Revista Colombiana de Endocrinología, Diabetes & Metabolismo

Giant atypical parathyroid adenoma with severe hypercalcemia and multiple brown tumors

2025-06-09T22:43:00-05:00

Background: Atypical parathyroid adenoma (APA) is a rare neoplasm with features between benign adenoma and carcinoma. It often presents with severe hypercalcemia and lytic bone lesions such as brown tumors, which may mimic metastatic disease, complicating the diagnosis.

Purpose: To describe a case of giant APA with multiple brown tumors mimicking bone metastases, highlighting clinical, biochemical, imaging, and histopathological findings, as well as treatment and follow-up.

Case presentation: A 33-year-old woman presented with chronic bone pain, progressive muscle weakness, and significant weight loss. On examination, she had a mandibular mass and a left cervical nodule. Labs showed hypercalcemia (14.16 mg/dL), elevated PTH (725 pg/mL), and high alkaline phosphatase (1183 U/L). Imaging revealed multiple lytic lesions suggestive of brown tumors. A SESTAMIBI scan localized a left parathyroid adenoma. She underwent parathyroidectomy, and histopathology confirmed APA. Postoperatively, PTH and calcium levels normalized. At two-year follow-up, the patient showed sustained clinical and radiologic improvement.

Discussion and conclusion: APA is a diagnosis of exclusion and requires histological and immunohistochemical evaluation to differentiate it from malignancy. Although its presentation can be misleading, timely surgical intervention usually results in favorable outcomes. Long-term follow-up is essential to monitor recurrence. This case highlights the importance of considering endocrine causes like APA in patients with aggressive bone lesions. A multidisciplinary approach with early diagnosis and surgery can significantly improve prognosis and reduce complications.

Euglycemic diabetic Ketoacidosis with DPP4 Inhibitors, the importance of thinking about your diagnosis

2025-04-30T16:38:03-05:00

Background: Diabetic ketoacidosis (DKA) is frequently in the emergency department (ED). It is an acute complication of diabetes, with a risk of potentially fatal events and increased morbidity in this patient group. This complication is generally clinically characterized by hyperglycemia, metabolic acidosis, and the finding of ketonemia due to an absolute insulin deficiency.

Purpose: However, there are exceptions within the definition of ketoacidosis, and elevated blood glucose levels are not always present. This complicates the diagnosis, delays management, and increases the morbidity and mortality associated with this condition, highlighting the importance of its timely identification

Case presentation: The following presentation presents a 63-year-old patient admitted to the ED with diabetes mellitus being managed with sitagliptin who developed euglycemic DKA.

Discussion and conclusion: In general, diabetic ketoacidosis is an atypical but potentially serious presentation that may go unnoticed due to the absence of marked hyperglycemia; therefore, a thorough clinical history is essential for its suspicion.

Follow-up of subclinical hypothyroidism in a group of children during two years

2024-11-05T23:16:13-05:00

Background: Subclinical hypothyroidism (SH) is defined as a serum thyroid-stimulating hormone (TSH) concentration above the reference range with normal free thyroxine (fT4) levels. It is a common condition in children, usually asymptomatic and with a low probability of progressing to primary hypothyroidism.

Purpose: To evaluate the natural course of SH in children over a 2-year follow-up period.

Methods: A total of 42 children (18 boys and 24 girls) were followed for 2 years. TSH, free T4, and antithyroid antibodies were measured every 6 months. Growth velocity and the presence of clinical goiter were assessed according to the 2007 WHO classification.

Results: The mean age was 9.7 ± 2.8 years. Initial TSH was 6.3 ± 1.4 mUI/ml, with fT4 at 1.1 ± 0.3. At 6 months, 14 children (six boys and eight girls) showed normal TSH and fT4 levels, while 28 continued with elevated TSH (7.2 ± 1.2) and normal fT4 (1.0 ± 0.2); growth velocity remained normal and no associated symptoms were observed. At 12 months, 20 children presented normal TSH and fT4 levels; eight continued with elevated TSH and normal fT4. At 18 months, two girls showed elevated TSH with positive antithyroid antibodies and began treatment with levothyroxine. The remaining six showed normal TSH and fT4. The incidence of progression to hypothyroidism was 4.7%.

Conclusions: SH is a self-limited condition with a low rate of progression. Treatment in children should be considered only when TSH > 10 mUI/L, clinical goiter is present, or antithyroid antibodies are positive.

One-year follow-up in the secondary fracture prevention program at San José Hospital

2024-10-19T11:45:31-05:00

Backgroung: Secondary fracture prevention programs (SFPPs) are designed to identify and treat individuals with fragility fractures, to prevent future fractures.

Purpose: To describe the follow-up in falls, refractures and mortality in the PPSF at the San José Hospital (HSJ) in Bogotá, for one year.

Methodology: Descriptive cohort study carried out in patients with fragility fractures of the PPSF at the HSJ between January/2022 and August/2023 with one year of follow-up. The Key Performance Indicators (KPI) established by the IOF were analyzed.

Results: 118 patients with a mean age of 79 years (74.6% women), of whom 103 had one year of telephone follow-up. The most frequent fracture was hip (66%). Antiosteoporosis treatment was prescribed to 87% of patients (n = 103) before hospital discharge, of which 58.2% (n = 60) started at 4 months, 54.4% (56) and 52.4% (54) continued it at 6 and 12 months post-fracture, respectively. Falls were recorded in 13.6% (n = 14), refracture in 1.9% (n = 2), and death in 11.6% (n = 12).

Discussion: Although PPSFs reduce the treatment gap in patients with fragility fracture, there are few studies evaluating refracture. In the HSJ, adequate performance is observed in the initiation and continuity of treatment, with low rates of falls, refractures, and mortality.

Conclusion: PPSF prevents refractures through timely treatment and follow-up, so its implementation will reduce morbidity and mortality associated with osteoporosis.

Advancing body composition analysis: Transitioning beyond conventional BMI standards

2025-01-21T12:07:53-05:00

Background: Body mass index (BMI) remains the primary tool for obesity classification despite its limitations in assessing body composition. This study aimed to evaluate the relationship between different body composition parameters and compare World Health Organization (WHO) and National Health and Nutrition Examination Survey (NHANES) classification systems.

Methods: In this cross-sectional study of 3,255 patients (74.3% women) from a Colombian obesity and metabolism center, we analyzed body composition using bioelectrical impedance analysis. We assessed the concordance between the World Health Organization and the National Health and Nutrition Examination Survey classifications, and examined correlations between body composition parameters, with particular focus on phase angle (PhA) as a predictor of muscle mass.

Results: While body mass index showed a strong correlation with body fat mass (? = 0.929, p < 0.001), it poorly predicted muscle mass. The World Health Organization and the National Health and Nutrition Examination Survey classifications showed fair overall agreement (? = 0.39), with better concordance in women (? = 0.43) than men (? = 0.28). Multiple regression analyses revealed PhA as a strong predictor of muscle mass (? = 1.032, p < 0.0001, R² = 0.332) but not fat mass (p = 0.525, R² = 0.055).

Conclusions: While body mass index adequately predicts adiposity, it falls short in assessing muscle mass. Phase angle emerges as a promising predictor of muscle mass, independent of age and sex, suggesting its potential utility in clinical assessment of body composition.

Global landscape of Cushing’s syndrome registries: A systematic mapping study of design, coverage, and outcomes

2025-04-15T01:00:50-05:00

Context: Cushing’s syndrome (CS) is a rare endocrine disorder associated with high morbidity and mortality. Its low prevalence and clinical heterogeneity challenge large-scale population studies, highlighting the role of patient registries as key sources of information for epidemiological surveillance, clinical research, and public health decision-making.

Objective: To describe and analyze the clinical, therapeutic, and outcome characteristics of population-based registries of Cushing’s syndrome worldwide.

Methodology: A systematic literature review was conducted in PubMed up to December 2024. Articles in English and Spanish reporting population-based registries of adult patients with Cushing’s syndrome were included. The search was complemented by manual reference screening.

Results: Fifteen articles corresponding to twelve registries were identified. Most registries originated in Europe, notably the multinational ERCUSYN registry. Only one study from Argentina represented Latin America. Significant heterogeneity was found in diagnostic criteria, treatment approaches, and remission definitions. The most frequent comorbidities were hypertension and type 2 diabetes. Reported mortality ranged from 0% to 26.5%, depending on follow-up duration.

Conclusions: Population-based registries are essential tools to improve clinical and epidemiological understanding of Cushing’s syndrome. However, their geographic coverage remains limited, and methodological standardization is insufficient. There is a pressing need to develop registries in underrepresented regions such as Latin America.

Clinical Practice Guideline for the Treatment and Follow Up of Type 2 Diabetes Mellitus in the Colombian Adult Population: Colombian Association of Endocrinology, Diabetes and Metabolism, 2025

2025-10-21T22:14:19-05:00

Background: The Colombian Association of Endocrinology, Diabetes and Metabolism
(ACE) developed this clinical practice guideline with the aim of providing updated
recommendations for the management and follow-up of individuals living with type 2
diabetes mellitus (T2DM) in Colombia. This update responds to the need to revise the
recommendations established in the national guideline published in 2016, in light of recent and robust global scientific evidence that has substantially modified the therapeutic approach.
Objective: The guideline emphasizes the preventive approach to cardiovascular and renal outcomes, as well as the integration of lifestyle interventions and the incorporation of technology as an essential component of a holistic approach to T2DM care.
Methods: The guideline was developed using the GRADE methodology, in accordance with the AGREE II and Institute of Medicine standards. The process included the formulation of nine PICO questions, systematic literature searches, critical appraisal of evidence, and formulation of recommendations by an interdisciplinary panel with patient participation.
Transparency was ensured through conflict-of-interest management and external international review.
Main recommendations: Combination therapy with metformin and either a sodium
glucose cotransporter-2 inhibitor (SGLT2i) or a dipeptidyl peptidase-4 inhibitor (DPP-4i)
is recommended for patients with significantly elevated HbA1c levels, while combinations with sulfonylureas are discouraged.
In patients who do not reach glycemic targets with metformin monotherapy, adding an SGLT2i or a glucagon-like peptide-1 receptor agonist (AR GLP-1) is suggested, the latter
being particularly indicated in individuals with overweight, obesity, or markedly elevated HbA1c.
For patients with inadequate glycemic control despite oral antidiabetic therapy, the preferred next step is the addition of a AR GLP-1, especially in those with a body mass index (BMI) >27 kg/m². Basal insulin should be considered when glycemic control is not achieved with a AR GLP-1.
In cases of T2DM associated with overweight or obesity, the use of AR GLP-1s or dual GLP-1/GIP receptor agonists is recommended. In individuals with class II or higher obesity, metabolic or bariatric surgery may be considered, provided it is accompanied by patient education, individualized risk–benefit assessment, and performed in specialized reference centers.
Cardiorenal protective therapies (SGLT2i, AR GLP-1, finerenone) should be prioritized and initiated regardless of glycemic control or concomitant therapy, in individuals with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, according to individual clinical profiles.
The use of real-time continuous glucose monitoring (CGM) systems is recommended in patients receiving multiple daily insulin doses and experiencing hypoglycemia or inadequate glycemic control.
Finally, the guideline underscores the importance of continuous diabetes education and a multidisciplinary approach as cornerstones of comprehensive care for all individuals with T2DM.
Conclusions: This guideline provides a practical and rigorous framework for the
comprehensive management of T2DM in Colombia, with recommendations tailored to the national context and high potential to improve quality of life and reduce disease burden.

Type 2 diabetes and urinary incontinence: A scoping review and position statement

2025-04-08T18:19:34-05:00

Context: Urinary incontinence (UI) is a highly prevalent and disabling condition among older adults and women with type 2 diabetes (T2D), yet it remains underrecognized in clinical guidelines. The global rise in diabetes and population aging amplifies its burden.

Objective: This position statement aims to raise clinical awareness about urinary incontinence in individuals with diabetes and provide evidence-based recommendations for its management. A multidisciplinary consensus process identified key barriers, challenges, and care priorities to guide healthcare professionals in delivering more comprehensive and person-centered care.

Methods: A scoping review was conducted to examine the clinical literature on urinary incontinence and its association with type 2 diabetes, following the Joanna Briggs Institute Reviewer’s Manual and PRISMA-ScR guidelines. The Nominal Group Technique was also used to obtain insights from a multidisciplinary panel of experts, including endocrinologists, geriatricians, nurses, and pelvic floor specialists.

Results: The review included 32 peer-reviewed articles and informed structured discussions on the epidemiology, clinical impact, treatment strategies, and lived experiences related to urinary incontinence in people with type 2 diabetes. The expert panel generated 57 ideas; 23 were considered critically important and incorporated into the final position statement.

Conclusions: Urinary incontinence remains underdiagnosed and undertreated among older adults and postmenopausal women with type 2 diabetes. Contributing factors include fragmented care, limited provider awareness, and financial barriers. Multidisciplinary strategies focusing on metabolic control, patient education, and improved healthcare accessibility are essential for advancing the quality of care and reducing the burden of urinary incontinence in this vulnerable population.

History of the discovery of calcitonin and its link to medullary thyroid carcinoma

2025-07-21T22:32:34-05:00

Context. Calcitonin, discovered in 1962 as the result of experimental observations and serendipitous findings, is a thyroid hormone secreted by C cells. Initially investigated for its hypocalcemic effect and potential therapeutic role in bone diseases, it was later established as a clinically valuable tumor marker.

Contents. This article reviews the historical and scientific milestones of calcitonin: from its identification by Douglas Harold Copp and collaborators, the characterization of its cellular origin, and its isolation from salmon tissue, to the development of immunoassays that enabled its plasma quantification. The contributions of Tashjian, Melvin, and Deftos in the 1960s demonstrated its diagnostic and follow-up value in medullary thyroid carcinoma (MTC). Its application in osteoporosis and pain management is also highlighted, although its major clinical relevance remains in endocrine oncology.

Conclusions. From an initially skeptical reception, calcitonin evolved into a specific and essential biomarker for the diagnosis and monitoring of MTC. Its history exemplifies how scientific curiosity and perseverance can transform clinical practice and significantly improve patient outcomes.

Vitamin D: The invisible deficiency that compromises overall health

2025-07-06T14:34:41-05:00

Vitamin D deficiency is one of the most common deficiency conditions worldwide, affecting millions of people in all age groups and in multiple clinical contexts. Despite its high prevalence, it continues to be underdiagnosed and undertreated, partly due to its silent course, the limited incorporation of screening into routine medical practice, and the persistent perception that its clinical consequences are limited to bone metabolism. This reductionist view has contributed to the underutilization of a safe, accessible therapeutic tool with broad preventive and prognostic potential in various chronic diseases.

For decades, vitamin D deficiency was mainly linked to rickets in children and osteomalacia in adults. However, advances in research have shown that vitamin D has receptors in multiple tissues, exerting endocrine, paracrine, and immunomodulatory functions that transcend its role in calcium and phosphorus homeostasis. It is now recognized that low levels of 25-hydroxyvitamin D are associated not only with bone fragility, falls, and fractures, but also with sarcopenia, muscle weakness, immune disorders, metabolic, neurocognitive, and emotional dysfunction, among other adverse outcomes.

Osteosarcopenia approach: Two overlapping geriatric syndromes

2025-01-20T20:34:46-05:00

Background: Osteosarcopenia is a term used since 2009 referring to the coexistence of bone microarchitectural deterioration (osteopenia/osteoporosis) and muscle involvement (sarcopenia), two geriatric syndromes prevalent in the older adult and which increases the risk of unfavorable outcomes.

Purpose: The objective of this review is to facilitate a comprehensive understanding of this syndrome, focused on primary care physicians.

Methodology: Narrative review of the literature with bibliographic search in databases such as PubMed/Medline, SCOPUS, ScienceDirect, SciELO, Redalyc and Google Scholar.

Results: Osteosarcopenia develops after the molecular, hormonal and mechanical interaction between bone and muscle; its dysregulation can promote the inhibition of muscle synthesis, negatively affecting bone metabolism. It is the result of a combination of biological, psychosocial, lifestyle, nutritional deficit, and exposure-related risk factors, as well as other syndromes such as frailty and the chronic proinflammatory state associated with aging. Osteosarcopenia has an average prevalence of 12,7?% and is associated with reduced gait speed, as well as increased risk of falls, fractures, hospitalizations, and mortality. Its diagnosis requires clinical, functional, and imaging assessments. Treatment involves a combination of pharmacological and non-pharmacological interventions, supported by a multidisciplinary approach that can be implemented at the primary care level. Comprehensive geriatric assessment enables the active detection, management, and follow-up of the syndrome. Further clinical trials in geriatric populations are needed to develop cost-effective diagnostic and interventional strategies at the primary care level.

Conclusions: Osteosarcopenia represents a dual geriatric syndrome, characterized by the simultaneous impairment of bone and muscle mass, with significant repercussions on functionality, quality of life, and life expectancy in older adults. Its management requires a systematic and comprehensive approach to enable early detection and timely treatment.

Colombia, in pursuit of excellence in bone fracture prevention

2025-09-12T06:57:58-05:00

By 2025, Colombia will be a country impacted by population aging. According to DANE statistics, the Colombian population is estimated at 53,057,212 million inhabitants, of which 51.2% are women and 48.8% are men. The population of people over 65 is growing exponentially and is expected to reach 9.1% by 2025, or around five million inhabitants. Osteoporotic fractures, which particularly affect this age group, have increased significantly, as shown in the article published in this edition on the follow-up to the secondary fracture prevention program at Hospital San José in Bogotá.

As stated in this editorial and based on the Audit Latam 2021 publication, the incidence of fractures doubled between 2015 and 2019, and projections for 2030 predict a 45.0% increase and for 2050 a 100% increase over current fracture figures. The article also reports on the estimated economic costs to the healthcare system attributed to the management of osteoporotic fractures, based on national reports and expressed in US dollars to facilitate interpretation and comparison in the Latin American context.

Although we have made progress in the diagnosis and therapeutic approach to osteoporosis with the update of the clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis, developed by the Colombian Association of Osteoporosis and Mineral Metabolism (ACOMM) (which seeks to bring early and timely management of osteoporosis to primary care, with the aim of preventing the first fracture), it is necessary that when a fracture does occur, the therapeutic care of patients be complemented by including them in secondary prevention programs, because it is known that the highest risk of subsequent fracture is observed in these patients and because it has been established not only in our environment but universally that long-term pharmacological and rehabilitation treatments do not achieve the levels of adherence required for optimal control of the disease and its complications.