Manuel Romero Muñoz

Documento de consenso de osteoporosis del varón

OBJECTIVE To provide practical recommendations to assess and treat osteoporosis in males. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology. METHODS Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: «osteoporosis», «men», «fractures», «bone mineral density», «treatment», «hypogonadism», and «prostate cancer». Papers in English and Spanish with publication date before 30 August 2017 were included. Current evidence for each disease was reviewed by 2group members. Finally, recommendations were discussed in a meeting of the working group. CONCLUSIONS The document provides evidence-based practical recommendations for diagnosis, assessment, and management of osteoporosis in men and special situations such as hypogonadism and prostate cancer.

Natural history and clinical characteristics of 50 patients with Wolfram syndrome

PurposeTo describe clinical characteristics of diabetes mellitus (DM) in a group of patients with Wolfram Syndrome (WS).MethodsDescriptive, cross-sectional observational design. The sample consisted of 50 patients diagnosed with WS. Clinical criteria contributing to WS diagnosis were analyzed: diabetes mellitus (DM), optic nerve atrophy (OA), sensorineural deafness, urological and neurological dysfunction, among others. These parameters were assessed according to their presence/absence, age of onset, and various clinical-analytical parameters.ResultsAll the patients studied presented DM and OA, with a mean age of onset of 5.4 ± .9 (1–14) years and 9 ± .9 (1–16) years, respectively. The remaining criteria were present with a variable frequency: 77% had diabetes insipidus, 66.7% auditory alterations, 77.8% neurogenic bladder, 61.1% neurological involvement, and 27.8% hypogonadism. A 16.7% of the patients had positive albuminuria (urinary albumin/creatinine ratio > 30 mg/g) and 72.2% had hyporreflexia. There were no significant differences in the age of diagnosis nor of the presence of different pathologies according to sex.ConclusionsThe early presence of a non-autoimmune insulin dependent DM, should alert us of an “infrequent” diabetes syndrome. Wolfram’s presumptive diagnosis could be established if juvenile-onset DM occurs concomitantly with OA, and this visual impairment is not attributable to diabetic retinopathy. Despite the long period of evolution of DM and altered values of HbA1c, the prevalence of microvascular complications in the sample are low.

Cirugía bariátrica en el paciente con diabetes mellitus tipo 1

While the benefits of bariatric surgery in type 2 diabetes mellitus (T2DM) are widely shown, few data are available for patients with type 1 diabetes mellitus (T1DM). In addition, the increasing prevalence of obesity may result in an increased frequency of patients with T1DM and morbid obesity, and it is therefore interesting to have data about the effects of bariatric surgery in this patient group. We report the case of a 43-year-old female patient diagnosed with T1DM in 1985 after experiencing diabetic ketoacidosis and monitored at our department since 1992, when she was referred for chronic poor metabolic control and obesity. The patient reported progressive weight increase for no identifiable cause which had led to gradual insulin dose adjustment, which had not resulted in improved metabolic control. She was receiving NPH (17-0-16) and regular insulin (12-17-11) at that time. The patient weighed 96.4 kg, and had a body mass index (BMI) of 34.5 kg/m. In 1995, treatment was switched to premixed insulin (regular/NPH 30/70) in two doses plus regular insulin at midday. From 1995 to 1998, HbA1c values ranged from 7.9% to 9.4%, and weight from 90 to 93 kg. During follow-up, microalbuminuria levels higher than 30 mg/24 h were intermittently detected, and control eye fundus examinations were performed with normal results. In 1998, treatment was started with ramipril 10 mg/day in the evening due to persistent positive albuminuria. In 2001, the patient attended our department again and was found to have a weight of 108 kg and an HbA1c level of 9.9%. Treatment was started with insulin analogues (biphasic aspart 30/70) in three doses. She was appointed for a subsequent visit, but did not return until March 2005, when she was referred from primary care. The patient weighed 110 kg at that time, and underwent the following examination and supplemental tests: ophthalmological examination with background diabetic retinopathy, preserved tactile and vibratory sensitivity in both lower limbs, blood pressure controlled with ramipril treatment, HbA1c 9.9%, urinary albumin excretion (UAE) 142 mg/24 h, positive high-titer anti-GAD antibodies, C-reactive peptide 1.02 (NR, 0.78--1.89) with a blood glucose level of 148 mg/dL (subsequent measurements confirmed undetectable C-reactive peptide levels), total cholesterol (TC) 178 mg/dL, HDL 41 mg/dL, LDL 97 mg/dL, and triglycerides (TGs) 238 mg/dL. Treatment was started with basal-bolus therapy (glargin 0-30-0 and aspart 8-8-8, with progressive increase in insulin dose to glargine 0-800 and aspart 10-12-10). After these measures, the patient maintained a stable weight of 110 kg, and showed a marked improvement in her metabolic control (HbA1c, 7%). By July 2007, however, her weight had increased to 117 kg (BMI 41.9 kg/m), which was associated with impaired metabolic control (HbA1c, 8.5%). Bariatric surgery was proposed and was initially refused by the patient, but one year later she