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Context Cushing’s disease (CD) is a life-threating disease, with increased mortality in comparison with the general population. Objective This study aimed to evaluate standardized mortality ratios (SMRs) in CD patients. We also analyzed independent risk factors related to increased mortality. Design We conducted a longitudinal cohort study in a 3rd level specialty center, from 1979 to 2018, in patients with CD. Results From 1375 cases with a pathology diagnosis of pituitary adenoma, 191 cases had the confirmed diagnosis of CD (14%). A total of 172 patients completed follow-up, with a mean age at diagnosis of 33 ± 11 years, female predominance (n = 154, 89.5%), majority of them with microadenoma (n = 136, 79%), and a median follow-up of 7.5 years (2.4–15). Eighteen patients (10.5%) died, 8 of them (44%) were with active CD, 8 (44%) were under remission, and 2 (11%) were under disease control. Estimated all-cause SMR = 3.1, 95% confidence interval (CI) 1.9–4.8, P Conclusions Main cause of CD mortality was cardiovascular disease. Main risk factors for mortality were uncontrolled diabetes, persistently high cortisol levels after 1600 hours at diagnosis, and active disease at last follow-up.

Se realiza una revisión sobre el riesgo de los pacientes que padecen diabetes mellitus en el contexto de morbimortalidad general y relacionada a infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2). Así mismo se repasan las recomendaciones generales, de alimentación y de la prevención de las comorbilidades que más frecuentemente padecen dichos enfermos. Finalmente se hace una revisión de las recomendaciones farmacológicas sobre el tratamiento tanto oral como parenteral en el paciente ambulatorio, en la hospitalización y en estados críticos infectados por el SARS-CoV-2.

The Mexican population with diabetes mellitus is at increased risk of severe disease and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) The factors that contribute to this are the potential increased risk of infections, the proinflammatory, procoagulant state, the inadequate immune regulation suffered by people with diabetes and the lack of glycemic control, particularly important in our population For this reason, the Sociedad Mexicana de Nutricion y Endocrinologia formed a group for recommendations facing coronavirus disease 2019 (COVID-19) pandemic and issues these recommendations for the therapeutic management of type 2 diabetes with the current information, which may be expanded or corrected considering new evidence La poblacion mexicana con diabetes mellitus se encuentra en mayor riesgo de enfermedad grave y de mortalidad por coro-navirus 2 del sindrome respiratorio agudo grave (SARS-CoV-2) Los factores que contribuyen a esto son el potencial mayor riesgo a infecciones, el estado proinflamatorio, procoagulante, la inadecuada regulacion inmunologica que sufren las personas con diabetes y el descontrol glucemico, particularmente importante en nuestra poblacion Por ello, la Sociedad Mexicana de Nutricion y Endocrinologia formo un Grupo para Recomendaciones ante la enfermedad por coronavirus 2019 (COVID-19) y emite estas recomendaciones para el manejo terapeutico de la diabetes mellitus tipo 2 con la informacion actual, mismas que podran ampliarse o corregirse a la luz de nueva evidencia

A review is carried out to examine the risk of patients suffering from diabetes mellitus in the context of general morbidity and mortality and related to infection by SARS-CoV-2. Likewise, the general recommendations for food and the prevention of comorbidities that most these patients suffer most frequently are also studied. Finally, a review of the pharmacological recommendations on both oral and parenteral treatment in the outpatient, in hospitalization and in critical states infected with SARS-CoV-2 is made.Se realiza una revisión sobre el riesgo de los pacientes que padecen diabetes mellitus en el contexto de morbimortalidad general y relacionada a infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2). Así mismo se repasan las recomendaciones generales, de alimentación y de la prevención de las comorbilidades que más frecuentemente padecen dichos enfermos. Finalmente se hace una revisión de las recomendaciones farmacológicas sobre el tratamiento tanto oral como parenteral en el paciente ambulatorio, en la hospitalización y en estados críticos infectados por el SARS-CoV-2.

Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis of small vessels that affect the pituitary gland in less than 1% of cases being exceptionally rare. To describe the clinical, biochemical, radiological findings, treatment, and outcomes of 4 patients with GPA-related hypophysitis. A systematic review of published cases with the same diagnosis is presented as well. A cross-sectional case series of patients with hypophysitis due to GPA from 1981 to 2018 at a third level specialty center. Literature review was performed searching in seven different digital databases for terms "granulomatosis with polyangiitis" and "pituitary gland" or "hypophysitis," including in the analysis all published cases between 1950 and 2019 with a minimum follow-up of 6 months. We found 197 patients with GPA in our institution of whom 4 patients (2.0%) had pituitary involvement. Clinical characteristics and outcomes are described. We also reviewed 7 case series, and 36 case reports describing pituitary dysfunction related to GPA from 1953 to 2019, including the clinical picture of an additional 74 patients. Pituitary dysfunction due to GPA is rare. Treatment is targeted to control systemic manifestations; nevertheless, the outcome of the pituitary function is poor. Central diabetes insipidus, particularly in younger women with other systemic features, should raise suspicion of GPA.Key Points• Involvement of the pituitary gland is an uncommon manifestation in GPA patients. The presence of central diabetes insipidus in the setting of systemic symptoms should prompt its suspicion.• In patients with pituitary involvement due to GPA, affection of other endocrine glands is rare, neither concomitant nor in different times during the disease course. This may arise the hypothesis of a local or regional pathogenesis affection of the gland.• There is no consensus on the best therapy strategy for GPA hypophysitis. Although the use of glucocorticoids with CYC is the most common drug combination, no differences in the outcome of the pituitary function and GPA disease course are seen with other immunosuppressants.• Poor prognosis regarding pituitary function is expected due to possible permanent pituitary tissue damage that results in the need of permanent hormonal replacement.

espanolAntecedentes: Irisin es una proteina escindida de la proteina 5 que contiene el dominio de fibronectina tipo III y se ha implicado en los efectos beneficiosos del ejercicio. Sin embargo, se desconoce que factores contribuyen al incremento de irisina despues del ejercicio intensivo en humanos. Este estudio tuvo como objetivo evaluar factores independientes relacionados con la irisina serica despues de 2 semanas de actividad fisica supervisada en mujeres jovenes sedentarias sanas. Diseno y metodos: desarrollamos un estudio comparativo, intervencionista, longitudinal y prospectivo en un centro de salud especializado de tercer nivel. Entre marzo de 2010 y agosto de 2011, se reclutaron 82 mujeres adultas jovenes sedentarias, sin enfermedades cronicas o tratamientos medicos regulares. Un total de 38 mujeres cumplieron los criterios de seleccion, y las concentraciones de irisina se cuantificaron antes y despues de la intervencion. Se evaluaron factores independientes relacionados con el incremento de irisina de acuerdo con la intensidad de actividad fisica leve a moderada y vigorosa. Se realizo una prueba supervisada de ejercicio en la cinta de correr siguiendo el protocolo de Bruce de lunes a viernes durante 2 semanas. Ademas, se tomaron medidas antropometricas y se midieron el factor de crecimiento de fibroblastos 21 (FGF21), glucosa, insulina y transaminasas hepaticas. Resultados: la intensidad del ejercicio se relaciono directamente conlos niveles sericos deirisina ( p = 0.02) y FGF21 ( p = 0.01). Sin embargo, no se confirmo una relacion independiente y significativa entre FGF21 e irisina. Se encontro una nueva asociacion entre alanina aminotransferasa (ALT) e irisina, que muestra una correlacion positiva y significativa ( r = 0.37, p = 0.02). La asociacion fue particularmente fuerte con una mayor intensidad de ejercicio aerobico ( r = 0.64, p = 0.01). El modelo de regresion lineal ajustado por glucosa e indice de masa corporal confirmo una asociacion independiente entre ALT e irisina y tambien entre insulina e irisina (R² ajustado = 0,12, p= 0.04). Dicha asociacion aumento despues de agrupar en intensidad de actividad fisica moderada a vigorosa (R² ajustado = 0.46, F = 4.7, p = 0.03). Conclusiones: los niveles sericos de irisina y FGF21 aumentaron significativamente despues de 2 semanas de actividad fisica supervisada. Sin embargo, solo la insulina en ayunas y ALT, pero no FGF21, fueron parametros independientes que explican el incremento de irisina, principalmente despues de un ejercicio moderado a vigoroso. EnglishBackground: Irisin is a protein cleaved from fibronectin type III domain-containing protein 5 and has been implicated in the beneficial effects of exercise. However, it is unknown which factors contribute to irisin increment after intensive exercising in humans. This study aimed to assess independent factors related with serum irisin after 2 weeks of supervised physical activity in young sedentary healthy women. Design and Methods: We developed a comparative, interventional, longitudinal, and prospective study at a third-level specialty health center. Between March 2010 and August 2011, 82 sedentary young adult women, without chronic diseases or regular medical treatments, were recruited. A total of 38 women fulfilled selection criteria, and irisin concentrations were quantified before and after the intervention. Independent factors related with irisin increment were evaluated according to mild to moderate and vigorous intensity of physical activity. A supervised treadmill exercise test following the Bruce’s protocol was conducted from Monday to Friday during 2 weeks. In addition, anthropometric measurements were taken, and fibroblast growth factor 21 (FGF21), glucose, insulin, and liver transaminases were measured. Results: Intensity of exercising was directly related to irisin (p = 0.02) and FGF21 (p = 0.01) serum levels. However, an independent and significant relationship between FGF21 and irisin was not confirmed. A novel association was found between alanine aminotransferase (ALT) and irisin, showing a positive and significant correlation (r = 0.37, p = 0.02). The association was particularly strong with higher intensity of aerobic exercising (r = 0.64, p = 0.01). Linear regression model adjusted for glucose and body mass index confirmed an independent association between ALT and irisin and also between insulin and irisin (adjusted R² = 0.12, p = 0.04). Such association increased after grouping in moderate to vigorous physical activity intensity (adjusted R² = 0.46, F = 4.7, p = 0.03). Conclusions: Serum irisin and FGF21 levels significantly increased after 2 weeks of supervised physical activity. However, only fasting insulin and ALT, but not FGF21, were independent parameters explaining irisin increment, mainly after moderate to vigorous exercising. (REV INVEST CLIN. 2019;71:133-40)

Objective It has been reported that Cushing’s disease due to macroadenoma is characterized by different biochemical features compared with microadenoma. We aimed to analyze and compare the clinical and biochemical features of patients with micro and macroadenomas causing Cushing disease. Methods We conducted a retrospective review of electronic and paper medical records that included 139 patients (108 microdenomas and 40 macroadenomas) with Cushing disease diagnosis who were studied and treated at the (undisclosed), in Mexico City from 2000 to 2017. Clinical characteristics, biochemical analysis of hypercorticolism, pituitary imaging findings, treatment modalities, remission as well as mortality rates were recorded. Results The mean age was 32.5 years (range 24-37) for microadenoma and 30.0 years (range 23-38) for macroadenoma (p=0.65). Female predominance was seen both in microadenoma (91.7%) and macroadenoma (87.1%) patients. Biochemical analysis of hypercortisolism including basal cortisol, ACTH, 24-hour urinary cortisol levels, and responsivity to low-dose dexamethasone suppression were similar between both groups. Remission and mortality rates after initial pituitary surgery for microadenoma and macroadenoma were 82.5 vs 17.5% (p=0.049) and 40.0% vs 60.0% (p=0.024), respectively. Using log-rank test we confirmed higher remission rates in microadenomas (p=0.049) and higher mortality risk with macroadenomas (p=0.024). Conclusion Our study suggest that patients with microadenomas showed better remission rates and lower mortality than those cases with macroadenomas, despite similar biochemical activity and treatment for CD. Therefore, further research is mandatory to identify those risk factors that gave different prognosis Reference Aydin, K & Dagdelen, S & Ozgen, Burce & Oruckaptan, H & Soylemezoglu, F & Erbas, T. (2014). Pituitary Corticotroph Microadenomas Versus Macroadenomas Causing Cushing’s Disease. Journal für Klinische Endokrinologie und Stoffwechsel. 7. 358-362. Keywords Cushing’s disease, corticotroph macroadenoma, corticotroph microadenoma Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Introduction Pituitary adenomas represent approximately 15% of all intracranial neoplasms. Those with the ability to produce more than one hormone are called plurihormonal pituitary adenomas. They are divided into monomorphic, single cell type may produces two or more hormones, and plurimorphic, different cell types may produce multiple hormones. Materials and methods We performed a retrospective review of all patients diagnosed with hyperprolactinemia and acromegaly secondary to pituitary adenoma during the period 2004-2018. Then, we identified 10 patients with high serum levels of PRL and IGF-1. Six of these patients were excluded due to hyperprolactinemia secondary to pituitary stalk compression. We collected clinical, biochemical and medical imaging information. We compared the clinical and biochemical characteristics before and after treatment. Results We identified 4 female patients with GH/PRL-secreting plurihormonal pituitary adenoma. The average age at diagnosis was 25 years-old (20-32). We documented high serum levels of IGF-1 with average of 818 ng/mL (474-1340 ng/ml) and PRL with average of 185.62 ng/mL (120.95 to 280.13 ng/ml). On admission, a pituitary Magnetic Resonance Imaging (MRI) revealed macroadenoma, with mean diameter 23.5 mm (18-32 mm). All patients were prescribed cabergoline in average dose of 0.75 mg (0.5-1 mg) per week. Half of the patients had their IGF-1 ng/mL plasma level normalized. PRL ng/ml plasma levels were decreased in all patients. In their last pituitary MRI, the size of the macroadenoma decreased in all patients (8.1mm), with a mean diameter of 15.4 mm. Conclusion We consider that the primary management of the plurihormonal pituitary adenomas is the use of dopamine receptor agonists; in case there is not a clinical or biochemical control of the disease, we suggest to evaluate using additional therapy. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Introduction: Cushing's disease (CD) is, in some cases, difficult to diagnose and the petrosal sinus catheterization (PSC) is indicated to rule out other etiologies of hypercortisolism, mainly in patients without a visible adenoma, that have an adenoma less than 6 mm or when the dynamic tests are discordant, and the suspicion of CD remains. Objective: To evaluate basal PSC and PSC after stimulation with desmopressin as a diagnostic tool for CD. As a secondary outcome we described the clinical and characteristics of the enrolled patients. Methods: We included all patients who underwent petrosal sinus catheterization since 1980 at our Institution and were >18 years old. We exclude all patients that underwent the procedure after surgical resection or radiotherapy of the adenoma for any reason. We eliminated patients that had incomplete information regarding the procedure. The gold standard for diagnosing CD was the histological evidence of an adenoma and/or remission of the disease with surgery. Results: We included 26 patients, 84.6% women, with an average age at diagnosis of 31 (23-40) years. The most common comorbidities were dyslipidemia (61.5%), followed by glucose abnormalities (50%). The main indication to perform the PSC was to have an adenoma smaller than 6 mm (38.4%). The final diagnosis was CD in 84.6% (n = 22) and adrenal hyperplasia in the rest (n = 4), there were no patients with ectopic Cushing's syndrome in our series. We couldn’t evaluate the usefulness of the procedure regarding the laterality of the adenoma because not all the patients had a complete report of the MRI. The central to peripheral gradient of ACTH (CPGA) > 1.2 (baseline), showed a sensitivity 95%, specificity 75%, positive predictive value (PPV) 95%, negative predictive value (NPV) 75%, positive likelihood ratio (LR+) 3.81 and negative likelihood ratio (LR-) 0.06. The CPGA post-stimulation with desmopressin > 2 had a sensitivity 86%, specificity 75%, PPV 95%, NPV 50%, LR+ 3.45, LR- 0.18. Conclusions: The PSC is a useful tool to make the differential diagnosis of CD with adrenal Cushing, when is indicated. The stimulation with desmopressin shows an adequate performance compared to that reported for CRH. A gradient > 1.2 baseline and > 2 post-stimulation can be used as diagnostic criteria.

OBJECTIVE To evaluate the quality of life (QoL) in patients with pituitary adenomas in comparison with healthy Mexican population QoL scores. DESIGN & MEASUREMENTS Cross-sectional study using the short form 36 questionnaire (SF-36) in 175 patients with pituitary adenomas grouped by adenoma subtype and disease activity, and compared them with the healthy Mexican population normative QoL scores. PATIENTS A total of 44 patients with non-functioning pituitary adenomas (NFPA), 48 with acromegaly, 53 with prolactinomas and 30 with Cushing disease (CD) were enrolled in this study. RESULTS Mental and physical components scores (MCS & PCS) of SF-36 questionnaire were lower in patients with active disease in all adenoma subtypes (P

Summary Non-Hodgkin lymphoma (NHL) is a hematological tumor caused by abnormal lymphoid proliferation. NHL can arise in any part of the body, including central nervous system (CNS). However, pituitary involvement is a quite rare presentation. The diffuse large B-cell lymphoma (DLBCL) is the most common subtype when pituitary is infiltrated. Here, we report a case of pituitary infiltration of NHL DLBCL type in a woman with hypopituitarism and an infundibulum-hypophysitis-like image on magnetic resonance imaging (MRI). A female aged 64 years, complained of dyspepsia, fatigue, weight loss and urine volume increment with thirst. Endoscopy and gastric biopsy confirmed diffuse large B-cell lymphoma. Treatment with chemotherapy using R-CHOP was initiated. During her hospitalization, hypotension and polyuria were confirmed. Hormonal evaluation was compatible with central diabetes insipidus and hypopituitarism. Simple T1 sequence of MRI showed thickening of the infundibular stalk with homogeneous enhancement. After lumbar puncture analysis, CNS infiltration was confirmed showing positive atypical lymphocytes. Pituitary and infundibular stalk size normalized after R-CHOP chemotherapy treatment. In conclusion, pituitary infiltration of NHL with infundibular-hypophysitis-like image on MRI is a rare finding. Clinical picture included hypopituitarism and central diabetes insipidus. Diagnosis should be suspected after biochemical analysis and MRI results. Treatment consists of chemotherapy against NHL and hormonal replacement for pituitary dysfunction. Learning points: Pituitary infiltration by lymphoma can present with signs and symptoms of panhypopituitarism and diabetes insipidus. MRI findings can resemble an autoimmune hypophysitis. Patients can recover pituitary function as well as normalization of MRI after chemotherapy treatment.

El objetivo de este proyecto es el estudio comparativo de tres nuevos algoritmos de clasificación sobre conjuntos de datos de las características mencionadas anteriormente, de forma que se pueda precisar de qué manera se pueden utilizar y qué utilidad tienen con respecto a las técnicas convencionales. Todo, con la esperanza de obtener resultados que ayuden en las investigaciones actuales. Una primera fase del trabajo se centra en la integración de los algoritmos en una plataforma única que permita realizar la experimentación de forma lo más automatizada posible. Para ello hemos seleccionado la plataforma MOA (Massive Online Analysis), en la que se han tenido que codificar varios algoritmos no incluidos que se describirán más adelante. El estudio se centra en la validación, y comprobación de la eficiencia de estos algoritmos sobre conjuntos de datos que puedan aplicarse a fines comerciales a fecha de hoy. Partiendo de estudios previos, así como de la literatura pertinente de cada algoritmo, se procederá a la integración a las herramientas de desarrollo WEKA y MOA, identificando las posibles dificultades y errores que pudieran surgir y validarlos mediante pruebas realizadas en artículos anteriores de la literatura pertinente. Por último se realizará un estudio comparativo. entre los tres algoritmos, buscando el algoritmo que mejor se adapte a los conjuntos de pruebas planteados, y que mejores soluciones ofrezca. El problema de la clasificación incremental supone muchos retos a nivel de estudio, debido a la profundidad teórica utilizada y cantidad de literatura existente en torno a éste. Sin embargo, una vez se vean sus posibilidades, podrá comprobarse como no deja de ser un tema interesante a tratar, no sólo a nivel de investigación, si no de utilidad en las aplicaciones de software como posible mejora y actualización a las mismas. Ingeniería Informática