Rosario I. Lorente

A study of insulin resistance using the minimal model in nondiabetic familial combined hyperlipidemic patients

The presence of insulin resistance in 20 male nondiabetic patients with familial combined hyperlipidemia (FCH) and 20 controls of similar age and body mass index (BMI) was investigated using the minimal model method modified by the administration of insulin and an oral glucose tolerance test. The peripheral sensitivity of insulin, expressed as the insulin sensitivity index (Si), was 1.91+/-1.05 and 2.86+/-1.19 x 10(-4) x min(-1) x mU/L in FCH patients and controls, respectively (P < .01), and the corresponding value for the peripheral utilization of glucose independently of insulin (Sg) was 1.70+/-1.13 in FCH patients and 2.35+/-0.60 x 10(-2) x min(-1) in controls (P < .02). In the FCH group, the Si value correlated significantly (P < .05) with the waist to hip ratio (WHR), plasma triglycerides (TG), free fatty acids (FFA), and the area under the curve of glucose (AUCg) and insulin (AUCi). In the control group, the correlation also reached statistical significance (P < .05) with age, BMI, WHR, blood pressure, TG, AUCg, and AUCi. Subgrouping the subjects with respect to central obesity defined as a WHR of 0.95 or greater, we observed lower Si values in obese and non-obese FCH subjects relative to controls (P < .02). The mean Si value in obese subjects was significantly lower than in non-obese FCH subgroups (1.40+/-0.79 v 2.68+/-0.95 x 10(-4) x min(-1) x mU/L, respectively, P < .01). In conclusion, a higher degree of insulin resistance relative to control values appears to be an integral part of the metabolic derangements observed in FCH, and central-trunk obesity exacerbates the insulin resistance syndrome.

Insulin Resistance in Patients With Familial Combined Hyperlipidemia and Coronary Artery Disease

The minimum model modified by the administration of insulin provides an objective and relatively easily measured index of peripheral sensitivity to insulin which was significantly lower (p <0.02) in familial combined hyperlipidemia (FCH) with ischemic heart disease (IHD) than in FCH without IHD and in control subjects (1.2 +/- 0.6, 1.9 +/- 1.0, 2.9 +/- 1.2 x 10(-4) mU/L/ min, respectively). In patients with FCH, insulin resistance explains, at least in part, their metabolic alterations (hypertension, abnormal glucose tolerance, hyperinsulinemia) and elevated IHD.

Plasma homocysteine levels are associated with ulceration of the foot in patients with type 2 diabetes mellitus

To examine the association of biochemical markers of risk (plasma Hcy, microalbuminuria, lipoprotein (a)(Lp(a)) and diabetic dyslipidaemia) with the prevalence of diabetic foot ulceration in type 2 diabetic patients.

Efecto metabólico del ejercicio físico regular en la población sana

AIM To assess the effect of moderate regular aerobic physical activity not associated to body weight changes on insulin resistance and the associated metabolic changes in general population. SUBJECTS AND METHODS A cross-sectional, observational study in an adult population (n=101 subjects aged 30-70 years) with no personal history of disease and with stable weight in the three months prior to the study. The group with regular exercise performed 30-60 minutes of moderate regular physical exercise 5 days per week (7.5-15 hours MET per week), while a control group performed no regular physical exercise and had a sedentary lifestyle. Subjects were age- and sex-matched. Lipids, lipoproteins, and HOMA index were measured using standard methods. RESULTS The group with regular physical activity consisted of 48 subjects (21 male/27 female), while the group with no regular physical activity included 53 subjects (31 male/22 female). No significant differences were found between the groups in age, sex, BMI, waist circumference, and blood pressure. Significant differences were found between the groups in fasting serum triglyceride, HDL-C, and apoB levels. Fasting plasma insulin levels (12.1 ± 4.13 vs 14.9 ± 4.8 mU/L, P= .004) and HOMA index (2.8 ± 1.1 vs 3.5 ± 4.1, P= .001) were significantly lower in the group with regular physical activity as compared to the sedentary group. Prevalence rates of metabolic syndrome were 20.7% and 45.8% (P=.01) in the regular physical activity and sedentary groups respectively. CONCLUSION Moderate regular physical activity is associated to higher insulin sensitivity, an improved lipid profile, and a decrease in components of metabolic syndrome with no change in weight or BMI.

Arteriosclerosis carotídea subclínica en pacientes con hiperlipidemia familiar combinada. Evolución tras dos años de tratamiento con dosis altas de atorvastatina

BACKGROUND AND OBJECTIVE Familial combined hyperlipidemia (FCH) is a genetic model of atherogenic dyslipidemia with insulin resistance and early coronary disease. Our objective was to evaluate the presence of carotid alterations as a marker of systemic atherosclerosis in subjects with FCH and assess the effect of 80 mg of atorvastatin per day in carotid plaque thickness after 2 years. SUBJECTS AND METHODS 100 non diabetic subjects with FCH in primary prevention were consecutively included. Clinical and biochemical parameters and carotid ultrasonography were performed. Subjects with carotid plaque started treatment with 80 mg of atorvastatin per day for 2 years. RESULTS 29% of subjects had carotid plaques. We did not find significant differences in any of the parameters between subjects with presence or absence of carotid plaques. Twenty subjects with carotid plaques accepted/agreed to participate in the interventional study. Two years follow-up showed a significant reduction in LDLc (30%) and carotid plaque thickness (10%). CONCLUSION Carotid ultrasonography is useful to detect subclinical atherosclerosis in high risk cardiovascular patients such as subjects with FCH. Treatment with high doses of atorvastatin induces the regression of carotid plaque thickness after 2 years follow-up. Our results suggest that intensive treatment with atorvastatin could be useful to reduce the development of cardiovascular disease in this group of patients.

Supresión del eje hipotálamo-hipofisario-suprarrenal por la exposición crónica a glucocorticoides de uso tópico. Presentación de dos casos clínicos

Presentamos 2 casos clinicos con psoriasis extensa en los que el mal uso prolongado de corticoides topicos indujo la supresion del eje hipotalamohipofisario- suprarrenal y, como consecuencia, una insuficiencia suprarrenal secundaria. Se comentan los mecanismos y los factores que pueden dar lugar a dicha supresion.

Síndrome de McCune-Albright: otra forma de neoplasias endocrinas múltiples

Presentamos el caso de una mujer con sindrome de McCune-Albright como paradigma de afeccion tumoral en multiples glandulas endocrinas. El diagnostico de la enfermedad se baso en la presencia de la triada clasica (lesiones hiperpigmentadas cutaneas de color cafe con leche, pubertad precoz y displasia fibrosa). Durante su seguimiento presento hipertiroidismo secundario a bocio multinodular toxico, hiperparatiroidismo, probablemente secundario a hiperplasia paratiroidea, y acromegalia secundaria a adenoma hipofisario productor de hormona de crecimiento. Se comenta la base molecular de la enfermedad y su amplia expresion fenotipica.

Pancitopenia en un varón de 59 años con feocromocitoma maligno tratado con I-131 metaiodobencilguanidina

Presentamos un paciente diagnosticado de feocromocitoma maligno silente que en su evolucion presento metastasis en cuerpos vertebrales, huesos iliacos, ambos pulmones e higado. El paciente solo referia lumbalgia intermitente y las determinaciones urinarias de catecolaminas y sus metabolitos fueron normales. Se realizo inicialmente suprarrenalectomia derecha y se aplico telecobaltoterapia externa en la region L4-S2 (dosis total de 20 Gy), para control del dolor y por inicio de compresion radicular. Posteriormente, de forma paliativa se administro una dosis unica de 200 mCi de 131-I metaiodobencilguanidina (MIBG), desarrollando al mes una pancitopenia con neutropenia grave, que preciso antibioticoterapia de amplio espectro, transfusion de concentrados de hematies y tratamiento con factor de crecimiento granulocitario. Se comprobo la ausencia de infiltracion de la medula osea por el tumor. Al tratarse de un feocromocitoma no secretor no se acompano de manifestaciones clinicas que permitiesen su diagnostico precoz. El tratamiento paliativo con 131-I MIBG provoco una importante toxicidad sistemica relacionada con irradiacion de la medula osea por el elevado numero de metastasis vertebrales captadoras. Este caso pone en evidencia la dificultad para determinar la dosis optima de esta terapia y los posibles efectos toxicos de la misma.

Utilidad de la ultrasonografía endoscópica para el diagnóstico de localización de tumores neuroendocrinos pancreáticos: presentación de 2 insulinomas benignos

Los insulinomas son tumores neuroendocrinos que se manifiestan por episodios de hipoglucemia de ayuno. El diagnostico se basa en la sospecha clinica, que debe ir seguida de la demostracion de hiperinsulinismo y la localizacion tumoral. Sin embargo, la localizacion no siempre es posible con las tecnicas de imagen habituales, por lo que se debe recurrir a otras mas complejas. Presentamos 2 casos de insulinomas cuya localizacion tumoral no fue posible con tecnicas de imagen convencionales, pero si con ultrasonografia endoscopica.

Dificultad en el tratamiento del hipertiroidismo por amiodarona: Presentación de un caso

Amiodarone causes changes in thyroid function tests in about 15-20% of patients, inducing either hypothyroidism or thyrotoxicosis. The iodine load and the destructive thyroiditis caused by amiodarone produce thyrotoxicosis. We report a case of amiodarone-induced thyrotoxicosis diagnosed when investigating the reason for worsening of cardiac function. Prognosis and treatment of cardiac disorder were determined by thyrotoxicosis. The management needed a closed monitoring of thyroid function. Treatment was based on high doses of propylthiouracil and dexamethasone, but they couldn t control cardiac condition and surgery was warranted. When amiodarone-induced thyrotoxicosis is refractory to medical treatment, we believe surgery should be considered earlier.