Asunto(s)

Asunto(s)

RESUMEN

Caso clínico: La oftalmopatía por enfermedad de Graves (exoftalmos, infiltración muscular y palpebral) se asocia casi sistemáticamente a hipertiroidismo. Paciente diagnosticada de hipotiroidismo subclínico y tratada adecuadamente con tiroxina oral. Unos meses después desarrolla un exoftalmos bilateral y simultáneamente presenta anticuerpos séricos antireceptor de TSH positivos. Se suspende entonces el tratamiento con tiroxina, y se comprueba que el hipotiroidismo ha progresado hasta hacerse primario. Se establece el diagnóstico de enfermedad de Graves hipotiroidea. Discusión: El diagnóstico se basó en la existencia de la oftalmopatía y los anticuerpos positivos, ambos específicos de la enfermedad de Graves. La coexistencia de hipotiroidismo es excepcional, pero posible

Clinical case: Graves' ophthalmopathy (exophthalmos, muscular and eyelid infiltration) is associated almost systematically to hyperthyroidism. A female patient was diagnosed with subclinical hypothyroidism and treated with oral thyroxine. Months later she developed bilateral exophthalmos and was serum-positive for thyrotropin receptor antibodies. Thyroxine treatment was suspended, and it was verified that her condition had developed into primary hypothyroidism. A diagnosis of Graves’ disease with hypothyroidism was made. Discussion: The diagnosis was based on the existence of ophthalmopathy and positive serum antibodies, both specific indicators of Graves' disease. The coexistence of hypothyroidism with Graves’ disease is exceptional, but possible

Asunto(s)

RESUMEN

CASE REPORT: Graves' ophthalmopathy (exophthalmos, muscular and eyelid infiltration) is associated almost systematically to hyperthyroidism. A female patient was diagnosed with subclinical hypothyroidism and treated with oral thyroxine. Months later she developed bilateral exophthalmos and was serum-positive for thyrotropin receptor antibodies. Thyroxine treatment was suspended, and it was verified that her condition had developed into primary hypothyroidism. A diagnosis of Graves' disease with hypothyroidism was made. DISCUSSION: The diagnosis was based on the existence of ophthalmopathy and positive serum antibodies, both specific indicators of Graves' disease. The coexistence of hypothyroidism with Graves' disease is exceptional, but possible.

Asunto(s)

RESUMEN

Los macroadenomas hipofisarios (de diámetro superior a 10 mm) son poco frecuentes como hallazgos casuales, y su manejo diagnóstico y terapéutico no está bien definido. Los criterios más habituales para el tratamiento neuroquirúrgico son la afectación del campo visual, la hipersecreción de hormonas distintas a la prolactina, la constatación de crecimiento, o la apoplejía no silente. Presentamos dos casos en los que la indicación de cirugía se estableció en función de la edad -joven- de la paciente (caso número uno) y de la afectación del eje gonadal en un varón no subsidiario de tratamiento androgénico (caso número dos). Se discute el beneficio de incluir tales indicaciones quirúrgicas en el protocolo de evaluación de estas lesiones (AU)

Pituitary macroadenomas (more than 10 mm in diameter) are infrequent as casual findings and optimal management strategy for these tumours has not been established. Neurosurgical approach must be always considered in patients with visual field defects or with hormone-secreting adenomas (but prolactinoma), and in those with evidence of lesion's growth or if clinical pituitary apoplexy occurs. We present two cases in which surgical indication was based on patient's young age (case number one), and on hypogonadal status, in a male patient not suitable of androgen substitution (case number two). We also discuss the benefits of including such unusual indications for neurosurgical treatment into the incidentally discovered pituitary macroadenomas evaluation strategy (AU)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

No disponible

No disponible

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

No disponible

No disponible

Asunto(s)

RESUMEN

Pituitary macroadenomas (more than 10 mm in diameter) are infrequent as casual findings and optimal management strategy for these tumours has not been established. Neurosurgical approach must be always considered in patients with visual field defects or with hormone-secreting adenomas (but prolactinoma), and in those with evidence of lesion's growth or if clinical pituitary apoplexy occurs. We present two cases in which surgical indication was based on patient's young age (case number one), and on hypogonadal status, in a male patient not suitable of androgen substitution (case number two). We also discuss the benefits of including such unusual indications for neurosurgical treatment into the incidentally discovered pituitary macroadenomas evaluation strategy.

Asunto(s)

RESUMEN

Antecedentes: La libre elección de especialista en Endocrinología es un derecho de los usuarios de la sanidad pública española. Objetivos: 1.- Averiguar si existe diferencia, en el contexto de un hospital comarcal español, en la opinión de los pacientes diabéticos vistos por primera vez en consulta y los que están en seguimiento prolongado respecto a la preferencia por la libre elección de especialista. 2.- Averiguar qué variables se asocian a esta preferencia entre los pacientes diabéticos en seguimiento. Diseño: estudio transversal con entrevista directa. Pacientes y métodos: 1.- Pacientes: Diabéticos tipo 1 y tipo 2, vistos en una primera consulta (grupo A, n = 60), o con un seguimiento mínimo de 4 años (grupo B, n = 100). Los pacientes fueron seleccionados de modo consecutivo en las consultas externas de Endocrinología. 2.- Métodos estadísticos: a) Descripción de las características de los pacientes y comparación entre grupos mediante las pruebas de Chi-cuadrado y U de Mann-Whitney. b) Objetivo 1: comparación mediante Chi-cuadrado. c) Objetivo 2: análisis mediante regresión logística multivariante. Resultados: Objetivo 1: Existe una diferencia estadísticamente significativa entre los grupos A y B en la preferencia por la libre elección de especialista. Objetivo 2: Dentro del grupo B los pacientes con niveles más altos de hemoglobina glicosilada son los que prefieren elegir especialista en mayor medida. Conclusiones: La libre elección de especialista es más apetecida por el grupo de pacientes diabéticos que opina “a priori” que por el grupo de pacientes que ha experimentado el sistema de atención en equipo. Dentro de este grupo sólo los niveles altos de hemoglobina glicosilada predicen la preferencia por la libre elección

Background: Free choice of specialized physicians is a patients´right in the Spanish Public Health Service. Objectives: 1.- In diabetic outpatients visited in a county hospital to as certain if there´s any difference about endocrinologist free choice opinion between new and long-standing follow-up groups. 2.- In the second group of patients to study wich variables are associated with the favourable free choice opinion. Design: Transversal, personal interview based. Patients and methods: 1.- Type 1 and type 2 diabetic patients firstly (A group, n=60) or at least 4 years time of follow-up (B group, n=100) visited in an outpatient department of Endocrinology. 2.- Statistical methods: a) Description of groups and comparative analysis of their characteristics (Chi-squared and Mann-Whitney U tests). b) Objective 1: Chi-squared test comparison. c) Objective 2: Multivariate logistic regression analysis. Results: Objective 1: The possibility of free choice of endocrinologist is preferred by A-group patients in a statistically significant greater proportion than B-group patients. Objective 2: In the latest group subjects with higher levels of glycated haemoglobin are the more favourables to the free choice. Conclusions: In a Spanish county hospital opinion about free choice of endocrinologist is better in an “a priori” judgement basis than after the personal experience of medical team attention. In long-standing follow-up patients only high levels of glycated haemoglobin predict the preference for the free choice

Asunto(s)

RESUMEN

BACKGROUND: Free choice of specialized physicians is a patients right in the Spanish Public Health Service. OBJECTIVES: 1.- In diabetic outpatients visited in a county hospital to ascertain if there s any difference about endocrinologist free choice opinion between new and long-standing follow-up groups. 2.- In the second group of patients to study wich variables are associated with the favourable free choice opinion. DESIGN: Transversal, personal interview based. PATIENTS AND METHODS: 1.- Type 1 and type 2 diabetic patients firstly (A group, n=60) or at least 4 years time of follow-up (B group, n=100) visited in an outpatient department of Endocrinology. 2.- STATISTICAL METHODS: a) Description of groups and comparative analysis of their characteristics (Chi-squared and Mann-Whitney U tests). b) Objective 1: Chi-squared test comparison. c) Objective 2: Multivariate logistic regression analysis. RESULTS: Objective 1: The possibility of free choice of endocrinologist is preferred by A-group patients in a statistically significant greater proportion than B-group patients. Objective 2: In the latest group subjects with higher levels of glycated haemoglobin are the more favourables to the free choice. CONCLUSIONS: In a Spanish county hospital opinion about free choice of endocrinologist is better in an "a priori" judgement basis than after the personal experience of medical team attention. In long-standing follow-up patients only high levels of glycated haemoglobin predict the preference for the free choice.

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)