Hiperparatiroidismo secundario en el cáncer de próstata avanzado

Background and ObjectiveHigh parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined.Materials and methodsWe performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed.ResultsIn patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values.ConclusionsThe present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.     

Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides

ObjectivesTo analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium.Patients and methodsA retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC.ResultsA total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2).ConclusionsIn our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death.     

Guía clínica para el manejo del nódulo tiroideo y cáncer de tiroides durante el embarazo

Special considerations are warranted in management of thyroid nodule and thyroid cancer during pregnancy. The diagnostic and therapeutic approach of thyroid nodules follows the standard practice in non-pregnant women. On the other hand, differentiated thyroid cancer management during pregnancy poses a number of challenges for the mother and fetus. The available data show that pregnancy is not a risk factor for thyroid cancer development or recurrence, although flare-ups cannot be completely ruled out in women with active disease. If surgery is needed, it should be performed during the second term or, preferably, after delivery. A majority of pregnant patients with low-risk disease only need adjustment in levothyroxine therapy. However, women with increased serum thyroglobulin levels before pregnancy or structural disease require regular thyroglobulin measurements and neck ultrasound throughout pregnancy. Pregnancy is an absolute contraindication for radioactive iodine administration.     

Análisis de biopsias líquidas para el diagnóstico del cáncer: revisión sistemática

The incidence of cancer has increased in recent years, especially in those over 65 years of age, posing a major health problem. Many tumours have a poor prognosis because they are diagnosed at very advanced stages. It is therefore especially important to incorporate liquid biopsy into clinical practice as a method for detecting tumours at very early stages. A systematic review was conducted, with the main objective of analysing the available literature on the use of liquid biopsy in the early diagnosis of cancer, and as a secondary objective, to determine the types of tumours that can be diagnosed early by liquid biopsy and the available biomarkers. The results indicate a lack of agreement with the biomarkers detected and the technologies applied. This highlights the need for multicentre studies to look at large cohorts and to establish protocols of action, as well as to increase analytical validity and the possibility of using a screening test for each type of tumour. This could be a very important step forward, as it could improve the management of cancer patients to a great extent.     

Edad de menopausia en pacientes tratadas con I131 por cáncer diferenciado de tiroides

IntroductionDifferentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment.ObjectiveTo analyze the effects of I¹³¹ therapy on ovarian and reproductive function.Material and methodsWe retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985–2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected.ResultsMenopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94±3.45 while that in their mothers and sisters was 49.20±5.37 and 48.73±3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found.ConclusionsIn our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found.     

¿Está de acuerdo nuestra conducta ante el nódulo tiroideo y cáncer diferenciado de tiroides con la guía norteamericana y el consenso europeo?

IntroductionThe aim of this study was to assess the approaches of specialists in Spain to patients with thyroid nodules and differentiated thyroid carcinoma and to compare them with the American guideline and European consensus.Material and methodsWe performed a cross-sectional study based on a questionnaire addressed to clinical endocrinologists specialized in thyroid cancer and specialists in nuclear medicine throughout Spain.ResultsA total of 177 questionnaires were completed, representing an overall response rate of 85%; 74% of responses were from endocrinologists and 24% from physicians active in nuclear medicine; 82% of respondents worked in third-level hospitals, 10% in second level hospitals and the remainder in private practice. Most used ultrasonography and cytology to assess thyroid nodules and collaborated with a group of surgeons expert in thyroid surgery. The majority preferred total or subtotal thyroidectomy in tumors with a diameter of 1 cm or more, and systematic lymph node dissection. Only 43 (24%) preferred prophylactic central lymph node dissection. Eighty-one respondents (45%) would still use whole body scan with ¹³¹I or ¹²³I before ¹³¹I ablation. Follow-up was based on cervical echography and thyroglobulin determination; however, 101 (57%) respondents continued to use diagnostic whole body scan in the follow-up.ConclusionThe approaches of the respondents were mainly in accordance with the guideline and consensus, although some variations were found, especially in the use of whole body scan with ¹³¹I before ablation and in follow-up.