Revista Colombiana de Endocrinología, Diabetes & Metabolismo

The complex medical and endocrine history of president John F. Kennedy

2021-08-26T17:52:03-05:00

John F. Kennedy had many medical conditions during his lifetime. Addison disease was diagnosed when Kennedy was 30 years of age, and he was found to have hypothyroidism when he was a senator. The coexistence of autoimmune adrenal disease and hypothyroidism is consistent with APS
2.

Possibly because of autoimmune disease but probably as a result of long-term steroid
replacement therapy, Kennedy's endocrinologist prescribed treatment with testosterone, and this may have been initiated during the 1960 presidential campaign. Despite his many medical
conditions as well as his recurrent back problems, John F. Kennedy managed to convey an image of health and vigor that masked the true state of his health to the U.S. public. In this narrative review
we mention marginally the autopsy that followed his assassination.

Polyserositis and endocrine disorders in a patient with anorexia nervosa: A case report

2025-07-01T12:01:51-05:00

Introduction: Anorexia nervosa is a psychiatric disorder that entails serious somatic sequelae, including endocrine and cardiovascular involvement. One of its rarest and most severe manifestations is polyserositis, which demands prompt clinical management.

Objective: To describe a case of anorexia nervosa complicated by polyserositis and profound endocrine dysfunction, emphasizing the diagnostic process, multidisciplinary management, and clinical evolution.

Case presentation: A 17-year-old female adolescent presented with a 10-month history of progressive weight loss, amenorrhea, cold intolerance, and autonomic symptoms. She was admitted after a syncopal episode with signs of shock—hypotension, bradycardia, and cachexia. Transthoracic echocardiography revealed a moderate-to-severe pericardial effusion with hemodynamic compromise, necessitating pericardiectomy and drainage. An exudative pleural effusion was also documented. Rheumatologic and oncologic work-ups were negative. Endocrine assessment showed hypogonadotropic hypogonadism, suppressed insulin-like growth factor-1 (IGF-1), elevated growth hormone levels, and dysregulation of the thyrotropic axis, all in the context of severe malnutrition. A progressive nutritional rehabilitation program was instituted, achieving a weekly weight gain of 600 g, which led to normalization of the hormonal profile and complete clinical resolution.

Discussion: Polyserositis in anorexia nervosa is a rare yet potentially life-threatening presentation. Its pathophysiology involves prolonged malnutrition, neuroendocrine dysfunction, and cardiovascular alterations. Diagnostic evaluation must rule out infectious, neoplastic, and autoimmune etiologies and should be conducted within a multidisciplinary framework.

Conclusion: This case underscores the need to consider anorexia nervosa as an underlying cause of polyserositis in severely malnourished adolescents. Monitored nutritional rehabilitation and a coordinated multidisciplinary approach were pivotal to achieving clinical and hormonal recovery.

Insulin resistance syndrome in a patient with limited cutaneous systemic sclerosis and type 2 diabetes and its response to plasma exchange, immunosuppression, and the Minimed® 780G continuous subcutaneous insulin infusion hybrid system

2024-06-20T08:20:08-05:00

Introduction: Type B insulin resistance syndrome (TBIRS) is an immune-mediated disorder characterized by severe acanthosis nigricans and difficult-to-control diabetes mellitus. This condition represents a complex clinical challenge.

Objective: To describe the case of a patient compatible with Type B insulin resistance syndrome, highlighting the challenges in glycemic control and the response to immunosuppressive therapy combined with a hybrid continuous subcutaneous insulin infusion system.

Case Presentation: A 57-year-old woman with a history of limited cutaneous systemic sclerosis and type 2 diabetes mellitus presented with severe insulin resistance, acanthosis nigricans, and markedly elevated blood glucose levels. Anti-insulin receptor antibodies were consistently negative. The patient received multiple treatments, including plasmapheresis, immunosuppressive therapy, and continuous subcutaneous insulin infusion using a MiniMed® 780G system, resulting in improved continuous glucose monitoring metrics and a reduction in daily insulin requirements.

Discussion: This case suggests a possible association between systemic sclerosis and Type B insulin resistance syndrome despite persistently negative anti-insulin receptor antibodies. A false-negative result may be explained by prior immunomodulatory treatments. The combination of immunosuppressive therapy and a hybrid closed-loop continuous subcutaneous insulin infusion system demonstrated favorable clinical outcomes.

Conclusion: This case report contributes to the. understanding of Type B insulin resistance syndrome and highlights the potential benefit of integrating immunosuppressive therapies with advanced insulin delivery technologies. Further studies are needed to define their role in the management of patients with severe insulin resistance

Adolescent patient with Wolfram syndrome and neurogenic bladder: Results of the Mitrofanoff technique

2024-11-26T21:22:43-05:00

Introduction: Wolfram Syndrome is an autosomal recessive genetic disorder characterized by type 1 diabetes mellitus, diabetes insipidus, deafness, optic nerve atrophy, and other neurodegenerative disorders.

Objective: To publicize the results of performing an appendicovesicostomy with the Mitrofanoff technique, as well as the basic aspects of Wolfram Syndrome, its diagnosis and treatment.

Case presentation: A 16-year-old female adolescent with type 1 diabetes and known visual disturbances, who was admitted to the emergency department due to diabetic ketoacidosis and urinary retention, in whom diabetes insipidus, neurogenic bladder, and optic nerve atrophy were subsequently documented, constituting Wolfram Syndrome or DIDMOAD. She was treated with desmopressin, insulin therapy adjustment, and bladder catheterizations to achieve urinary evacuation. However, due to the progressive visual loss, a Mitrofanoff- type appendicovesicostomy was performed to ensure intermittent catheterizations by the patient independently.

During a multidisciplinary follow-up consultation, the diagnosis was confirmed as being a homozygous carrier of the WFS1 gene that encodes wolframin with a potentially pathogenic variant and after 2 years from the hospitalization where the intervention was performed, functionality of the surgery and good metabolic control were observed.

Discussion and conclusion: Wolfram Syndrome is a rare entity with progressive clinical deterioration that should be suspected in all patients with type 1 diabetes associated with visual impairment. Early diagnosis of the disease allows for timely interventions such as Mitrofanoff-type appendicovesicostomy that facilitates independent urinary evacuation and the progression to renal failure.

Metabolic syndrome: Prevalence and associated factors in postmenopausal women in Quindío

2025-11-01T19:39:20-05:00

Objective: To estimate the prevalence of metabolic syndrome and identify the associated factors in postmenopausal women.

Materials and methods: An analytical cross-sectional study was conducted. A total of 627 women aged 40 years or older, diagnosed with menopause and not using hormone therapy, residing in the department of Quindío (Colombia) between 2013 and 2023, were included. Metabolic syndrome was defined according to the criteria of the International Diabetes Federation. Descriptive and bivariate analyses were performed, and measures of association were estimated using odds ratios (OR) with 95% confidence intervals (CI).

Results: The study included 627 postmenopausal women with a mean age of 57 ± 8.64 years and a mean age at menopause onset of 49 ± 3.52 years. The prevalence of metabolic syndrome was 74.16% (95% CI: 70.73–77.59). Metabolic syndrome was strongly associated with obesity (adjusted OR [ORa]: 9.00; 95% CI: 5.00–16.00), a history of gestational diabetes (ORa: 5.50; 95% CI: 2.50–12.00), and alcohol consumption (ORa: 4.50; 95% CI: 2.80–7.20). In contrast, a higher educational level (ORa: 0.45; 95% CI: 0.25–0.82) and adherence to a healthy diet (ORa: 0.60; 95% CI: 0.40–0.90) were inversely associated with metabolic syndrome.

Conclusions: Metabolic syndrome was highly prevalent among postmenopausal women. Key associated factors included alcohol consumption, smoking, and a history of gestational diabetes, while a higher educational attainment and adherence to a healthy diet were inversely associated. These results underscore the importance of implementing comprehensive cardiovascular prevention strategies for this population. Nevertheless, further analytical studies are needed to clarify causal relationships and inform targeted interventions.

Geographic distribution of risk factors and their correlation with diabetes complications in indigenous patients from the H.M.O. Mallamas, Colombia

2025-07-09T17:39:20-05:00

Context: Diabetes mellitus is a highly prevalent chronic disease that leads to multiple complications, which impair quality of life and significantly impact health systems. Its progression is influenced by factors such as obesity, sedentary lifestyle, hypertension, and dyslipidemia. However, the geographic distribution of these factors and their relationship with complications—particularly in Indigenous communities such as the Pastos and Quillacingas peoples—has been poorly studied.

Objective: To identify the predominant risk factors in regions served by the Indigenous Health Provider (I.P.S.) Mallamas and analyze their association with the prevalence of diabetic complications.

Methodology: A cross-sectional study was conducted among Indigenous Pastos and Quillacingas patients diagnosed with type 2 diabetes mellitus and treated by the I.P.S. Mallamas. Clinical data, including body mass index, blood pressure, glucose, lipid profile, and the presence of complications, were collected. Bivariate and multivariate analyses were applied to evaluate associations.

Results: A total of 609 patients were evaluated (mean age: 64.9 ± 12.3 years; 68.1% were women). Hypertension was present in 60.4% of patients and was more frequent in rural areas (63.4%) than in urban areas (59.8%). Diabetic complications were more frequent in rural areas (4.5%) than in urban areas (1.6%). Systolic blood pressure showed a significant association with these complications (OR: 1.05; 95% CI: 1.005–1.09).

Conclusions: There are territorial differences in risk factors and diabetic complications. Hypertension and the rural environment are associated with higher prevalence, highlighting the need for differentiated preventive strategies for these communities.

Use of the FreeStyle Libre 2 system in children and adolescents with type 1 diabetes in Colombia: Clinical guidelines

2025-05-28T13:38:18-05:00

Context: Continuous glucose monitoring (CGM) has significantly improved the management of type 1 diabetes in children and adolescents. In Colombia, two systems are marketed within the FreeStyle Libre family: FreeStyle Libre (first-generation isCGM without alarms, approved for ? 4 years) and FreeStyle Libre 2 Plus (FSL2 Plus), which can operate as rtCGM with the FreeStyle LibreLink application (with alarms) or as isCGM with a reader (without alarms), approved for ? 2 years.

Objective: To develop clinical recommendations for the use of FreeStyle Libre 2 Plus in children and adolescents with type 1 diabetes in Colombia, integrating scientific evidence with contextualized clinical experience.

Methodology: A structured literature review (2015–2024) was conducted on the use of FreeStyle Libre (FSL2 and FSL2 Plus) in pediatric type 1 diabetes. A nominal group technique involving six pediatric endocrinologists was used to formulate recommendations adapted to the Colombian context, with the support of an independent methodological team.

Results: A total of 22 recommendations were agreed upon and organized into five thematic areas: initiation of CGM, structured education, use of metrics and therapeutic targets, psychosocial support, and coordinated care. The recommendations cover practical aspects such as patient selection, alarm configuration when using the application, and scan frequency when using the reader, metric interpretation, and educational and emotional support.

Conclusions: This document provides practical guidance for healthcare professionals in Colombia and may be adaptable to other countries with similar healthcare systems. The implementation of the FreeStyle Libre 2 Plus system could promote safer, more equitable, and family-centered clinical decision-making.

Risk of thyroid cancer in pediatric patients with Hashimoto's thyroiditis

2025-07-24T14:17:31-05:00

Introduction: Hashimoto’s thyroiditis (HT) is highly prevalent and has attracted growing interest because of its potential association with thyroid cancer, suggesting that chronic inflammation may contribute to the development of thyroid neoplasms. In addition, the incidence of thyroid cancer in children has increased over recent decades.

Objective: To summarize the available evidence regarding the association between Hashimoto’s thyroiditis and thyroid cancer in children and adolescents.

Case Presentation: A 14-year-old female patient with a history of Hashimoto’s thyroiditis receiving levothyroxine treatment. During follow-up, thyroid ultrasound identified a 14-mm solid hypoechoic nodule with microcalcifications located in the thyroid isthmus. Fine-needle aspiration biopsy reported a follicular lesion of undetermined significance (Bethesda III). The case was evaluated by a multidisciplinary team to determine the most appropriate diagnostic and therapeutic approach.

Discussion: This narrative review found a higher prevalence of HT among pediatric patients with papillary thyroid carcinoma (PTC), suggesting an association, although not a causal relationship. The presence of HT has not been consistently associated with poor prognostic features such as extrathyroidal extension, capsular invasion, or lymph node metastases. Most studies included patients who underwent thyroidectomy, which limits the generalizability of the findings.

Conclusion: There is an association between autoimmune thyroiditis and an increased risk of differentiated thyroid cancer in children and adolescents. Careful follow-up of pediatric patients with HT and thyroid nodules is recommended, including ultrasound evaluation and fine-needle aspiration biopsy when indicated.

Systematic review of validated Spanish-language questionnaires for measuring treatment adherence in type 2 diabetes mellitus: Analysis of internal reliability

2025-11-10T17:15:37-05:00

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition with substantial global public health implications, characterized by rising prevalence and mortality rates, particularly in Latin America. Despite advancements in treatment, fewer than one-third of individuals with T2DM achieve a haemoglobin A1c (HbA1c) level below 7%. Medication adherence is a key contributor to poor glycemic outcomes, highlighting the need for strategies that enhance adherence to diabetes therapy.

Purpose: To determine the reliability of Spanish validated questionnaires measuring therapeutic adherence in patients with T2DM.

Methodology: A systematic review was conducted using the Medline, Scopus, LILACS, and SciELO databases, following the PRISMA guidelines, and including studies published up to January 2024. Studies presenting questionnaires validated in Spanish with measures of internal consistency (Cronbach’s alpha) were selected.

Results: Eight questionnaires validated in Spanish were identified, ranging from 8 to 30 items in length, with study sample sizes varying between 40 and 500 patients. The Cronbach’s alpha coefficient was high for the MBG (Martín-Bayarre-Grau Questionnaire), the ARMS-e (Adherence to Refill and Medication Scale–Spanish version), and the EATDM-III (Type 2 Diabetes Mellitus Treatment Adherence Scale, Version III), moderate for the ATTA (Attitude Toward Treatment Adherence), and low or unacceptable for the MMAS-8 (8-item Morisky Medication Adherence Scale), the AFCP (Principal Component Factor Analysis), the SMP-T2D (Self-Management Profile for Type 2 Diabetes), and the BMQ-e (Beliefs About Medicines Questionnaire–Spanish version). The majority of the questionnaires were validated in Spain, Mexico, or Cuba.

Conclusions: The reliability of adherence questionnaires varied significantly. MBG, ARMS-e, and EATDM-III demonstrate acceptable internal consistency and are suitable options for measuring and monitoring adherence.

A scoping review on the efficacy, effectiveness, and safety of different pharmacological therapies for the management of patients with glucocorticoid-induced osteoporosis

2025-05-09T09:37:15-05:00

Introduction: Glucocorticoid-induced osteoporosis (GIOP) is a common secondary osteoporosis resulting from chronic corticosteroid use. It affects bone homeostasis, leading to significant reductions in bone mineral density (BMD) and an increased risk of vertebral and non-vertebral fractures. Due to the increasing number of patients requiring long-term glucocorticoid therapy, a comprehensive understanding of pharmacological interventions available for glucocorticoid-induced osteoporosis is essential.

Objective: To evaluate the efficacy, effectiveness, and safety of different pharmacological therapies used in the management of patients with glucocorticoid-induced osteoporosis through a scoping review of the available literature.

Methods: Following the Joanna Briggs Institute (JBI) methodology, a scoping review was conducted using major databases (PubMed, Embase, Cochrane, and others). Studies including adults with glucocorticoid-induced osteoporosis treated with pharmacological therapies such as bisphosphonates, denosumab, teriparatide, and others were considered. Outcomes focused on changes in bone mineral density, fracture risk reduction, and treatment safety. A total of 40 studies were included (37 on efficacy, 1 on effectiveness, and 12 on safety).

Results: Bisphosphonates (e.g., risedronate, alendronate, and zoledronate) significantly improved lumbar spine bone mineral density (up to +4.8%; with variability across studies, including mean changes around +4.9% ± 4.5% in randomized controlled trials [RCTs]) and reduced vertebral fracture risk (by up to 82.4%). Teriparatide demonstrated superior efficacy in increasing bone mineral density (+7.8% to +11.0%) and reducing fracture incidence, especially in high-risk patients. Denosumab also showed notable improvements in bone mineral density and bone turnover markers. Adverse events were generally mild, with gastrointestinal and flu-like symptoms being the most commonly reported.

Discussion: Bisphosphonates remain the first-line therapy for glucocorticoid-induced osteoporosis due to their efficacy and safety profile. Teriparatide may be preferable for high-risk patients or those with severe bone formation suppression. Denosumab is a valid alternative, particularly for patients who are intolerant to bisphosphonates. This review highlights the importance of individualized therapy based on fracture risk and comorbidities.

Cardiovascular disease in patients with acromegaly: A narrative review

2025-08-31T23:33:50-05:00

Background: Acromegaly is a rare disease, most often caused by growth hormone (GH)-secreting pituitary adenomas. It produces multiple systemic manifestations, with cardiovascular involvement representing the leading cause of morbidity and mortality.

Objective: To describe the epidemiology and pathophysiology of cardiovascular disease in patients with acromegaly, as well as to review the impact of hormonal control in this setting.

Methods: A narrative literature search was performed in PubMed, Scielo, and Google Scholar up to January 2025 using the terms acromegaly, cardiovascular disease, hypertension, diabetes mellitus, dyslipidemia, arrhythmia, valvulopathy, cardiomyopathy, coronary artery disease, and cerebrovascular disease. Original articles, clinical trials, systematic reviews, and meta-analyses were included. Publications not available in English or Spanish were excluded.

Results: Excess GH and IGF-1 are associated with a high prevalence of cardiovascular comorbidities, including arterial hypertension affecting 50–64% of patients, followed by dyslipidemia, which affects more than 60%, and diabetes mellitus, present in approximately 30%. Cardiac arrhythmias occur in 7–40% of cases, and moderate to severe valvular disease occurs in 6–11%, both of which are associated with ventricular hypertrophy and myocardial fibrosis. Biochemical control achieved through surgery or pharmacological therapy may improve cardiovascular risk factors such as blood pressure and the lipid profile; however, evidence regarding its impact on the reduction of major cardiovascular events remains heterogeneous.

Conclusions: Cardiovascular involvement in acromegaly is frequent and clinically relevant. Although hormonal control improves some metabolic parameters, its effect on major cardiovascular outcomes such as death, myocardial infarction, and cerebrovascular disease remains uncertain. A comprehensive approach focused on hormonal control and the optimization of traditional risk factors is required, as well as prospective studies to more clearly define the therapeutic impact on clinically significant outcomes.

Molecular mechanisms of resistance to tyrosine kinase inhibitors in patients with iodine-refractory differentiated thyroid carcinoma

2025-07-14T11:20:29-05:00

Background: Iodine-refractory differentiated thyroid carcinoma (IRDTC) is associated with increased recurrence, metastatic disease, and mortality. Sorafenib and lenvatinib are approved in IDC for the treatment of locally unresectable disease and/or progressive metastatic disease, considering their positive impact on progression-free survival (PFS) and disease control. However, some patients develop resistance from the outset or after initiating these treatments.

Objective: To identify the molecular resistance mechanisms described to these tyrosine kinase inhibitors (TKIs) in IDC.

Methodology: A literature search was conducted, including articles in English or Spanish, all study types, and studies from the past 15 years. The PICO search strategy was: thyroid cancer OR thyroid carcinoma OR thyroid neoplasms AND sorafenib OR lenvatinib AND resistance OR non-response OR therapeutic failure. It does not present ethical implications.

Results: Three studies reported resistance to sorafenib and one to lenvatinib in IDC.

Conclusions: The identified resistance mechanisms were decreased miR-124/506, increased TSP-1 and TFG? induced by tumor pericytes, and KRAS and TERT mutations.