Revista Colombiana de Endocrinología, Diabetes & Metabolismo

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.

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.

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.