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Addison’s disease (AD) entails a chronic insufficient production of gluco- and mineralocorticoids. Fatigue and decreased quality of life are frequently reported symptoms, but little is known about its effects on cognition. This study aims to explore the existence of cognitive impairment in patients with AD and the influence of treatment regimens. We conducted a systematic review. Inclusion criteria were met by 10 articles, most of them ranked as intermediate quality. Three studies analyzed the relationship between AD and cognitive impairment; one explored the effect of delaying treatment showing no effect on cognitive performance, and another one studied the effect of fludrocortisone treatment. Episodic memory was the most frequent cognitive domain impaired across studies, in comparison to healthy controls. Two papers investigated the relationship between impaired sleep quality and poor cognitive performance. Two studies related cognitive impairments with hypocortisolism-derived brain neuroglycopenia. Two studies investigated the effect of DHEA substitution. In conclusion, patients exhibit a moderately reduced performance in verbal learning. The pathophysiology of this impairment is likely multifactorial. Future studies should include larger sample sizes, the use of comprehensive and multi-domain neuropsychological and behavioral protocols, and neuroimaging.

Introduction. Pituitary adenomas are the most frequent intracranial tumors. Surgical excision is the primary approach for these tumors, except for prolactinomas, and secondary hypopituitarism is its main complication.Aim: to assess the prevalence of postoperative hypopituitarism and analyze the risk factors involved in its development.Materials and methods. Ambispective multicenter observational study. Data were collected from The Molecular Registry of Pituitary Adenomas (REMAH). Univariate and multivariate analysis were performed in 128 patients with histologically confirmed adenomas who underwent transsphenoidal surgery between 2009 and 2015 in hospitals from Madrid, with more than one-month follow-up.Results. Postoperative hypopituitarism was found in 73.9% of cases (28.4% of new onset). Combined pituitary deficiency was the most frequently observed (46.3%), and hypoadrenalism the most frequent single postsurgical deficit (63.7%). Factors significantly associated with postoperative hypopituitarism in the univariate analysis were: previous hypopituitarism, larger tumor diameter, transsphenoidal endoscopic approach and presence of other postoperative complications (p

Introduction. Pituitary adenomas are the most frequent intracranial tumors of the central nervous system. Except for prolactinomas, surgery is the treatment of choice.Aim: to assess the percentage of patients with persistent disease after surgery and to identify independent predictors of persistent disease.Material and methods. Ambispective multicenter observational study. Data were collected from The Molecular Registry of Pituitary Adenomas (REMAH). Univariate and multivariate analysis were performed in 128 patients with histologically confirmed adenomas who underwent transsphenoidal surgery between 2009 and 2015 in hospitals from Madrid, with at least one month of follow-up.Results. During follow-up, persistent disease was observed in 50.8% of patients (radiological 30.7%, biochemical 2.4%, both 14.2%), especially in nonfunctioning tumors. Factors significantly associated with persistent disease in the univariate analysis were age, male gender, previous hypopituitarism, large tumor diameter and microscopic transsphenoidal surgery (p

Background: C-peptide (Cp) serves as a surrogate of pancreatic beta-cell reserve. This study evaluates the clinical significance of basal Cp as a predictor of type 2 diabetes (T2D) remission after bariatric surgery (BS). Research design and methods: Retrospective study of 22 patients with BMI > 35 kg/m² and T2D who underwent BS. Evaluation of anthropometric and glucose metabolism parameters before BS and at one-year follow-up. Analysis of patients with T2D remission (HbAlc < 6%, fasting glucose (FG) < 100 mg/dl, absence of pharmacologic treatment) and preoperative characteristics associated (logistic binary regression model). ROC curve to estimate an optimal Cp value to predict T2D remission. Results: Preoperativeley (mean ± SD): age 53.3 ± 9.4 years, BMI 42.9 ± 6.8 kg/m², T2D duration 6.9 ± 5.2 years, FG 159.6 ± 56.6 mg/dL, HbAlc 7.5 ± 1.1%, Cp 4.0 ± 2.0 (median 3.8, range 0.1-8.9) ng/mL. At one year follow-up, remission of T2D in 12 cases (54.5%). Preoperative Cp correlated with 12-month HbA1c (r = -0.519, p = 0.013). Preoperative Cp was higher in those who achieved remission: 5.0 ± 1.7 vs 3.0 ± 1.7 ng/ml, p = 0,013. A Cp concentration > 3.75 ng/mL provided a clinically useful cut-off for prediction of T2D remission. T2D remission rates were different according to median preoperative Cp: 27.3% if Cp < 3.8 ng/mL and 81.7% if Cp > 3.8 ng/mL (p = 0.010). Conclusions: Patients with elevated preoperative Cp levels achieve higher rates of T2D remission one year after BS. A Cp concentration > 3.75 ng/mL seems clinically useful. Introducción: La determinación del péptido C (pC) suele emplearse como un indicador de la reserva beta-pancreática. El objetivo de este estudio es evaluar si el pC basal, es un parámetro predictor de remisión de diabetes mellitus tipo 2 (DM2) tras cirugía bariátrica (CB). Material y métodos: Estudio retrospectivo de 22 pacientes con DM2 e IMC > 35 kg/m², intervenidos mediante CB. Recogida de datos clínicos, antropométricos y analíticos relativos al metabolismo de la glucosa, antes de la CB y al año. Análisis de pacientes en remisión completa de DM2 al año de la CB (glucosa basal [GB] < 100 mg/dl, HbAlc < 6%, sin tratamiento farmacológico) y las variables preoperatorias asociadas a remisión (regresión logística binaria). Estimación del mejor valor umbral de pC para predecir la remisión de DM2 con curva ROC. Resultados: Características pre-CB (media ± DE): edad 53,3 ± 9,4 años, IMC 42,9 ± 6,8 kg/m², duración DM2 6,9 ± 5,2 años, GB 159,6 ± 56,6 mg/dl, HbAlc 7,5 ± 1,1%, pC 4,0 ± 2,0 (mediana 3,8, rango 0,1-8,9) ng/ml. 12 pacientes (54,5%) presentaron remisión de DM2. El pC preoperatorio se correlacionó con la HbA1c a los 12 meses (r = -0,519, p = 0,013). Los valores de pC pre-CB fueron más elevados en los pacientes que alcanzaron remisión de DM2 (5,0 ± 1,7 vs 3,0 ± 1,7 ng/ml, p = 0,013). Un valor de pC > 3,75 ng/ml supuso una sensibilidad y especificidad para remisión de DM2 de 75% y 80%, respectivamente. La tasa de remisión de DM2 fue de 27,3% si el pC basal pre-CB < 3,8 ng/ml, y 81,7% si > 3,8 ng/ml (p = 0,010). Conclusiones: Los pacientes con pC basal preoperatorio elevado son los que mayores tasas de remisión alcanzan al año de la CB. Una concentración de pC basal > 3,75 ng/dL parece un buen predictor de remisión completa de DM2 al año de la CB.

The prevalence of obesity in Western countries has increased at a much greater pace than the development of new efficient and safe drugs, beyond mere lifestyle changes, for the treatment of overweight. Numerous different types of drugs which had been used in the past for the treatment of obesity have currently been withdrawn due to undesirable long-term side effects. The only available drug in Europe is orlistat, which serves only as an aid for the treatment of obesity. In the USA, however, a few central adrenergic-mediators, for instance, diethylpropion and phentermine, have been available for decades to treat obesity during a short-term period (less than 12 weeks). The Food and Drug Administration (FDA) has recently approved lorcaserin and the combination phentermine/topiramate for the treatment of obesity. The first one is a selective serotonin 2C receptor agonist that works by decreasing food intake with few side effects. Its outcomes on weight are modest, but may be helpful in certain selected patients. The phentermine/topiramate combination has proved to be highly effective, achieving a 10% reduction in weight in the majority of patients, although attention must be drawn to the possible development of side effects in both the short and the long-term follow-up. Further investigation regarding the mechanisms involved in weight balance will anticipate the development of new expectations for the treatment of obesity in the near future. El incremento de la prevalencia de obesidad en los países occidentales no ha sido paralela al desarrollo de nuevos fármacos eficaces y seguros a largo plazo para el tratamiento del exceso de peso más allá de los cambios en el estilo de vida. La larga lista de fármacos que se han utilizado para el tratamiento de la obesidad han tenido que ser retirados por efectos secundarios indeseables para la salud a largo plazo. En Europa solo contamos con orlistat, como único fármaco coadyuvante para el tratamiento de la obesidad, mientras que en EEUU hace décadas disponen de unos pocos fármacos adrenérgicos de acción central (como Dietilpropion o Phentermine) para un tratamiento a corto plazo (inferior a 12 semanas). Recientemen te, la Food and Drug Administration (FDA), acaba de aprobar la lorcaserina y la combinación de Phentermine y topiramate. Lorcaserine es un agonista específico del receptor serotoninérgico 2c, con actividad anorexígena y pocos efectos secundarios. Sus efectos sobre el peso son moderados, pero pueden ser de utilidad en algunos pacientes seleccionados. La combinación de phentermine y topiramate es muy eficaz alcanzando un 10% de pérdida de peso en una mayoría de pacientes, aunque debemos estar atentos acerca de sus potenciales efectos secundarios a corto y largo plazo. La profundización en la investigación de los mecanismos implicados en la regulación del peso corporal conllevará nuevas expectativas de tratamientos para la obesidad en un futuro próximo.

We present two patients who underwent successful bariatric surgery and developed peroneal nerve palsy six months after the procedure. This is an unusual complication which determines a significant functional limitation, mainly because of foot drop, and its presence may be a hallmark of excessive and rapid weight loss. We discuss possible pathogenic mechanisms and therapeutic options, and we emphasize the important role of an adequate nutritional management, in order to avoid the need for a surgical nerve decompression. Se presentan dos pacientes sometidos a cirugía bariátrica que desarrollaron una neuropatía del nervio peroneo común seis meses después de la intervención. Se trata de una complicación poco frecuente que supone una importante limitación funcional, y su aparición puede ser indicativa de una pérdida de peso demasiado rápida y excesiva. Se discute la patogenia y las posibles alternativas terapéuticas, y se destaca el papel esencial del correcto manejo nutricional, con el fin de evitar la necesidad de descompresión quirúrgica nerviosa.

We present a patient who underwent successful classic duodenal switch and developed a marked dermatitis with a significant functional limitation. This is an unusual complication, despite the relatively moderate prevalence of nutrient deficiency after this type of bariatric surgery. We discuss possible pathogenic mechanisms and emphasize the importance of an appropriate nutritional management. Se presenta el caso de una mujer sometida a cirugía bariátrica malabsortiva que desarrolló una llamativa dermopatía y neuropatía secundarias al déficit de zinc. Se trata de una complicación muy poco frecuente, a pesar de la prevalencia de déficit de micronutrientes que se ha observado tras este tipo de intervención. Se discute la patogenia y se recalca el papel del correcto manejo nutricional como tratamiento eficaz.

Vitamin A deficiency may occur after malabsorptive bariatric surgery. However, it rarely entails important functionally limiting symptoms. We present the case of a woman who underwent bariatric surgery and developed ocular dryness, xeroderma and hearing loss due to severe vitamin A deficiency. We illustrate an outstanding and exceptional case of the consequences of an excessive and uncontrolled malabsorption. Aunque el déficit de vitamina A puede desarrollarse tras la realización de cirugía bariátrica malabsortiva, raramente conlleva la aparición de síntomas que repercutan en la situación funcional del paciente. Presentamos el caso de una mujer que desarrolló xeroftalmia, xerodermia e hipoacusia secundarias a déficit muy severo de vitamina A. Ilustramos el llamativo y excepcional ejemplo de la repercusión de una malabsorción descontrolada.