Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.010
Rodolfo Lahsen MD
The purpose of this review is to raise awareness and educate physicians about the concept, pathogenesis, and general aspects of diabesity treatment. The concept of diabesity is based on the twin epidemics of obesity and diabetes. Given a positive caloric balance, the inability of subcutaneous adipose tissue to expand leads to the deposition of visceral and ectopic fat, which favors lipotoxicity and inflammation, causing insulin resistance in the liver and muscle. At early stages, pancreatic beta cells compensate insulin resistance with hyperinsulinemia. However, lipotoxicity and inflammation trigger beta cell apoptosis, rendering them unable to compensate, resulting in hyperglycemia, first in the prediabetic range and later, full-blown diabetes. Furthermore, lipotoxicity and inflammation affect other organs and systems, such as the heart, circulatory system, and kidneys, which in turn are targets for the complications of diabetes, thus constituting a metabolic-cardio-renal syndrome. Weight loss through a healthy lifestyle, the eventual use of antidiabetic drugs that produce weight loss, and endoscopic or surgical interventional procedures, can reduce the morbidity and mortality associated with diabesity.
{"title":"Diabesidad: concepto e implicancias","authors":"Rodolfo Lahsen MD","doi":"10.1016/j.rmclc.2025.08.010","DOIUrl":"10.1016/j.rmclc.2025.08.010","url":null,"abstract":"<div><div>The purpose of this review is to raise awareness and educate physicians about the concept, pathogenesis, and general aspects of diabesity treatment. The concept of diabesity is based on the twin epidemics of obesity and diabetes. Given a positive caloric balance, the inability of subcutaneous adipose tissue to expand leads to the deposition of visceral and ectopic fat, which favors lipotoxicity and inflammation, causing insulin resistance in the liver and muscle. At early stages, pancreatic beta cells compensate insulin resistance with hyperinsulinemia. However, lipotoxicity and inflammation trigger beta cell apoptosis, rendering them unable to compensate, resulting in hyperglycemia, first in the prediabetic range and later, full-blown diabetes. Furthermore, lipotoxicity and inflammation affect other organs and systems, such as the heart, circulatory system, and kidneys, which in turn are targets for the complications of diabetes, thus constituting a metabolic-cardio-renal syndrome. Weight loss through a healthy lifestyle, the eventual use of antidiabetic drugs that produce weight loss, and endoscopic or surgical interventional procedures, can reduce the morbidity and mortality associated with diabesity.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 340-347"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.007
Francisco Cordero MD
Pituitary incidentalomas (PI) are pituitary lesions identified incidentally through imaging. They have become common in clinical practice due to the increased use of imaging and radiological advances with improved resolution. Most PI in adults are pituitary adenomas, and since their nomenclature has recently changed to PitNET, we will focus on this type of tumor, its definition, functional study, and management. Emphasis is also placed on the need for patients to be evaluated by a multidisciplinary team with experience in medical and surgical management
{"title":"Enfrentamiento del incidentaloma hipofisiario","authors":"Francisco Cordero MD","doi":"10.1016/j.rmclc.2025.08.007","DOIUrl":"10.1016/j.rmclc.2025.08.007","url":null,"abstract":"<div><div>Pituitary incidentalomas (PI) are pituitary lesions identified incidentally through imaging. They have become common in clinical practice due to the increased use of imaging and radiological advances with improved resolution. Most PI in adults are pituitary adenomas, and since their nomenclature has recently changed to PitNET, we will focus on this type of tumor, its definition, functional study, and management. Emphasis is also placed on the need for patients to be evaluated by a multidisciplinary team with experience in medical and surgical management</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 237-244"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.002
Pedro Pineda MD
Medullary thyroid cancer (MTC) is an infrequent neuroendocrine malignant tumor that presents significant challenges in its diagnosis, therapy, and follow-up. The preoperative diagnosis is based on clinical suspicion, measurement of calcitonin (Ct) levels, and careful analysis of cytology obtained by fine needle aspiration. Once the diagnosis is confirmed, genetic testing of RET proto-oncogene should be performed to define prognosis, complementary studies and genetic counseling. Pre and postoperative staging is essential to perform adequate therapy. Cervical surgery is the only potentially curative therapy for MTC. Follow-up should be systematic, with measurement of Ct and CEA levels and appropriate imaging according to disease staging. Systemic therapy should be evaluated on an individual basis, considering the evolution and progression of the disease. As this is a low-frequency malignant tumor with variable behavior, it is recommended that these cases should be managed by experienced multidisciplinary groups.
The objective of this article is to describe the main characteristics of this neoplasia, highlighting its genetic aspects, clinical manifestations, diagnostic methods, and current treatment and follow-up options.
{"title":"Carcinoma medular de tiroides: genética, diagnóstico, opciones terapéuticas y seguimiento","authors":"Pedro Pineda MD","doi":"10.1016/j.rmclc.2025.08.002","DOIUrl":"10.1016/j.rmclc.2025.08.002","url":null,"abstract":"<div><div>Medullary thyroid cancer (MTC) is an infrequent neuroendocrine malignant tumor that presents significant challenges in its diagnosis, therapy, and follow-up. The preoperative diagnosis is based on clinical suspicion, measurement of calcitonin (Ct) levels, and careful analysis of cytology obtained by fine needle aspiration. Once the diagnosis is confirmed, genetic testing of RET proto-oncogene should be performed to define prognosis, complementary studies and genetic counseling. Pre and postoperative staging is essential to perform adequate therapy. Cervical surgery is the only potentially curative therapy for MTC. Follow-up should be systematic, with measurement of Ct and CEA levels and appropriate imaging according to disease staging. Systemic therapy should be evaluated on an individual basis, considering the evolution and progression of the disease. As this is a low-frequency malignant tumor with variable behavior, it is recommended that these cases should be managed by experienced multidisciplinary groups.</div><div>The objective of this article is to describe the main characteristics of this neoplasia, highlighting its genetic aspects, clinical manifestations, diagnostic methods, and current treatment and follow-up options.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 288-294"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.006
Thomas Uslar MD , Rene Baudrand MD , Cristian A. Carvajal PhD , Carlos E. Fardella MD
Mineralocorticoid-dependent hypertension is a common form of secondary hypertension that encompasses various disorders sharing a common feature: hyperactivation of the mineralocorticoid receptor. The most relevant causes include primary aldosteronism (PA), 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) deficiency, and the hypertensive forms of classic congenital adrenal hyperplasia. PA is an adrenal disorder characterized by inappropriate aldosterone production that is independent of its physiological regulators. It is a frequent cause of secondary hypertension and is associated with higher cardiovascular risks compared to primary (essential) hypertension. Despite the availability of effective diagnostic and therapeutic methods, PA remains underdiagnosed, preventing many patients from receiving personalized, effective, and potentially curative treatments. The aim of this review is to provide healthcare professionals managing patients with arterial hypertension with an updated and practical overview of the main causes of mineralocorticoid-dependent secondary hypertension, with a particular focus on PA. It addresses its pathophysiology, diagnostic criteria, genetic advances, and therapeutic strategies, with the goal of improving its detection and timely management in clinical practice, ultimately reducing the associated morbidity and mortality burden.
{"title":"Hipertensión arterial mineralocorticoidea","authors":"Thomas Uslar MD , Rene Baudrand MD , Cristian A. Carvajal PhD , Carlos E. Fardella MD","doi":"10.1016/j.rmclc.2025.08.006","DOIUrl":"10.1016/j.rmclc.2025.08.006","url":null,"abstract":"<div><div>Mineralocorticoid-dependent hypertension is a common form of secondary hypertension that encompasses various disorders sharing a common feature: hyperactivation of the mineralocorticoid receptor. The most relevant causes include primary aldosteronism (PA), 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) deficiency, and the hypertensive forms of classic congenital adrenal hyperplasia. PA is an adrenal disorder characterized by inappropriate aldosterone production that is independent of its physiological regulators. It is a frequent cause of secondary hypertension and is associated with higher cardiovascular risks compared to primary (essential) hypertension. Despite the availability of effective diagnostic and therapeutic methods, PA remains underdiagnosed, preventing many patients from receiving personalized, effective, and potentially curative treatments. The aim of this review is to provide healthcare professionals managing patients with arterial hypertension with an updated and practical overview of the main causes of mineralocorticoid-dependent secondary hypertension, with a particular focus on PA. It addresses its pathophysiology, diagnostic criteria, genetic advances, and therapeutic strategies, with the goal of improving its detection and timely management in clinical practice, ultimately reducing the associated morbidity and mortality burden.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 331-339"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.013
A. Verónica Araya MD
The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical guidelines have established recommendations for the management of these lesions.guidelines have established recommendations for the management of these lesions.
The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We will review the main elements used in the differential diagnosis of benign and malignant adrenal will review the main elements used in the differential diagnosis of benign and malignant adrenal lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite testing, which has proven useful in the differential diagnosis of SI with testing, which has proven useful in the differential diagnosis of SI with ≥10 HU on unenhanced CT. 10 HU on unenhanced CT. We will also review new mutations associated with multiple endocrine neoplasia syndromes, which We will also review new mutations associated with multiple endocrine neoplasia syndromes, which should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current approach regarding the follow-up of non-functioning benign lesions and patients with MACS.approach regarding the follow-up of non-functioning benign lesions and patients with MACS.
{"title":"Avances en el diagnóstico y etiología de los tumores de la corteza suprarrenal","authors":"A. Verónica Araya MD","doi":"10.1016/j.rmclc.2025.08.013","DOIUrl":"10.1016/j.rmclc.2025.08.013","url":null,"abstract":"<div><div>The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for The frequent finding of adrenal incidentalomas (AI) is mainly due to the increased request for computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical computed tomography (CT) scans and their improved resolution. Currently, evidence-based clinical guidelines have established recommendations for the management of these lesions.guidelines have established recommendations for the management of these lesions.</div><div>The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We The aim of this article is to highlight the main recommendations for the correct evaluation of AI. We will review the main elements used in the differential diagnosis of benign and malignant adrenal will review the main elements used in the differential diagnosis of benign and malignant adrenal lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional lesions, such as Hounsfield units (HU) and AI size on unenhanced CT; the indication for additional imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous imaging; tests indicated in the evaluation of hyperfunction; the definition of mild autonomous cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite cortisol secretion (MACS) and its implications; and the introduction of adrenal steroid metabolite testing, which has proven useful in the differential diagnosis of SI with testing, which has proven useful in the differential diagnosis of SI with ≥10 HU on unenhanced CT. 10 HU on unenhanced CT. We will also review new mutations associated with multiple endocrine neoplasia syndromes, which We will also review new mutations associated with multiple endocrine neoplasia syndromes, which should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current should be suspected especially in bilateral adrenal lesions. Finally, we will mention the current approach regarding the follow-up of non-functioning benign lesions and patients with MACS.approach regarding the follow-up of non-functioning benign lesions and patients with MACS.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 348-356"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.004
Luis Inzunza C. MD
Surgery remains the cornerstone of thyroid cancer treatment. Greater access to imaging studies now allows for the diagnosis of nodules at earlier stages. While this improves diagnostic performance, it also requires careful evaluation to avoid overdiagnosis and overtreatment. In this context, less aggressive surgical procedures, such as lobectomy or partial thyroidectomy, or less invasive approaches, have gained relevance in recent years. Proper preoperative evaluation and planning by the surgeon and a multidisciplinary team is essential to offer personalized treatment to each patient. Advances in anesthesia, the use of energy instruments for hemostasis, and intraoperative monitoring of the laryngeal nerve have improved surgical safety, although they do not replace the surgeon's meticulous technique or clinical judgment. Remote access routes and radiofrequency ablation techniques represent surgical management alternatives for selected cases of patients with thyroid cancer. The objective of this review is to analyze the current status of diagnosis and surgical treatment of this pathology.
{"title":"Recomendaciones para el manejo quirúrgico actual del nódulo tiroideo maligno","authors":"Luis Inzunza C. MD","doi":"10.1016/j.rmclc.2025.08.004","DOIUrl":"10.1016/j.rmclc.2025.08.004","url":null,"abstract":"<div><div>Surgery remains the cornerstone of thyroid cancer treatment. Greater access to imaging studies now allows for the diagnosis of nodules at earlier stages. While this improves diagnostic performance, it also requires careful evaluation to avoid overdiagnosis and overtreatment. In this context, less aggressive surgical procedures, such as lobectomy or partial thyroidectomy, or less invasive approaches, have gained relevance in recent years. Proper preoperative evaluation and planning by the surgeon and a multidisciplinary team is essential to offer personalized treatment to each patient. Advances in anesthesia, the use of energy instruments for hemostasis, and intraoperative monitoring of the laryngeal nerve have improved surgical safety, although they do not replace the surgeon's meticulous technique or clinical judgment. Remote access routes and radiofrequency ablation techniques represent surgical management alternatives for selected cases of patients with thyroid cancer. The objective of this review is to analyze the current status of diagnosis and surgical treatment of this pathology.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 273-287"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.07.001
Francisco J. Guarda , Flavia Nilo , Pablo Villanueva
Acromegaly is a rare disorder, primarily caused by benign growth hormone-secreting tumors of the pituitary gland, leading to multisystemic complications and increased morbidity and mortality. This review aims to show the most updated advances in its management, which should be individualized and conducted by specialized multidisciplinary teams with expertise in pituitary disorders. Surgery, when performed by experienced surgeons, remains the first-line treatment in most cases. For patients with persistent disease, alternative therapeutic options include radiation, repeat surgery, and pharmacological agents targeting different molecular pathways, such as first and second-generation somatostatin analogs, dopamine agonists, and growth hormone receptor antagonists, among others. A multimodal treatment approach, combining multiple therapeutic strategies, has been shown to achieve high remission rates. Treatment selection should be tailored based on clinical, biochemical, radiological, and histological parameters to optimize outcomes, minimize long-term complications, and ultimately improve patients’ quality of life.
{"title":"Avances en el enfrentamiento diagnóstico y terapéutico de la acromegalia","authors":"Francisco J. Guarda , Flavia Nilo , Pablo Villanueva","doi":"10.1016/j.rmclc.2025.07.001","DOIUrl":"10.1016/j.rmclc.2025.07.001","url":null,"abstract":"<div><div>Acromegaly is a rare disorder, primarily caused by benign growth hormone-secreting tumors of the pituitary gland, leading to multisystemic complications and increased morbidity and mortality. This review aims to show the most updated advances in its management, which should be individualized and conducted by specialized multidisciplinary teams with expertise in pituitary disorders. Surgery, when performed by experienced surgeons, remains the first-line treatment in most cases. For patients with persistent disease, alternative therapeutic options include radiation, repeat surgery, and pharmacological agents targeting different molecular pathways, such as first and second-generation somatostatin analogs, dopamine agonists, and growth hormone receptor antagonists, among others. A multimodal treatment approach, combining multiple therapeutic strategies, has been shown to achieve high remission rates. Treatment selection should be tailored based on clinical, biochemical, radiological, and histological parameters to optimize outcomes, minimize long-term complications, and ultimately improve patients’ quality of life.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 245-251"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.001
José Canessa García MD
New techniques are discussed to complement the conventional assessment of bone mineral density (BMD) performed using radiological bone densitometry (DXA), with the aim of evaluating bone quality and estimating the risk of osteoporotic fracture. These approaches allow for a more accurate clinical assessment of bone health, early and selective initiation of targeted therapy, and monitorization of its progression.
Complementary to standard DXA studies and fully validated, the 10-year fracture risk estimation tool (FRAX), which incorporates well-established clinical risk factors, and the trabecular bone score (TBS), derived from texture analysis, are available. Hip structural analysis (HSA), although available, has not yet been clinically validated.
Beyond DXA, which has limitations such as exposure to ionizing radiation (albeit very low), the analysis of bone area rather than volume, and the inability to differentiate cortical from trabecular bone, other imaging modalities include quantitative radiological techniques such as quantitative computed tomography (QCT) and high-resolution peripheral quantitative computed tomography (HR-pQCT), which also involve radiation exposure (with higher doses). Radiaton-free techniques like quantitative ultrasound (QUS), radiofrequency echographic multi-spectrometry (REMS), and quantitative magnetic resonance imaging (QMRI) are also available. These latter methods, to varying extents, provide three-dimensional or volumetric assessments, high-resolution imaging, and the ability to distinguish between cortical and trabecular bone, thereby increasing diagnostic specificity.
The main limitations of these newer technologies include their high cost, limited availability, and, in some cases, a lack of clinical validation in large population studies. The integration of artificial intelligence into these techniques is expected to revolutionize image analysis and interpretation, as well as the automation of diagnostic processes.
{"title":"Nuevos métodos de evaluación de la densidad y contenido mineral óseo","authors":"José Canessa García MD","doi":"10.1016/j.rmclc.2025.08.001","DOIUrl":"10.1016/j.rmclc.2025.08.001","url":null,"abstract":"<div><div>New techniques are discussed to complement the conventional assessment of bone mineral density (BMD) performed using radiological bone densitometry (DXA), with the aim of evaluating bone quality and estimating the risk of osteoporotic fracture. These approaches allow for a more accurate clinical assessment of bone health, early and selective initiation of targeted therapy, and monitorization of its progression.</div><div>Complementary to standard DXA studies and fully validated, the 10-year fracture risk estimation tool (FRAX), which incorporates well-established clinical risk factors, and the trabecular bone score (TBS), derived from texture analysis, are available. Hip structural analysis (HSA), although available, has not yet been clinically validated.</div><div>Beyond DXA, which has limitations such as exposure to ionizing radiation (albeit very low), the analysis of bone area rather than volume, and the inability to differentiate cortical from trabecular bone, other imaging modalities include quantitative radiological techniques such as quantitative computed tomography (QCT) and high-resolution peripheral quantitative computed tomography (HR-pQCT), which also involve radiation exposure (with higher doses). Radiaton-free techniques like quantitative ultrasound (QUS), radiofrequency echographic multi-spectrometry (REMS), and quantitative magnetic resonance imaging (QMRI) are also available. These latter methods, to varying extents, provide three-dimensional or volumetric assessments, high-resolution imaging, and the ability to distinguish between cortical and trabecular bone, thereby increasing diagnostic specificity.</div><div>The main limitations of these newer technologies include their high cost, limited availability, and, in some cases, a lack of clinical validation in large population studies. The integration of artificial intelligence into these techniques is expected to revolutionize image analysis and interpretation, as well as the automation of diagnostic processes.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 315-324"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.rmclc.2025.08.011
Marcelo Mardones Parga MD
Primary hyperparathyroidism (PHPT) is an endocrine disease resulting from hyperfunction of one or more parathyroid glands (80% and 15-20% of cases, respectively) and is characterized by the presence of hypercalcemia associated with elevated or inappropriately normal parathyroid hormone (PTH) levels. Currently, PHPT is mainly an asymptomatic condition; therefore, it should be actively sought in the presence of nephrolithiasis, hypercalciuria, osteoporosis, or fractures in order to achieve appropriate management. During the diagnostic process, other conditions that present with elevated PTH levels, as well as other causes of hypercalcemia (such as familial hypocalciuric hipercalcemia or lithium use) must be excluded. Definitive treatment is surgical and involves preoperative imaging localization of parathyroid glands. Patients who do not qualify for surgery may opt for medical therapy. This paper reviews current epidemiological, pathophysiological, clinical, diagnostic, and therapeutic aspects of PHPT.
{"title":"Hiperparatiroidismo primario","authors":"Marcelo Mardones Parga MD","doi":"10.1016/j.rmclc.2025.08.011","DOIUrl":"10.1016/j.rmclc.2025.08.011","url":null,"abstract":"<div><div>Primary hyperparathyroidism (PHPT) is an endocrine disease resulting from hyperfunction of one or more parathyroid glands (80% and 15-20% of cases, respectively) and is characterized by the presence of hypercalcemia associated with elevated or inappropriately normal parathyroid hormone (PTH) levels. Currently, PHPT is mainly an asymptomatic condition; therefore, it should be actively sought in the presence of nephrolithiasis, hypercalciuria, osteoporosis, or fractures in order to achieve appropriate management. During the diagnostic process, other conditions that present with elevated PTH levels, as well as other causes of hypercalcemia (such as familial hypocalciuric hipercalcemia or lithium use) must be excluded. Definitive treatment is surgical and involves preoperative imaging localization of parathyroid glands. Patients who do not qualify for surgery may opt for medical therapy. This paper reviews current epidemiological, pathophysiological, clinical, diagnostic, and therapeutic aspects of PHPT.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 4","pages":"Pages 252-259"},"PeriodicalIF":0.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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