Teresa Sir

Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck

Multiple skin tags appear associated with abnormalities in glucose/insulin metabolism. Clinical and metabolic glucose/insulin characteristics of men with multiple (8 or more) skin tags on the neck were compared with a control group with few or none. Both groups were divided in two subgroups according to normal or abnormal laboratory findings. In the study subgroup with normal laboratory findings the number of skin tags varied from 8–33, whereas in those with abnormal laboratory findings the range was 9–65. Eight or more skin tags were related with statistically significant laboratory glucose/insulin abnormalities: basal hyperinsulinemia (p<0.002), postprandial hyperinsulinemia (p<0.003), and postprandial hyperglycemia (p<0.01). In the multiple skin tag group 77 % had diverse laboratory abnormalities, including insulin resistance, basal hyperinsulinemia, postprandial hyperinsulinemia, glucose intolerance or type 2 diabetes, in contrast with the control group, where only 33 % showed laboratory abnormalities. One‐third of the study group had acanthosis nigricans. Only 15 % of patients with metabolic abnormalities did not show any cutaneous expression of glucose/insulin alterations (9 or more skin tags on the neck, acanthosis nigricans, or waist circumference greater than 95 cm). Multiple skin tags were more sensitive than acanthosis nigricans in identifying those with alterations in the glucose/insulin metabolism (77 vs. 32 % respectively), although less specific (68 vs.100%). Multiple skin tags should raise suspicion of insulin resistance or hyperinsulinemia.

Regulation of steroid hormone synthesis by human corpora lutea: failure of follicle-stimulating hormone to support steroidogenesis in vivo and in vitro

Abstract The authors studied the role of follicle-stimulating hormone (FSH) in luteal steroido-genesis by replacing gonadotropin-releasing hormone (GnRH) infusion with pure FSH 48 hours after ovulation in two hypogonadotropic patients. Plasma progesterone (P) and estradiol (E 2 ) decreased after FSH administration. Human luteal cells were cultured for 48 hours in the presence and absence of FSH, human chorionic gonadotropin (hCG), testosterone (T), or dibutyryl cyclic adenosine monophosphate (Bu 2 cAMP). In the presence of T, E 2 synthesis increased significantly, indicating an active aromatase system in these cells. Human chorionic gonadotropin as well as Bu 2 cAMP significantly increased E 2 , T, and P synthesis. Follicle-stimulating hormone did not stimulate luteal E 2 , T, or P synthesis. The authors conclude that FSH does not sustain luteal steroidogenesis. Moreover, the in vitro findings reveal that hCG modulation of luteal E 2 synthesis is mediated principally by an increase in androgen precursors. These in vivo and in vitro results confirm a crucial role for luteinizing hormone (LH) in the maintenance ofluteal steroidogen-esis.

II Consenso de la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina

Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.

Hormonal and ultrasound profile of luteinized unruptured follicle following pulsatile gonadotrophin releasing hormone infusion. Case report

A 23-year-old woman presented with a 7-year history of amenorrhoea. Adrenarche and thelarche occurred at age 14, and menarche at age 16. She had had only three menstrual periods during the 7 years since the menarche. Physical examination revealed a healthy woman weighing 58 kg with Tanner 4 breast development. Anosmia, galactorrhea and hirsutism were absent. Pelvic examination was normal. Laboratory results were as follows: luteinizing hormone (LH) 4.7 m-i.u./ml, follicle stimulating hormone (FSH) 4.4 m-i.u./ml, oestradiol (E2) 12 pgiml, testosterone 0.40 ngiml, thyroid stimulating hormone (TSH) 0.84 p-i.u./ml, thyroxine (T4) 10 pg/dl, prolactin 10 ng/ml, cortisol (at 08.00 hours) 180 pgidl, and the X cone view of the sella turcica was normal. Release of LH and FSII after a standard administration of 100 pg of LH-releasing hormone (LHRH) was normal. Steroids and gonadotrophins were measured by radioimmunoassay as reported previously (Devoto et al. 1980), TSII, T4 and prolactin were measured with commercial kits. She had no vaginal bleed after withdrawal of