[Thyrotoxic periodic paralysis as a form of presentation of primary autoimmune hyperthyroidism: utility of non-selective beta blockers]. / Parálisis periódica tirotóxica como forma de presentación de hipertiroidismo primario autoinmunitario. Utilidad del bloqueo betaadrenérgico no selectivo.

A 40-year-old Caucasian man presented to the emergency room of our hospital with bilateral lower extremity weakness with onset 1 hour previously and concurrent hypokalemia. After dramatic clinical progression for the first 5 hours, the episode resolved once serum potassium levels were normalized. Laboratory data revealed primary hyperthyroidism, indicating a diagnosis of thyrotoxic periodic paralysis (TPP). Treatment consisted of potassium, propranolol and methimazole administration. Although the mainstay of therapy is potassium replacement, the role of propranolol in improving the acute clinical manifestations of TPP has yet to be adequately clarified.

Laparoscopic Gastric Banding in Obese Patients with Sleep Apnea: A 3-Year Controlled Study and Follow-up After 10 Years.

BACKGROUND: The purpose of this study was to compare the effects of intensive nutritional care (INC) and laparoscopic adjustable gastric banding (LAGB) on nocturnal non-invasive ventilation (NIV) requirement in obese patients using short-, medium-, and long-term follow-up data. METHODS: This prospective randomized controlled trial included obese patients with obstructive sleep apnea (OSA) treated by NIV. Patients were randomized to the INC and LAGB groups. The primary endpoint was the theoretical rate of weaning from NIV at years 1 and 3. Data were also collected from patients 10 years after randomization. RESULTS: Sixty-three patients were randomized. The rate of weaning from NIV did not differ significantly between the LAGB and INC groups at year 1 (35 vs. 13%) or year 3 (14 vs. 21%). Percentages of excess weight loss were greater in the LAGB group than in the INC group at years 1 (33 vs. 15%, p = 0.002) and 3 (27 vs. 8%, p = 0.014). Decreases in the apnea-hypopnea index were observed in the LAGB group from baseline to year 1 (-44%, p = 0.001) and from baseline to year 3 (-26%, p = 0.044). After 10 years, the weaning rate was low and similar between groups. CONCLUSION: LAGB was not superior to INC for weaning from NIV at 1 and 3 years in obese patients with OSA.

Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases.

In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI) within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

Las indicaciones de la cirugía bariátrica en los pacientes con diabetes tipo 2 y obesidad están bien establecidas, pero no existe consenso que contemple esta posibilidad de tratamiento en los pacientes con diabetes tipo 1 que presentan obesidad severa. Presentamos la evolución a largo plazo de dos mujeres diagnosticadas de diabetes tipo 1 (DM1) y que presentaban obesidad mórbida y comorbilidades asociadas que fueron intervenidas mediante la realización de una cirugía bariátrica malabsortiva. Tras seguimiento de más de 4 años, ambas pacientes mantienen un BMI dentro de la normalidad, concentraciones de hemoglobina glicada < 7%, reducción de sus necesidades de insulina en más del 50 %, remisión de las comorbilidades y clara mejoría de su calidad de vida. Se analizan estos resultados en comparación a otros publicados previamente con la finalidad de señalar las potenciales indicaciones de la cirugía bariátrica en pacientes con DM 1.

[Thyroid dysfunction in patients with advanced renal cell carcinoma treated with sunitinib: a multifactorial issue]. / Disfunción tiroidea en los pacientes con carcinoma de células renales avanzado en tratamiento con sunitinib: un problema multifactorial.

OBJECTIVE: Several studies have reported the substantial prevalence of sunitinib-induced thyroid dysfunction. However, the underlying mechanism and the benefit of thyroid hormone replacement therapy remain to be determined. To evaluate the effect of sunitinib on thyroid function, we carried out a descriptive study in patients with advanced renal cell carcinoma. PATIENTS AND METHODS: A total of 24 patients treated by sunitinib between 2006 and 2008 at Hospital Clínico San Carlos were included. The data were collected retrospectively and analyzed with SPSS 15.0. RESULTS: Treatment duration was 30 weeks (18-42) [median (IQR)]. Five patients (20.8%) developed subclinical hypothyroidism and three (12.5%) developed overt hypothyroidism. The number of weeks needed to observe an increase in thyroid-stimulating hormone (TSH) values in these patients was 15 (6-20) [median (IQR)]. TSH levels were below the normal range in five patients (20.8%) before or during the treatment period, but the diagnosis of subclinical hyperthyroidism could not be established because of concomitant factors. Fourteen patients (58.3%) showed sunitinib adverse events, but these were not related to the development of hypothyroidism (p=0.388). CONCLUSIONS: Because of the high prevalence of sunitinib-induced hypothyroidism, thyroid function should be systematically monitored in patients with renal cell carcinoma treated with this drug. However, several pathophysiological and pharmacological factors may interfere with monitoring. Consequently, it might be useful to determine not only TSH and free T4 but also free T3 and, ideally, reverse T3. Evidence-based recommendations to manage hypothyroidism in oncology patients are not available at present.