Unusual Course of an Aggressive Pituitary Prolactinoma: Case Report and Review of the Literature

Pituitary carcinomas are rare tumors with heterogeneous behaviors. Their carcinogenesis is still unknown. Consequently, treatment is multimodal and not standardized. Dopamine (DA) agonists are used as first-line treatments, while radiotherapy and surgery may be used for local control of invasive tumors. We describe the case of a 35-year-old male who presented with an invasive prolactinoma, managed initially with a transsphenoidal resection, postsurgical radiotherapy and DA agonists. The patient posteriorly presented a sole metastatic lesion to the lumbar spine that was later managed with local radiotherapy. Due to pituitary recurrence of the lesion, multiple surgical resections were needed until further treatment was declined. The clinical course in this patient was unusual. He lived for 13 years after initial diagnosis, with a very invasive tumor without systemic chemotherapy. Radiotherapy is used in pituitary tumors in which surgery fails; we hypothesize that it contributed to the malignant transformation and the late resistance to DA agonists in our patient. Several biomarkers in tumoral tissue have been evaluated regarding their association with malignancy and aggressive behaviors, although more studies are still needed. Therapeutic strategies are limited, without evidence on the impact on overall survival and prognosis. Risk factors associated with early malignancy in pituitary prolactinomas include recurrent behavior, increase in prolactin levels with a stable sellar mass, and secondary development of DA agonist resistance. However, there are still no conclusive answers as to whether physicians should rigorously follow up these patients or provide direct therapy with aggressive approaches

Long-term efficacy and safety of subcutaneous pasireotide alone or in combination with cabergoline in Cushing’s disease

ObjectiveThis study evaluated short- and long-term efficacy and safety of the second-generation somatostatin receptor ligand pasireotide alone or in combination with dopamine agonist cabergoline in patients with Cushing’s disease (CD).Study designThis is an open-label, multicenter, non-comparative, Phase II study comprising 35-week core phase and an optional extension phase. All patients started with pasireotide, and cabergoline was added if cortisol remained elevated. Eligible patients had active CD, with or without prior surgery, were pasireotide naïve at screening or had discontinued pasireotide for reasons other than safety. Primary endpoint was proportion of patients with a mean urinary free cortisol (mUFC) level not exceeding the upper limit of normal (ULN) at week 35 with missing data imputed using last available post-baseline assessments.ResultsOf 68 patients enrolled, 26 (38.2%) received pasireotide monotherapy and 42 (61.8%) received pasireotide plus cabergoline during the core phase. Thirty-four patients (50.0%; 95% CI 37.6–62.4) achieved the primary endpoint, of whom 17 (50.0%) received pasireotide monotherapy and 17 (50.0%) received combination therapy. Proportion of patients with mUFC control remained stable during the extension phase up to week 99. Treatment with either mono or combination therapy provided sustained improvements in clinical symptoms of hypercortisolism up to week 99. Hyperglycemia and nausea (51.5% each), diarrhea (44.1%) and cholelithiasis (33.8%) were the most frequent adverse events.ConclusionAddition of cabergoline in patients with persistently elevated mUFC on maximum tolerated doses of pasireotide is an effective and well-tolerated long-term strategy for enhancing control of hypercortisolism in some CD patients.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT01915303, identifier NCT01915303

Insuficiencia de vitamina D en pacientes adultos con baja masa ósea y osteoporosis en la Fundación Santa Fe de Bogotá 2008–2009

Hypovitaminosis D is associated with osteoporosis, neuromuscular diseases, autoimmune diseases and cancer. The prevalence varies from 11–70% in different populations. Due osteoporosis is a common disease, we determined the prevalence of hypovitaminosis D associated with bone demineralization in FSFB population evaluated between August 2008 and July 2009, we reviewed age, gender, T-Score, Z-score. Values between 32–150 ng/ml were considered as normal. We found 460 25OHD results, 105 subjects with mineral density for DXA method, 80% female. Mean age for women was 66 years (SD ± 12.5, range 39–91) for women was 67.1 years (SD ± 12.2, range 39–91) for men was 61 years (SD ± 10.7, range 42–82). Mean 25OHD levels were 31 ng / ml (SD ± 17.6, range 8.2 to 110), for women 30.5 ng / mL (SD ± 16.1, range 10.6 to 96 ng / mL), for men 33.5 ng / mL (SD ± 23.4, range 8.2 to 110 ng / mL). 69,5% of cases were considered as vitamin D insufficiency, 45,7% mild, 23,8% moderate, and no cases of severe déficit. No significant difference between 25OHD concentrations and gender, or age were considered. Osteoporosis was correlated with 25OHD levels below 28 ng/ml (P=0,046) but not between low 25OHD and subjects with osteopenia. The vitamin D deficiency is highly prevalent in patients with osteoporosis and low bone mass and should be evaluated in the context of osteoporosis. © 2010 Asociación Colombiana de Reumatologí

Insuficiencia de vitamina D en pacientes adultos con baja masa ósea y osteoporosis en la Fundación Santa Fe de Bogotá 2008–2009

"Hypovitaminosis D is associated with osteoporosis, neuromuscular diseases, autoimmune diseases and cancer. The prevalence varies from 11–70% in different populations. Due osteoporosis is a common disease, we determined the prevalence of hypovitaminosis D associated with bone demineralization in FSFB population evaluated between August 2008 and July 2009, we reviewed age, gender, T-Score, Z-score. Values between 32–150 ng/ml were considered as normal. We found 460 25OHD results, 105 subjects with mineral density for DXA method, 80% female. Mean age for women was 66 years (SD ± 12.5, range 39–91) for women was 67.1 years (SD ± 12.2, range 39–91) for men was 61 years (SD ± 10.7, range 42–82). Mean 25OHD levels were 31 ng / ml (SD ± 17.6, range 8.2 to 110), for women 30.5 ng / mL (SD ± 16.1, range 10.6 to 96 ng / mL), for men 33.5 ng / mL (SD ± 23.4, range 8.2 to 110 ng / mL). 69,5% of cases were considered as vitamin D insufficiency, 45,7% mild, 23,8% moderate, and no cases of severe déficit. No significant difference between 25OHD concentrations and gender, or age were considered. Osteoporosis was correlated with 25OHD levels below 28 ng/ml (P=0,046) but not between low 25OHD and subjects with osteopenia. The vitamin D deficiency is highly prevalent in patients with osteoporosis and low bone mass and should be evaluated in the context of osteoporosis. © 2010 Asociación Colombiana de Reumatología

Fructosuria and recurrent hypoglycemia in a patient with a novel c.1693T>A variant in the 3′ untranslated region of the aldolase B gene

Hereditary fructose intolerance, caused by mutations in the ALDOB gene, is an unusual cause of hypoglycemia. ALDOB encodes the enzyme aldolase B, responsible for the hydrolysis of fructose 1-phosphate in the liver. Here, we report the case of a 33-year-old female patient who consulted due to repetitive episodes of weakness, dizziness and headache after food ingestion. An ambulatory 72-h continuous glucose monitoring revealed multiple short hypoglycemic episodes over the day. After biochemical exclusion of other endocrine causes of hypoglycemia, hereditary fructose intolerance seemed a plausible diagnosis. Repeated measurements of urinary fructose revealed pathologic fructosuria, but genetic testing for the three most common mutations in ALDOB resulted negative. We decided to perform complete Sanger sequencing of the ALDOB gene and encountered a variant consisting of a T>A substitution in position 1963 of the ALDOB transcript (c.1693T>A). This position is located within the 3′ untranslated region of exon 9, 515 nucleotides downstream the stop codon. After complete withdrawal of dietary fructose and sucrose, the patient presented no new hypoglycemic episodes

Second Colombian Consensus on the Management of Post-menopausal Osteoporosis: 2017 Update

La Asociación Colombiana de Osteoporosis y Metabolismo Mineral se reunió a principios de 2017 para actualizar el Consenso Colombiano de Osteoporosis, elaborado por primera vez en 2005, un paso que se consideró necesario en vista del subdiagnóstico de esta enfermedad, el impacto esperado del envejecimiento poblacional y los cambios en el tratamiento farmacológico que ha habido desde entonces. Se seleccionó un equipo técnico con especialistas de múltiples áreas y amplia trayectoria, repartidos en 4 grupos de trabajo: definición y epidemiología, diagnóstico, tratamiento farmacológico y medidas no farmacológicas. Luego de una revisión de la literatura científica, en reuniones de trabajo se generaron las definiciones y recomendaciones que se resumen en este documento.The Colombian Osteoporosis and Mineral Metabolism Association met in early 2017 to update the Colombian Consensus on Osteoporosis. This was first issued in 2005, and is seen as a necessary step in view of the underdiagnosed status of this disease, and the expected impact of population ageing. A technical team was formed with specialists with long experience across multiple disciplines, who were assigned to four working groups: definitions and epidemiology, diagnosis, pharmacological treatment, and non-pharmacological treatment. After a scientific literature review and a series of meetings, the definitions and recommendations are summarised in this article

Second Colombian Consensus on the Management of Post-menopausal Osteoporosis: 2017 Update

La Asociación Colombiana de Osteoporosis y Metabolismo Mineral se reunió a principios de 2017 para actualizar el Consenso Colombiano de Osteoporosis, elaborado por primera vez en 2005, un paso que se consideró necesario en vista del subdiagnóstico de esta enfermedad, el impacto esperado del envejecimiento poblacional y los cambios en el tratamiento farmacológico que ha habido desde entonces. Se seleccionó un equipo técnico con especialistas de múltiples áreas y amplia trayectoria, repartidos en 4 grupos de trabajo: definición y epidemiología, diagnóstico, tratamiento farmacológico y medidas no farmacológicas. Luego de una revisión de la literatura científica, en reuniones de trabajo se generaron las definiciones y recomendaciones que se resumen en este documento.Q4Artículo de revisión184-210The Colombian Osteoporosis and Mineral Metabolism Association met in early 2017 to update the Colombian Consensus on Osteoporosis. This was first issued in 2005, and is seen as a necessary step in view of the underdiagnosed status of this disease, and the expected impact of population ageing. A technical team was formed with specialists with long experience across multiple disciplines, who were assigned to four working groups: definitions and epidemiology, diagnosis, pharmacological treatment, and non-pharmacological treatment. After a scientific literature review and a series of meetings, the definitions and recommendations are summarised in this article