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La obesidad es una enfermedad muy prevalente con múltiples complicaciones crónicas que se reducen o desaparecen tras pérdidas pequeñas (5-10%) pero mantenidas de peso. Sin embargo, mantener la pérdida de peso tras el tratamiento es muy difícil, siendo uno de los mayores retos en el control de esta enfermedad. Aunque las razones que contribuyen a recuperar el peso perdido son de diversa índole, relacionadas con la respuesta biológica a la restricción calórica y con la pérdida de adherencia al tratamiento, hasta un 20% de los pacientes son capaces de mantenerlo. Las claves del éxito están relacionadas con el mantenimiento de los hábitos de vida saludable, el ejercicio físico y una ingesta calórica razonable que permita realizar una vida normal, sin pérdida de vida social. En este sentido, aprender a distinguir las opciones de comida y bebida en una sociedad donde la vida social gira en torno a la mesa en muchas ocasiones es muy importante. Revisamos en este artículo las claves para mantener el peso tras una dieta, así como el papel de las bebidas fermentadas, en especial, la cerveza, en este proceso. En conclusión, mantener el peso perdido es más difícil que perderlo. El consumo leve-moderado de bebidas fermentadas como la cerveza no se asocia con incremento del peso

Obesity is a very prevalent disease with multiple chronic complications that decrease or disappear after a small (5-10%) but maintained weight loss. Nevertheless, maintaining weight loss after the treatment is very difficult and it involves one of the biggest challenges to control this epidemic. Although the reasons that contribute to regain the lost weight are diverse and related to the biological response to caloric restriction and the lack of adherence to treatment, up to 20% of the patients are able to keep it off. The keys to success, involve the maintenance of healthy habits, exercise and a reasonable daily calorie intake to allow a normal way of life, without sacrificing the social life. At this point, learning to distinguish food and drink options in a society where social life often revolves around the table is very important. We review the keys to keep the weight off after a diet as well as the role of fermented beverages such as beer, in this process. In conclusion, maintenance the weight loss is harder than losing it. The mild-to-moderate consumption of fermented beverages such as beer is not associated with weight increase.La obesidad es una enfermedad muy prevalente con múltiples complicaciones crónicas que se reducen o desaparecen tras pérdidas pequeñas (5-10%) pero mantenidas de peso. Sin embargo, mantener la pérdida de peso tras el tratamiento es muy difícil, siendo uno de los mayores retos en el control de esta enfermedad. Aunque las razones que contribuyen a recuperar el peso perdido son de diversa índole, relacionadas con la respuesta biológica a la restricción calórica y con la pérdida de adherencia al tratamiento, hasta un 20% de los pacientes son capaces de mantenerlo. Las claves del éxito están relacionadas con el mantenimiento de los hábitos de vida saludable, el ejercicio físico y una ingesta calórica razonable que permita realizar una vida normal, sin pérdida de vida social. En este sentido, aprender a distinguir las opciones de comida y bebida en una sociedad donde la vida social gira en torno a la mesa en muchas ocasiones es muy importante. Revisamos en este artículo las claves para mantener el peso tras una dieta, así como el papel de las bebidas fermentadas, en especial, la cerveza, en este proceso. En conclusión, mantener el peso perdido es más difícil que perderlo. El consumo leve-moderado de bebidas fermentadas como la cerveza no se asocia con incremento del peso.

El sindrome de Cushing dependiente de ACTH supone aproximadamente el 80% de todos los sindromes de Cushing. Diferenciar el origen hipofisario del ectopico sigue siendo un problema diagnostico en determinados casos, especialmente en los carcinoides bronquiales, ya que, aproximadamente, un 50% pueden presentar supresion de las concentraciones de cortisol tras dexametasona y suelen ser de pequeno tamano y, por lo tanto, dificiles de detectar en la radiografia de torax. Presentamos el caso de una paciente con sindrome de Cushing dependiente de ACTH, de dificil localizacion con las pruebas diagnosticas habituales.

La acidosis lactica es una rara enfermedad con una mortalidad en torno al 50%. Se caracteriza por una acidosis metabolica con anion gap y acido lactico elevado. Presentamos un caso de acidosis lactica en una paciente diabetica en tratamiento con metformina, que presento una insuficiencia renal aguda secundario a deshidratacion por un cuadro de gastroenteritis. El tratamiento con hemodialisis venovenosa continua fue exitoso con recuperacion gradual de la funcion renal. Se describe el caso clinico, los mecanismos fisiopatologicos, las diferentes causas y el pronostico de esta infrecuente y grave complicacion.

ObjectiveIGF1 and IGFBP3 gene polymorphisms have been recently described. However, their potential role in the setting of acromegaly and its outcome is unknown. In this study, we analyze these polymorphisms in patients with acromegaly and investigate their association with clinical presentation and response to treatments.DesignA retrospective observational study was conducted in patients with acromegaly to analyze IGF1 and IGFBP3 gene polymorphisms.MethodsA total of 124 patients with acromegaly (57.3% women, mean age 44.9±13.1 years old) were followed up for a period of 11.4±8.0 years in eight tertiary referral hospitals in Spain. Clinical and analytical data were evaluated at baseline and after treatment. IGF1 and IGFBP3 gene polymorphisms were analyzed using PCR and specific primers.ResultsBaseline laboratory test results were GH 19.3 (8.0–39.6) ng/ml, nadir GH 11.8 (4.1–21.5) ng/ml, and index IGF1 2.65±1.25 upper limit of normal. Regarding the IGF1 gene polymorphism, we did not find any association between the number of cyto-adenosine (CA) repeats and patients’ baseline characteristics. Nevertheless, a trend for higher nadir GH values was observed in patients with ConclusionsPolymorphisms in the IGF1 and IGFBP3 genes may not be invariably determinant of treatment outcome in acromegalic patients, but they may be associated with higher nadir GH levels or baseline IGF1, and determine a higher rate of colorectal polyps and cancer.

El feocromocitoma es un tumor derivado de las celulas cromafines de la medula adrenal. Cuando afecta a celulas situadas en la cadena simpatica, se denomina paraganglioma. Pese a ser infrecuente, debe incluirse entre las posibles causas de hipertension, arritmias cardiacas y crisis de ansiedad. Presentamos el caso de una mujer con un feocromocitoma vesical y una lesion hepatocelular con captacion positiva en el estudio isotopico con MIBG (metayodobencilguanidina) que se ha interpretado como un falso positivo.

ACTH dependent Cushing syndrome accounts for approximately 80% of all Cushing syndrome. Distinguishing the pituitary origin from ectopic one is still a diagnosis problem in some cases, especially in bronchial carcinoids, because approximately 50% show cortisol suppresion after dexametasone and may be small and, therefore, difficult to detect in chest radiography. We present a case of a patient with ACTH dependent Cushing syndrome of difficult localization with usual diagnosis tests.

Pheochromocytoma is a tumor derived from the chromaffin cells of the adrenal medulla. When this type of tumor involves the sympathetic ganglia it is called paraganglioma. Although infrequent, paraganglioma should be considered in the evaluation of hypertension, arrhythmias, and panic disorder. We report the case of a woman with bladder pheochromocytoma and a hepatic lesion. MIBG scintigraphy showed non-physiological uptake, which was interpreted as a false positive result.

Objective: To assess the validity of the use of IGF-1, IGFBP-1 and IGFBP-3 as biochemical markers of nutritional status in prepubertal healthy children. Design: Cross-sectional survey. Setting: Healthy children from the Madrid area. Participants: Prepubertal children (aged 7–10 years) with a body mass index (BMI) above the 90th percentile (n = 25) and below the 10th percentile (n = 31) were selected from 2,559 included in the CAENPE study (Food Intake and Nutritional Status in Schoolchildren from Madrid). Results: Overweight children were found to have higher serum levels of IGF-1 (306 ± 162.2 vs. 209 ± 71.2 ng/ml, p < 0.001) and IGFBP-3 (3.3 ± 1.0 vs. 2.9± 0.5 mg/l, p < 0.01) and lower serum levels of IGFBP-1 (4.3 ± 3.9 vs. 13.8 ± 7.4 μg/l, p < 0.01). There was a positive correlation with BMI, for IGF-1 and IGFBP-3, and negative correlation for IGFBP-1. No differences in albumin and transferrin concentrations were observed between both groups of children. Conclusion: IGF-1, IGFBP-1 and IGFBP-3 clearly classify over- and underweight prepubertal children, showing a good correlation with BMI. They can be used as biochemical markers of caloric nutritional status in this population.

La tiroiditis subaguda, descrita por primera vez por De Quervain en 1904, es la causa principal de dolor tiroideo. Las etiologias mas probables son una infeccion viral o un proceso inflamatorio postinfeccioso. La clinica tipica incluye dolor cervical anterior, bocio difuso y alteracion de la funcion tiroidea que sigue un curso predecible en la mayoria de los casos. Presentamos el caso de una paciente de 63 anos con una tiroiditis subaguda de inicio focal, con un nodulo tiroideo doloroso a la palpacion y manifestaciones sistemicas concomitantes.

Objective: Our aim was to go deeper in the self-perception of weight and health status among the Spanish population, together with the connections of familiar relationships, physical activity practice, nutritional habits, and sleep patterns with the presence of obesity. Methods: A total of 1,000 subjects were enrolled in April 2017 in a representative adult Spanish population sample. Computer-assisted telephone interviewing was used and self-reported anthropometric data was obtained. Results: The population was composed of 51.3% women, with a mean age of 48 (36–63) years and a BMI of 23.2 (20.3–26.6). Although only 17.7% of subjects with self-reported obesity exhibited the self-perception to suffer from obesity, they referred a bad (16%) or regular (47%) self-perceived health status. Subjects who considered themselves as people with overweight and obesity displayed a BMI of 30.5 (28.7–32.2) and 37.1 (34.8–41.5), respectively. The obesity group displayed the highest percentage (71.9%) of participants with some first-degree relative with overweight or obesity (p < 0.001) in comparison with the other groups. The main reason put forward of preventing healthy eating among subjects with obesity was that they dislike healthy food. The multivariable logistic regression model for presence of obesity showed that there was a significant association with older age, presence of a first-degree relative with weight excess, a positive snacking habit, and daily alcohol consumption (p ≤ 0.019). Conclusion: The Spanish population has a low self-perception of obesity. Our data also reinforces the strong association between obesity and age, family interactions, usual snacking, and daily consumption of wine or beer.