alberto Sabogal Sologuren (Callao, Perú). Materiales y métodos: Se realizó un estudio descriptivo de análisis de datos secundarios obtenidos del Sistema de Salud Inteligente del Seguro Social de Perú. Se analizó datos de las consultas ambulatorias entre mayo 2019 y noviembre 2021. Resultados: Debido a la pandemia, la proporción de consultas presenciales disminuyó de 100% (periodo prepandemia) a 29,4% (durante la pandemia), mientras que las teleconsultas predominaron tras su implementación. Mas del 68% de pacientes fueron mujeres, en las consultas presenciales la mediana de edad antes y durante la pandemia fue 59 y 56 años, respectivamente, mientras que en teleconsultas fue 58 años. La diabetes mellitus fue el principal motivo de consulta (entre 32,6% a 34,4% del total de consultas), seguido del hipotiroidismo y la enfermedad nodular tiroidea. Durante la pandemia, la proporción de consultas por hipotiroidismo fue mayor en teleconsultas vs consulta presencial (25,3% vs 18%). Conclusiones: Durante la pandemia, las teleconsultas predominaron sobre la consulta presencial. No hubo diferencias relevantes en la mediana de edad o sexo predominantes entre los pacientes antes o durante la pandemia. La diabetes mellitus fue el principal motivo de consulta en general y durante la pandemia las consultas por hipotiroidismo fueron mayor en teleconsulta.

ABSTRACS Background: The COVID-19 pandemic affected the continuity of face-to-face medical consultations, so strategies, such as teleconsultations, were implemented to close the gaps in care. The objective of this study was to describe the impact of the pandemic in the traditional endocrinology consultation at Hospital Nacional Alberto Sabogal Sologuren (Callao, Peru). Materials and methods: We carried out a descriptive study of analysis of secondary data, that was obtained from the Sistema de Salud Inteligente of the Social Security of Peru. Data from outpatient consultations between May 2019 and November 2021 were analyzed. Results: Due to the pandemic, the proportion of face-to-face consultations decreased from 100% (pre-pandemic period) to 29,4% (during the pandemic), while teleconsultations predominated after its implementation. More than 68% of patients were women, in face-to-face consultations the median age before and during the pandemic was 59 and 56 years, respectively, while in teleconsultations it was 58 years. Diabetes mellitus was the main reason for consultation (between 32,6% and 34,4% of all consultations), followed by hypothyroidism and nodular thyroid disease. During the pandemic, the proportion of consultations for hypothyroidism was higher in teleconsultations vs. face-to-face consultations (25,3% vs. 18%). Conclusions: During the pandemic, teleconsultations predominated over face-to-face consultation. There were no relevant differences in median age or predominant gender among patients before or during the pandemic. Diabetes mellitus was the main reason for consultation in general and during the pandemic consultations for hypothyroidism were higher in teleconsultation.

Analysis of the evolution of the publication of case reports in endocrinology journals.

INTRODUCTION: A case report is a scientific article describing one or more patients with unusual clinical presentations. In recent years, the number of case reports in publications has decreased. In this study, we analyze the publication of case reports in journals of Endocrinology during the years 2010, 2015 and 2019. MATERIALS AND METHODS: The Pubmed web was browsed for clinical journals of Endocrinology, those published in English and/or Spanish being selected, and the relevant variables analyzed. RESULTS: Of 84 analyzed journals, 51 accepted cases for publication, 29 did not, and 4 did so only in exceptional cases. In 2010, 11,754 articles were published, of which 709 were clinical cases (6.9% of the total); in 2015, a total of 14,594 articles of which 655 were clinical cases (5.8% of the total); and in 2019 a total of 14,110 articles, of which 472 were clinical cases (4.6% of the total). In journals demanding payment for the publishing of clinical cases, case reports represented 9% of all articles, and in free journals, 3% (P < 0.05). CONCLUSION: There has been a decline in publication of case reports in journals of Endocrinology in recent years, both in absolute and relative terms. Even though the cases described by these reports are, by definition, exceptional, the decline of their publication implies a significant loss of scientific information and clinical knowledge regarding certain pathologies.