Revista Medica Clinica Las Condes最新文献

{"title":"Avances en el diagnóstico y etiología de los tumores de la corteza suprarrenal","authors":"A. Verónica Araya MD","doi":"10.1016/j.rmclc.2025.08.013","DOIUrl":"10.1016/j.rmclc.2025.08.013","url":null,"abstract":"<div><div>The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical guidelines have established recommendations for the management of these lesions.guidelines have established recommendations for the management of these lesions.</div><div>The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We will review the main elements used in the differential diagnosis of benign and malignant adrenal will review the main elements used in the differential diagnosis of benign and malignant adrenal lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite testing, which has proven useful in the differential diagnosis of SI with testing, which has proven useful in the differential diagnosis of SI with ≥10 HU on unenhanced CT. 10 HU on unenhanced CT. We will also review new mutations associated with multiple endocrine neoplasia syndromes, which We will also review new mutations associated with multiple endocrine neoplasia syndromes, which should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current approach regarding the follow-up of non-functioning benign lesions and patients with MACS.approach regarding the follow-up of non-functioning benign lesions and patients with MACS.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 348-356"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912559","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}

{"title":"Recomendaciones para el manejo quirúrgico actual del nódulo tiroideo maligno","authors":"Luis Inzunza C. MD","doi":"10.1016/j.rmclc.2025.08.004","DOIUrl":"10.1016/j.rmclc.2025.08.004","url":null,"abstract":"<div><div>Surgery remains the cornerstone of thyroid cancer treatment. Greater access to imaging studies now allows for the diagnosis of nodules at earlier stages. While this improves diagnostic performance, it also requires careful evaluation to avoid overdiagnosis and overtreatment. In this context, less aggressive surgical procedures, such as lobectomy or partial thyroidectomy, or less invasive approaches, have gained relevance in recent years. Proper preoperative evaluation and planning by the surgeon and a multidisciplinary team is essential to offer personalized treatment to each patient. Advances in anesthesia, the use of energy instruments for hemostasis, and intraoperative monitoring of the laryngeal nerve have improved surgical safety, although they do not replace the surgeon's meticulous technique or clinical judgment. Remote access routes and radiofrequency ablation techniques represent surgical management alternatives for selected cases of patients with thyroid cancer. The objective of this review is to analyze the current status of diagnosis and surgical treatment of this pathology.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 273-287"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912550","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}

{"title":"Avances en el enfrentamiento diagnóstico y terapéutico de la acromegalia","authors":"Francisco J. Guarda ,&nbsp;Flavia Nilo ,&nbsp;Pablo Villanueva","doi":"10.1016/j.rmclc.2025.07.001","DOIUrl":"10.1016/j.rmclc.2025.07.001","url":null,"abstract":"<div><div>Acromegaly is a rare disorder, primarily caused by benign growth hormone-secreting tumors of the pituitary gland, leading to multisystemic complications and increased morbidity and mortality. This review aims to show the most updated advances in its management, which should be individualized and conducted by specialized multidisciplinary teams with expertise in pituitary disorders. Surgery, when performed by experienced surgeons, remains the first-line treatment in most cases. For patients with persistent disease, alternative therapeutic options include radiation, repeat surgery, and pharmacological agents targeting different molecular pathways, such as first and second-generation somatostatin analogs, dopamine agonists, and growth hormone receptor antagonists, among others. A multimodal treatment approach, combining multiple therapeutic strategies, has been shown to achieve high remission rates. Treatment selection should be tailored based on clinical, biochemical, radiological, and histological parameters to optimize outcomes, minimize long-term complications, and ultimately improve patients’ quality of life.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 245-251"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912688","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}

{"title":"Hiperparatiroidismo primario","authors":"Marcelo Mardones Parga MD","doi":"10.1016/j.rmclc.2025.08.011","DOIUrl":"10.1016/j.rmclc.2025.08.011","url":null,"abstract":"<div><div>Primary hyperparathyroidism (PHPT) is an endocrine disease resulting from hyperfunction of one or more parathyroid glands (80% and 15-20% of cases, respectively) and is characterized by the presence of hypercalcemia associated with elevated or inappropriately normal parathyroid hormone (PTH) levels. Currently, PHPT is mainly an asymptomatic condition; therefore, it should be actively sought in the presence of nephrolithiasis, hypercalciuria, osteoporosis, or fractures in order to achieve appropriate management. During the diagnostic process, other conditions that present with elevated PTH levels, as well as other causes of hypercalcemia (such as familial hypocalciuric hipercalcemia or lithium use) must be excluded. Definitive treatment is surgical and involves preoperative imaging localization of parathyroid glands. Patients who do not qualify for surgery may opt for medical therapy. This paper reviews current epidemiological, pathophysiological, clinical, diagnostic, and therapeutic aspects of PHPT.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 252-259"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912689","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}

{"title":"Nuevos métodos de evaluación de la densidad y contenido mineral óseo","authors":"José Canessa García MD","doi":"10.1016/j.rmclc.2025.08.001","DOIUrl":"10.1016/j.rmclc.2025.08.001","url":null,"abstract":"<div><div>New techniques are discussed to complement the conventional assessment of bone mineral density (BMD) performed using radiological bone densitometry (DXA), with the aim of evaluating bone quality and estimating the risk of osteoporotic fracture. These approaches allow for a more accurate clinical assessment of bone health, early and selective initiation of targeted therapy, and monitorization of its progression.</div><div>Complementary to standard DXA studies and fully validated, the 10-year fracture risk estimation tool (FRAX), which incorporates well-established clinical risk factors, and the trabecular bone score (TBS), derived from texture analysis, are available. Hip structural analysis (HSA), although available, has not yet been clinically validated.</div><div>Beyond DXA, which has limitations such as exposure to ionizing radiation (albeit very low), the analysis of bone area rather than volume, and the inability to differentiate cortical from trabecular bone, other imaging modalities include quantitative radiological techniques such as quantitative computed tomography (QCT) and high-resolution peripheral quantitative computed tomography (HR-pQCT), which also involve radiation exposure (with higher doses). Radiaton-free techniques like quantitative ultrasound (QUS), radiofrequency echographic multi-spectrometry (REMS), and quantitative magnetic resonance imaging (QMRI) are also available. These latter methods, to varying extents, provide three-dimensional or volumetric assessments, high-resolution imaging, and the ability to distinguish between cortical and trabecular bone, thereby increasing diagnostic specificity.</div><div>The main limitations of these newer technologies include their high cost, limited availability, and, in some cases, a lack of clinical validation in large population studies. The integration of artificial intelligence into these techniques is expected to revolutionize image analysis and interpretation, as well as the automation of diagnostic processes.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 315-324"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912499","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}

{"title":"Neoplasias endocrinas múltiples: de lo molecular a lo clínico","authors":"Nelson Wohllk MD ,&nbsp;Consuelo Olave MD","doi":"10.1016/j.rmclc.2025.08.012","DOIUrl":"10.1016/j.rmclc.2025.08.012","url":null,"abstract":"<div><div>Multiple Endocrine Neoplasia (MEN) types 1, <strong>2</strong> (subdivided int<strong>o</strong> 2A and 2B), 4, and <strong>5</strong> ar<strong>e</strong> hereditary genetic syndromes with an autosomal dominant inheritance <strong>p</strong>attern. They ar<strong>e</strong> characterized by the development of multiple endocrine tumors, both benign and malignant, affecting various glands, with clinical manifestations that vary depending on the MEN subtype.</div><div>MEN type <strong>1 (</strong><em>MEN1</em>) is associated with inactivating mutations in the <em>MEN1</em> gene and is mainl<strong>y</strong> manifested by <strong>par</strong>athyroid, pituitary<strong>,</strong> and gastroenteropancreatic tumors. Molecular anal<strong>y</strong>sis of the MEN1 gene is indicated in <strong>p</strong>atients with clinical suspicion and their <strong>r</strong>elatives, although the genotype–phenotype correlation <strong>r</strong>emains limited.</div><div>MEN type <strong>2</strong> (MEN2) <strong>r</strong>esults from activating mutations in the proto-oncogene <em>RET</em> and is characterized by medullary thyroid carcinoma (MTC), which is highl<strong>y</strong> penetrant, aggressive, and common <strong>to</strong> all MEN2 subtypes. MEN2A is also associated with pheochromocytoma and hyperparathyroidism, whereas MEN2B includes pheochromocytoma and mucosal neuromas. Prophylactic thyroidectomy is <strong>r</strong>ecommended in childhood <strong>f</strong>or carrier<strong>s</strong> of <em>RET</em> mutations, according <strong>to</strong> the risk stratification defined by the American Thyroid Association. Moreover<strong>,</strong> apparentl<strong>y</strong> sporadic cases of MT<strong>C</strong> may represent undiagnosed MEN2, supporting the systematic anal<strong>y</strong>sis of the RET proto-oncogene.</div><div>MEN type <strong>4</strong> (MEN4), associated with mutations in the <em>CDKN1B</em> gene, presents <strong>a</strong> phenotype similar t<strong>o</strong> MEN1 but with lower severity and later onset.</div><div>MEN type <strong>5</strong> (MEN5), linked <strong>to</strong> mutations in the <em>MAX</em> gene, is mainl<strong>y</strong> associated with hereditary pheochromocytomas and <strong>par</strong>agangliomas.</div><div>Earl<strong>y</strong> diagnosis and <strong>tar</strong>geted genetic <strong>t</strong>esting enable the implementation of surveillance and personalized management strategies, thereby <strong>r</strong>educing morbidity and mortality<strong>.</strong></div><div>The aim of this article is <strong>to r</strong>eview the genetic, clinical, and diagnostic <strong>f</strong>eatures of the main multiple endocrine neoplasia (MEN) syndromes, with emphasis on their classification, specific manifestations, the <strong>r</strong>ole of molecular <strong>t</strong>esting, and earl<strong>y</strong> management strategies aimed at <strong>r</strong>educing associated morbidity and mortality</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 295-305"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912552","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}

{"title":"Ablación de nódulos tiroideos: revisión de la literatura","authors":"Alex Wash Franulic MD","doi":"10.1016/j.rmclc.2025.08.014","DOIUrl":"10.1016/j.rmclc.2025.08.014","url":null,"abstract":"<div><div>The ablation of benign thyroid nodules using minimally invasive techniques has emerged as an effective and safe alternative to conventional surgery. Minimally invasive ablative procedures such as radiofrequency ablation, microwave ablation, laser ablation, and percutaneous ethanol injection allow significant nodule volume reduction (≥ al 50%), improvement of local symptoms and preservation of thyroid function. This article reviews the main guidelines and expert consensuses, including the American Thyroid Association (ATA 2015) Guidelines, the European Thyroid Association Guidelines (ETA 2020), the Korean Society of Thyroid Radiology Consensus (KSThR 2012 and its updates up to 2025), the Chinese Expert Consensus (English version 2020), the Brazilian Consensus (2024) and European and North American articles. In this review the main techniques, indications, clinical outcomes, safety, associated complications and future perspectives are highlighted.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 267-272"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912549","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}

{"title":"Hipofosfatemia","authors":"Pablo Florenzano MD","doi":"10.1016/j.rmclc.2025.08.003","DOIUrl":"10.1016/j.rmclc.2025.08.003","url":null,"abstract":"<div><div>Phosphate is a mineral essential for key functions such as bone mineralization and proper muscle function. Its homeostasis is mainly regulated by parathyroid hormone (PTH), active vitamin D (calcitriol), and fibroblast growth factor 23 (FGF23). Hypophosphatemia can lead to skeletal abnormalities such as rickets or osteomalacia, and systemic symptoms like proximal muscle weakness. The causes are grouped into three mechanisms: intracellular redistribution, decreased intestinal absorption, and increased renal excretion. Diagnosis requires a structured evaluation, including medical history, physical examination, laboratory studies, and eventually FGF23 measurement. Treatment depends on the cause, severity, and symptoms. In hereditary forms such as X-linked hypophosphatemia (XLH), chronic treatment with oral phosphate, calcitriol, and eventually the anti-FGF23 monoclonal antibody, burosumab, is required. A multidisciplinary approach and close follow-up are key to preventing skeletal and systemic complications. The objective of this review is to recognize hypophosphatemia as a relevant metabolic disorder in clinical practice, understanding its pathophysiology, causes, clinical manifestations, diagnosis, and therapeutic options, in order to optimize its detection and timely management.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 325-330"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912500","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}

{"title":"Cáncer de mama HER2-bajo: una nueva era en terapias dirigidas","authors":"Benjamín Walbaum MD ,&nbsp;Francisco Acevedo MD, MSc ,&nbsp;Lidia Medina RN ,&nbsp;César Sánchez MD","doi":"10.1016/j.rmclc.2025.05.003","DOIUrl":"10.1016/j.rmclc.2025.05.003","url":null,"abstract":"<div><div>Breast cancer is a heterogeneous disease that goes beyond traditional clinicopathological classifications. Identifying low and ultra-low levels of HER2 expression through immunohistochemistry, in tumors previously classified as HER2-negative, has led to a paradigm shift in patient management. This reclassification has expanded therapeutic options for a significant proportion of patients, with estimates indicating that over 60% of patients with hormone receptor-positive breast cancers fall into the HER2-low category.</div><div>Trastuzumab deruxtecan, an antibody-drug conjugate, has demonstrated significant survival benefits in patients with advanced HER2-low breast cancer, who, in most cases, were previously candidates solely for chemotherapy following hormonal treatment. However, this therapy is not exempt from toxicity, notably interstitial lung disease/pneumonitis, which can be severe and even fatal in some instances. Early detection of these toxicities and their interdisciplinary management are crucial to optimize clinical outcomes in these patients.</div><div>This article provides an overview of recent advancements in treating patients with HER2-low breast cancer, highlighting pivotal studies and emphasizing the importance of stringent monitoring for toxicities associated with new therapies.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 3","pages":"Pages 210-220"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572255","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}

{"title":"Hospitalización en los pacientes con enfermedad de parkinson","authors":"Marcos E. Franchello MD ,&nbsp;Juan José Paz MD, MSc","doi":"10.1016/j.rmclc.2025.06.005","DOIUrl":"10.1016/j.rmclc.2025.06.005","url":null,"abstract":"<div><div>Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder. It is the third leading cause of disability in individuals over 80 years old and the fifth in those over 60. The incidence and prevalence of Parkinson's disease have significantly increased worldwide from 1990 to 2021. All patients with PD have a significant risk of requiring hospitalizations that demand greater complexity in managing comorbidities, complications, and/or intercurrent conditions. The aim of this brief review is to update the management of patients with PD during hospitalization.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 3","pages":"Pages 163-168"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572251","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}