Jorge Sapunar Z

Consenso de diagnóstico y manejo de los nódulos tiroideos no palpables

With the availability of new diagnostic techniques, numerous alter-ations are found, whose real importance for health is uncertain. The term «incidentalomas», isused for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidentalfinding of thyroid nodules is common. The occurrence of those incidental nodules requires a re-view of the «classical» statements for the management of palpable nodules. The most important is-sue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism andNutrition appointed a group of experts to generate a consensus on the management of non palpa-ble nodules. These experts reviewed international literature, and the local experience, analyzedthe value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy.This consensus is a clinical guide for the management of non palpable thyroid nodules, consider-ing that a unique and optimal approach is still lacking (Rev Med Chile 2004; 132: 1249-55).(

Hiperparatiroidismo primario con compromiso esquelético grave: Un caso de carcinoma paratiroideo

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skelletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up (Rev Med Chile 2005; 133; 77-81). (Key-words: Hypercalcemia; Hyperparathyroidism; Parathyroid neoplasms)

Hipofosfatemia revertida al extirpar hemangioendotelioma compuesto del dedo mayor del pie

We report a 43 years old male admitted to the hospital for progressivelumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serumphosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkalinephosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximumphosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increasedradionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violetcolored mass was detected in a great toe. It was removed and the pathological diagnosis was acomposite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normalvalues and symptoms disappeared within 15 days (Rev Med Chile 2003; 131: 909-14).(

Tumores pardos en múltiples localizaciones: manifestación de osteodistrofia renal severa. Caso Clínico

We report a 25 years old woman with a four years history of end stage renal disease on hemodialysis. During the last two years of follow up, multiple tender nodules appeared in the left clavicle and ribs. These were diagnosed as brown tumors, secondary to osteitis fibrosa cystica, in the context of a secondary hyperparathyroidism. A subtotal parathyroidectomy was performed and a homologous parathyroid implant was done in the right forearm. The pathological study of the surgical pieces confirmed the presence of the brown tumors and parathyroid hyperplasia. Nine months after surgery, parathormone levels and brown tumor calcifications decreased significantly and bone mineral density increased by 20%. (Rev Med Chile 2003; 131: 1183-87) . (Key Words: Brown tumors; Osteritis fibrosa cystica; Parathyroid neoplasms)

Asociación entre malnutrición por exceso con caries temprana de la infancia

Objetivo: Determinar si la malnutricion por exceso es un factor de riesgo para el desarrollo de caries temprana de la infancia (CTI) en preescolares. Pacientes y Metodo: Se realizo un estudio observacional de cohorte retrospectivo en 196 ninos de 2 anos del Hospital de Calbuco, Region de Los Lagos, Chile, ingresados durante los anos 2007 a 2009. Los pacientes fueron agrupados de acuerdo a su estado nutricional al ingreso en ninos eutroficos y ninos con malnutricion por exceso. La informacion respecto a incidencia de caries y el estado nutricional fueron recuperados de la ficha anualmente hasta la edad de 5 anos, segun registro de las fichas medicas y odontologicas. Resultados: El 33,67% estaba en sobrepeso al inicio de la cohorte y el 16,33% obeso, alcanzando 40% sobrepeso y 20,56% obesidad a los cuatro anos de edad. La incidencia de caries temprana de la infancia en ninos con malnutricion por exceso fue de 57,14% en relacion al 40,82% de los ninos eutroficos (p = 0,022) con RR de 1,4 (95% IC, 1.044-1,88). Conclusiones: El mayor riesgo asociado a CTI en pacientes con malnutricion por exceso invita a generar las instancias de derivacion oportuna desde el profesional que pesquisa a ninos con malnutricion por exceso hacia el odontologo infantil, con el fin de desarrollar intervenciones preventivas para ambas patologias.

Epidemiología del cáncer de tiroides en Chile: Resultados del estudio INCATIR

BACKGROUND Thyroid cancer (TC) detection is increasing steadily. AIM To determine the incidence of TC based on pathological reports of thyroidectomies. MATERIAL AND METHODS Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. RESULTS In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. CONCLUSIONS The incidence and features of TC in Chile are similar to the figures reported abroad.Background: Thyroid cancer (TC) detection is increasing steadily. Aim: To determine the incidence of TC based on pathological reports of thyroidectomies. Material and methods: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. Results: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. Conclusions: The incidence and features of TC in Chile are similar to the figures reported abroad.

Hipotiroidismo primario luego de la resección de un Struma ovarii: Report of one case

Struma ovarii is a teratoma composed of thyroid tissue and can be a rare cause of hyperthyroidism. We report a 35 years old woman with a left ovarian mass whose pathology revealed a Struma ovarii. This tumor was partially excised initially to avoid fertility problems and after a successful gestation, the tumor was completely removed during a cesarean section. Sixty days after delivery a hypothyroidism was diagnosed. Levothyroxine was started and euthyroidism was achieved (Rev Med Chile 2003; 131: 785-7)

Anomalías de la esteroidogénesis suprarrenal en niños chilenos con micropene

Background: Mutations in type II 3s hydroxysteroid Dehydrogenase (3sHSD) are found in male children with severe undervirilized genitalia. Mild undervirilization (isolated micropenis or with distal hypospadia) can be associated with a partial deficit in 3sHSD activity. Aim: To assess the frequency of abnormal adrenal response to ACTH, suggesting a deficit in adrenal enzymatic activity, in children with mild undervirilization. Patients and methods: We studied 26 male children with micropenis, aged one to eight years. Children with evidences of puberal development or in treatment with drugs that affect steroidal metabolism were excluded from the study. Serum levels of androstenedione (A), dehydroepiandrosterone (DHEA), progesterone (P), 17 hydroxyprogesterone (17 P) and the ratios DHEA/A, P/17 P, 17 P/DHEA were measured after an adrenal stimulation with 0.25 mg/m2 intramuscular ACTH. Results: Two children had DHEA y DHEA/A values suggesting a defective 3sHSD activity. Other two children had high levels of 17 P, suggesting a deficiency of cytochrome p450c21. A CYP 21 gene mutation was found in one of the later children. Conclusions: A low proportion of children with micropenis have a deficient 3sHSD activity (Rev Med Chile 2003; 131: 46-54)

Comparación del efecto de la terapia prolongada con antipsicóticos atípicos o convencionales en la incidencia de diabetes mellitus 2: Revisión sistemática y metaanálisis

Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.