Background: Cushing’s syndrome (CS) is a rare endocrine disorder caused by long-term exposure to excess cortisol and is linked to significant morbidity. Data from multiple centers in Latin America remains limited. Objectives: To describe the clinical, diagnostic, and treatment characteristics of patients with CS in a regional Colombian cohort and to assess surgical outcomes in patients with Cushing’s disease (CD) based on neurosurgical expertise. Design: Multicenter retrospective cohort study. Methods: Medical records from six hospitals in Antioquia, Colombia, were reviewed, including adult patients with biochemically confirmed endogenous CS diagnosed between 2010 and 2024. Data collected included sociodemographic, clinical features, diagnostic tests, etiological classification, treatments, and outcomes. In patients with CD, surgical remission, recurrence, persistence, and postoperative complications were compared based on neurosurgical expertise. Results: A total of 130 patients were included; 86.9% were women, with an average age of 50.7 years. The most common presenting features were weight gain (79.2%), moon face (36.9%), and striae (29.2%). CD was the leading cause (74.6%), followed by adrenal CS (17.6%) and ectopic adrenocorticotropic hormone syndrome (1.5%). The most frequently used diagnostic tests were 24-h urinary free cortisol and the 1-mg overnight dexamethasone suppression test, while late-night salivary cortisol and inferior petrosal sinus sampling were less commonly performed. Transsphenoidal surgery in CD achieved an initial remission rate of 63.3%, with no significant differences based on neurosurgical experience. All cases of adrenal CS underwent unilateral adrenalectomy. Conclusion: In this Colombian multicenter cohort, the clinical features, etiological distribution, and surgical outcomes in CS and CD were similar to those reported in specialized international centers. These findings highlight the importance of early detection, better access to diagnostic tools, and multidisciplinary care to improve outcomes in this rare disease.

Type 2 diabetes mellitus (T2DM) impacts the development of cardiovascular disease. Prediabetes, called intermediate hyperglycemia, is diagnosed with glucose levels that do not meet the criteria for T2DM, but are elevated. Lifestyle changes achieve a reversal of up to 58%, structured within an adequate follow-up in cardiovascular risk programs. Longitudinal, descriptive study, with analytical scope, retrospective collection of information from a cohort of adults with a diagnosis of prediabetes; in quarterly follow-up by a cardiovascular risk program of a III level institution between 2019 - 2023. Univariate and bivariate analysis and logistic regression were performed to define the correlation between reversion to normoglycemia and associated factors. Mean age was 69.5 years (SD 10.1), 50.8% women, median follow-up 366 days (IQR 249 - 569). Performing physical activity > 150 minutes per week (validated by International Physical Activity Questionnaire - IPAQ), increases 4.15 times the chance of reversing prediabetes (p< 0.001); while decreasing the chance of reversal, having an HbA1c ≥ 6.0 to 86% (p= 0.014) and BMI ≥ 25 to 75% (p= 0.005). Follow-up in structured cardiovascular risk programs allows estimating factors related to prediabetes reversion and emphasizing strategies to reduce comorbidities. Population-based studies are required to expand the results.

Objetivo: describir la presentación clínica, el diagnóstico y el tratamiento quirúrgico de un paciente con síndrome de la arteria mesentérica superior o síndrome de Wilkie combinado con síndrome de cascanueces o síndrome de compresión de la vena renal izquierda, en un centro de alta complejidad de un país latinoamericano. Descripción del caso: paciente masculino de 25 años, procedente de Estados Unidos, quien consultó por un año de pérdida de peso y episodios de obstrucción intestinal de etiología desconocida tras múltiples estudios de imagen. Se le realizaron estudios endoscópicos sin hallazgos; en la sala de recuperación desarrolló dolor abdominal que requirió ingreso al servicio de urgencias. La enterotomografía mostró dilatación de asas de colon e intestino delgado, con disminución del ángulo aortomesentérico y la serie gastrointestinal con paso filiforme del medio de contraste. Se intentó el manejo conservador como terapia inicial, con intolerancia al soporte nutricional entérico. Finalmente, se optó por el tratamiento quirúrgico, con un proceso de recuperación tórpido inicialmente, pero al final con resolución de los síntomas y aumento de peso. Conclusión: el síndrome de Wilkie es una enfermedad rara y un desafío diagnóstico en pacientes con pérdida de peso y dolor abdominal. Describimos un caso de compresión de la arteria mesentérica superior en el que se logró el diagnóstico con múltiples estrategias diagnósticas y resolución completa luego del tratamiento quirúrgico. La disminución del ángulo aortomesentérico puede comprimir la arteria mesentérica superior, así como la vena renal izquierda, que en ese caso resultó en un síndrome combinado de Wilkie y de cascanueces.

Objetivo: describir la presentación clínica y el proceso diagnóstico de un paciente con tuberculosis peritoneal como reto clínico en un centro de alta complejidad de un país latinoamericano. Descripción del caso: un paciente masculino de 61 años procedente del área urbana de Cali consultó por edema en los miembros inferiores, ascitis, hiporexia, pérdida de peso, caquexia, trombocitopenia, elevación de transaminasas, imágenes de esplenomegalia y nódulos pulmonares, hepáticos y en el peritoneo. Inicialmente se sospechó neoplasia, pero el reporte de adenosina desaminasa y la histopatología fueron consistentes con el diagnóstico de tuberculosis peritoneal. Conclusión: la tuberculosis peritoneal representa la sexta causa de tuberculosis extrapulmonar, después de las manifestaciones linfáticas, pleurales, osteoarticulares, genitourinarias y meníngeas. A pesar de contar con sistemas de vigilancia, la tuberculosis peritoneal sigue siendo considerada como la enfermedad infecciosa más desafiante para llegar a un diagnóstico definitivo. Se presenta un caso de tuberculosis diseminada en el que se comprobó invasión del peritoneo, por lo que se inició un tratamiento tetraconjugado; sin embargo, presentó una reacción adversa hepática y falleció producto del compromiso multisistémico de una complicación infecciosa pulmonar.

The purpose of our study was to develop and externally validate a multivariable diagnostic model to distinguish ectopic ACTH secretion (EAS) from Cushing’s disease (CD) using routine clinical parameters. The model was derived from a Spanish multicenter retrospective cohort and externally validated in a Colombian cohort. Predictors were selected through a multivariable logistic regression model with penalized logistic regression (LASSO) using the Spanish cohort. Discriminative performance was assessed using the area under the ROC curve (AUC) and calibration using the slope, the origin, and the Brier score. The derivation cohort included 253 patients from Spain (199 with CD and 54 with EAS). The external validation cohort comprised 72 Colombian patients (53 with CD and 19 with EAS). In the derivation cohort, multivariable modeling identified four independent predictors: ACTH concentration, 24-h urinary free cortisol (UFC), serum potassium, and maximum pituitary tumor diameter. The final model demonstrated good discrimination in the derivation cohort (mean AUC of 0.987), with excellent calibration (calibration slope ranged from 0.998 to 5.22, intercept −0.2 to 0.99, Brier score 0.035). In external validation, model performance remained robust (AUC ranging from 0.9885 to 0.9890; Brier score 0.0381). The model achieved a sensitivity of 95.3%, specificity of 93.6%, positive predictive value of 82.3%, and negative predictive value of 98.7% for detecting EAS. Thus, the diagnostic model developed, based on routinely available clinical variables, shows high accuracy and calibration in differentiating between EAS and CD, supporting its potential use in diverse clinical settings and integration into diagnostic workflows.