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Female hyperandrogenism 女性高雄激素症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.004
A. López Guerra, E. Fernández Fernández, S. Bacete Cebrián, O. González Albarrán
{"title":"Female hyperandrogenism","authors":"A. López Guerra,&nbsp;E. Fernández Fernández,&nbsp;S. Bacete Cebrián,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.004","DOIUrl":"10.1016/j.med.2024.09.004","url":null,"abstract":"<div><div>Hyperandrogenism in women is a clinical syndrome resulting from an excess of circulating androgens in the blood. They can be produced either in the ovary or the adrenal gland. The clinical manifestations are highly variable. Patients present characteristic physical signs (alopecia, hirsutism, acne) as well as menstrual cycle irregularities. The most common cause of hyperandrogenism in women of childbearing age is polycystic ovary syndrome. There are specific criteria to establish a clear diagnosis of this syndrome. Nevertheless, in the presence of hyperandrogenism, a differential diagnosis must be made among other possible causes, such as congenital adrenal hyperplasia, use of drugs (anabolic agents), or the presence of androgen-secreting tumors. The specific treatment of this disease is usually chronic and aimed at controlling secondary symptoms of the disease, attempting to improve patients’ quality of life.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1013-1025"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo de tratamiento hormonal sustitutivo en la posmenopausia 绝经后妇女的激素替代疗法方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.007
G. Pérez López, E. Fernández Fernández, I. Jiménez Hernando, O. González Albarrán
{"title":"Protocolo de tratamiento hormonal sustitutivo en la posmenopausia","authors":"G. Pérez López,&nbsp;E. Fernández Fernández,&nbsp;I. Jiménez Hernando,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.007","DOIUrl":"10.1016/j.med.2024.09.007","url":null,"abstract":"<div><div>Hormone replacement therapy (HRT) is a treatment for postmenopausal women to improve quality of life and the adverse effects associated with hormonal deficiencies that occur at this stage of life. In most healthy women under 60 years of age who are in early menopause (within the first 10 years of the onset of menopause), the benefits of HRT outweigh the risks. Initiation of HRT in the 60-70 age group requires an individualized risk/benefit calculation, consideration of other available drugs, and the lowest effective dose. HRT should generally not be started after age 70. Estrogen formulations are the most effective therapeutic option available and the addition of progesterone is intended to protect against the consequences of systemic estrogen therapy in women with intact uteruses.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1034-1037"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hipogonadismo masculino 男性性腺功能减退症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.003
G. Pérez López, S. Bacete Cebrián, L. González Fernández, O. González Albarrán
{"title":"Hipogonadismo masculino","authors":"G. Pérez López,&nbsp;S. Bacete Cebrián,&nbsp;L. González Fernández,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.003","DOIUrl":"10.1016/j.med.2024.09.003","url":null,"abstract":"<div><div>Male hypogonadism (HG) is defined as the functional incompetence of the gonads with suboptimal or altered production of hormones and germ cells. The prevalence between 30 and 70 years of age is 10% and increases with age. It is classified according to the origin, as primary hypergonadotropic HG, secondary hypothalamic-pituitary hypogonadotropic HG and HG due to peripheral resistance to the androgenic effect. The diagnosis requires clinical suspicion and hormonal determinations that confirm it. The main treatment is the administration of testosterone by transdermal or injectable route, with the option of using GnRH or gonadotropins.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1004-1012"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Síndrome de secreción inadecuada de hormona antidiurética 抗利尿激素分泌失调综合征
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.002
J. Atencia Goñi, I. Losada Gata, R. García-Centeno, O. González Albarrán
{"title":"Síndrome de secreción inadecuada de hormona antidiurética","authors":"J. Atencia Goñi,&nbsp;I. Losada Gata,&nbsp;R. García-Centeno,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.002","DOIUrl":"10.1016/j.med.2024.09.002","url":null,"abstract":"<div><div>Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is defined as a disorder in renal free water excretion control due to the inability to suppress the secretion of antidiuretic hormone (ADH) or vasopressin. The most frequent causes are usually acquired, notable among which are central nervous system involvement, malignancy, pulmonary diseases, or drugs. Up to 35% of admitted patients have hyponatremia, of which up to 40% can be attributed to SIADH. It is considered acute when it occurs in less than 48<!--> <!-->hours. It can trigger vomiting, convulsions, coma, and death due to cerebral herniation resulting from increased intracranial pressure. Chronic forms are more common and entail symptoms such as nausea, confusion, weakness, or agitation. In order to diagnose it, it is necessary to identify the presence of a true hypoosmolar euvolemic hyponatremia, ruling out other hormonal abnormalities or drug use. Treatment of the acute form is based on the emergency use of hypertonic saline solution, avoiding excessively rapid sodium correction that would trigger an osmotic demyelination syndrome. In the case of chronic hyponatremia, water restriction, increased osmole intake, and tolvaptan can be used in addition to acting on the triggering causes.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 994-1003"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diabetes insípida 尿崩症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.001
A. Rivas Montenegro, A. García Piorno, A. Galdón Sanz-Pastor, O. González Albarrán
{"title":"Diabetes insípida","authors":"A. Rivas Montenegro,&nbsp;A. García Piorno,&nbsp;A. Galdón Sanz-Pastor,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.001","DOIUrl":"10.1016/j.med.2024.09.001","url":null,"abstract":"<div><div>Diabetes insipidus (DI) is a disorder of water metabolism characterized by the development of a polyuria-polydipsia syndrome with a large volume of dilute urine. It may be due to alterations in vasopressin production at the central level (arginine-vasopressin hormone deficiency) or lack of response to its renal action (arginine-vasopressin hormone resistance). A third form is gestational DI, caused by increased vasopressin degradation by placental vasopressinase. The severity of the picture will be determined by the degree of hypovolemia and osmotic imbalance. The different forms of classify hypotonic polyuria has evolved from the classic Miller dehydration test to the current determination of copeptin, which offers greater diagnostic accuracy. Treatment is variable depending on the underlying etiology.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 985-993"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142316000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Varón de 70 años con anorexia, pérdida de peso, vómitos y síntomas cognitivos 70 岁男性，厌食、体重下降、呕吐和认知症状。
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-24 DOI: 10.1016/j.med.2024.09.009
J. Atencia Goñi, I. Losada Gata, E. Fernández Fernández, O. González Albarrán
{"title":"Varón de 70 años con anorexia, pérdida de peso, vómitos y síntomas cognitivos","authors":"J. Atencia Goñi,&nbsp;I. Losada Gata,&nbsp;E. Fernández Fernández,&nbsp;O. González Albarrán","doi":"10.1016/j.med.2024.09.009","DOIUrl":"10.1016/j.med.2024.09.009","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 17","pages":"Pages 1043.e1-1043.e3"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de la hiperprolactinemia 高催乳素血症诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-01 DOI: 10.1016/j.med.2024.08.014
R. García-Centeno, G. Collado González, A. Galdón Sanz-Pastor, O. González-Albarrán
{"title":"Protocolo diagnóstico de la hiperprolactinemia","authors":"R. García-Centeno,&nbsp;G. Collado González,&nbsp;A. Galdón Sanz-Pastor,&nbsp;O. González-Albarrán","doi":"10.1016/j.med.2024.08.014","DOIUrl":"10.1016/j.med.2024.08.014","url":null,"abstract":"<div><p>Hyperprolactinemia is a common cause for assessment in clinical endocrinology practice. It can have several causes, including prolactinoma, the most common functioning pituitary tumor. In order to reach an accurate differential diagnosis, it is essential to take a detailed medical history to rule out possible physiological or pathological causes. Non-tumoral hyperprolactinemia of pathological origin is usually associated with pharmacological factors as the predominant cause. Typical clinical symptoms include galactorrhea and manifestations resulting from hypogonadism induced by excess prolactin. The clinical presentation may vary according to gender, age, and underlying cause. The necessary additional tests, including magnetic resonance imaging, should be performed based on the medical history.</p></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 16","pages":"Pages 970-974"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de una lesión ocupante de espacio hipofisaria 垂体占位性病变诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-01 DOI: 10.1016/j.med.2024.08.016
A. García Piorno, I. Losada Gata, A. Rivas Montenegro, E. Fernández Fernández, O. González-Albarrán
{"title":"Protocolo diagnóstico de una lesión ocupante de espacio hipofisaria","authors":"A. García Piorno,&nbsp;I. Losada Gata,&nbsp;A. Rivas Montenegro,&nbsp;E. Fernández Fernández,&nbsp;O. González-Albarrán","doi":"10.1016/j.med.2024.08.016","DOIUrl":"10.1016/j.med.2024.08.016","url":null,"abstract":"<div><p>Space-occupying pituitary lesions are a common finding in imaging tests performed for the study of diseases not related to the pituitary gland, such as computed tomography (CT) or magnetic resonance imaging (MRI). Its prevalence varies between 10%-38% in radiological studies and 15% in autopsies. They are mostly pituitary adenomas (HA), classified according to size into microadenomas (&lt; 10<!--> <!-->mm) or macroadenomas (≥ 10<!--> <!-->mm) and are usually benign and non-functional. Its management requires a multidisciplinary approach, including anamnesis, physical examination, pituitary hormonal profile to rule out hyperfunction or hypofunction, and ophthalmological studies. High-resolution pituitary MRI is the primary tool for evaluating these lesions and their impact on surrounding structures. The differential diagnosis is broad, and includes benign tumors, malignant tumors, cystic lesions, granulomatous diseases, infiltrative diseases, and vascular malformations. The growth of the lesion can compromise vision and even produce optic atrophy. Neuro-ophthalmological evaluation is essential to evaluate the degree of involvement and the indication for surgical treatment.</p></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 16","pages":"Pages 979-982"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adenomas hipofisarios no funcionantes. Incidentaloma hipofisario 无功能的垂体腺瘤垂体偶发瘤
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-01 DOI: 10.1016/j.med.2024.08.012
L. González Fernández, G. Pérez López, S. Bacete Cebrián, O. González-Albarrán
{"title":"Adenomas hipofisarios no funcionantes. Incidentaloma hipofisario","authors":"L. González Fernández,&nbsp;G. Pérez López,&nbsp;S. Bacete Cebrián,&nbsp;O. González-Albarrán","doi":"10.1016/j.med.2024.08.012","DOIUrl":"10.1016/j.med.2024.08.012","url":null,"abstract":"<div><p>Non-functioning pituitary adenomas (NFPAs) are tumors of the pituitary gland that are usually benign and show no clinical or biochemical signs of excessive hormone production. These tumors manifest clinically when they are large enough to exert pressure on surrounding structures. Among pituitary incidentaloma, NFPAs are the most common, as they are often diagnosed accidentally during imaging tests performed for other reasons. To properly evaluate these tumors and their relationship to other structures, the use of contrast-enhanced MRI is preferred. In addition, it is necessary to perform a hormonal analysis to rule out hormonal alterations and a neuro-ophthalmological examination in those cases in which the adenomas are close to the optic chiasm or cavernous sinuses, or in patients who present vision problems. In cases where the tumors are symptomless, observation is an option. However, transsphenoidal surgery is the first-line treatment for patients with symptoms or large tumors. Other options include radiation therapy and medical treatment with dopaminergic agonists and other drugs that are being explored more recently.</p></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 16","pages":"Pages 947-958"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico del síndrome de la silla turca vacía 空蝶鞍综合征诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-09-01 DOI: 10.1016/j.med.2024.08.015
E. Fernández Fernández, I. Jiménez Hernando, R. García-Centeno, O. González-Albarrán
{"title":"Protocolo diagnóstico del síndrome de la silla turca vacía","authors":"E. Fernández Fernández,&nbsp;I. Jiménez Hernando,&nbsp;R. García-Centeno,&nbsp;O. González-Albarrán","doi":"10.1016/j.med.2024.08.015","DOIUrl":"10.1016/j.med.2024.08.015","url":null,"abstract":"<div><p>Empty sella is a radiologic finding in which the sella turcica appears empty due to cerebral spinal fluid within the subarachnoid space herniating. Today, this finding is relatively common, this proportion increases with aging, and is more prevalent in women. It has been historically thought that empty sella is an incidental finding without clinical significance that does not require further monitoring or treatment. However, some patients will have endocrine or neurologic consequences. Symptoms in this clinical condition can include headache or vision loss associated with idiopathic intracranial hypertension, hyperprolactinemia or hypopituitarism. Symptomatic patients should be treated with pharmacologic to surgical therapies.</p></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 16","pages":"Pages 975-978"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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