Almudena Vicente

Patterns of Iodine Intake and Urinary Iodine Concentrations During Pregnancy and Blood Thyroid-Stimulating Hormone Concentrations in the Newborn Progeny

BACKGROUND Appropriate maternal intake of iodine during pregnancy is essential for maternal thyroxine production and thyroid status of the fetus. It should be possible to enhance iodine intake during pregnancy by using iodine fortified salt or taking iodine supplements. In the present report we determined the status of iodine nutrition in pregnant women who were stratified on the basis of their history of taking or not taking iodized salt or iodine supplements. The study was performed in Toledo (Spain), a region in which prior studies have noted borderline iodine sufficiency. Iodine nutrition was assessed by measuring urinary iodine concentration (UIC) and neonatal thyrotropin (TSH). METHODS UIC was measured in 525 pregnant women. They were grouped according to their history of iodine intake. Diet Group 1 patients (n = 69) did not take iodized salt or iodine supplements during pregnancy. Diet Group 2 patients (n = 75) took iodized salt but not iodine supplements during pregnancy. Diet Group 3 patients (n = 381) took iodine supplements during pregnancy. Plasma determinations included TSH, free thyroxine, thyroid peroxidase antibody, and thyroglobulin antibody. UIC was measured in a single urine sample from all the pregnant women. Neonatal TSH was measured in capillary spot blood from all the neonates as part of a screening for congenital metabolic abnormalities. RESULTS The median UIC in all subjects was 164 μg/L (interquartile range [IR]: 116-245). The median UICs in Diet Groups 1, 2, and 3 were 134.5 (IR: 90-196), 146 (IR: 103-205), and 183 (IR: 124-261) μg/L, respectively (p = not significant [NS] for Diet Group 1 vs. 2; p < 0.01 for Diet Group 2 vs. 3; all other comparisons NS). The median (IR) TSH of the neonates in all Diet Groups was 1.0 (IR: 0.7-1.6) μU/mL. Only 2 neonates had blood TSH concentrations >5 mU/L. Neonatal blood TSH concentrations were similar in all Diet Groups. CONCLUSIONS In a region with a history of borderline iodine deficiency the UICs were below 150 μg/L in a substantial percentage of pregnant women who did not take iodine supplements, regardless of whether or not they took iodized salt. Our results support the use of iodine supplements from the start of the pregnancy, or even before pregnancy in women who live in regions with a history of even small degrees of iodine deficiency. In addition, neonate TSH screening is not the best tool to assess whether the iodine status in populations is ideal.

Guía de práctica clínica para el diagnóstico y tratamiento de la apoplejía hipofisaria

UNLABELLED Classic pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland. PA is considered a neuroendocrinological emergency. However, there is no consensus about the best options for PA diagnosis and management. OBJECTIVE To develop a clinical practice guideline with a number of recommendations for diagnosis and treatment of patients with PA based on the medical evidence available, in order to help clinicians involved in their care. METHODS The clinical guideline for diagnosis and treatment of pituitary apoplexy issued in 2006 by the Neuroendocrinology Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the British Clinical Practice Guideline published in 2011 were taken as the basis. The text has been adapted to the format used in most international medical journals. For this, after updated medical literature, the quality of evidence and the strength of the recommendations were evaluated using the system proposed by the Agency for Health Care Policy and Research (AHCPR). CONCLUSIONS Diagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. Patients with PA must undergo a complete history and physical examination. All patients with suspected pituitary apoplexy should have urgent blood samples drawn to test electrolytes, renal function, liver function, coagulation screen, complete blood count, and basal levels of pituitary and peripheral hormones, and to rule out adrenocorticotropic hormone (ACTH) deficiency. Formal visual field assessment should be performed when the patient is clinically stable. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Indications for empirical urgent corticosteroid therapy in patients with PA include hemodynamic instability, impaired consciousness, reduced visual acuity, and severe visual field defects. In patients with these severe neuro-ophthalmic signs, surgery should be considered. Surgery should preferably be performed within seven days of the onset of symptoms. Patients with mild and stable signs may be managed conservatively with careful monitoring. Treatment and long-term follow-up of patients with PA should be conducted by a multidisciplinary team consisting, amongst others, of an experienced pituitary neurosurgeon, an ophthalmologist, and an endocrinologist.

Bocio amiloideo como primera manifestación de amiloidosis secundaria en pacientes con espondilitis anquilopoyética: a propósito de un caso

La amiloidosis secundaria y, sobre todo, la aparicion de bocio amiloideo como primera manifestacion de esta es una complicacion poco frecuente de la espondilitis anquilopoyetica. Se describe el caso de un varon de 41 anos con bocio difuso normofuncionante de crecimiento rapido y sintomas compresivos diagnosticado de espondilitis anquilopoyetica, en el que el estudio citologico mediante puncion aspiracion con aguja fina (PAAF) de tiroides evidencio la presencia de tejido amiloideo, confirmandose el diagnostico de bocio amiloideo tras estudio posquirurgico. Se revisan las caracteristicas clinicas e histologicas de los casos publicados en la bibliografia y se apoya la utilidad de la PAAF de tiroides como una tecnica adecuada para el diagnostico del bocio amiloideo y de la amiloidosis sistemica.

Comisión de Asistencia de la Sociedad Española de Endocrinología y Nutrición (CASEEN): documentos para la solicitud del consentimiento informado para diferentes procedimientos de la especialidad

La Comision de Asistencia de la Sociedad Espanola de Endocrinologia y Nutricion ha elaborado documentos especificos para la solicitud de los procedimientos diagnosticos que pueden realizarse por un especialista en Endocrinologia y Nutricion. Se han obviado aquellas pruebas que, frecuentemente indicadas en esta especialidad, son realizadas por otros especialistas.

Análisis de los resultados del tratamiento de la enfermedad de Cushing en los hospitales de Castilla-La Mancha

OBJECTIVE Treatment of Cushings disease poses interesting dilemmas in clinical practice. The aim of our study was to analyze the outcomes of the different treatments, the control and recurrence rates, and the complications derived from them. MATERIAL AND METHODS Data were collected from the clinical records of 22 patients over 18 years of age (86.4% women). They had been diagnosed with Cushings disease between 2000 and 2012, and were monitored at Complejo Hospitalario Universitario-Albacete, Hospital Virgen de la Salud-Toledo Hospital General Universitario de Ciudad Real, Hospital Virgen de la Luz-Cuenca, Hospital Nuestra Señora del Prado-Talavera de la Reina, and Complejo Hospitalario la Mancha Centro-Alcázar de San Juan. RESULTS Surgery was the treatment of choice in all patients. Biochemical cure was achieved in 72.2% of patients. Nine patients developed in the early postoperative period diabetes insipidus, which became in 2 patients only. Surprisingly, 3 patients with normal postoperative neurohypophyseal function later developed permanent diabetes insipidus. New hormone deficiencies occurred in 7 patients. Seventeen patients received ketoconazole before surgery (5 of them after surgery also), and 70% of them achieved normal urinary free cortisol levels. Three patients also received radiotherapy, and all of them were cured after a median follow-up of 85.5 months; they developed no tumors or other complications. CONCLUSIONS Our study reports the outcomes of management of Cushings disease in non-reference centers for this disease, possibly giving a realistic picture of standard clinical practice for the condition in Spain.

Evolución del hiperparatiroidismo primario en 56 pacientes. Comparación entre hiperparatiroidismo hipercalcémico y normocalcémico

Introduccion Actualmente, el hiperparatiroidismo primario (HPP) se considera una enfermedad escasamente sintomatica y poco progresiva. El HPP normocalcemico (HPPN) es una entidad reconocida e identificada esencialmente por complicaciones asociadas al HPP (osteoporosis y urolitiasis). Pacientes y metodo Estudio de 56 pacientes con HPP no operados o con seguimiento minimo de 1 ano previo a la paratiroidectomia. Se subdividio a los pacientes en HPP hipercalcemico (HPPH) (27 pacientes) y HPPN (29 pacientes). Se pretendio analizar las comorbilidades hipertension arterial [HTA] y nefrolitiasis) en el grupo total y en cada subgrupo, valorar la evolucion anual de calcemia, fosfatemia, paratirina PTH) y fosfatasa alcalina sericas, calciuria, filtrado glomerular y densidad mineral osea lumbar durante un periodo de 1 a 5 anos y hallar posibles diferencias entre HPPH y HPPN para estas variables. Resultados El 55,4% de los pacientes presentaban HTA y se registraron episodios de nefrolitiasis en el 37,5% de los casos. No se apreciaron cambios a lo largo del tiempo en los parametros bioquimicos y densitometricos ni en el grupo total ni por subgrupos. Excepto en los valores de calcio, fosforo y PTH sericos no se hallaron diferencias entre HPPH y HPPN. Conclusiones El HPP parece una enfermedad poco progresiva si bien no se incluyo en este estudio a los pacientes remitidos precozmente a cirugia con seguimiento previo escaso que podrian corresponder a casos mas agresivos. El HPPN es una entidad asociada a complicaciones similares a las del HPPH por lo que pensamos deberia someterse a los mismos criterios de derivacion quirurgica.

Hipotiroidismo y gestación: importancia del control periconcepcional

Objetivo : Conocer los efectos del embarazo en las necesidades de tiroxina (T 4 ) en un grupo de mujeres diagnosticadas de hipotiroidismo previo a la gestacion y valorar la importancia del adecuado control de la funcion tiroidea preconcepcional. Pacientes : Se analizan los datos de 48 gestaciones en 46 pacientes hipotiroideas (39 con hipotiroidismo autoinmunitario, 7 con hipotiroidismo tras 131I o posquirurgico) durante el periodo 1999-2001. Todas las pacientes fueron controladas antes, durante y despues de la gestacion. Se estudiaron las concentraciones de tirotropina (TSH), T 4 libre y la dosis de T 4 en cada visita. Se analizo separadamente un subgrupo de pacientes que presentaba concentraciones normales de TSH (valores normales, 0,5-4 μU/ml) en la visita antes del embarazo (grupo “normo”; n = 28). Resultados : En el grupo total se aumento la dosis sustitutiva en 29 de las 48 pacientes (60,4%); la dosis media durante el embarazo es un 27,1% superior a la dosis inicial. En el primer trimestre se aumento la dosis al 45,8% de las pacientes (incremento medio de 14,6 ± 22 μg/dia), en el segundo trimestre, al 33,3% (incremento de 7,3 ± 13 μg/dia) y en el tercero, al 12,5% (incremento de 2,7 ± 8,2 μg/dia). La dosis posgestacion fue significativamente superior a la utilizada antes del embarazo. En el grupo “normo” la dosis de T 4 aumento en 13 de las 28 pacientes (46,4%); la dosis media durante el embarazo fue un 11,6% superior a la dosis inicial. La distribucion del aumento por trimestres fue superponible a la del grupo total. La dosis final posgestacion no fue diferente de la dosis inicial. Conclusiones : La gestacion ocasiona un aumento de las necesidades de T 4 en un porcentaje alto de los pacientes de nuestro grupo. Un control adecuado del hipotiroidismo antes del embarazo disminuye la proporcion de pacientes que necesitan incrementar la dosis de T 4 asi como la cuantia de este aumento.