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Prieto-Tenreiro A.,Seccion de Endocrinologia y Nutricion | Villar-Taibo R.,Hospital Universitario Of Leon | Pazos-Couselo M.,Complexo Hospitalario Universitario Of Santiago Of Compostela | Gonzalez-Rodriguez M.,Complexo Hospitalario Universitario Of Santiago Of Compostela | And 3 more authors.
Endocrinologia y Nutricion | Year: 2012

Background: Hypoglycemia limits the efficacy of intensive insulin therapy, especially in patients with great glucose variability. The extent to which continuous subcutaneous insulin infusion (CSII) overcomes this limitation is unclear. Our aim was to determine whether CSII is helpful for decreasing glucose variability and hypoglycemia, mainly in patients with the greatest variability. Method: Twenty-four patients with type 1 diabetes wore a continuous glucose monitoring system sensor for three days before starting therapy with CSII and 6 months later. Glucose variability (SD, MAGE, M) and hypoglycemia duration (area under the curve (AUC) <70. mg/dL) were compared in all patients and in those with the greatest MAGE (highest quartile). Results: At 6 months, a decreased glucose variability was seen, as measured by MAGE, M, and SD (median: -28. mg/dL (interquartile range, -48 to 1), p=0.03; -22(-40 to 0), p=0.04; -11(-23 to 0), p=0.009; respectively). Patients with the greatest initial glucose variability (MAGE quartile 4) showed a greater decrease in both MAGE (-47. mg/dL (-103 to -34) vs -20 (-36 to 17), p=0.01) and AUC <70 (-10.7. mg/dL x day (-15 to 0) vs -1.1 (-4.7 to 3.8), p=0.03) as compared to all others. Patients with longer initial hypoglycemia (AUC quartile 4) achieved a greater reduction in AUC <70 (-9.7. mg/dL x day(-15 to -6.5) vs -0.08 (-2.9 to 3.8), p=0.003). A correlation was found between ΔMAGE-ΔAUC (r 0.4, p=0.03). Conclusions: During CSII, glucose variability significantly decreased, especially in patients with the greatest initial variability. Hypoglycemia was also markedly less in patients with greater variability, with the greatest reduction occurring in those who experienced more marked hypoglycemia with CSII. © 2011 SEEN. Source


Sanchez-Ortiga R.,Hospital General Universitario Of Alicante | Tejada L.S.,Hospital General Universitario Of Alicante | Cabrera G.P.,Hospital General Universitario Of Alicante | Moreno-Perez O.,Hospital General Universitario Of Alicante | And 3 more authors.
Endocrinologia y Nutricion | Year: 2010

The pathogenesis of pituitary tumours is far to be understood. Pituitary transforming tumour gene (PTTG), a gen that induces aneuploidy, genetic instability, cellular proliferation and to stimulate angiogenesis, has been involved in neoplasic transformation and shown overexpressed in many neoplasm as lung, breast, endometrium, thyroid and colon malignant tumours. On the other hand, PTTG has been inconsistently studied in pituitary tumours. The majority of studies have been performed in animals and there is a great variability in the methods used in its determination. The goal of this review is to resume the role of PTTG in tumourogenesis and critically to revise the studies published in humans in order to advance in the knowledge of the pathogenesis of pituitary adenomas and to find clinical useful predictors of the behavior of these tumours. © 2010 Sociedad Española de Endocrinología y Nutrición. Source


Sastre Marcos J.,Seccion de Endocrinologia y Nutricion | Llamazares Iglesias O.,Seccion de Endocrinologia y Nutricion | Vicente Delgado A.,Seccion de Endocrinologia y Nutricion | Marco Martinez A.,Seccion de Endocrinologia y Nutricion | And 4 more authors.
Endocrinologia y Nutricion | Year: 2011

Background and aims: Differentiated thyroid carcinoma (DTC) is the most common endocrine tumor. DTC has a good prognosis and survival rates higher than 85%. The aim of our study was to assess our current survival rate and to analyze prognostic factors. Patients and methods: A retrospective analysis was conducted of 308 patients with DTC (93.5% with papillary tumors, 78.8% women). Mean age at diagnosis was 45.4 ± 15.8. years, and mean follow-up time was 8.9 ± 6.8. years. The whole group was treated and followed up using the same protocol at our hospital. The following data were collected: age at diagnosis, sex, histology, TNM stage, treatments, and date and cause of death. Survival probability was calculated using Kaplan-Meier analyses. Prognostic factors were analyzed using a univariate log rank test and a multivariate Cox regression analysis model. Results: Twenty-six patients died during follow-up, 15 of them (4.9%) from DTC. Thyroid carcinoma-related survival was 92.7% for the whole group. In multivariate analyses, the following parameters were associated to a significantly increased risk of death from DTC: presence of distant metastases, follicular histology, age at diagnosis older than 60. years, and extrathyroid invasion. Discussion: Our survival rate is similar to that reported in literature. Assessment of prognostic factors related to an increased risk of death in our patient group, is essential to establish active therapeutic approaches in high risk patients. © 2010 SEEN. Source


Louhibi L.,Seccion de Endocrinologia y Nutricion | Marco A.,Seccion de Endocrinologia y Nutricion | Pines P.J.,Seccion de Endocrinologia y Nutricion | Padillo J.C.,Seccion de Endocrinologia y Nutricion | And 6 more authors.
Endocrinologia y Nutricion | Year: 2014

Objective: Medullary thyroid cancer is a rare tumor that is more aggressive and has a worse prognosis than differentiated thyroid cancer. The purpose of this study was to report the demographic, clinical, and genetic characteristics of patients seen in the health care system of the community of Castilla-La Mancha over a 16-year period. Patients and methods: Data were collected through a review of patients' medical records. Results: The medical records of 58 patients (mean age at diagnosis, 51 years; range, 6-82 years; 63.8% women) were reviewed. Prevalence rate was 2.84 cases per 100,000 inhabitants, with a high variability between areas (range, 0-5.4 cases per 100,000 inhabitants). Familial cases accounted for 34.5% of all medullary thyroid cancers, and the most common mutation was C634Y. The condition was most commonly diagnosed following palpation of a cervical lump (70.6%). At diagnosis, 56 of 58 patients underwent ultrasound and 8 of 58 patients were tested for serum calcitonin. Tumor multicentricity was reported in 59 and 50% of patients with multiple endocrine neoplasia syndrome type 2A and 2B, respectively, and in no sporadic cases. Fifty-two percent of patients had an advanced stage (iii or iv) at diagnosis. Median follow-up was 36 months (interquartile range, 14-210); 11 patients were lost to follow-up. Conclusions: In Castilla-La Mancha, medullary thyroid cancer is diagnosed by cervical ultrasound, rather than calcitonin assay. There is a high prevalence of both familial and sporadic medullary thyroid cancer, and a significant variability in the type of proto-oncogen rearranged during transfection mutation as compared to the rest of the Spanish population. © 2013 SEEN. Source


Gutierrez-Alcantara C.,Servicio de Endocrinologia y Nutricion | Moreno-Fernandez J.,Hospital General Universitario Of Ciudad Real | Palomares-Ortega R.,Hospital Universitario Reina Sofia | Garcia-Manzanares T.,Seccion de Endocrinologia y Nutricion | Benito-Lopez P.,Hospital Universitario Reina Sofia
Endocrinologia y Nutricion | Year: 2011

Introduction: In 2006, a new training program was approved for resident physicians in endocrinology and nutrition (EN). A survey was conducted to EN residents to assess their training, their depth of knowledge, and compliance with the new program, as well as potential changes in training, and the results obtained were compared to those from previous surveys. Material and methods: A survey previously conducted in 2000 and 2005 was used for this study. The survey included demographic factors, questions about the different rotations, scientific and practical training, assessment of their training departments and other aspects. Results of the current survey were compared to those of the 2005 survey. Results: The survey was completed by 40 residents. Mandatory rotations are mainly fulfilled, except for neurology. Some rotations removed from the program, such as radiology and nuclear medicine, still are frequently performed and popular among residents, who would include them back into the program. There was a low compliance with practical training in the endocrinology area. Forty percent of residents were not aware of the new program, but 60% thought that it was fulfilled. A total of 82.5% of residents thought that their departments fulfilled the training objectives. Conclusions: Few differences were found in rotations as compared to the data collected in 2005 despite changes in the training program, and there was still a lack of practical training. By contrast, rating of training received from departments and senior physicians was improved as compared to prior surveys. © 2011 SEEN. Source

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