Postmenopausal osteoporosis is the most common presentation of bone disease and is caused by estrogen deficiency that promotes bone resorption, increased osteoclastogenesis and osteoclast activity secondary to an inflammatory state due to activation of proinflammatory signal chains, increased synthesis of proinflammatory cytokines and production of reactive oxygen species. The use of antioxidants present in the diet (ascorbate) or drugs (N-acetyl cysteine and nitroglycerin) has proven to be beneficial in promoting or preserving osteoblastic function, recommending their use as part of the management of osteoporosis in postmenopausal women.

“Doege–Potter syndrome (DPS) is a paraneoplastic syndrome characterized by nonislet cell tumor hypoglycemia due to a solitary fibrous tumor, which produces insulin-like growth factor II. In this report, we present the case of a 67-year-old male with recurrent and refractory hypoglycemia due to DPS successfully treated with imatinib. He initially presented with neuroglycopenic symptoms and dyspnea secondary to a giant tumor in the left hemithorax, which was totally resected. During follow-up, 7 years later, he presented with thoracoabdominal tumor recurrence associated with severe hypoglycemia and underwent subtotal tumor resection, with a subsequent improvement of symptoms. The following year, he had a recurrence of his intra-abdominal tumor, which was unresectable, associated with severe hypoglycemia refractory to dextrose infusion and corticosteroids, thus receiving imatinib with a...

“Autoimmune dysglycemia syndrome (ADS) is a rare condition that presents as episodes of hypoglycemia as well as hyperglycemia and is classified as insulin autoimmune syndrome (IAS) and type B insulin resistance (TBIR). Autoimmunity plays a key role in the pathogenesis ofthis disorder, as evidenced by the presence of autoantibodies against endogenous insulin or the insulin receptor, and by its association with rheumatologic disorders. Treatment usually includes glycemic control and immunomodulatory agents. We report a case of a 31-year-old woman who was admitted for severe hypoglycemia. Further workup revealed underlying systemic lupus erythematosus (SLE) with renal involvement. During hospitalization, she continued to experience episodes of fasting hypoglycemia, as well as episodes of postprandial hyperglycemia. Hypoglycemia associated with a high serum insulin concentration and positi...

Diabetes mellitus is a worldwide public health problem which is associated with an increase in morbidity and mortality in the affected population due the development of micro and macrovascular complications. Currently, the SARS-CoV-2 epidemic is constantly increasing in many countries, causing the collapse of healthcare systems by leading to an increased demand for care, as well as an upsurge in the associated mortality. Available reports describe that patients with diabetes mellitus have an increased risk of unfavorable progression, development of complications and even an increase in mortality rate. Some physiological mechanisms have been proposed to try to explain this special evolution in patients with diabetes. Given the presence of 2019 coronavirus disease in our country and an important group of high-risk patients, a review of the pathophysiology and management considerations of t...

El hipotiroidismo puede asociarse con pancitopenia en casos raros. Se presenta el caso de una mujer de 33 años con edema durante los últimos seis meses, asociado a fatiga, hiporexia, intolerancia al frío y parestesias. Los exámenes revelaron pancitopenia e hipotiroidismo primario autoinmune, además de niveles bajos de vitamina B12, asociados a gastritis atrófica. Se inició tratamiento con levotiroxina y prednisona por púrpura trombocitopénica autoinmune. Cuatro semanas después, la pancitopenia se resolvió. El diagnóstico final fue síndrome poliglandular autoinmune tipo 3B. De los 12 casos reportados de pancitopenia asociada a hipotiroidismo primario, se observa una afectación predominante en mujeres (75%), con una edad promedio de 55 años, y su resolución con levotiroxina en un promedio de 47 días. Su fisiopatología implica una disfunción medular por la deficiencia de ...

El carcinoma papilar de tiroides (CPT) es la neoplasia tiroidea más frecuente, mientras que la tiroiditis subaguda (TSA) es un trastorno inflamatorio autolimitado. Su coexistencia representa un desafío diagnóstico. Presentamos el caso de una mujer de 34 años con 6 semanas de fiebre y dolor cervical. Presentó taquicardia, bocio doloroso y nódulo tiroideo derecho. Los exámenes mostraron velocidad de sedimentación globular y tiroglobulina elevadas. La ecografía reveló un nódulo sólido subcapsular y la gammagrafía mostró ausencia de captación. La biopsia confirmó CPT. Se realizó tiroidectomía total, que evidenció CPT variante clásica y folicular sin invasión. Recibió terapia ablativa con I-131 y se encuentra en seguimiento sin recurrencia. Este caso subraya la necesidad de una evaluación exhaustiva en casos de TSA con nódulos, pues la inflamación puede enmascarar mal...

Se presenta el caso de un varón de 54 años con tirotoxicosis de dos meses de evolución, en quien se identificó un nódulo tiroideo de 1,5 cm, TSH suprimida, T4L elevada, anticuerpos antitiroideos positivos y calcitonina aumentada. La gammagrafía mostró bocio difuso hipercaptante y la biopsia confirmó carcinoma medular de tiroides (CMT), coexistiendo con enfermedad de Graves-Basedow (EGB). Fue sometido a tiroidectomía total con disección central y tratamiento con levotiroxina, sin recurrencia hasta la fecha. Este caso es único por la rara asociación entre EGB y CMT, entidades con fisiopatologías distintas, y destaca la importancia de una evaluación integral ante hallazgos atípicos. Aporta a la literatura al evidenciar la necesidad de considerar diagnósticos diferenciales incluso en contextos clínicos aparentemente claros, subrayando el valor del diagnóstico temprano en el...

Introduction. Type 2 diabetes is a public health problem whose management is very complex, recognizingmultiple problems and limitations for an adequate control of the disease. Objective. To determine the effect of educational program added to the usual treatment, in the control of patients with type 2 diabetes in a peruvian national hospital. Methods. A longitudinal analytical study of three months of follow-up was conducted. Fifty consecutive patients with uncontrolled type 2 diabetes who were treated in the outpatient clinical of the endocrinology service agreed to voluntarily participate in the four sessions in groups of 5-8 participants (1session/week). The availability of antidiabetic medication was assured, as well as the maintenance of the prescribed pharmacological doses from three months before the intervention and during the follow-up period. ...

La infección por SARS-CoV-2 se ha extendido por 187 países, habiendo afectado, al momento del escrito (12/05/2020), a 4 201 921 personas y causado 286 835 decesos a nivel mundial y en nuestro medio ha provocado 68 822 infecciones y 1 961 fallecidos. La diabetes mellitus (DM) es una de las comorbilidades más importantes relacionadas con la gravedad de las infecciones conocidas por coronavirus patógenos humanos, incluido el SARSCoV-2. Los pacientes con DM tienen un mayor riesgo de complicaciones graves (síndrome de dificultad respiratoria del adulto y falla multi-orgánica). Dependiendo de la región, del 20-50% de pacientes con COVID-19 tenían DM y el ministerio de salud peruano la reconoce como la segunda comorbilidad asociada a muerte por COVID-19 en 9,1% de los decesos con un índice de letalidad del 10.4%

El síndrome de disglucemia autoinmune (SDA) es una enfermedad poco frecuente que se presenta en forma de episodios de hipoglucemia e hiperglucemia y se clasifica como síndrome autoinmune a la insulina (SAI) y resistencia a la insulina tipo B (RTBI). La autoinmunidad desempeña un papel clave en la patogenia de este trastorno, como lo demuestra la presencia de autoanticuerpos contra la insulina endógena o el receptor de insulina, y por su asociación con trastornos reumatológicos. El tratamiento suele incluir control glucémico y agentes inmunomoduladores. Informamos de un caso de una mujer de 31 años que ingresó por hipoglucemia grave. Estudios posteriores revelaron lupus eritematoso sistémico (LES) subyacente con afectación renal. Durante la hospitalización, continuó experimentando episodios de hipoglucemia en ayunas, así como episodios de hiperglucemia posprandial. La hipogl...

La diabetes mellitus es un problema de salud pública a nivel mundial y causa un aumento de la morbimortalidad en la población afectada con el desarrollo de complicaciones micro y macrovasculares. Actualmente la epidemia causada por el SARS-CoV-2 está en constante aumento en muchos países provocando el colapso de los sistemas de salud al generar un aumento de la demanda de atención, así como un aumento de la mortalidad asociada. Los reportes disponibles describen que los pacientes con diabetes mellitus presentan un mayor riesgo de evolución desfavorable, desarrollo de complicaciones e incluso un aumento de la tasa de mortalidad. Se ha propuesto algunos mecanismos fisiopatológicos para tratar de explicar esta especial evolución en los pacientes con diabetes. Ante la presencia de enfermedad por el coronavirus 2019 en nuestro país y de un importante grupo de pacientes de alto riesg...

Diabetes mellitus is a worldwide public health problem which is associated with an increase in morbidity and mortality in the affected population due the development of micro and macrovascular complications. Currently, the SARS-CoV-2 epidemic is constantly increasing in many countries, causing the collapse of healthcare systems by leading to an increased demand for care, as well as an upsurge in the associated mortality. Available reports describe that patients with diabetes mellitus have an increased risk of unfavorable progression, development of complications and even an increase in mortality rate. Some physiological mechanisms have been proposed to try to explain this special evolution in patients with diabetes. Given the presence of 2019 coronavirus disease in our country and an important group of high-risk patients, a review of the pathophysiology and management considerations of t...

Postmenopausal osteoporosis is the most common presentation of bone disease and is caused by estrogen deficiency that promotes bone resorption, increased osteoclastogenesis and osteoclast activity secondary to an inflammatory state due to activation of proinflammatory signal chains, increased synthesis of proinflammatory cytokines and production of reactive oxygen species. The use of antioxidants present in the diet (ascorbate) or drugs (N-acetyl cysteine and nitroglycerin) has proven to be beneficial in promoting or preserving osteoblastic function, recommending their use as part of the management of osteoporosis in postmenopausal women.

Background: Euglycemic diabetic ketoacidosis (EDKA) accounts for up to 7% of cases of diabetic ketoacidosis (DKA) and is characterized by blood glucose levels below 200 mg/dL. It has been associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i).  Case report: We present the case of a 34-year-old male with obesity and type 2 diabetes who, four days prior to admission, began treatment with empagliflozin/metformin 12.5/1000 mg twice daily due to hyperglycemia exceeding 350 mg/dL. He presented to the emergency department with symptoms consistent with DKA and a blood glucose level of 180 mg/dL. The patient was managed with fluid resuscitation and insulin therapy, resulting in significant clinical improvement.  Discussion: The typical blood glucose level in EDKA is 184.5 mg/dL, often with false-negative urine ketone results, which can delay diagnosis. Management include...

Introducción: El carcinoma adrenocortical (CAC), el segundo tumor endocrino maligno más frecuente, se origina en la corteza suprarrenal y se diagnostica principalmente en personas de mediana edad. El CAC funcionante suele presentarse con hiperandrogenismo, con o sin hipercortisolismo. Aproximadamente el 50 % de los casos son funcionantes. Reporte de caso: Presentamos los casos de dos mujeres adultas que manifestaron hiperandrogenismo y una masa abdominal gigante al examen físico. El diagnóstico de CAC fue confirmado mediante análisis histopatológico. Discusión: El CAC funcionante se presenta típicamente con una gran masa abdominal y niveles elevados de hormonas suprarrenales. El diagnóstico incluye pruebas hormonales y estudios de imagen. La tomografía computarizada es fundamental en la evaluación inicial del CAC, ya que permite identificar características como la heterogen...

 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...

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...

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...