- Email: [email protected]
Hyperglycaemia in acutely ill non-diabetics
Abstracts
OF
cardiovascular risk factors. There are no clear recommendations for its management. Objectives: To determine how doctors in an internal medicine ward manage subclinical hyperthyroidism, its consequences and short and long-term prognosis. Methods: Prospective study of patients (pts) consecutively admitted over one year. We compared clinical characteristics, in-hospital and long-term mortality (322 ± 227 days) of pts with subclinical hyperthyroidism (normal free T4 and decreased TSH) and without thyroid dysfunction. We assessed outpatient prescription (surveillance vs. radioactive iodine or antithyroid drugs) and thyroid function evolvement. Results: 475 pts were included; 71 (14.9%) had subclinical disease. Subclinical hyperthyroidism (n = 38) vs. pts without thyroid dysfunction (n = 404): men 39.5% vs. 46.5% (ns), age 79 ± 14.8 vs. 73 ± 14.9 years old (p = 0.022), and atrial fibrillation (AF) 26.3% vs 28.9% (ns); HR at admission 85.4 ± 20.2 vs. 84.4 ± 22.9 ppm (ns), systolic arterial pressure 143.5 ± 31.5 vs. 135.1 ± 29.2 mm Hg (p = 0.098), and BMI 26.1 ± 4.8 vs. 26.6 ± 5.6 (ns). 27.8% of pts with subclinical hyperthyroidism were on prior therapy with amiodarone. In-hospital mortality is 18.4 vs. 4.9% (p = 0.001) and long-term mortality is 16.1 vs. 14.6% (ns). On follow-up, from the 31 pts with hyperthyroidism, 80.6% evolved to euthyroidism, 12.9% to subclinical hyperthyroidism and 6.5% to clinical hyperthyroidism. At discharge, only one patient, who evolved to euthyroidism, was prescribed an antithyroid drug. Conclusion: Patients with hyperthyroidism are significantly older and have significantly higher in-hospital mortality than pts without thyroid dysfunction. Even without directed therapy, most evolved to normal thyroid function. The favorable long-term prognosis supports our conservative attitude.
DP
them with several drugs. Therefore, when thyroid dysfunction is identified, iatrogenic effects must be considered. Most of these drugs seem to induce thyroid abnormalities either in normal or in predisposed glands. Several mechanisms are involved in thyroid dysfunction, ranging from impairment in thyroid-stimulating hormone secretion to those interfering with the transport and metabolism of thyroid hormone. The most implicated drug is amiodarone. Objective: Analyze the impact of thyroid dysfunction induced by drugs in endocrinology consultation; understand which drugs are associated more frequently and the therapeutic implications. Method: Retrospective, observational and longitudinal study in which the authors analyzed all patients who were consulted by two endocrinology assistants, at the Hospital of Santa Maria, between January and December 2012, and where those selected are with thyroid dysfunction induced by drugs. Statistical analysis was performed with Microsoft Office Excel©. Results: The authors studied 1458 patients, of whom 508 have or had presented primary thyroid dysfunction (characterized by hyper or hypothyroidism). In 45 patients the thyroid dysfunction was induced by drugs, 27 of them were female and 18 male. The average age was 64 years old. There were 24 patients with hyperthyroidism and 21 with hypothyroidism. In 38% (17), previous thyroid dysfunction was present. The most implicated drugs were amiodarone (78%), followed by lithium (14%), interferon (6%), bexarotene (2%) and sunitinibe (2%). In the patients with thyroid dysfunction induced by amiodarone, 22 (63%) had hyperthyroidism and 13 (37%) hypothyroidism. Within the patients with hyperthyroidism induced by amiodarone, 9 had type I and 10 had type II amiodaroneinduced thyrotoxicosis (AIT). Patients with type I AIT where mainly treated with an association of glucocorticoids and antithyroid drug (thionamides). Only 2 patients weren't under glucocorticoids. Patiens with type II AIT were all treated with thionamides (except one patient) and in 3 cases, thionamides were started together with glucocorticoids. Patients with thyroid dysfunction induced by the remaining drugs had all hypothyroidism, except two patients with hyperthyroidism associated with lithium. The responsible drug was suspended in 67% of the 45 patients. Conclusions: Drugs are an important cause of thyroid dysfunction. They accounted for 9% of all thyroid abnormalities in our endocrinology consultation. Hyperthyroidism was the mainly dysfunction found, probably due to the specific nature of the follow-up required in this setting, while most patients with hypothyroidisms can be followed by generalist specialties. Amiodarone was the main drug implicated. This can be explained by its widespread use to control arrhythmias, making it more common than the remaining drugs identified. Total use of glucocorticoids was less when compared with other series, but patients with AIT type I and II were treated according to the general recommendations. In 67% of the patients the responsible drug was suspended, showing many resistance in maintaining therapy. This study addresses a very important subject, as it concerns different specialties and alerts for the problem of iatrogeny and consequent difficulties in therapeutic management.
RO
e102
doi:10.1016/j.ejim.2013.08.256
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ID: 796 Hyperglycaemia in acutely ill non-diabetics R. Cardigaa, M. Proencaa, F. Marquesa, I. Araujoa, M. Alfacea, J. Rodriguesa, S. Augustoa, C. Fonsecaa,b, A. Leitaoa,b, F. Ceiaa,b a
CO
RR
EC
Medicine III, Sao Francisco Xavier Hospital, Lisbon, Portugal Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
UN
doi:10.1016/j.ejim.2013.08.255
ID: 790 Prognostic value of subclinical hyperthyroidism in an internal medicine ward M. Proencaa, R. Cardigaa, I. Araujoa, F. Marquesa, S. Jesusa, D. Cardosoa, S. Serraa, C. Fonsecaa,b, A. Leitaoa,b, F. Ceiaa,b a
Medicine III, Sao Francisco Xavier Hospital, Lisbon, Portugal Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
b
Introduction: Subclinical hyperthyroidism is a relatively common condition, especially in the elderly, and is associated with major
b
Introduction: Diabetes mellitus (DM) is an independent predictor of mortality in hospitalized patients (pts). Prospective observational studies have reported a greater association between hyperglycaemia and increased mortality in non-diabetic pts compared with diabetics. Objectives: To compare the clinical characteristics and prognosis of non-diabetic vs. diabetic pts with hyperglycaemia in an internal medicine ward. Methods: Prospective study of consecutively admitted pts with a diagnosis of type 2 DM — Group A — vs. non-diabetic pts with hyperglycaemia (at least one occasional glucose ≥200 mg/dl or fasting glucose ≥126 mg/dl in the acute phase) — Group B. We compared prevalence, clinical characteristics and in-hospital and long-term mortality (277.6 ± 186.5 days). Results: 306 pts were included. Group A (175, 57.2%) vs. Group B (131, 42.8%); prevalence 30.8% vs. 23.8%, men 46.9 vs. 42.7% (ns); age 75.1 ± 11.6 vs. 77.2 ± 13.4 years old (ns), and BMI 27.9 ± 5.9 vs. 25.1 ± 4.8 kg/m2 (p = 0.001). Comorbidities A vs. B: hypertension 86.9 vs. 74.0% (p = 0.007); coronary disease 35.4 vs. 19.8% (p = 0.004), heart failure 65.1 vs. 39.7% (p = 0.001), peripheral artery disease 11.4 vs. 9.4% (ns), cerebrovascular disease 19.4 vs. 25.2% (ns), chronic kidney disease 51.4 vs. 40.5% (ns), and Charlson index 8.0 ± 2.6 vs. 6.6 ± 3.0 (p = 0.001). In-hospital mortality A vs. B: 3.4 vs. 12.2% (p = 0.007); long-term mortality A vs. B: 23.5 vs. 36.6% (p = 0.03). 14.7% of pts with hyperglycaemia met criteria for type 2 DM. Conclusion: Hyperglycaemia occurred in almost a quarter of acutely ill pts admitted in an internal medicine ward. Although
Abstracts
ID: 806 HFABP levels relationship carotid artery intima media thickness and role as a diagnostic marker for atherosclerosis in patient with hypothyroidism F. Gunesa, M. Asıkb, A. Temizc, A. Vurald, H. Sene, E. Binnetoglua, N. Bozkurta, Z. Tekelia, K. Ukincb, E. Akbale a
Internal Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey Endocrinology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey c Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey d Microbiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey e Gastroentrology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey b
UN
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Objective: Hypothyroidism (HT) is associated with increasing risk for all-cause and cardiovascular mortality. HT has multiple adverse effects on the cardiovascular system through dyslipidaemia, diastolic hypertension, altered coagulation status, endothelial dysfunction, and arterial stiffness. Heart fatty acid binding protein (H-FABP) is an intracellular molecule engaged in the transport of fatty acids through the myocardial cytoplasm and a rapid marker of myocardial injury. The aims of this study are to detect serum concentrations of H-FABP in patient with subclinic hypothroidism (SCH) and overt hypothyroidism (OH) and to investigate its associations with CIMT, metabolic parameters and subclinical atherosclerosis. Patients and methods: A total of 40 patients with SCH, 24 patients with OH and 35 healthy subjects were enrolled in the study. All subject H-FABP levels were measured and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with CIMT which was measured by high resolution B mode ultrasonography. Results: H-FABP levels were elevated in patients with SCH (3.8 ± 2.7 ng/ml) when compared with healthy controls (2.1 ± 1.6 ng/ml; p = 0.013). H-FABP levels were increased in patients with OH (6.0 ± 3.27 ng/ml) when compared with healthy controls (2.1 ± 1.6 ng/ml; p b 0.001). In comparison with SCH, OH had significantly different serum H-FABP levels (p = 0.018). CIMT differed significantly among all groups (p b 0.001). The CIMT was increased in patients with SCH (0.64 ± 0.12 mm) when compared with healthy controls (0.54 ± 0.11 mm; p:0.005). CIMT was increased in patients with OH (0.79 ± 0.24 mm) when compared with healthy controls (0.54 ± 0.11 mm; p b 0.001). CIMT was also significantly greater in OH patients (mean CIMT, 0.79 ± 0.24 mm) than in SCH (mean CIMT, 0.64 ± 0.12 mm; p: 0.043). Conclusions: H-FABP might be used as a marker of subclinical atherosclerosis, as it is with CIMT. Serum H-FABP levels and CIMT may be useful indicators of early atherosclerosis and are markers of subclinical myocardial damage in patients with HT.
OF
doi:10.1016/j.ejim.2013.08.257
Inroduction: Neuroendocrine tumours are relatively rare neoplasms. However, the incidence has increased over the last 20 years from approximately 2 persons per 100,000 to 4 persons per 100,000 per year. These tumours derive from the diffuse endocrine system and can be found anywhere in the body. They are classified according to their site of origin and whether they are functioning or nonfunctioning. There are many types of neuroendocrine tumours, including medullary thyroid cancers, paragangliomas, pheochromocytomas, bronchial carcinoids and the most common ones: gastroenteropancreatic tumours. Material and methods: We studied 16 patients with NETs admitted in our hospital between 2007 and 2012. Results: We present 16 patients, 7 men and 9 women, 52.75 +/− 20.15 year-old. One patient presented carcinoid syndrome at the time of diagnosis whereas the others presented symptoms related to primary tumours, such as abdominal pain (appendicitis) or HTA (pheochromocytoma). Location: appendix (5), ileum (3), adrenal glands (2), colon (2) stomach (1), pancreas (1), and others (2). Six patients had hepatic metastasis at the time of diagnosis. The diagnostic methods were surgery in 9 patients and CT scan in 7, and PET in 2 patients. Laboratory tests were also requested (urinary catecholamines, chromogranin, 5-HIAA), Inmunohistochemic markers were analysed in 8 patients and were positive in all of them. Treatment: In all patients surgical treatment was performed, and chemotherapy and radiotherapy were conducted in 2 patients, 1 patient treated only with Octreotide. Diagnostic: carcinoid tumours (69%), pheochromocytoma (12.5%) sporadic MEA I (12.5%), and non-fuctioning pancreatic tumour (6%). Outcome: 6 patients died during the follow-up. Discussion: The majority of NETs are carcinoid tumours. These tumours arise from enterochromaffin cells and are defined as lesions that release serotonin. Approximately 2/3 of NETs are found in the gastrointestinal tract and approximately 1/4 occur in the pulmonary tissue, with the remainder arising in other endocrine tissues. Presentation of NETs can vary widely. Patients with functioning NETs may present symptoms related to the overproduction of certain hormones, while non-functioning NETs can present symptoms such as pain, weight loss, jaundice, nauseas or vomiting. Diagnosis strategy uses blood markers and imaging, such as computed tomography, magnetic resonance image, PET or octreoscan. Treatment relies on surgery, chemotherapy, somastostatine analogues and/or radiotherapy. Conclusion: NETs are infrequent tumours, so internists must know the characteristics and diagnostic methods for a quick and efficient diagnosis.
RO
significantly less obese and with fewer comorbidities, non-diabetic pts with hyperglycaemia had a significantly worse short and long-term prognosis than diabetics. This important issue and the potential benefit of correction of glycaemia in these patients deserve assessment in large, randomized, and multicentre studies.
e103
doi:10.1016/j.ejim.2013.08.258
ID: 2 Neuroendocrine tumours (NETs). Experience in the last 6 years in Goierri county J. Marti, A. Zurutuza, B. Lasa, J.M. Rodriguez Chinesta Internal Medicine, Osakidetza, Zumarraga, Spain
doi:10.1016/j.ejim.2013.08.259
ID: 8 Hypomagnesemia because of kidney failure and rhabdomyolysis associated with sitagliptin and atorvastatin J.L. Puerto, P. Diaz de Souza, G. Pérez-Vázquez, R. Holgado, I. Trouillhet, E. Rojas Internal Medicine, Hospital S.A.S La línea, La Línea de la Concepción, Cádiz, Spain
Introduction: Sitagliptin is a dipeptidyl-dipeptidase-4 inhibitor used in the daily treatment of type 2 diabetes. The drug most frequent secondary effects are headache and pharyngitis. The association between sitagliptin and rhabdomyolysis and acute kidney failure has been exceptionally described. We present here a case of hypomagnesemia and acute kidney failure associated with the use of full-dose of sitagliptin and atorvastatin. Clinical case: An 80-year-old man with history of hypertension, diabetes treated with metformin (with poor metabolic control), dyslipidemia and generalized atherosclerosis (previous myocardial infarction and ictus, this last one, three weeks
OF
cardiovascular risk factors. There are no clear recommendations for its management. Objectives: To determine how doctors in an internal medicine ward manage subclinical hyperthyroidism, its consequences and short and long-term prognosis. Methods: Prospective study of patients (pts) consecutively admitted over one year. We compared clinical characteristics, in-hospital and long-term mortality (322 ± 227 days) of pts with subclinical hyperthyroidism (normal free T4 and decreased TSH) and without thyroid dysfunction. We assessed outpatient prescription (surveillance vs. radioactive iodine or antithyroid drugs) and thyroid function evolvement. Results: 475 pts were included; 71 (14.9%) had subclinical disease. Subclinical hyperthyroidism (n = 38) vs. pts without thyroid dysfunction (n = 404): men 39.5% vs. 46.5% (ns), age 79 ± 14.8 vs. 73 ± 14.9 years old (p = 0.022), and atrial fibrillation (AF) 26.3% vs 28.9% (ns); HR at admission 85.4 ± 20.2 vs. 84.4 ± 22.9 ppm (ns), systolic arterial pressure 143.5 ± 31.5 vs. 135.1 ± 29.2 mm Hg (p = 0.098), and BMI 26.1 ± 4.8 vs. 26.6 ± 5.6 (ns). 27.8% of pts with subclinical hyperthyroidism were on prior therapy with amiodarone. In-hospital mortality is 18.4 vs. 4.9% (p = 0.001) and long-term mortality is 16.1 vs. 14.6% (ns). On follow-up, from the 31 pts with hyperthyroidism, 80.6% evolved to euthyroidism, 12.9% to subclinical hyperthyroidism and 6.5% to clinical hyperthyroidism. At discharge, only one patient, who evolved to euthyroidism, was prescribed an antithyroid drug. Conclusion: Patients with hyperthyroidism are significantly older and have significantly higher in-hospital mortality than pts without thyroid dysfunction. Even without directed therapy, most evolved to normal thyroid function. The favorable long-term prognosis supports our conservative attitude.
DP
them with several drugs. Therefore, when thyroid dysfunction is identified, iatrogenic effects must be considered. Most of these drugs seem to induce thyroid abnormalities either in normal or in predisposed glands. Several mechanisms are involved in thyroid dysfunction, ranging from impairment in thyroid-stimulating hormone secretion to those interfering with the transport and metabolism of thyroid hormone. The most implicated drug is amiodarone. Objective: Analyze the impact of thyroid dysfunction induced by drugs in endocrinology consultation; understand which drugs are associated more frequently and the therapeutic implications. Method: Retrospective, observational and longitudinal study in which the authors analyzed all patients who were consulted by two endocrinology assistants, at the Hospital of Santa Maria, between January and December 2012, and where those selected are with thyroid dysfunction induced by drugs. Statistical analysis was performed with Microsoft Office Excel©. Results: The authors studied 1458 patients, of whom 508 have or had presented primary thyroid dysfunction (characterized by hyper or hypothyroidism). In 45 patients the thyroid dysfunction was induced by drugs, 27 of them were female and 18 male. The average age was 64 years old. There were 24 patients with hyperthyroidism and 21 with hypothyroidism. In 38% (17), previous thyroid dysfunction was present. The most implicated drugs were amiodarone (78%), followed by lithium (14%), interferon (6%), bexarotene (2%) and sunitinibe (2%). In the patients with thyroid dysfunction induced by amiodarone, 22 (63%) had hyperthyroidism and 13 (37%) hypothyroidism. Within the patients with hyperthyroidism induced by amiodarone, 9 had type I and 10 had type II amiodaroneinduced thyrotoxicosis (AIT). Patients with type I AIT where mainly treated with an association of glucocorticoids and antithyroid drug (thionamides). Only 2 patients weren't under glucocorticoids. Patiens with type II AIT were all treated with thionamides (except one patient) and in 3 cases, thionamides were started together with glucocorticoids. Patients with thyroid dysfunction induced by the remaining drugs had all hypothyroidism, except two patients with hyperthyroidism associated with lithium. The responsible drug was suspended in 67% of the 45 patients. Conclusions: Drugs are an important cause of thyroid dysfunction. They accounted for 9% of all thyroid abnormalities in our endocrinology consultation. Hyperthyroidism was the mainly dysfunction found, probably due to the specific nature of the follow-up required in this setting, while most patients with hypothyroidisms can be followed by generalist specialties. Amiodarone was the main drug implicated. This can be explained by its widespread use to control arrhythmias, making it more common than the remaining drugs identified. Total use of glucocorticoids was less when compared with other series, but patients with AIT type I and II were treated according to the general recommendations. In 67% of the patients the responsible drug was suspended, showing many resistance in maintaining therapy. This study addresses a very important subject, as it concerns different specialties and alerts for the problem of iatrogeny and consequent difficulties in therapeutic management.
RO
e102
doi:10.1016/j.ejim.2013.08.256
TE
ID: 796 Hyperglycaemia in acutely ill non-diabetics R. Cardigaa, M. Proencaa, F. Marquesa, I. Araujoa, M. Alfacea, J. Rodriguesa, S. Augustoa, C. Fonsecaa,b, A. Leitaoa,b, F. Ceiaa,b a
CO
RR
EC
Medicine III, Sao Francisco Xavier Hospital, Lisbon, Portugal Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
UN
doi:10.1016/j.ejim.2013.08.255
ID: 790 Prognostic value of subclinical hyperthyroidism in an internal medicine ward M. Proencaa, R. Cardigaa, I. Araujoa, F. Marquesa, S. Jesusa, D. Cardosoa, S. Serraa, C. Fonsecaa,b, A. Leitaoa,b, F. Ceiaa,b a
Medicine III, Sao Francisco Xavier Hospital, Lisbon, Portugal Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
b
Introduction: Subclinical hyperthyroidism is a relatively common condition, especially in the elderly, and is associated with major
b
Introduction: Diabetes mellitus (DM) is an independent predictor of mortality in hospitalized patients (pts). Prospective observational studies have reported a greater association between hyperglycaemia and increased mortality in non-diabetic pts compared with diabetics. Objectives: To compare the clinical characteristics and prognosis of non-diabetic vs. diabetic pts with hyperglycaemia in an internal medicine ward. Methods: Prospective study of consecutively admitted pts with a diagnosis of type 2 DM — Group A — vs. non-diabetic pts with hyperglycaemia (at least one occasional glucose ≥200 mg/dl or fasting glucose ≥126 mg/dl in the acute phase) — Group B. We compared prevalence, clinical characteristics and in-hospital and long-term mortality (277.6 ± 186.5 days). Results: 306 pts were included. Group A (175, 57.2%) vs. Group B (131, 42.8%); prevalence 30.8% vs. 23.8%, men 46.9 vs. 42.7% (ns); age 75.1 ± 11.6 vs. 77.2 ± 13.4 years old (ns), and BMI 27.9 ± 5.9 vs. 25.1 ± 4.8 kg/m2 (p = 0.001). Comorbidities A vs. B: hypertension 86.9 vs. 74.0% (p = 0.007); coronary disease 35.4 vs. 19.8% (p = 0.004), heart failure 65.1 vs. 39.7% (p = 0.001), peripheral artery disease 11.4 vs. 9.4% (ns), cerebrovascular disease 19.4 vs. 25.2% (ns), chronic kidney disease 51.4 vs. 40.5% (ns), and Charlson index 8.0 ± 2.6 vs. 6.6 ± 3.0 (p = 0.001). In-hospital mortality A vs. B: 3.4 vs. 12.2% (p = 0.007); long-term mortality A vs. B: 23.5 vs. 36.6% (p = 0.03). 14.7% of pts with hyperglycaemia met criteria for type 2 DM. Conclusion: Hyperglycaemia occurred in almost a quarter of acutely ill pts admitted in an internal medicine ward. Although
Abstracts
ID: 806 HFABP levels relationship carotid artery intima media thickness and role as a diagnostic marker for atherosclerosis in patient with hypothyroidism F. Gunesa, M. Asıkb, A. Temizc, A. Vurald, H. Sene, E. Binnetoglua, N. Bozkurta, Z. Tekelia, K. Ukincb, E. Akbale a
Internal Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey Endocrinology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey c Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey d Microbiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey e Gastroentrology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey b
UN
CO
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Objective: Hypothyroidism (HT) is associated with increasing risk for all-cause and cardiovascular mortality. HT has multiple adverse effects on the cardiovascular system through dyslipidaemia, diastolic hypertension, altered coagulation status, endothelial dysfunction, and arterial stiffness. Heart fatty acid binding protein (H-FABP) is an intracellular molecule engaged in the transport of fatty acids through the myocardial cytoplasm and a rapid marker of myocardial injury. The aims of this study are to detect serum concentrations of H-FABP in patient with subclinic hypothroidism (SCH) and overt hypothyroidism (OH) and to investigate its associations with CIMT, metabolic parameters and subclinical atherosclerosis. Patients and methods: A total of 40 patients with SCH, 24 patients with OH and 35 healthy subjects were enrolled in the study. All subject H-FABP levels were measured and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with CIMT which was measured by high resolution B mode ultrasonography. Results: H-FABP levels were elevated in patients with SCH (3.8 ± 2.7 ng/ml) when compared with healthy controls (2.1 ± 1.6 ng/ml; p = 0.013). H-FABP levels were increased in patients with OH (6.0 ± 3.27 ng/ml) when compared with healthy controls (2.1 ± 1.6 ng/ml; p b 0.001). In comparison with SCH, OH had significantly different serum H-FABP levels (p = 0.018). CIMT differed significantly among all groups (p b 0.001). The CIMT was increased in patients with SCH (0.64 ± 0.12 mm) when compared with healthy controls (0.54 ± 0.11 mm; p:0.005). CIMT was increased in patients with OH (0.79 ± 0.24 mm) when compared with healthy controls (0.54 ± 0.11 mm; p b 0.001). CIMT was also significantly greater in OH patients (mean CIMT, 0.79 ± 0.24 mm) than in SCH (mean CIMT, 0.64 ± 0.12 mm; p: 0.043). Conclusions: H-FABP might be used as a marker of subclinical atherosclerosis, as it is with CIMT. Serum H-FABP levels and CIMT may be useful indicators of early atherosclerosis and are markers of subclinical myocardial damage in patients with HT.
OF
doi:10.1016/j.ejim.2013.08.257
Inroduction: Neuroendocrine tumours are relatively rare neoplasms. However, the incidence has increased over the last 20 years from approximately 2 persons per 100,000 to 4 persons per 100,000 per year. These tumours derive from the diffuse endocrine system and can be found anywhere in the body. They are classified according to their site of origin and whether they are functioning or nonfunctioning. There are many types of neuroendocrine tumours, including medullary thyroid cancers, paragangliomas, pheochromocytomas, bronchial carcinoids and the most common ones: gastroenteropancreatic tumours. Material and methods: We studied 16 patients with NETs admitted in our hospital between 2007 and 2012. Results: We present 16 patients, 7 men and 9 women, 52.75 +/− 20.15 year-old. One patient presented carcinoid syndrome at the time of diagnosis whereas the others presented symptoms related to primary tumours, such as abdominal pain (appendicitis) or HTA (pheochromocytoma). Location: appendix (5), ileum (3), adrenal glands (2), colon (2) stomach (1), pancreas (1), and others (2). Six patients had hepatic metastasis at the time of diagnosis. The diagnostic methods were surgery in 9 patients and CT scan in 7, and PET in 2 patients. Laboratory tests were also requested (urinary catecholamines, chromogranin, 5-HIAA), Inmunohistochemic markers were analysed in 8 patients and were positive in all of them. Treatment: In all patients surgical treatment was performed, and chemotherapy and radiotherapy were conducted in 2 patients, 1 patient treated only with Octreotide. Diagnostic: carcinoid tumours (69%), pheochromocytoma (12.5%) sporadic MEA I (12.5%), and non-fuctioning pancreatic tumour (6%). Outcome: 6 patients died during the follow-up. Discussion: The majority of NETs are carcinoid tumours. These tumours arise from enterochromaffin cells and are defined as lesions that release serotonin. Approximately 2/3 of NETs are found in the gastrointestinal tract and approximately 1/4 occur in the pulmonary tissue, with the remainder arising in other endocrine tissues. Presentation of NETs can vary widely. Patients with functioning NETs may present symptoms related to the overproduction of certain hormones, while non-functioning NETs can present symptoms such as pain, weight loss, jaundice, nauseas or vomiting. Diagnosis strategy uses blood markers and imaging, such as computed tomography, magnetic resonance image, PET or octreoscan. Treatment relies on surgery, chemotherapy, somastostatine analogues and/or radiotherapy. Conclusion: NETs are infrequent tumours, so internists must know the characteristics and diagnostic methods for a quick and efficient diagnosis.
RO
significantly less obese and with fewer comorbidities, non-diabetic pts with hyperglycaemia had a significantly worse short and long-term prognosis than diabetics. This important issue and the potential benefit of correction of glycaemia in these patients deserve assessment in large, randomized, and multicentre studies.
e103
doi:10.1016/j.ejim.2013.08.258
ID: 2 Neuroendocrine tumours (NETs). Experience in the last 6 years in Goierri county J. Marti, A. Zurutuza, B. Lasa, J.M. Rodriguez Chinesta Internal Medicine, Osakidetza, Zumarraga, Spain
doi:10.1016/j.ejim.2013.08.259
ID: 8 Hypomagnesemia because of kidney failure and rhabdomyolysis associated with sitagliptin and atorvastatin J.L. Puerto, P. Diaz de Souza, G. Pérez-Vázquez, R. Holgado, I. Trouillhet, E. Rojas Internal Medicine, Hospital S.A.S La línea, La Línea de la Concepción, Cádiz, Spain
Introduction: Sitagliptin is a dipeptidyl-dipeptidase-4 inhibitor used in the daily treatment of type 2 diabetes. The drug most frequent secondary effects are headache and pharyngitis. The association between sitagliptin and rhabdomyolysis and acute kidney failure has been exceptionally described. We present here a case of hypomagnesemia and acute kidney failure associated with the use of full-dose of sitagliptin and atorvastatin. Clinical case: An 80-year-old man with history of hypertension, diabetes treated with metformin (with poor metabolic control), dyslipidemia and generalized atherosclerosis (previous myocardial infarction and ictus, this last one, three weeks