Amiodarone is a potent class III anti-arrhythmic drug used in clinical practice for the prophylaxis and treatment of many cardiac rhythm disturbances, ranging from paroxismal atrial fibrillation to life threatening ventricular tachyarrhythmias. Amiodarone often causes changes in thyroid function tests mainly related to inhibition of 5'-deiodinase activity resulting in decrease in the generation of T3 from T4 with consequent increase in rT3 production and decrease in its clearance. In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction, either amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH). Both AIT and AIH may develop either in apparently normal thyroid glands or in glands with preexisting clinically silent abnormalities. AIT is primarily related to excess iodine-induced thyroid hormone synthesis in an abnormal thyroid gland (type...

 We present the case of a 43-year-old patient with a diagnosis of HIV infection on antiviral treatment who developed seizures without response to anticonvulsant treatment. The metabolic and structural study showed the presence of hyperinsulinemic hypoglycemia whose evaluation concluded that she had an insulinoma and was therefore subjected to subtotal pancreatectomy without recurrence of seizure episodes during the follow-up.

Introducción: La mayoría de los pacientes con enfermedad renal crónica terminal en hemodiálisis desarrollan hiperparatiroidismo secundario. Algunas veces este tipo de hiperparatiroidismo secundario suele ser severo y refractario al tratamiento médico, inclusive algunos desarrollarán hiperparatiroidismo terciario, el tratamiento de ambas situaciones suele ser la paratiroidectomía subtotal o total. Reporte de Caso: Presentamos el caso de un paciente de 29 años, con enfermedad renal terminal en hemodiálisis durante 13 años, quien desarrolló hiperparatiroidismo terciario por lo que fue sometido a paratiroidectomía subtotal con autotrasplante de media glándula; el estudio patológico informó la presencia de un carcinoma de paratiroides en una de las cuatro glándulas paratiroides extirpadas. Conclusión: El carcinoma de paratiroides es una neoplasia rara que causa hiperparatiroi...

Background: Primary aldosteronism is a disorder due to excessive aldosterone production in the presence of low renin levels. It is an underdiagnosed pathology despite its simple screening. Establishing the unilateral or bilateral location represents the greatest diagnostic challenge and is crucial to define the therapeutic approach. Adrenal venous catheterization (AVC) is the best test to establish the location, but it is invasive and expensive. New predictive markers of laterality are being developed. Case series presentation: We present a case series of 8 patients diagnosed with primary aldosteronism due to arterial hypertension with hypokalaemia, elevated aldosterone-renin ratio and compatible computed tomography. 4 patients underwent adrenal venous catheterization. Conclusion: In patients who underwent catheterization as well as in those who did not, the Küpers score adequately pred...

Background: Most patients with terminal chronic kidney disease on hemodialysis develop secondary hyperparathyroidism. Sometimes this type of secondary hyperparathyroidism becomes severe and refractory to medical treatment, some will even develop tertiary hyperparathyroidism, the treatment of both situations is usually subtotal or total parathyroidectomy. Case Report: We present the case of a 29-year-old patient with end-stage kidney disease on hemodialysis for 13 years, who developed tertiary hyperparathyroidism, for which he underwent subtotal parathyroidectomy with half gland autotransplantation; the pathological study reported the presence of a parathyroid carcinoma in one of the four excised parathyroid glands. Conclusion: Parathyroid carcinoma is a rare neoplasm that causes primary hyperparathyroidism in less than 1% of all cases, and has been reported in some patients operated on f...

Background: Primary aldosteronism is a disorder due to excessive aldosterone production in the presence of low renin levels. It is an underdiagnosed pathology despite its simple screening. Establishing the unilateral or bilateral location represents the greatest diagnostic challenge and is crucial to define the therapeutic approach. Adrenal venous catheterization (AVC) is the best test to establish the location, but it is invasive and expensive. New predictive markers of laterality are being developed. Case series presentation: We present a case series of 8 patients diagnosed with primary aldosteronism due to arterial hypertension with hypokalaemia, elevated aldosterone-renin ratio and compatible computed tomography. 4 patients underwent adrenal venous catheterization. Conclusion: In patients who underwent catheterization as well as in those who did not, the Küpers score adequately pred...

Up to 80% of patients with hypothyroidism present with neuromuscular symptoms. We report the case of a 56-year-old male with a two-year history of symptoms suggestive of hypothyroidism, which worsened over the last five months, with difficulty walking, muscle rigidity, and cramps. Laboratory tests confirmed primary hypothyroidism with elevated creatine kinase (CK) and lactate dehydrogenase (LDH) levels. Following treatment with levothyroxine, the clinical and biochemical response was favorable. Hoffmann syndrome, an atypical form of hypothyroid myopathy, is rare and primarily affects males with long-standing hypothyroidism. It is characterized by pseudohypertrophy and progressive muscle weakness, affecting less than 10% of hypothyroid patients. The pathogenesis is thought to involve alterations in the IGF1–PI3K–Akt/mTOR and myostatin-Smad3 pathways. Treatment with levothyroxine norma...

Se presenta el caso de una paciente de 43 años con el diagnóstico de infección por VIH en tratamiento antiviral que desarrolló convulsiones sin respuesta al tratamiento anticonvulsivante. El estudio metabólico y estructural evidenció la presencia de hipoglicemia hiperinsulinémica cuya evaluación concluyó que ella tenía un insulinoma por lo que fue sometida a pancreatectomía subtotal sin recurrencia de episodios convulsivos en el seguimiento.

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Determina el efecto de un programa educativo añadido al tratamiento habitual en el control de los pacientes con diabetes mellitus tipo 2 atendidos en la consulta ambulatoria especializada del Hospital Nacional Edgardo Rebagliati Martins, Lima - Perú. El estudio es cuasiexperimental, se distribuyeron 90 pacientes en 2 grupos: intervención versus control. El grupo de intervención recibió 4 sesiones educativas en grupos de 5-8 participantes (1 sesión/semana). Se procuró que la terapia farmacológica se mantuviera sin modificaciones significativas 3 meses antes y durante todo el seguimiento. Se determinaron los cambios en los parámetros clínico-bioquímicos principalmente la HbA1c al inicio, a los 6 y 12 meses después de la intervención. Los 90 pacientes completaron todas las sesiones y las consultas de seguimiento con la toma de muestras para la determinación de los parámetros ...

Introducción: El insulinoma es la causa más frecuente de hipoglicemia adquirida. Su localización con el uso de imágenes auxiliares puede constituir un reto diagnóstico. Reporte de caso: Adolescente de 14 años con convulsión y glucosa de 22mg/dl; insulina en 62UI/ml, péptido C: 9.4ng/ml, compatibles con hipoglicemia hiperinsulinémica. Tomografía, resonancia magnética de páncreas y ecoendoscopía son negativas. Se realiza test de estimulación intraarterial con calcio (TEIC) que muestra elevación de insulina menor al doble en arteria esplénica. Ante resultado no concluyente se decide pancreatectomía subtotal cuerpo-cola. Anatomía patológica informa: tumoración de 0.7cm compatible con insulinoma. Discusión: Insulinoma debería considerarse siempre como posibilidad diagnostica en toda hipoglicemia hiperinsulinémica. No existe un protocolo definido a seguir en caso de TEIC...

Introduction: Insulinoma is the most frequent cause of acquired hypoglycemia. Tumor localization with auxiliary images is possible in many patients, and it is necessary to resort to other methods in the rest. Report: 14-year-old adolescent with seizure and glucose 22mg/dl; insulin at 62UI/ml, C-peptide: 9.4ng/ml, compatible with hyperinsulinemic hypoglycemia. Tomography, magnetic resonance imaging of the pancreas, and echoendoscopy are negative. An intra-arterial stimulation test with calcium (TEIC) was performed, which showed less than a double elevation of insulin in the splenic artery. Given the inconclusive result, a body-tail subtotal pancreatectomy was decided. Pathological anatomy reports: 0.7cm tumor compatible with insulinoma. Discussion: Insulinoma should always be considered as a diagnostic possibility in all hyperinsulinemic hypoglycemia. There is no defined protocol to follo...

Objectives. To determine the effects of aerobic exercise on the components of the metabolic syndrome in older diabetic patients. Materials and methods: We used the PubMed/Medline, Scopus, Cochrane library, Web of Science databases and the Google Scholar search engine. Randomized controlled trials ( RCTs ) were selected according to the inclusion criteria. Two review authors independently determined whether studies met the inclusion criteria, extracted data and used the Cochrane risk of bias (ROB 2.0) tool. Quantitative analyzes were performed in R V. 4.0.5 using random effects. Results. The searches identified 8697 studies, of which 7 RCTs were included in the qualitative synthesis. Most studies were assessed to have high or low ROB in at least three domains. The meta-analysis showed that aerobic exercise was effective in improving glucose levels (standardized mean difference [SMD]: -1.0...

A 43-year-old woman with a recent diagnosis of Graves-Basedow disease was admitted to the emergency room due to soft tissue infection, thiamazole agranulocytosis, and severe hyperthyroidism. The patient required definitive treatment for hyperthyroidism, but given the context of the SARS-COV-2 pandemic, radioactive iodine was not available, so she prepared for total thyroidectomy. A rapid and effective preoperative preparation was required, so it was decided to compensate her hyperthyroidism with lugol, lithium carbonate, dexamethasone and finally plasmapheresis before surgery. Thyroid hormone levels normalized in a short time, and the thyroidectomy was performed. The case is presented because of the anecdotal and because knowledge of management in scenarios, such as this pandemic, where thereis no access to 131I.