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La diabetes tipo 2 es una enfermedad caracterizada por una hiperglucemia crónica secundaria a un doble mecanismo patogénico: resistencia a la acción de la insulina asociada a un fallo progresivo en la secreción pancreática de insulina. La resistencia insulínica suele mantenerse a lo largo de la evolución de la enfermedad, pero puede mejorar con modificaciones en el estilo de vida (terapia nutricional y ejercicio), con la consecución de unas características antropométricas más favorables y con algunos fármacos. El fallo progresivo de la secreción de insulina pancreática aconseja adoptar una actitud precoz y activa, con un incremento progresivo de la dosis y el número de fármacos para mantener los objetivos de control. Algunas sociedades científicas1-6 han elaborado consensos con recomendaciones sobre objetivos de control, escalonamiento de los distintos fármacos y adaptación de ambos a las características del paciente. Entre ellos, existen algunas concordancias y discrepancias, dada la dificultad que representa la ausencia de ensayos clínicos aleatorizados y con potencia suficiente que comparen directamente las distintas pautas terapéuticas recomendadas. Por ello, la Junta Directiva de la Sociedad Española de Diabetes (SED) decidió encargar a nuestro Grupo de Trabajo la elaboración de un documento que adaptara lo más posible las evidencias disponibles y las distintas recomendaciones a la situación en nuestro país, teniendo en cuenta que la decisión terapéutica definitiva dependerá en cada momento del médico, que deberá individualizar el tratamiento según las características del paciente en cuestión. El Grupo de Trabajo se ha planteado que el presente documento debe ser dinámico y que ha de actualizarse periódicamente, de acuerdo con las evidencias que vayan surgiendo y con las sugerencias de los miembros de la SED.

Introduction and Objectives: Several types of lipoproteins beyond low-density lipoproteins (LDL) are causally related to cardiovascular disease. We aimed to analyze an advanced lipoprotein profile in individuals with normal and impaired glucose metabolism from different cohorts of a Mediterranean region., Methods: Cross-sectional study in 929 participants (463 normoglycemia, 250 prediabetes, and 216 type 2 diabetes mellitus) with normal renal function, free from cardiovascular disease, and without lipid-lowering treatment. Conventional and advanced (nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analyzed., Results: Compared with men, normoglycemic women showed lower serum triglyceride and LDL cholesterol concentrations, lower total LDL particles (P) as well as their subclasses and their cholesterol and triglyceride content, higher high-density lipoproteins (HDL)-P and all HDL-related variables (P≤ .05 for all comparisons). Compared with normoglycemic participants, diabetic participants showed higher large and small very LDL-P concentrations (P <.05) and lower total HDL-P and medium HDL-P concentrations (P <.05). Waist circumference and Fatty Liver Index were positively associated with a proatherogenic profile., Conclusions: Women had a better advanced lipoprotein profile than did men. Adiposity indexes related to insulin-resistance were positively associated with a proatherogenic lipid profile. NMR revealed altered lipoprotein particles other than LDL in participants with diabetes, frequently associated with an increased cardiovascular risk. Our findings support the usefulness of extended lipoprotein analysis by NMR spectroscopy to uncover new therapeutic targets to prevent cardiovascular events in at-risk participants., (Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Pituitary neuroendocrine tumors (PitNETs) constitute, together with other tumors of the sellar region, 15-25% of intracranial neoplasms. In 2017, the World Health Organization proposed a new classification of PitNETs. The main innovation with respect to the 2004 classification was the recommendation to include in the immunohistochemical evaluation of PitNETs the determination of the transcription factors of the 3 pituitary cell lineages: Pit-1, Tpit and SF-1. Additionally, other clinicopathological classifications with a predictive capacity of tumor behavior during follow-up were proposed. Given these changes, it is appropriate to adapt the knowledge generated during the last 15 years to the daily practice of the treatment and monitoring of PitNETs at the Centers of Excellence in Pituitary Pathology. This document includes the positioning of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Society of Pathology (SEAP) on the classification and denomination of the PitNETs and the information that the pathologist should provide to the clinician to facilitate the treatment and monitoring of these tumors., (Copyright © 2021 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To evaluate the long-term efficacy of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts., Patients and Methods: 100 subjects (48±12 years; 58% women) with symptomatic thyroid cysts relapsing after drainage were prospectively included. PEIT was conducted using an established procedure, and the initial cyst volume, symptoms and pain perceived by the patient were assessed. The volume of instilled alcohol was ≤2ml without re-extraction in all cases. Patients were followed-up for more than 3 years and final cyst volume and symptom improvement were assessed., Results: Mean maximum cyst diameter before drainage was 3.1±1.2cm. In 71% of patients ≤2 PEIT sessions were required. Median maximum cyst volume was 12.7 (5.4-21.7)ml before the first drainage and median total volume extracted from the cysts was 13.0 (6.2-37.0)ml. After a mean follow-up period of 52±10 months, 98% of patients reported a complete absence of symptoms. The final median volume for the whole group was 0.8 (0.1-2.0)ml with a median volume reduction of 94 (81-99)%. A final volume reduction greater than 65% was observed in 90% of cases. Reported pain during the procedure was absent or mild in 76.4% of cases., Conclusions: PEIT is a safe and well-tolerated first-line treatment for symptomatic thyroid cysts with long-term effectiveness., (Copyright © 2020 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To seek a consensus on issues that may generate doubts in management of acromegaly in Spain., Method: Nominal groups and Delphi. Four experts defined relevant issues in management of acromegaly and generated different assertions and recommendations. Subsequently, a group of 30 additional experts was selected to test agreement with the assertions through two Delphi rounds. The following response categories were established: 1) Totally disagree; 2) Basically disagree; 3) Basically agree; 4) Totally agree. Agreement was defined as ≥70% of answers in categories 1 and 2 (consensus with the disagreement) or 3 and 4 (consensus with the agreement) in the second Delphi round., Results: Assertions covers various aspects of clinical practice, including: 1) Useful instruments in individualization of treatment (response predictive markers, imaging techniques, etc.); 2) Clinical profiles and relevant comorbidities in treatment individualization; 3) Role of patient in treatment decision-making; 4) Access to treatments (accessibility and equity). The first Delphi round included 35 assertions. Consensus was reached on six of these assertions, two were eliminated, and two were reformulated. Of the 27 assertions included in the second round, consensus was reached on 24 (22 in the agreement, two in the disagreement) and three were eliminated., Conclusions: This document is intended to solve some common clinical questions and to facilitate decision making in the management of patients with acromegaly., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

The prevalence of type 2 diabetes mellitus (DM2) increases markedly with age. Antidiabetic treatment and the objectives of glycaemic control in elderly patients with DM2 should be individualised according to their biopsychosocial characteristics. In elderly patients for whom the benefits of intensive antidiabetic treatment are limited, the basic objectives should be to improve the quality of life, preserve functionality and avoid adverse effects, especially hypoglycaemia. Treatment of DM2 in the elderly was the subject of a consensus document published in 2012 and endorsed by several Spanish scientific societies. Since then, new therapeutic groups and evidence have emerged that warrant an update to this consensus document. The present document focuses on the therapeutic aspects of DM2 in elderly patients, understood as being older than 75 years or frail., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

There is currently no consensus among the different scientific societies on screening for thyroid dysfunction in the first trimester of pregnancy. Indeed, diagnosis and treatment of subclinical hypothyroidism during pregnancy are controversial, as no cut-off value for thyrotropin (TSH) is universally accepted. TSH measurement may be influenced by different factors throughout pregnancy, but especially during the first trimester. The association between overt hypothyroidism during pregnancy and obstetric and perinatal complications is well established. It is also accepted that thyroid hormones are important for neurodevelopment of the offspring. However, there is no scientific evidence available about the impact of subclinical hypothyroidism and its treatment during the first trimester of pregnancy on children's neurodevelopment. In recent years, studies conducted in the offspring of mothers with subclinical hypothyroidism have reported new biochemical parameters which may eventually serve as biomarkers of offspring neurodevelopment and which are more reproducible and are measured at an earlier time than the conventional clinical tests., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To describe real-world use of lanreotide combination therapy for acromegaly., Patients and Methods: ACROCOMB is a retrospective observational Spanish study of patients with active acromegaly treated with lanreotide combination therapy between 2006 and 2011. 108 patients treated at 44 Spanish Endocrinology Departments were analyzed separately: 61 patients received lanreotide/cabergoline (cabergoline cohort) and 47 lanreotide/pegvisomant (pegvisomant cohort)., Results: Patient median age was 50.8 years in the cabergoline cohort and 42.7 years in the pegvisomant cohort. Prior medical treatments were somatostatin analogue (SSA) monotherapy (40 [66%] patients) or dopamine agonists (7 [11%] patients) in the cabergoline cohort and SSA (29 [62%] patients) or pegvisomant monotherapy (16 [34%] patients) in the pegvisomant cohort. Across both cohorts 12 patients were previously untreated, and prior therapy was unknown/missing in 4 patients. Median duration of combined treatment was 1.6 years (0.1-6) and 2.1 years (0.4-6.3) in the cabergoline and pegvisomant cohorts, respectively. At baseline, median insulin growth factor (IGF)-I values were 149% upper limit of normal (ULN) (15-505%) in the cabergoline cohort and 156% ULN (15-534%) in the pegvisomant cohort, and decreased to 104% ULN (13-557%) p<0.001 and 86% ULN (23-345%) p<0.0001, respectively, at end of study (EOS). Normal age-adjusted values of IGF-I were obtained in 48% of lanreotide/cabergoline-treated patients and 70% of lanreotide/pegvisomant-treated patients at EOS. There were no significant changes in hepatic, cardiac or glycaemic parameters in either cohort., Conclusion: In clinical practice lanreotide treatment combinations are useful options for patients with acromegaly when monotherapy is insufficient; particularly, the combination of lanreotide and pegvisomant in patients not controlled with either SSA or pegvisomant alone has high efficacy and is well-tolerated., (Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Pituitary adenomas are uncommon, difficult to diagnose tumors whose heterogeneity and low incidence complicate large-scale studies. The Molecular Registry of Pituitary Adenomas (REMAH) was promoted by the Andalusian Society of Endocrinology and Nutrition (SAEN) in 2008 as a cooperative clinical-basic multicenter strategy aimed at improving diagnosis and treatment of pituitary adenomas by combining clinical, pathological, and molecular information. In 2010, the Spanish Society of Endocrinology and Nutrition (SEEN) extended this project to national level and established 6 nodes with common protocols and methods for sample and clinical data collection, molecular analysis, and data recording in a common registry (www.remahnacional.com). The registry combines clinical data with molecular phenotyping of the resected pituitary adenoma using quantitative real-time PCR of expression of 26 genes: Pituitary hormones (GH-PRL-LH-FSH-PRL-ACTH-CGA), receptors (somatostatin, dopamine, GHRH, GnRH, CRH, arginine-vasopressin, ghrelin), other markers (Ki67, PTTG1), and control genes. Until 2015, molecular information has been collected from 704 adenomas, out of 1179 patients registered. This strategy allows for comparative and relational analysis between the molecular profile of the different types of adenoma and the clinical phenotype of patients, which may provide a better understanding of the condition and potentially help in treatment selection. The REMAH is therefore a unique multicenter, interdisciplinary network founded on a shared database that provides a far-reaching translational approach for management of pituitary adenomas, and paves the way for the conduct of combined clinical-basic innovative studies on large patient samples., (Copyright © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved.)

Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) has led to a growing interest in the investigation of new therapies. Treatment of T2DM has focused on the insulinopenia and insulin resistance. However, in the last 10 years, new lines of research have emerged for the treatment of T2DM and preclinical studies appear promising. The possibility of using these drugs in combination with other currently available drugs will enhance the antidiabetic effect and promote weight loss with fewer side effects. The data provided by post-marketing monitoring will help us to better understand their safety profile and potential long-term effects on target organs, especially the cardiovascular risk., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Introduction: The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC)., Patients and Methods: The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012)., Results: In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p<0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion., Conclusions: Patient characteristics analyzed are similar to those reported in other parts of the world., (Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.)

Glucagon-like peptide-1 receptor agonists (GLP-1ra) are a new group of drugs with a glucose-lowering action due to their incretin effect. The GLP-1 receptor is expressed in various human tissues, which could be related to the pleiotropic effects of human GLP-1, as well as to the adverse effects described in patients treated with GLP-1ra. The risk of hypoglycaemia is low, which is one of the main considerations in the safety of this family of compounds and is also important to patients with diabetes. The most frequent adverse effect is nausea, which usually occurs at the start of treatment and is transient in 20-60% of affected patients. This article also reviews the information available on antibody formation, the potential effect on the thyroid gland, and the controversial association between this group of drugs with pancreatitis and cancer., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Advances in molecular biology have discovered new genes involved in the development of familial paraganglioma syndrome (PGL) including those encoding mitochondrial succinate dehydrogenase complex (SDH). We describe the diagnosis, clinical expression and genetic counselling in a family diagnosed of PGL due to a new SDHB mutation., Patients and Method: Genetic study by PCR-direct sequencing SDHB gene and biochemical determination in blood/urine fractionated catecholamine 24h, metanephrines and conventional (computed tomography/magnetic resonance imaging) and functional imaging ((123)I-MIBG) in all members of a family diagnosed of PGL., Result: DNA sequencing showed a non-described SDHB heterozygous mutation (c.287-3C>G intron3/exon4) in 5 of the subjects (71%). The estimated penetrance of the mutation's carriers was 40%, with a mean age of 35 years at diagnosis. All patients with active illness required surgical treatment after imaging and laboratory confirmation., Conclusions: We describe the pathogenicity, diagnostic algorithm, genetic counselling and clinical expression of a new SDHB mutation (c.287-3C>G) in a family diagnosed of PGL., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Adrenal insufficiency (AI) is a rare endocrine disease, associated to increased mortality if left untreated. It can be due to a primary failure of the adrenal glands (primary AI) or malfunctioning of the hypothalamic-pituitary-adrenal axis (HPA) (secondary AI). The lack of data on incidence/prevalence of adrenal insufficiency in Spain complicates any evaluation of the magnitude of the problem in our country. Initial symptoms are non-specific, so often there is a delay in diagnosis. Current therapy with available glucocorticoids is associated with decreased quality of life in patients with treated AI, as well as with increased mortality and morbidity, probably related to both over-treatment and lack of hydrocortisone, associated with non-physiological peaks and troughs of the drug over the 24 hours. The availability of a new drug with a modified dual release (immediate and retarded), that requires one only daily dose, improves and simplifies the treatment, increases compliance as well as quality of life, morbidity and possibly mortality. This revision deals with the knowledge on the situation both globally and in Spain, prior to the availability of this new drug., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

There is a controversy among different scientific societies in relation to the recommendations on whether universal screening for the detection of thyroid dysfunction during gestation should be performed or not. Although various studies have shown an association between subclinical hypothyroidism or hypothyroxinemia with obstetric problems and/or neurocognitive impairment in the offspring, no evidence on the possible positive effects of treatment of such conditions with thyroxin has been demonstrated so far. However, there is a general agreement about the need for treatment of clinical hypothyroidism during pregnancy and the risks of not doing so. Because it is a common, easily diagnosed and effectively treated disorder without special risk, the working Group of Iodine Deficiency Disorders and Thyroid Dysfunction of the Spanish Society of Endocrinology and Nutrition and Spanish Society of Gynaecology and Obstetrics recommends an early evaluation (before week 10) of thyroid function in all pregnant women. Given the complex physiology of thyroid function during pregnancy, hormone assessment should be performed according to reference values for each gestational trimester and generated locally in each reference laboratory. Thyrotropin determination would be sufficient for screening purposes and only if it is altered, free thyroxin or total thyroxin would be required. Adequate iodine nutrition is also highly recommended before and during pregnancy to contribute to a normal thyroid function in the pregnant women and fetus.

Introduction: Most of the studies on urinary iodine levels in Spain in the last decade have reported a significant improvement. A survey was undertaken together with an information campaign on the thyroid gland, the importance of iodine intake and hypothyroidism in four Spanish cities. The goals of the survey were to obtain information on consumption of iodine-containing foods, to measure urinary iodine levels and to evaluate the prevalence of thyroid dysfunction., Materials and Methods: A non-preselected population attending the information campaign centers located in Barcelona, La Coruña, Malaga and Madrid was studied. A questionnaire on fish, milk and iodized salt consumption was administered. Urinary iodine levels (Pino's method) and thyrotropin (TSH) concentrations (Whatman 903® dry paper method) were measured., Results: A total of 872 questionnaires were completed (Madrid 40%; La Coruña 27%; Malaga 19%; and Barcelona 14%). The mean age was 51 years (SD 16); 81% were women. A total of 60.6% of interviewees reported they consumed iodized salt, 90.8% reported daily milk intake and 29.3% reported fish consumption ≥3 times per week. The mean urinary iodine concentration was 143.2 μg/L. The prevalence of high TSH levels (>4 mUI/L) was 1.3% and that of low TSH levels (<0.4 mUI/mL) was 1.2%., Conclusions: According to the World Health Organization criteria, the median urinary iodine concentration, both overall or by city, is indicative of optimal iodine intake. In addition to iodized salt intake, consumption of products such as milk and fish has probably contributed to these positive results. The prevalences of undiagnosed hyperthyroidism and hypothyroidism detected in this study were similar to those found in other studies., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)

Background and Objective: There is little national literature on descriptive series of patients with differentiated thyroid carcinoma (DTC) and long-term monitoring in Spain. The aim of our study was to describe the DTC series in two tertiary hospitals [Hospital Clínic de Barcelona (HC) and Hospital Germans Trias i Pujol (HGTiP)] and compare these series with those described in the National Cancer Data Base (NCDB) and the Mayo Clinic, the leading international series by number of patients and length of follow-up., Material and Methods: We performed a retrospective review of the medical records of patients diagnosed with DTC in two tertiary hospitals in the Barcelona area. The results were compared with those published by the NCDB and the Mayo Clinic., Results: We reviewed 480 medical records of patients with DTC diagnosed between 1973 and 2006, with a mean follow-up of 16±8 years. No significant differences were observed in clinical characteristics, risk factors or the most frequent form of presentation between the joint HC/HGTiP group and the NCDB series. The most commonly used diagnostic methods were ultrasound and cytology in all series and the main type of surgery was total or nearly total thyroidectomy, with no differences between groups. Postoperative I-131 was administered more often in the HC/HGTiP series (83.9%) than in the NCDB series (55.1%) and in the Mayo Clinic (46%). In the HC/HGTiP group tumor recurrence was 9.3% and mortality 1.8%., Conclusions: The HC and HGTiP series were comparable and the various diagnostic and therapeutic techniques used were similar. This study highlights historical trends in the use of imaging techniques, as well as differences with large American series in some procedures (such as laryngoscopy) and the use of radioiodine therapy., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: To explore the opinion of clinical endocrinologists as to the deleterious effects of thyrotropin (TSH) suppressive therapy in patients with differentiated thyroid carcinoma (DTC)., Materials and Methods: A self-administered survey was sent by e-mail to a group of endocrinologists with expertise in the treatment of patients with differentiated thyroid carcinoma. The questionnaire consisted of three questions related to: 1) the possible adverse effects of this therapy on different organ systems, 2) the clinical significance of these effects and 3) the usefulness of treatment guidelines for DTC., Results: A total of 91 endocrinologists responded with a wide divergence of opinions. No question had more than 80% of answers in a particular option. Of the possible side effects of suppressive therapy, a high degree of ignorance to three of them (increased left ventricular mass, reentrant tachycardia and diastolic dysfunction). Most respondents felt that the seven items, dementia and Alzheimer, decreased quality of life, decreased bone mineral density (BMD) in premenopausal women and men, thromboembolic disease, signs and symptoms of hyperthyroidism and increased risk of fractures were not affected by suppressive therapy, while most responded positively to two items (increased heart rate and decreased BMD in postmenopausal women). Eighty percent of the respondents felt that in any case these effects were not clinically significant and 33% considered that treatment guidelines should be reviewed., Conclusions: Clinical endocrinologists seem to have a very heterogeneous opinion regarding the potential harmful effects of TSH-suppressive therapy for DTC., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: To study the potential associations among circulating insulinlike growth factor 1 (IGF-1) and adrenal and gonadal steroids with cognitive status and depression in a group of independently-living elders., Design: Population-based cross sectional study., Methods: A total of 313 individuals (160 women and 153 men, with a mean age of 76.7±7 years) participated in this study. A physical examination, assessment of functional capacity, cognitive function, depression, educational level and measurement of plasma cortisol, dehydroepiandrosterone (DHEA) and its sulphate (DHEAs), testosterone, estradiol, and IGF-1 were performed., Results: In women, adrenal steroids showed a negative correlation with global cognition (β=-0.79; p=0.03 for DHEA and β=-0.27; p=0.002 for cortisol). A positive correlation with IGF-1 (β=0.026; p=0.04) was found for cognition in women after adjustment for depression. For memory function, DHEA correlated negatively but no relationship with IGF-1 and cortisol was observed. No relationships with cognition were observed in men for any of the steroids or other hormones studied. Educational level showed the highest protective effect (odds ratio [OR] = 6.25) for preserved cognition for both sexes; in women, OR for deteriorated cognition with age, DHEA and cortisol were 1.14, 1.57 and 1.09, respectively. No associations between depression and hormonal profile were found in either sex., Conclusions: Educational level was positively associated with cognitive function in independently-living elderly men and women, while adrenal steroids were associated with impaired cognition in elderly women but not in men. The hormonal milieu seemed to have little or no influence on depression in the men and women studied., (Copyright © 2008 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.)

Background and Objective: The metabolic syndrome (MS) is a constellation of factors apparently associated to an increased cardiovascular risk, and with a reported increasing prevalence in parallel with aging process. The aim of this study was to assess the prevalence of MS in elder subjects according to the criteria of the National Education Program (ATP-III) and the International Diabetes Federation (IDF)., Subjects and Method: Population-based cross-sectional study including 313 individuals (153 men and 160 women) older than 70 years. The prevalence of MS was evaluated according to both definitions and its association with cardiovascular disease (CD) was investigated., Results: MS was observed in 50.2% of subjects according to ATP-III (41.5% of men and 58.6% of women; p = 0.004) and in 57.9% when using IDF criteria (54.9% of men and 61% of women; p = 0.29). Prevalence differences were observed between ATP-III and IDF only in men. No differences were found in the frequencies of the different components of the MS for the 2 definitions, neither for tobacco consumption, ethanol intake and educational level. There was no differences in the coexistence of CD in relation the presence or absence of MS, no matter the definition used; also, no special association with CD was found for any of the individual components of the MS., Conclusions: Among a representative population sample of old people living in a Mediterranean community, despite a very high frequency of MS, there was no excess prevalence of CD in those identified as having MS.

The epidemic characteristics of type 2 diabetes mellitus (DM) pose a formidable challenge in terms of healthcare, given the tremendous impact it has on the healthcare resources needed not only to treat it, but also to prevent and treat the associated cardiovascular complications. This makes up the number 1 cause of DM-associated morbidity-mortality in addition to its social and personal impact. We currently have a growing number of available treatment tools that make it possible to achieve the target glycemic control in most of our patients, albeit unfortunately, only temporarily in a good many of them, because of the progressive nature of the disease. Furthermore, current therapy often entails undesirable effects, such as weight gain or the emergence of hypoglycemias that limit their optimization. Recently, a new class of drugs has been incorporated into the treatment of DM - incretin mimetics. These new drugs act in very much the same way as the intestinal hormones that are naturally secreted following the intake of nutrients, called incretins (e.g., glucagon like peptide-1 [GLP-1]), with the added advantage that these molecules are resistant to enzymatic degradation by the DPP-IV enzyme. This provides them with a half-life that makes ambulatory treatment possible, unlike natural incretins whose half-life is too short to make them viable as treatment. The incretin mimetics bind to GLP-1 receptors, increasing glucose-dependent secretion of insulin and decreasing glucose-dependent posprandial secretion of glucagon, slowing gastric emptying, and reducing food intake. All these mechanisms have a significant impact on glucose homeostasis and a beneficial effect on body weight. Moreover, studies in experimental models suggest that these new molecules might have a promising effect on pancreatic beta cell function and mass. Exenatide is the first incretin mimetic available to date. Efficacy and safety data of this drug show it as a therapeutic option for the treatment of type 2 DM.

Objective: To estimate the epidemiology of transsexualism in the autonomous community of Catalonia according to data gathered at the Hospital Clinic of Barcelona, the single public hospital providing specialized psychiatric and endocrinological care for transsexual patients in this community., Patients and Methods: Prevalence was calculated on the basis of the total number of patients diagnosed of transsexualism (ICD-10, F64.0) at the Hospital Clinic and living in Catalonia, and the incidence by counting all new cases of transsexuals for the last 5 years, based on the population census between 15 and 65 years of age., Results: During the period from 1996 through 2004 a total of 201 subjects were referred to this hospital with complaints of gender dysphoria. Transsexualism was diagnosed in 182 patients, 161 of whom were living in Catalonia. This yields a prevalence rate in Catalonia of 1:21,031 males and 1:48,096 females. The sex ratio was 2.6. Annual incidence in the last five years was 0.73/100,000/year., Discussion: The low prevalence compared with recently published data from European Union countries may be due to the relatively few years of data collection and to the low clinical demand because surgical procedures costs are not covered by the public health insurance. In contrast, the high incidence may be due to the increasing demand since 2000, when a more benevolent and tolerant social climate in Spain started.