Arteaga E

High prevalence of vitamin D deficiency in Chilean healthy postmenopausal women with normal sun exposure: additional evidence for a worldwide concern.

Objective:To assess the prevalence of vitamin D deficiency in healthy postmenopausal women with normal sun exposure but without vitamin D fortification in their diets. Design:We studied 90 healthy ambulatory women who were residents of Santiago, Chile (latitude 33°S); 30 were premenopausal (32.6 ± 7.4 y), and 60 were postmenopausal (63.7 ± 9.7 y). Half of the women were studied during the winter and the other half during the following summer. Each provided a fasting blood sample to measure biochemical parameters, parathyroid hormone, and 25-hydroxyvitamin D and completed a questionnaire to estimate sunlight exposure. A first morning urine sample was collected in postmenopausal women to measure deoxypyridinoline. Various cutoff points of 25-hydroxyvitamin D were used to assess the prevalence of vitamin D deficiency (<9, <15, and <20 ng/mL). Results:All of the women had normal renal and liver parameters. Sunlight exposure was adequate in almost all of the volunteers (93% in both groups, P > 0.05). In postmenopausal women, serum 25-hydroxyvitamin D was less than 9 ng/mL in 12%, less than 15 ng/mL in 40%, and less than 20 ng/mL in 60%, compared with 0%, 13%, and 27%, respectively, in premenopausal women. Deoxypyridinoline was 75% higher during winter than summer (9.8 ± 2.5 vs 5.6 ± 1.4 nmol/mmol creatinine, P < 0.0001). Conclusions:Vitamin D deficiency is very common in Chilean healthy postmenopausal women with normal sun exposure but without vitamin D fortification in their diets. This finding is associated with higher bone resorption during winter time and emphasizes the need to increase vitamin D intake in healthy postmenopausal women.

La melatonina reduce la respuesta de cortisol al ACTH en humanos

Adrenal glandswere obtained from 4 patients undergoing unilateral nephrectomy-adrenalectomy for renalcancer. Expression of mRNA MT1 and MT2 melatonin receptors was measured by ReverseTranscriptase Polymerase Chain Reaction (RT-PCR). The effect of melatonin on the response tointravenous (i.v.) ACTH was tested (randomized cross-over, double-blind, placebo-controlledtrial) in eight young healthy males pretreated with dexamethasone (1 mg) at 23:00 h. On thenext day, at 08:00 h, an i.v. line was inserted, at 08:30 h, and after a blood sample, subjectsingested 6 mg melatonin or placebo. At 09:00 h, 1-24 ACTH (Cortrosyn, 1

Cutaneous and renal geotrichosis in a giant tortoise (Geochelone Elephantopus)

A case of cutaneous and renal geotrichosis in a giant tortoise, Geochelone elephantopus, at the Zoological Park of Barcelona is reported. Fungal hyphae and spores were seen in skin and kidney. Culture of these tissues yielded Geotrichum candidum. This fungus was isolated from the faeces of 5 other giant tortoises that were housed with the dead animal and from specimens of corn hydroponic culture which is part of their diet. Arthrospore suspensions of the 2 strains isolated from the dead animals skin and kidney were experimentally inoculated into mice and turtles (Testudo horsfiedi) in order to determine the pathogenicity of G. candidum for animal tissues. Our results confirm its low pathogenicity.

An ultrasound model to discriminate the risk of thyroid carcinoma.

RATIONALE AND OBJECTIVES Thyroid nodules are common on ultrasonographic examination and are mostly benign. Ultrasound characteristics may help discriminate thyroid carcinoma (TC) from benign nodules. The aims of this study were to identify ultrasonographic characteristics associated with TC and to validate a previously proposed model based on the presence of three ultrasonographic characteristics. MATERIALS AND METHODS From a protocolized prospective registry of 1108 fine needle aspiration biopsies performed during a 16-month period at an ambulatory center, the ultrasonographic characteristics of TC and non-TC biopsies were compared. Adjusted odds ratios (ORs) and likelihood ratios for TC were estimated for eight combinations of three previously identified characteristics (microcalcifications, hypoechogenicity, and irregular borders). RESULTS Microcalcifications (OR, 6.6; 95% confidence interval [CI], 4.4-9.9), hypoechogenicity (OR, 4.7; 95% CI, 2.8-8.0), and irregular borders (OR, 4.3; 95% CI, 2.8-6.5) were independently associated with TC. When added to a logistic regression model, the three ultrasonographic characteristics remained statistically significant. In the absence of these three features, the likelihood ratio for TC was 0.1 (95% CI, 0.0-0.2), while in their simultaneous presence, the likelihood ratio was 11 (95% CI, 6.6-19.0). CONCLUSIONS The absence or simultaneous presence of three simple ultrasonographic characteristics generates a large change of pretest probability of TC and could avoid unnecessary fine needle aspiration biopsy.

Persistent hypokalemia after successful adrenalectomy in a patient with Cushing’s syndrome due to ectopic ACTH secretion: Possible role of 11β-hydroxysteroid dehydrogenase inhibition

Ectopic ACTH secretion is characterized by a high incidence of hypokalemia. The pathophysiology of hypokalemia has not been totally clarified, although it has been postulated that excessive amounts of adrenal steroids may play a role, as well as a possible role of the inhibition of the enzyme 11β-hydroxysteroid dehydrogenase (11β-OHSD). This enzyme normally converts cortisol to cortisone avoiding the mineralocorticoid action of cortisol. We present a patient with ectopic ACTH secretion due to a metastatic carcinoid tumor. The clinical picture was characterized by maintained hypokalemia (1.4 mmol/l) resistant to potassium, spironolactone and ketoconazole administration. A bilateral adrenalectomy was performed but the hypokalemia persisted while he was receiving a physiological dose of cortisol. Eight days after adrenalectomy cortisol was replaced by an equivalent dose of dexamethasone. This change was followed by a rapid and persistent normalization of hypokalemia suggesting a mineralocorticoid effect of cortisol. In conclusion, the origin of hypokalemia in our patient with ectopic ACTH secretion was secondary to cortisol. We postulate that this peculiar effect of cortisol could have happened if an inhibition of 11β-OHSD occurred.

Personal and professional use of menopausal hormone therapy among gynecologists: A multinational study (REDLINC VII)

BACKGROUND Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE To determine the use of MHT and perceived related risks among gynecologists. METHODS A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.

Early pregnancy thyroid hormone reference ranges in Chilean women: the influence of body mass index

Thyroid dysfunction and obesity during pregnancy have been associated with negative neonatal and obstetric outcomes. Thyroid hormone reference ranges have not been established for the pregnant Hispanic population. This study defines thyroid hormone reference ranges during early pregnancy in Chilean women and evaluates associations of body mass index (BMI) with thyroid function.

Utilidad de la PTH intraoperatoria como predictor de curación quirúrgica en hiperparatiroidismo primario

Serum PTH was measuredto all patients operated for PHPT between 2003 and 2008, before and five and ten minutes after theexcision of the parathyroid gland causing the disease. The criteria for complete cure were a normalserum calcium at 24 hours and 6 months after surgery and the pathological confirmation ofparathyroid gland excision.

Diseño de una escala ecográfica predictora de malignidad en nódulos tiroideos: Comunicación preliminar

One hundred twenty two biopsies of atotal of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for thepresence of micro-calcifications (Odds ratio (OR) 49.2: 95% confidence intervals (CI) 18.7-140.9),solid predominance (OR 25.1; 95% CI 6-220), hypoechogenicity (OR 23.5, 95% CI 6.5-122.6),irregular borders (OR 17, 95% CI 7.2-42.9), lymph node involvement (OR 12.3, 95% CI 2.7-112),central vascularization (OR 12.2, 95% CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2;CI 95% CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95% 8.9-89),hypoechogenicity (OR 9.4; 95% CI 1.5-59.5) and irregular borders (OR 4.7; CI 95% 1.5-15) as thevariables independently associated with the presence of PTC. The prevalence of PTC in the presenceof the three variables was 97.6% (Likelihood ratio (LR) 45) and 5.4% in their absence (LR 0.06).

Carcinoma familiar del tiroides no medular (CFTNM): características de presentación en 17 casos

Retrospective analysis of medical records of patients with thyroid carcinoma. An index case wasdefined as a subject with the diagnosis of differentiated thyroid carcinoma with one or morefirst degree relatives with the same type of cancer. Seventeen such patients were identified andwere compared with 352 subjects with PTC.