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Abstract Background Pituitary adenomas (PA) are the second most common intracranial tumors and are classified according to hormone they produce, and the transcription factors they express. The majority of PA occur sporadically, and their molecular pathogenesis is incompletely understood. Methods Here we performed transcriptome and proteome analysis of tumors derived from POU1F1 (GH-, TSH-, and PRL-tumors, N = 16), NR5A1 (gonadotropes and null cells adenomas, n = 17) and TBX19 (ACTH-tumors, n = 6) lineages as well as from silent ACTH-tumors (n = 3) to determine expression of kinases, cyclins, CDKs and CDK inhibitors. Results The expression profiles of genes encoding kinases were distinctive for each of the three PA lineage: NR5A1-derived tumors showed upregulation of ETNK2 and PIK3C2G and alterations in MAPK, ErbB and RAS signaling, POU1F1-derived adenomas showed upregulation of PIP5K1B and NEK10 and alterations in phosphatidylinositol, insulin and phospholipase D signaling pathways and TBX19-derived adenomas showed upregulation of MERTK and STK17B and alterations in VEGFA-VEGFR, EGF-EGFR and Insulin signaling pathways. In contrast, the expression of the different genes encoding cyclins, CDK and CDK inhibitors among NR5A1-, POU1F1- and TBX19-adenomas showed only subtle differences. CDK9 and CDK18 were upregulated in NR5A1-adenomas, whereas CDK4 and CDK7 were upregulated in POUF1-adenomas. Conclusions The kinome of PA clusters these lesions into three distinct groups according to the transcription factor that drives their terminal differentiation. And these complexes could be harnessed as molecular therapy targets.

Objetivo: Identificar en la resonancia magnética (RM) al diagnóstico características asociadas con resistencia a cabergolina. Material y métodos: De una clínica especializada en prolactinomas, se incluyeron 30 pacientes sensibles a cabergolina y 17 con resistencia (no normalizaron la prolactina [PRL] ni disminuyeron mas del 50% del tamaño tumoral). Resultados: No se encontró diferencia en la proporción de mujeres (30 vs. 29%), ni en la edad (32 vs. 33) entre los grupos sensible y resistente a cabergolina. La PRL al diagnóstico fue de 1,982 ng/ml (intervalo intercuartílico [RIC]: 581-5,373) vs. 1,541 ng/ml (RIC: 454-4,019), respectivamente (p = 0.78). El eje mayor de las lesiones sensibles (32 mm) no mostró diferencia significativa con el de las lesiones resistentes (36 mm), el volumen tampoco mostró diferencia, 10.3 cm3 (3.1-15.3) vs. 18.3 cm3 (5.1-26.9), respectivamente. En la RM se compararon las siguientes características: composición, escala de Knosp, intensidad en ponderación T1 simple y contrastada, en ponderación T2, así como la presencia de áreas quísticas y de sangrado. Ninguna de estas características mostró diferencia significativa entre los grupos. Conclusiones: No fue posible identificar características en la RM al diagnóstico de los prolactinomas que tuvieran asociación con la resistencia a cabergolina en el tratamiento.

La enfermedad de Cushing es la causa más frecuente de hipercortisolismo endógeno. Es ocasionada por un tumor hipofisario productor de hormona adrenocorticotrópica. En algunos casos se asocia a un estado severo de morbilidad y a tasas elevadas de mortalidad. El pronóstico puede verse modificado por dificultades en el diagnóstico y tratamiento. El presente trabajo es el resultado de los acuerdos tomados por el Grupo de Trabajo de Neuroendocrinología de la Sociedad Mexicana de Nutrición y Endocrinología durante las reuniones que tuvieron como objetivo el señalar la posición del grupo respecto al diagnóstico y tratamiento de la enfermedad de Cushing.

La hiperprolactinemia es una causa muy frecuente de consulta en la práctica cotidiana, pero solamente en algunos casos de hiperprolactinemia significativa y persistente se puede identificar un adenoma del lactotropo como la causa. En este trabajo se presentan algunas recomendaciones de abordaje, diagnóstico y tratamiento de la hiperprolactinemia/ prolactinoma, con énfasis en escenarios de difícil decisión o en situaciones especiales como el embarazo o la edad pediátrica. Sin pretender ser considerado una guía clínica o un consenso, la Sociedad Mexicana de Nutrición y Endocrinología A. C., y en particular el Grupo de Trabajo en Neuroendocrinología, presentan este documento en el que se sintetiza información reciente y relevante que ha sido analizada y organizada por especialistas relacionados con el tema.

Abstract Background Currently, bariatric surgery is the most effective treatment for severe obesity and its metabolic complications; however, 15–35% of the patients that undergo bariatric surgery do not reach their goal for weight loss. The aim of this study was to determine the proportion of patients that didn’t reach the goal of an excess weight loss of 50% or more during the first 12 months and determine the factors associated to this failure. Methods We obtained the demographic, anthropometric and biochemical information from 130 patients with severe obesity who underwent bariatric surgery in our institution between 2012 and 2017. We used self-reports of physical activity, caloric intake and diet composition. An unsuccessful weight loss was considered when the patient lost

Abstract Background Mexico has one of the highest prevalence rates of obesity worldwide. New pharmacological strategies that focus on people with class III obesity are required. Metformin and dapagliflozin are two drugs approved for the treatment of diabetes. Beyond its effects on glucose, metformin has been suggested by some studies to result in weight loss. Therapy with dapagliflozin is associated with a mild but sustained weight loss in patients with diabetes. The primary outcome of the study is to determine if the combined treatment with dapagliflozin and metformin is more effective than monotherapy with metformin for weight loss in patients with class III obesity and prediabetes or diabetes who are awaiting bariatric surgery (including those patients who do have surgery). We also aimed to assess the effect of this combined treatment on waist circumference, triglycerides, blood pressure, and inflammatory cytokines. Methods This randomized phase IV clinical trial will include patients with diabetes or prediabetes who are between the ages of 18 and 60 years and exhibit grade III obesity (defined as body mass index ≥ 40 kg/m2). Patients using insulin will be excluded. Subjects will be randomized to one of two groups as follows: 1) metformin tablets 850 mg PO bid or 2) metformin tablets 850 mg PO bid plus dapagliflozin tablets 10 mg PO qd. The sample size required is 108 patients, which allows for a 20% dropout rate: 54 patients in the metformin group and 54 in the metformin/dapagliflozin group. All participants will receive personalized nutritional advice during the study. A run-in period of one month will be used to assess tolerance and adherence to treatment regimens. Anthropometric and biochemical variables will be recorded at baseline and at 1, 3, 6, and 12 months. A serum sample to determine glucagon, ghrelin, adiponectin, resistin, interleukin 6, and interleukin 10 will be collected at baseline and before surgery, or at 12 months (whatever happens first). Adherence to treatment and adverse and secondary events will be recorded throughout the study. An intention-to-treat analysis will be used. Discussion Forty-six percent of the patients in our Obesity Clinic have been diagnosed with prediabetes (32%) or diabetes (14%). The use of dapagliflozin in this population could improve weight loss and other cardiovascular factors. This effect could be translated into less time before undergoing bariatric surgery and better control of associated comorbidities. Trial registration Clinicaltrials.gov, ID: NCT03968224. Retrospectively registered on May 29, 2019.

Background. Nonfunctioning pituitary adenomas (NFPAs) are the most common benign lesions of the pituitary gland. Objective. To describe our experience with the management of NFPA. Study Design and Methods. Retrospective evaluation of NFPA patients managed between 2008 and 2013. We analyzed data regarding clinical presentation, imaging diagnosis, hormonal status, surgical, radiotherapeutic, and pharmacological treatment, and outcome. Results. 485 patients (54% men, mean age 53±14 years) were followed for a median of 6.5 years. Visual field abnormalities and headaches were the presenting complaints in 87% and 66%, respectively. The diagnosis of NFPA was made incidentally in 6.2%, and 8% presented with clinical evidence of apoplexy. All patients harbored macroadenomas, with a median volume of 10306 mm3; 57.9% had supra- or parasellar invasion and 19.6% had tumors larger than 4 cm. Central hypothyroidism, hypogonadism, and hypocortisolism were present in 47.2%, 35.9%, and 27.4%, respectively. Surgical resection was performed at least once in 85.7%. Tumor persistence was documented in 27% and was related to the size and invasiveness of the lesion. In selected cases, radiotherapy proved to be effective in controlling or preventing tumor growth. Conclusions. The diagnosis and treatment of NFPA are complex and require a multidisciplinary approach.

Copyright of Revista Mexicana de Endocrinología, Metabolismo y Nutrición is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Mexicana de Endocrinología, Metabolismo y Nutrición is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)