Síndrome de Cushing / Cushing syndrome

Julio 24, 2017. No. 2759

Síndrome de Cushing Medicina y Laboratario, 2009 PDF MANEJO DE PACIENTES CON SÍNDROME DE CUSHING. Marcos M. Lima-Martínez, José Zerpa, Yorly Guerrero, Jenny Rivera, Marly Vielma Rev Venez Endocrinol Metab 2013; 11(3):147-156 RESUMEN El exceso crónico de glucocorticoides se acompaña de una amplia variedad de signos y síntomas conocidos como síndrome de Cushing. Esta condición, ocurre con mayor frecuencia por causas iatrogénicas cuando los glucocorticoides son usados como terapia antiinflamatoria por tiempo prolongado. El mecanismo patogénico del Cushing endógeno puede dividirse en dependiente o independiente de ACTH. A pesar de los avances en el diagnóstico y tratamiento de esta patología, el síndrome de Cushing continúa siendo un reto para el clínico. En este artículo, basado en niveles de evidencia científica y en la experiencia clínica de la Unidad de Endocrinología del IAHULA, se presenta el protocolo de manejo del Síndrome de Cushing, el cual incluye criterios diagnósticos, manejo clínico y tratamiento de esta condición. Palabras Clave: Síndrome de Cushing, cortisol, ACTH, hipófisis PDF Diferenciación del hipercortisolismo patológico / neoplásico (síndrome de Cushing) del hipercortisolismo fisiológico / no neoplásico (antes conocido como síndrome de pseudo-Cushing). DIAGNOSIS OF ENDOCRINE DISEASE: Differentiation of pathologic/neoplastic hypercortisolism (Cushing's syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing's syndrome). Findling JW1, Raff H2. Eur J Endocrinol. 2017 May;176(5):R205-R216. doi: 10.1530/EJE-16-0946. Epub 2017 Feb 8. Abstract Endogenous hypercortisolism (Cushing's syndrome) usually implies the presence of a pathologic condition caused by either an ACTH-secreting neoplasm or autonomous cortisol secretion from a benign or malignant adrenal neoplasm. However, sustained or intermittent hypercortisolism may also accompany many medical disorders that stimulate physiologic/non-neoplastic activation of the HPA axis (formerly known as pseudo-Cushing's syndrome); these two entities may share indistinguishable clinical and biochemical features. A thorough history and physical examination is often the best (and sometimes only) way to exclude pathologic/neoplastic hypercortisolism. The presence of alcoholism, renal failure, poorly controlled diabetes and severe neuropsychiatric disorders should always raise suspicion that the presence of hypercortisolism may be related to physiologic/non-neoplastic Cushing's syndrome. As late-night salivary cortisol and low-dose dexamethasone suppression have good sensitivity and negative predictive value, normal studies exclude Cushing's syndrome of any form. However, these tests have imperfect specificity and additional testing over time with clinical follow-up is often needed. When there is persistent diagnostic uncertainty, secondary tests such as the DDAVP stimulation test and the dexamethasone-CRH test may provide evidence for the presence or absence of an ACTH-secreting tumor. This review will define and characterize the numerous causes of physiologic/non-neoplastic hypercortisolism and provide a rational clinical and biochemical approach to distinguish it from pathologic/neoplastic hypercortisolism (true Cushing's syndrome). PDF  La mejor práctica actual en el manejo de pacientes después de la cirugía hipofisaria. Current best practice in the management of patients after pituitary surgery. Prete A1, Corsello SM1, Salvatori R2. Ther Adv Endocrinol Metab. 2017 Mar;8(3):33-48. doi: 10.1177/2042018816687240. Epub 2017 Mar 1. Abstract Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment. The perioperative management of AI is influenced by the preoperative status of the hypothalamic-pituitary-adrenal axis. Disorders of water metabolism are another common complication, and they can span from diabetes insipidus, to the syndrome of inappropriate antidiuretic hormone secretion, up to the rare cerebral salt-wasting syndrome. These abnormalities are often transient, but require careful monitoring and management in order to avoid abrupt variations of blood sodium levels. Cerebrospinal fluid leaks, damage to neurological structures such as the optic chiasm, and vascular complications can worsen the postoperative course after transsphenoidal surgery as well. Finally, long-term follow up after surgery varies depending on the underlying pathology, and is most challenging in patients with acromegaly and Cushing disease, in whom failure of primary pituitary surgery is a major concern. When these pituitary functioning adenomas persist or relapse after neurosurgery other treatment options are considered, including repeated surgery, radiotherapy, and medical therapy. KEYWORDS: Cushing disease; diabetes insipidus; hypopituitarism; hypothalamic hormones; hypothalamic neoplasms; hypothalamo-hypophyseal system; pituitary hormones; pituitary neoplasms PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Cirugia trans nasal-transesfenoidal / Transnasal transsphenoidal surgery

Julio 26, 2017. No. 2761

Cambios en los resultados funcionales en la cirugía de adenomas hipofisarios después de la ocurrencia intraoperatoria del reflejo trigeminocárdico: primera descripción en un estudio observacional retrospectivo. Functional Outcome Changes in Surgery for Pituitary Adenomas After Intraoperative Occurrence of the Trigeminocardiac Reflex: First Description in a Retrospective Observational Study. Chowdhury T1, Nöthen C, Filis A, Sandu N, Buchfelder M, Schaller B. Medicine (Baltimore). 2015 Sep;94(37):e1463. doi: 10.1097/MD.0000000000001463. Abstract Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma.  It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice. PDF Efectos de la dexmedetomidina y el sulfato de magnesio en adultos sometidos a endoscópica transnasal transsfenoidal para resección de adenoma hipofisario: Un estudio aleatorizado doble ciego. The effects of dexmedetomidine and magnesium sulphate in adult patients undergoing endoscopic transnasal transsphenoidal resection of pituitary adenoma: A double-blind randomised study. Soliman R1, Fouad E1. Indian J Anaesth. 2017 May;61(5):410-417. doi: 10.4103/ija.IJA_581_16. Abstract BACKGROUND AND AIM: Transnasal transsphenoidal resection of pituitary tumours is associated with blood loss and wide fluctuations in haemodynamic parameters. The aim of the present study was to compare the effect of dexmedetomidine and magnesium sulphate during the transsphenoidal resection of pituitary tumours. METHODS: The study was a double-blind, randomised study and included 152 patients classified randomly into two groups: Group D: Dexmedetomidine was given as a loading dose 1 μg/kg over 10 min before induction followed by an infusion at 0.5 μg/kg/h during the surgery. Group M: Magnesium sulphate was given as loading dose of 50 mg/kg over 10 min followed by an infusion at 15 mg/kg/h during the surgery. The systolic, diastolic and mean arterial blood pressures, in addition to the amount of blood loss were measured at specific timepoints. Data were described in terms of mean ± standard deviation, median, frequencies, 95% confidence of interval of mean and percentages. RESULTS: Mean bleeding score was lower in Group D than Group M (1.36 ± 0.48 vs. 3.05 ± 0.65, respectively; P = 0.002). Mean blood loss was lower in Group D (157.43 ± 48.79 ml vs.299.47 ± 77.28 ml in Group M; P < 0.001)Heart rate, mean arterial pressure, fentanyl requirements, end-tidal sevoflurane concentration, and extubation and emergence times were lower, while incidence of bradycardia and hypotension were higher in Group D. CONCLUSIONS: During transsphenoidal pituitary resection, dexmedetomidine, compared to magnesium, is associated with lower blood loss and better operating conditions but with more hypotension and bradycardia. KEYWORDS: Dexmedetomidine; magnesium sulphate; pituitary adenoma; transsphenoidal resection PDF Efecto de la infiltración intramucosa de diferentes concentraciones de adrenalina en la hemodinámica durante la cirugía transesfenoidal. Effect of intramucosal infiltration of different concentrations of adrenaline on hemodynamics during transsphenoidal surgery. Bhatia N1, Ghai B1, Mangal K1, Wig J1, Mukherjee KK2. J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):520-5. doi: 10.4103/0970-9185.142848. Abstract BACKGROUND AND AIMS: Neurosurgeons routinely instill vasopressors, with or without local anesthetics, to prepare nasal passages prior to transsphenoidal surgeries. As there is a paucity of data comparing the effect of intramucosal nasal infiltration of different concentrations of adrenaline that is, 1:200,000 and 1:400,000 in patients undergoing transsphenoidal surgery, we conducted this study to evaluate the effect of these two concentrations of adrenaline with 2% lignocaine on hemodynamics as well as bleeding. MATERIALS AND METHODS: Fifty-two American Society of Anesthesiologists I/II patients, aged 15-70 years, undergoing transsphenoidalsurgery for pituitary or sellar masses were enrolled. Prior to surgical incision, nasal septal mucosa was infiltrated with lignocaine-adrenaline solution, after randomly allocating them to one of the two groups, with patients in Group A receiving intramucosal infiltration using 2% lignocaine with 1:200,000 adrenaline and those in Group B receiving 2% lignocaine with 1:400,000 adrenaline. Following infiltration, hemodynamic parameters were recorded every 1 min for 5 min and thereafter at every 5 min interval. RESULTS: Fewer patients (3/24 [12.5%]) in Group B had a rise of >50% in systolic blood pressure, from baseline values, after nasal mucosa infiltration as compared with patients in Group A (9/24 [37.5%]). In addition, mean rise in systolic, diastolic and mean arterial pressure was also significantly lower in Group B as compared with Group A. CONCLUSION: Adrenaline in a concentration of 1:400,000 added to 2% lignocaine for nasal mucosa infiltration produces less hemodynamic response as compared with adrenaline 1:200,000 added to 2% lignocaine while at the same time providing similar operating conditions. KEYWORDS: Hemodynamic effects; intramucosal infiltration; lignocaine-adrenaline infiltration; transsphenoidal surgery PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Angulo BIO-RSA (incremento óseo-artroplastia reversa de hombro compensada) : Una solución para el manejo de la perdida ósea glenoidea y la erosión

http://www.lesionesdeportivas.com.mx/academia/angulo-bio-rsa-incremento-oseo-artroplastia-reversa-de-hombro-compensada-una-solucion-para-el-manejo-de-la-perdida-osea-glenoidea-y-la-erosion/

Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management glenoid bone loss and erosion

Fuente:

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28735842

http://www.jshoulderelbow.org/article/S1058-2746(17)30310-5/fulltext

De:

Boileau P1,Morin-Salvo N2,Gauci MO2,Seeto BL2,Chalmers PN3,Holzer N4,

Walch G5.

J Shoulder Elbow Surg. 2017 Jul 20. pii: S1058-2746(17)30310-5. doi: 10.1016/j.jse.2017.05.024. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Abstract

BACKGROUND:

Glenoid deficiency and erosion (excessive retroversion/inclination) must be corrected in reverse shoulder arthroplasty (RSA) to avoid prosthetic notching or instability and to maximize function, range of motion, and prosthesis longevity. This study reports the results of RSA with an angled, autologous glenoid graft harvested from the humerus (angled BIO-RSA).

CONCLUSION:

Angled BIO-RSA predictably corrects glenoid deficiency, including severe (>25°) multiplanar deformity. Graft incorporation is predictable. Advantages of using an autograftharvested in situ include bone stock augmentation, lateralization, low donor-site morbidity, low relative cost, and flexibility needed to simultaneously correct posterior and superior glenoid defects.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Glenoid bone loss; bony lateralization; bony-increased offset reverse shoulder arthroplasty (BIO-RSA); glenoid erosion; glenoid inclination; glenoid retroversion; reverse total shoulder arthroplasty

Resumen

ANTECEDENTES:

La deficiencia glenoidea y la erosión (retroversión / inclinación excesiva) deben ser corregidas en la artroplastia reversa del hombro (RSA) para evitar la muesca protésica o inestabilidad y para maximizar la función, el rango de movimiento y la longevidad de la prótesis. Este estudio reporta los resultados de RSA con angulación con un injerto glenoideo, autólogo, recolectado del húmero (angulado BIO-RSA).

CONCLUSIÓN:
La BIO-RSA angulada corrige de forma predecible la deficiencia glenoide, incluyendo una deformidad multiplanar severa (> 25 °). La incorporación del injerto es predecible. Las ventajas de usar un autoinjerto in situ incluyen aumento de la masa ósea, lateralización, baja morbilidad del donante, bajo costo relativo y flexibilidad necesaria para corregir simultáneamente los defectos glenoides posteriores y superiores.

Copyright © 2017 Los Autores. Publicado por Elsevier Inc. Todos los derechos reservados.

PALABRAS CLAVE:
Pérdida ósea glenoidea; Lateralización ósea; incremento óseo-artroplastia reversa de hombro compensada(BIO-RSA); Erosión glenoide; Inclinación glenoide; Retroceso glenoideo; Artroplastia total del hombro reversa

PMID:  28735842   DOI:  

10.1016/j.jse.2017.05.024

#Pérdida ósea glenoidea#Lateralización ósea#Erosión glenoide#artroplastia reversa#hombro