Diagnostico Laboratorial de Endocrinopatias PDF

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DIREC TO R:
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Coordinacin Editorial:
M. A. Garca Fernndez
Redactora Jefe:
Elena Malmierca
Produccin Editorial:
Fernando Latorre Margolles
Direccin Artstica:
Jos Luis Garca Alonso
Coordinacin estudio:
Isabel Velasco Granados
Maquetacin:
Beatriz Garca Martn
Reproduccin fotogrfica:
Enrique Leiva Hidalgo
Infografa:
Isabel Velasco Granados
Correcin de textos:
Marta Martnez Sandoval
Composicin de textos:
M. Dolores Llano Garca
Colaboradores:
Jose Manuel Pin Cubero
MLuz Franco Fdez- Conde
C AN IS ET FELIS N .
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DIAG N STIC O DE LABO RATO RIO DE LAS PRIN C IPALES EN DO C RIN O PATAS
taff
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LAS GLNDULAS ADRENALES
LAS GLNDULAS PARATIROIDEAS
EDITORIAL
INTRODUCCIN
DIAGNSTICO DEL HIPOTIROIDISMO CANINO
GLUCEMIA: CONTROL Y TRASTORNOS
INDICE DE COLABORADORES
MRKETING EN LA
CLNICA VETERINARIA
DIAGNSTICO DE LABORATORIO DE
LAS PRINCIPALES ENDOCRINOPATAS
GERIATRA CANINA (I)
AFECCIONES DEL TRACTO
URINARIO INFERIOR DEL GATO
ENFERMEDADES ESPINALES (I)
GERIATRA CANINA (II)
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STAFF
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ditorial
A Endocrinologa clnica es la rama de la M edicina interna ms relacionada con el resto de
especialidades, ya que todos los sistemas del cuerpo estn influidos por el sistema endocri-
no o son una parte de l. C uando existe una alteracin en la secrecin hormonal, se altera
la funcin de otros sistemas orgnicos, lo que produce mltiples anormalidades que casi
siempre siguen un patrn caracterstico.
G e n e ra l m e n te, los signos clnicos de las enfe rm edades endocrinas se pre s e n tan como los de una
e n fe rm edad del rgano blanco de la horm ona y, si esto no se tiene en cuenta, se puede, con fa c i-
lidad, llegar a conclusiones errneas al pensar que esos signos dependen siem p re del sistema qu e
los muest ra .
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C APTULO I IN TRO DUC C I N
M. C. MUOZ OJEDA
O. FERRER QUINTANA
U.D. Patologa General y Mdica
Facultad de Veterinaria de Las Palmas de Gran Canaria
CAUSAS BSICAS DE
ENFERMEDAD ENDOCRINA
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MEDICIN DE LA
CONCENTRACIN HORMONAL
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C APTULO II LAS G LN DULAS ADREN ALES
A DA glndula adrenal se compone de una corteza y una mdula, las cuales son embri o-
lgica y funcionalmente glndulas endocrinas dife re n tes. Los tra sto rnos que con mayo r
f recuencia afe c tan a la corteza adrenal son ta n to el hipera d re n o c o rticismo (enfe rm e-
dad de C ushing) como el hipoadre n o c o rticismo (enfe rmedad de Addison). Las condi-
ciones que afe c tan a la mdula adrenal son ms ra ras, lo ms fre c u e n te son los tumores (fe o c ro m o c i to m a ) .
La corteza adrenal produce una gran cantidad de hormonas, las cuales pueden dividirse en tres gru p o s
basados en su accin pre d o m i n a n te: minera l o c o rticoides, los cuales son im p o rta n tes en la homeostasis del
agua y electr l i tos, gl u c o c o rticoides (fig. 1), los cuales pro m u even la gl u c o n e o gnesis, y una pequea can-
tidad de hormonas sex u a l e s .
O. FERRER QUINTANA
M. C. MUOZ OJEDA
U.D. Patologa General y Mdica.
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| tri] rt s t ma |i] rt s.
Signos clnicos
|a t1 a 1 mt1 ia 1 t a j a ritit r 1 t |a trItrmt1 a 1 ts 1 t
- a 1t s, a ar| at taa || aitr ra ta j at1 t 1 tsa rrt ||a r|t
Iitrtr ar mat r rits] t 1 t j a 1 tttr 1 k | -| | |t s | a rit|ts,
trritrs j t| at1t s, Yt r|s|irt, | ta ] |ts. |t s Iamt rts a 1 rt-
rt tt rIita |ts sat|tr 1 a rst tt r ma t r Irttatrtia tr ra ta s
1 t ma t r Ia ma 1t , a 1 tma s 1 t |t s | a rit|ts t t Ira s
ta rit1 a 1 ts 1 t | a rit|ts.
|a ttjtsititr trt rita a| ttttst 1 t ttrIist| a mtra1t
j rttt ta ara ttm|ira titr t|a sita 1 t sirIt m a It |t ]ia |tsit -
rts ||a maIita s Ii] s. 1 \ . |sIas irt|atr jt |i1ijsia, jt |ia-
ria, jt|iIa ]ia, a]ra r 1 a m i t r It a| 1tmira |, a |t jttia , jit 1tr-
ma, }a 1tt, 1 t|i|i1a 1 masta|ar |tIa r] ia. |t s si]rts str |as
sttat|as 1 t |ts tIt t It s tt m|ira 1t s ] | a t t r t t ] tritt s, |ijt-
|iIitts, ta Ia |t |itt s j rt Ititt s, arIiirI| a m a It rits t irmartsa-
j rt s t rts 1 t |ts ]| a t t t t rIitti1 ts st |rt |t s 1 iIt rt r Its sisIt-
mas t r]a ritts. || tarst 1 t |a trIt rmt1a 1 sat|t str irsi1it-
st 1t j rt ]rtsit r |trIa , a mtra1 t j rt } a t ] a 1t ttmt t|
HIPERADRENOCORTICISMO
(ENFERMEDAD DE CUSHING)
| | i j t ra 1 rt r t t t rI i t i s-
mt st a sttia ttr ara
ttt t s i ta j rt 1attitr t
a 1 m i r i sI ra tit r 1 t ] | a-
t t t t rIitt i1 ts ts ara
1 t |as tr1 t tri r t j a I i-
a s mas Irt t a t r It m t r-
It 1ia] rt sIita 1 a tr t| jtrrt . || |ij tra-
1 rt r t t t rIitismt ts jt tt Irt t a t r It tr t|
] a It .
Causas de
hiperadrenocorticismo (HAC)
|| 1 k | j at1 t t tarrir 1 t It rma ra Ia-
ra | t Ira s |a a 1 mirisIra tit r ttt ] tra 1 t
] | a t t t t rIitt i 1 ts a I rt ] t ritt . |a
It rma ra Iara | st a st tia tt r ara sttrt-
tit r ira 1 ttaa 1 a 1 t k | 1 j t r j a rIt 1 t
|a j iIaiIa ria t |ij t Iisis 1 k | 1 tj tr-
1 itrIt 1 t j iIaiIa ria t | itr tt r ar Ira s-
It rrt a 1 rtra | j rima rit 1 k | 1 tj tr-
1 itrIt 1 t a 1 rtra | Ii] . I .
|| 1 k | 1 tj tr1 itrIt 1 t j iIaiIa ri a
1 k| -| | Iitrt |a] a r tr ar 1 X 1 t
j t rrt s tt r |i j t ra 1 rt r t t t rI i t i s m t
| at t tarrt 1 t It rma ra Iara |. |a ttt t-
s i ta sttrt tit r 1 t k | 1 tt r||tta ara
| i j t rj |a sia a 1 rt r t t t rIita | | i|a It ra |
ara ttt t s i ta sttrttit r 1 t tt rI i s t | .
1 a ar Ia ||t tr t| mtta rismt 1 t
rtI rt a | i m t r Ia tit r rt] a I i ta 1 t| tt rI i-
st | st | rt |a k | 1 . ir tm| a r] t , |a
s t t rttit r tj ist 1 ita 1 t |a k| 1 rt s a |-
Ia tt r ara I|atIaa tit r tr |t s ritt | t s
1 t tt rIist | | at j at1 t t sIa r a tt t t s
1 t r I rt 1 t| ra r] t rt rma |. | | rt sIt 1 t
! -I 1 X 1 t ta st s tsj t rIa r tt s 1 t
1 k| t sIa r j rt1 ati1 t s jt r Iamt rt s
Fig. 1. M ecanism o de regulacin de los glucocorticoides.
Eje pituitaria-adrenal en anim ales norm ales.
|
|
s i mj|t rt s a | Ia1 t 1 t| trtt } t t i m i t r It . |s
j tr t||t | at st rt t a rrt mat|as tttts a |a
t t r s a | Ia 1t| ttIt ri r a rit st |t 1 tsj ats
| at |ts si]rts st tat|ttr irIt | t ra | | t s
j a ra |ts t|itrIt s .
| ra ttt rta |ita 1t t| 1ia ]rtsIitt t|iri-
tt , |t s ara|isis ra I i r a rit s ttmt t| |tmt-
] ra ma, jtrIi| |it| aimitt ara|isis 1t
t rira rt s strt i rar j ara tt rIi rmar rats-
I ra st sjtt|a ja ra 1 tstarIar trIt rm t-
1 a1ts rt a1rtra|ts |at jat1tr tars a r
tt r si]rts simi|arts, tt mt irsaIi t i t r t i a
rtra|, 1ia |tIts mt||iIas t irsij i1 a , trIt r-
mt1a 1ts |tja Iitas t |ijt I i rt i 1 i s m t .
Hallazgos laboratoriales de rutina
|t s j ri rti j a |ts |a ||a t] t s |tma It -
|t ] itt s, | it | aimi tt s aria ra |isis st
| i sIa r tr |a Ia | |a | .
Hematologa
|| |a ||a t]t |tma It |t ] itt ma s tt rsisIt r It ts ar |tatt -
] rama 1t tsI rts ttr ara |irItj tria ttsirt jtria rt | a I i ta
a | st |aIa . |a |ij trj rt 1attit r 1 t ttrIist | t ri] ira rtaIrt -
Ii|ia mt rttiIt sis a ta asa 1 t |a 1tsmar] ira tit r ta j i|a r
1 t tsIa s tt|a|a s ir1 ati1 a s j t r |t s tsIt rt i1 ts t| jt sIt ri t r
| | t | att 1 t| rt ] rtst rt rma| 1ts1 t t| sisItma ta s t a | a r. ||
rt t a t r It 1 t tri I rt t i It s sat|t str rtrma |, a ar| at a tt t t s
st rt Ia j t |itiItmia |ttt. |a s j |a | a tIa s Iam| itr jat1tr
t sIa r t|tta 1 a s .
Bioqumica
|t sIa Ia sa a |ta |ira . |t s ] |att tt rIitt i1 ts, Ia rIt tr1 t -
] trt s tt mt ttt ] trt s, ir1 attr ara ist trtima |tj a Iita
tsj ttiIita 1 t |a It sIa Ia sa a |ta |ira . |a It sIa Ia sa a |ta |ira
sat|t irtrtmtrIa rst 1 t ! a \ 1 tttts sa ta |t r rt rma | ts
| aita s art 1 t |t s ir1 ita 1 t rts ma s Iia | |ts 1 t |ij tra 1 rt-
rt tt rIismt .
k |a rirt a mirt Ira rsItra sa k | .
|a k | sat|t tsIa r t|t ta 1 a tr t| |ij t-
ra 1 rtrt tt rIitismt . |t r |t ] trtra | tsIa
t|tta tit r |i] tra st tt rsi1 tra sttar1 a-
ria a | 1 a 1t |tj a Iitt ta asa 1 t j t r |t s
| t j a It t i Its IamtIa t It s, a tama|a tit r
1 t ] |att ] trt t irItrItrtrtia s tt r |a
j trIasit r |tj a Iita .
| | a t t m i a . |t s a rima |ts tt r
| as|ir] tr ttasit rts j rt s t r Iar a amtr-
It |i] t rt 1t |a ]|attmia |asa| , ttr
mtrt r asi1 ai1 a1 , 1ia |tIts mt||iIas, a
| at |t s ] | a t t t t rIitt i1 ts rt1 attr t|
t mj|tt j tri It ritt 1t |a ] |attsa a| a rIa-
] tritar |t s tIt t It s 1t |a irsa|ira.
| rta sa r] airta. |a 1 iartsis tsIi-
ma|a 1 a j t r |t s ] |att tt rIitt i1 ts t ta -
sit ra j tr1 i1 a s arira ria s tt rIiraa s 1 t
arta sa r] airta tt r simi|a rts rtsa|Ia -
1 t s 1 t |a trta Iirira strita .
| t |tsItrt| |ij tmia. |a tsIima|atit r tsIt rti1 t 1 t |a
|ij t|isis taasa irtrt m t r It tr |as ttrttrIratitrts sar]airtas
1 t |iji1ts tt|tsIt rt|. |a |ijtmia jat1t irIt rIt rir |as mt1 i-
tit rts jrttisas 1t ar ramtrt 1t ja ra m tI rts |a| tra It ri a | t s .
Urianlisis
| trsi1 a 1 arira ria . |a 1 trsi1 a 1 ari r a ria sat|t str
i r It rit r a . 1 ! tt r Irttatrtia |ij t sIt r a rita . |t s a ri -
ma |ts tt r 1 k | j at1 tr tt rttrIra r sa t rira si st |ts
j ri ta 1 t a ] aa , j trt sa ta j a ti1 a 1 1 t tt rttrIra t i t r
sat|t tsIa r rt 1 a t i 1 a .
| rItttit r 1 t| Ira tIt arira rit . | t mt |a irItttit r ari-
ra ria ts ara sttat|a tt mar tr t| 1 k | , st ir1 ita |a tis-
It ttrItsis j a ra t| art ta|Iitt .
Otros hallazgos
irt tira
\
. || |ij trtt rIist |ismt trt ritt saj rimt |a
sttrttit r 1 t 1 |ij t Iisa ria ] trtra r1 t |ij t Iirt i1 ismt
Fig. 2. A ) Eje pituitaria-adrenal en perros con hiperadrenocorticism o dependiente de la pituitaria.
B) Eje pituitaria-adrenal en perros con tum or adrenal funcional.
sttar1 a rit . a m| itr j at1 t mt 1 iIita r
|a a Iiri1 a 1 j rt Itita 1 t |a |t rmt ra
Iirt i1 ta , j t Itrtia r t| mtIa | t |ismt 1 t
tsIa |t rmt ra rt1 atir |a 1 tst 1 ira -
tit r j triItrita 1 t |a
\
tr
1
. |t r It 1 t
t||t , ar imj t rIa rIt ramtrt 1 t j trrt s
tt r 1 k | Iitrtr 1 ismiratit r 1 t |a Iirt -
tirtmia | a sa |,
\
|i| rt It
1
.
Hallazgos radiogrficos
|s rttt mtr1 a ||t |attr ra 1 i t ]ra I i a s
1t It rat a |1 tmtr tr It 1ts |ts ta st s.
ka r | at |a irIt rmatitr 1 t ar 1ia ]rt sI i-
tt j tsiIitt st|t st t| Iitrt tr ar j t|a t-
1t ramtrt 1 t ta st s tr t| | at st 1 tIt t Ia
ar a] ra r 1 a m i t r It a1rtra|, |t s ta m| its
ra 1 i t ] ra Iitts | at st sat|tr jrt s t r Ia r tr
t| |ij tra 1 rt r t t t rIitismt jrttttr ara
a a1 a a1 itit ra| jara t| 1ia ]rtsIitt Ii ] .
! . k 1tma s, t| tsIa1 it ra 1 i t | t ] i t t
j at1 t rttt|a r trIt rmt1 a1ts tt rtarrt r-
Its. |t s si]rts ra 1it |t]itt s | at j at1 tr
j rt s t r Ia rst str. |tja It m t ]a |ia , ta |tiIi-
ta tit r It a ] ra r 1 a m i t r It a1 rt r a | ,
m i r t ra |itatitr 1 t It}i1 ts | |a r1 ts ta|-
tirt sis taIis, tsIt t j t rt sis, tt } i ]a 1 isIt r-
1 i1a Ita|ta|t s tisIitts, ta|tiIitatit r Ira-
| ata| 1 t |a s ja rt1ts | rt r | a i a | t s .
Confirmacin del diagnstico
|tisItr 1 ittrsa s j rat| a s j a ra ||tta r
a ta | t ar 1 ia ] rt sIitt 1 t |ij tra 1 rtrt -
tt rIitismt , 1 tsa It rIara 1 a mtrIt rir] a-
ra 1 t t||a s ts It Ia |mtrIt tIita t |t s
rtsa|Ia 1 t s Ia |st s rt st r irIrttatrIts.
|s j t r t||t , | at a |a |t ra 1 t a | t r1 a r
tsIt Iij t 1 t 1 ia ] rt sIitt 1 t| tmt s tt r-
si1 tra r |a s tt r1 itit rts 1 t ta 1 a j a titr-
It j a ra st|tttit ra r a | at||a Is j rat| a Is
| at sta r ma s rttt mtr1 a | |ts tr ta 1 a
siIaa tit r. k tt rIiraa tit r 1 tstri| irtmt s |t s 1 ittrst s j rt -
It tt |t s | at st j at1 tr tmj |ta r tt r sas ttrIa }a s t irtt r -
ttritrIts a | Iira | 1 t| ta j iIa|t tt mtrIa rtmt s |a s 1 a1 a s
| at st sat|tr j |a rIta r tt r ma t r Irttatrtia taa r1 t
a Irt rIa mt s ar 1 ia ] rt sIitt 1 t ar sir1 rt mt 1 t | as|ir] .
|a tta |aa tit r 1t ar arima | ttr st sjtt|a 1 t 1 k| st
t IttIaa mt1ia rIt 1 ts ja sts | a sitt s. || jrimtr tsIa1 it ts
j a ra tt rIi rmar t 1tsta rIar |a jrtstrtia 1 t ar | as|ir]. |r
t| st] ar1 t , st irIt r Ia 1 iIt rtrtia r trIrt 1 k| -| | t 1 k| -| k .
Fig. 3. C aniche de 9 aos de edad con hiperadrenocorticis-
m o dependiente de pituitaria m ostrando distensin
abdom inal y alopecia bilateral sim trica.
Fig. 4. Regin ventral de un anim al con hiperadrenocorticis-
m o en que la piel es delgada, donde se aprecian los
vasos sanguneos y hay presencia de com edones.
|sIa1 it s st|ttIitt s j a ra 1 ij tra 1 rt-
rt tt rIitismt .
| t rIist |tmia | a sa | rt rttt mtr-
1 a 1 a .
|sIima|a tit r tt r k | 1 .
aj rtsit r tt r 1 tta mtIa st ra tr
1 t sis | a }a 1 ,1 m] I|] .
| t m|ira tit r 1 t saj rtsit r tt r
1 tta m tIa s t r a I t sIima|a titr ttr k| 1 .
|rt j t rti t r tt rI i s t | I t rt a I i r i r a
strita .
Concentraciones basales
de cortisol
|a tt rIist |tmia | a sa | ts 1 t tsta st
irItrts 1 ia ] rt sIitt . |a tt rttrIra tit r
| a sa | mt1 ia tr j trrt s tt r 1 k | tsIa
Fig. 5. Radiografa abdom inal lateral de un perro con un
tum or adrenal funcional que causa hiperadrenocorti-
cism o. N tese el tum or adrenal calcificado, hepato-
m egalia y el excelente contraste debido a la m oviliza-
cin de grasa.
TABLA I
HEMATOLOGA Linfopenia (<1.500/mm
2
)
Eosinopenia (<200/mm
2
)
Neutrofilia
Monocitosis
Eritrocitosis
BIOQUMICA Fosfatasa alcalina incrementada (generalmente muy marcada)
ALT incrementada
Glucosa de normal a alto (raramente diabtico)
Urea disminuida
Colesterol incrementado
Lipemia
cidos biliares elevados
URIANLISIS Densidad <1.015
Glucosuria (<10% de los casos)
Infeccin del tracto urinario
OTROS HALLAZGOS Niveles de T
4
bajos
ma j t r trtima 1 t a | at||a tr j trrt s
rt rma |ts, j trt |t s rtsa|Ia 1 t s ir1 iti-
1 aa |ts sat|tr tsIa r 1 trIrt 1 t| ra r] t
rt rma |. |a k | 1 t| tt rIist | st r sttrt-
Ia 1 t s 1 t ma rtra tj ist 1 ita . |a | a }a
strsi| i|i1 a 1 tsj ttiIiti1 a 1 1 t |t s ritt-
|ts | a sa |ts 1 t tt rIist | |imiIa |a aIi|i1 a 1
1 t tsIa j rat| a j a ra t| 1 ia ] rt sIitt 1 t
|ij tra 1 rtrt tt rIitismt .
Estimulacin con ACTH
|sIt mtIt 1 t st aIi|ita j a ra .
| tIttIa r j rtstrtia 1 t |ij tra 1 rt-
rt tt rIitismt .
| iItrtrtia r trIrt |ij tra 1 rtrt tt r-
Iitismt tsj t rIa rtt si r1 rt mt 1 t
| as|ir] a Irt ] tritt .
| ia ] rt sIita r trIt rmt1 a 1 1 t
k 1 1 ist r.
| t rIrt |a r |a rtsj atsIa a | miIt Ia rt |st 1 rtr t a |
|tIt tt ra tt | t mtIira j t ra .
|| mtIt 1 t a ra |ita |a rtstrta a 1 rtrt tt rIita |. | t r |a
|ij trj |a sia a 1 rtra | t ar Iamt r a 1 rtra | Iartit ra | k | ,
j t r t}tmj |t , 1 t| t ttisIir ma t r rtstrta j t r Ia rIt ara
|ij trstrsi| i|i1 a 1 a |a k | 1 ttt ] tra . |a j rat| a ts 1 t
t}ttatit r strti||a rt| aitrt a I |t ra s st] ar |a j rt-
j a ra tit r 1 t k | 1 tmj |ta 1 a k | 1 ] t|, k | 1 sirItIita
|a tsj ttit a rima | ItsIa 1 a . |sIa j rat| a st j at1 t ||t ta r
a ta | t tr taa || aitr mt mtrIt 1 t| 1 ia sir ara j rtj a ra -
tit r tsj ttia | 1 t |t s j a titrIts.
|r |t s jtrrts st t |Iitrt ara matsI ra sa r] airta j rt -
k| 1 ja ra mt1ir |a tt rIist |tmia . |at] t st irt t Ia 1 ,I ! m]
tia |V 1t k| 1 sirItIita | t rI rt s r
|a matsI ra jt sI -
k| 1 st t| Iitrt |tra 1tsjats. |t t i t r It m t r It st |a
1 t m t sI ra 1t | at ttr 1tsis irIt ri t rts Iam| itr st a|ta rta
ara ma tima tsIima|a tit r 1t |a ]|ar1 a|a a1rtra |. |r |ts
] a It s st tt I ra t |a matsI ra j rt -k| 1 st irt t Ia 1 , I !
m ] I ] a It j tr tia | V, st t| Iitrtr 1 ts matsI ras j tsI -k| 1 ,
ara a |ts 1 1 miraIt s |a t I ra a |t s t 1
m i r a Its. t rttt mitr1a r 1t s matsI ra s
j t sI -k| 1 , jt r|at a|]arts ] a It s Iitrtr
t t rIist|tmia matima tr |a j ri m t ra t
st]ar1a mt1 itit r. k|It rr a I i ta m t r It st
j at1t tmj |ta r |a k| 1 j t rtira tr
It rma 1 t ] t| | trI i ] t | -\ 1
, 1tr1 t |as
m a t sI ra s 1t tt rIist | st It m a ra r arIts I
| t ras 1 tsj ats 1t |a a 1mirisI ra tit r 1t
I 1 | | 1 t k| 1 .
| r I t r j r t I a t i t r. ta1 a |a| tra It rit 1 t|t
t sIa| |tttr |t s ta | t rts rtrma|ts. K t t|s-
Ia r It, tr sa ma tria irIt rmar tt rI i s t | t-
mias ra t t r a | | t m t r It simi|arts. |ts ra r-
] ts 1t rt It rtrtia ja ra |as ttrI i s t | t m i a s
|asa|ts str 1 t 1 ,! -t j ] I1| t| ta | t r
r t rma| jtstsIima|atit r tsIa trIrt t I
j ]I1|. |ts ta | t rts j tstsIima|a tit r trIrt
I I I j ]I1| st tt rsi1 tra r |imiIrt It s
1 a1t st s a | at||t s -I I j ]I1 | str
t t mja Ii||ts ttr t| 1ia ]rt sIitt 1 t |ijt-
ra 1 rt r t t t rIitismt. | ra rt s j a t sIa rt r-
ma | a |a k| 1 sa]itrt irIt ] ri1a 1 Iartit-
ra| 1 t| t}t 1 |k |ijt Ia | a m t -j i I a i Ia ri a -
a 1 rtra | , sir tm|a r]t, ttrta 1 t| ! -
I 1 X 1t |t s j trrt s |ij tra 1 rtra|ts tt | i-
| tr ara rt s j a t sIa rt rma | a |a k| 1 .
| ra sajrtsit r ttr 1tta m tIa stra tr
1tsis |a }a st rtttmitr1 a tr tsIa siIaa-
tit r taa r1 t |a stsjtt|a 1 t |a trIt r-
mt1 a 1. | ra rt s j a t sIa rt1 ati1 a st
t | s t rta tr |a trIt rmt1a 1 1t k 1 1 i s t r ,
s a j rtsit r a 1rt r t t t rIita| jt r ttrI i t t It ra-
j ia 1 ara r It t 1tsjats 1t |a It ra j i a
tt r miItIart Ii] . t .
|as rt s j a t sIas tta ] t ra 1a s a |a k| 1
a j a rtttr tr t| I ! X 1t |ts j trrt s ttr
1 k | -| |, mitrIra s | at ttrta 1 t| ! 1 X 1t
|t s ta sts 1t 1 k| -| k Iitrtr rt s j a t sIa s
ttt t s i ta s a |a k| 1 . |a s rt s j a t sIa s tta-
] t ra 1as Iam| itr st jat1tr t | strtar tr
j t rrts tt r trIt rmt1a1 ts trtrita s jt r t}., |tj aIt j a I i a
t rtrita t 1 ia| tIts mt||iIas sir a It t Iatit r 1irt t Ia 1 t| t}t
1 |k . | a |t 1 tsIatar | at |t s jtrrt s 1ia |tIitts jat1tr
Itrtr ara rt s j a t sIa tta ] t ra1 a a |a k| 1 sir trIt rm t 1 a 1
1t | as|ir] . || 1 ia]rtsIitt 1 t |ij tra 1 rt r t t t rIitismt tr
t sIa siIaa tit r 1t| t tt rIi rm a rst tt r |ts rt s a | Ia1 ts tr1 ttri-
rts a rt rma |ts sirIt m a It|t]ia 1t | as|ir]. |a irsa|irtrrt-
s i sItrtia ts irtsjttiIita rt 1t| tria str t| aritt mt I i tt
j a ra Ira Iar ar sir1rt mt 1 t | as|ir].
Supresin con dexametasona en dosis baja
| sIt ts t| mtIt 1 t st|ttIitt mas jrttist j ara t| |ij tra -
1 rt r t t t rIitismt tarirt. | atrIa a 1tma s ttr |a tt r Ia }a 1 t
str taj at 1 t 1iIt rtrtiar trIrt 1 k| -| | t 1 k| -| k tr t|
\ 1 X 1t |ts jtrrt s ttr | as|ir] . |a sajrtsitr ttr 1tta m t-
Iastra ta | t ra |a irIt ] ri1 a1 1t| mtta rismt 1 t rtI rt a | i m t r-
Iatit r rt] a I i ta 1t| t}t 1 |k .
Fig. 6. P rueba de estim ulacin con A CTH. C ortisolem ia m edia
d e t e rm inada antes y 1 hora despus de la adm inistra-
cin de ACTH sinttica en perros norm ales, perros con
h i p e r a d re n o c o rticism o espontneo y otros con hipera-
d re n o c o rticism o yatrognico.
|r |t s j trrt s st t | Iitrt ara matsIra
sa r] airt a j rt 1 tta m tIa st ra j a ra
mt1 ir tt rIist |tmia . t irttIa |a 1 rt ] a
1 ,1 m] I|] , | V st t | Iitrtr 1 t s
matsIra s, ara a |a s \ |t ra s |a si] aitr-
It a |a s |t ra s. k mtra1 t ts ttrIa }t -
st 1 i|air |a 1 tta m tIa st ra 1 i|atit r
. 1 tt r st |atit r sa |ira tsItri| j a ra
ara 1 t siIita tit r ma s j rttisa tr |t s
j a titrIts 1 t Ia ma 1t rt1 ati1 t .
| rItrj rtIa tit r. |t s j trrt s rt rma |ts
Iitrtr tt rIist |tmia s mtr t rts 1 t
j ] I1 | a |a s \ |t ra s j t s1 tta mtIa -
st ra . | trta 1 t| 1 1 -1 ! X 1 t |t s j trrt s
|ij tra 1 rtra |ts rt matsIra r ara saj rt-
sit r rt rma | 1 t| tt rIist | tt r |a 1 tta mt-
Ia st ra tr 1 t sis | a }a . |a matsIra a |a s
|t ra s ts |a ma s imj t rIa rIt j a ra |a
irItrj rtIa tit r. |a Ia |Ia 1 t saj rtsit r a
|a s \ It |t ra s ts tt mj a Ii| |t tt r ar
1 ia ] rt sIitt 1 t sir1 rt mt 1 t | as|ir]
j at1 t rtj rtstrIa r ar 1 k | -| k t 1 k | -
| |. K t t | sIa rIt, |a saj rtsit r a |a s \
|t ra s tt r ar rt| tIt a |a s |t ra s stria
tt mj a Ii| |t tt r ar 1 k | -| | Ii] . I .
i | itr |a saj rtsit r tt r 1 tta mtIa-
st ra tr 1 t sis | a }a ts ar tttt|trIt
tsIa1 it st|ttIitt tr t| j trrt , titrIt j t r-
ttrIa }t 1 t ] a It s rt rma |ts tsta j a a |a
saj rtsit r tr |a matsIra 1 t |a s |t ra s.
|t r t||t , |a j rat| a j at1 t ta rtttr 1 t
aIi|i1 a 1 1 ia ] rt sIita j a ra t| |ij tra 1 rt-
rt tt rIitismt It|irt . |a j rat| a 1 t t|tt-
tit r tr t||t s ts |a saj rtsit r tt r 1 tta -
mtIa st ra a 1 t sis a |Ia .
Prueba combinada de supresin
con dexametasona/estimulacin
con ACTH
|a mt Ia 1 t tsIt j rt t t 1 i m i t r It ts
| rir1 a r irIt rma tit r ttrttrr i t r It a |a
a tIi ti1 a 1 |ij t Ii s a ria a 1 rtra | tr ar trsa t simj | t ,
| rttt rt | a I i ta m t r It ttt rt mitt . t j rtsamt | at ts |a
ttm|i ra tit r 1 t 1 t s mtIt 1 ts imj t rIt t It s tt r rt s a | Ia -
1 t s mtrt s tt rIia | |ts | at taa || a i t ra 1 t |t s 1 t s j tr
s t j a ra 1 t .
t rta |ita tr j trrt s ] a It s mt1 ia rIt |a ttIra ttit r
1 t ara matsIra j rt1 tta mtIa st ra j a ra mt1 ir tt rIist |t-
mia |at] t st irttIa j t r tia | V 1 , m] I|] , a |a s \
| t ra s st tt I ra t |a mat sI ra j t sI 1 tta m t Ia s t r a .
| rmt1 ia Ia mtrIt 1 tsj ats st a 1 mirisIra |a k | 1 1 t a tatr-
1 t a sa j rt It tt |t 1 t tsIima|a tit r. |at] t st ttIra t ara
matsIra j t sI-k| 1 tr |t s ] a It s st t | Iitrtr I matsIra s
j t sI-k| 1 .
| rItrj rtIa tit r. tr |t s j trrt s, |a Ia |Ia 1 t saj rtsit r tr
rtsj atsIa a |a 1 t ta mtIa st ra , ara rtsj atsIa tta ] tra 1 a
Fig. 7. P rueba de supresin con dexam etasona a dosis baja.
C o rtisolem ias m edidas antes y despus de la adm inis-
tracin de una dosis baja de dexam etasona, en donde
se aprecian los resultados en anim ales norm ales, perro s
con tum ores funcionales de adrenales (HA C-DA) y
aqullos con hiperadre n o c o rticism o dependiente de
pituitaria (HA C-DP).
st s j t siIitt s tt r trItrmt1 a 1 ts rt a 1 rtra |ts. || ra r] t
rt rma | 1 t| ra Iit tt rIist |Itrta Iirira ta rirt ts 1 t ,I -t ,1
t 1
t
rmt |Ij mt |.
|sIa1 it s 1 iItrtrtia |ts j a ra t| |ij tra 1 rtrt tt rIitismt .
| t rttrIra tit rts | a sa |ts 1 t k | 1 .
aj rtsit r tt r 1 t ta mtIa st ra tr 1 t sis a |Ia 1 , t
m] I|] .
| ia ] rt sIitt j t r ima ] tr.
Medicin de la ACTH plasmtica endgena
|t s Iamt rts a 1 rtra |ts Iartit ra |ts saj rimtr |a sttrt-
tit r 1 t k | 1 t| 1 k | -| | ts t| rtsa|Ia 1 t 1 t |a |ij trst-
trttit r 1 t k | 1 . |t s a ra |isis 1 t |a k | 1 rt st tmj |ta r
j a ra t| 1 ia ] rt sIitt 1 t| |ij tra 1 rtrt tt rIitismt j t r| at ar
] ra r ramtrt 1 t rtsa|Ia 1 t s ta tr 1 trIrt 1 t| ra r] t 1 t
rtItrtrtia . k 1 tma s, |a a 1 mirisIra tit r 1 t tt rIitt i1 ts
j at1 t saj rimir |t s ritt|ts 1 t k | 1 . K t t | sIa rIt, |a
mt1 itit r 1 t |a k | 1 tr1 t ] tra ts ta |it sa j a ra 1 isIir] air
|t s j a titrIts tt r k | 1 t a | at||t s tt r 1 k | -| |.
|a ra rt1 atir |a s ta ria | |ts 1 t| tsI rts mt mtrIt 1 t|
1 ia , |a matsI ra 1 t sa r] rt 1 t| t tt I ra t rst trIrt |a s
|a s 1 1 t |a ma 1a ra 1 tsj ats 1 t | at t | a rima | |a t sIa -
1 t irIt rra 1 t 1 ara r It ara rt t|t . |a sa r] rt 1 t| t
tt I ra t rst tt r t| a rima | Ira r | ai|t t r Ia| t s tt r || k t
| t j a rira t i1 ta |mtrIt tt rIri I a ] a 1 a a \ | . | | j |a sma
st tt r] t|a tt r ra j i1 tt tr Ia| t s 1 t j |a sIitt j ara sa
rtmisit r a | |a | t ra It rit . |a tt |t ta tit r t r |it |t sttt ts
r t t t s a ria j a ra ma rItrtr |a matsI ra tt r] t|a 1 a |a sIa
t| mt mtrIt 1 t sa a ra |i sis. |a rttt |tttit r, tt rstrta -
tit r rtmisit r a 1 ttaa 1 a 1 t |a s matsI ra s st r 1 t t i s i -
t a s j a ra t| |t ] rt 1 t rt s a | Ia 1 t s tta t It s. | | ttIt ri r a ri t
1 t | t tt r tttr |t s rt | a i s i It s sa] t ri1 t s j t r t| |a | t ra It -
rit j a ra |a t | Itrtit r 1 t |a s matsI ra s sa j t sIt ri t r
ma rij a|a tit r. | t mt |a ma t ria 1 t |t s |t m t ra ria s Iit-
rt r ta | t rts t |tta 1 t s, tsIt tsIa1 it 1 t| t irIt rj rtIa rs t
tt r ta aIt|a tr tsIa ra t a .
Supresin con dexametasona en dosis alta
| sIa jrat|a st tmj |ta j ara 1iIt rtrtia r trIrt 1 k| -| | t
1 k | -| k . a j rirtij it ts | at |a 1 tta m tIastra tr 1 tsis
a |a k | 1 , t a m| a s, ts tt mj a Ii| |t tt r
| i j t ra 1 rt r t t t rIitismt , ara tt rI i s t | t-
mia j t sI1 tta mtIa st ra mtrt r 1 t| ! 1 X
1 t| ta |t r 1 t |a j rt1 t sis, }arIt a ara
rtsj atsIa tta ] tra 1 a a |a k | 1 stria
tt mj a Ii| |t tt r 1 k | -| |. |sIt j a Irt r 1 t
rtsj atsIa t tarrt tr ttrta 1 t| \ 1 a |
! 1 X 1 t |t s j trrt s |ij tra 1 rtra |ts. |a
saj rtsit r ira 1 ttaa 1 a }arIt a ara rts-
j atsIa t ta ] tra 1 a a |a k | 1 Ia m| itr
ts tt mj a Ii| |t tt r |ij tra 1 rtrt tt rIitis-
mt , sir tm| a r] t , st rtttsiIa r tsIa1 it s
a 1 itit ra |ts j a ra 1 iIt rtrtia r tr Irt
1 k | -| | t 1 k | -| k .
|ts rt s a | Ia1 t s rt rma|ts 1t |a j ra t | a
ttm| ira1 a rt 1tstarIar t| 1 ia]rtsI i t t
1 t |ij tra 1 rt r t t t rIitismt . | t t i j rt t a -
m t r It, tt mt tr t I rt s tsIa1its st|ttIitt s ,
|ts rt s a | Ia 1t s a rt rma |ts str jt si||ts tr
arima|ts ttr trIt rmt1a1ts trtrita s sir
a Itttit r 1t| t}t 1 |k jtr t}., Ia ||t rt r a | ,
1 i a | tIts mt||iIas t 1 isIartitr |tjaIita
t rtrita t tr j atitrIts Ira Ia1 ts ttr titr-
Ia s mt1 ita tit rts ] | a t t t t rIitt i1 ts t
a r I i t t rt a | s i tt s .
Determinacin de la proporcin
cortisol/creatinina urinarios
|s ara j rat| a st|ttIita j a ra t|
|ij tra 1 rtrt tt rIitismt ta rirt | at Ia m -
| itr j trmiIt saj trtisa r |a rtsj atsIa a |
miIt Ia rt. |sIt sisItma tt mj rtr1 t |a
rttt |tttit r 1 t ara matsIra arira ria
|at] t |a ta |t ra tit r 1 t| tt rIist | trta -
Iirira j a ra ta |ta|a r |a j rt j t rtit r. | t s
matsIra s arira ria s ma Iira |ts tt rsttaIi-
ta s 1 t| tr str tta |aa 1 a s taa r1 t st
tmj |ta tt mt mtIt 1 t st|ttIitt j a ra t|
|ij tra 1 rtrt tt rIitismt . K t t | sIa rIt, |a
irItrj rtIa tit r 1 t |t s rtsa|Ia 1 t s 1 t| t
str ta aIt|t sa j t r|at j at1 t |a | tr Ia |-
a | Ia saj rimiria |a ttrIist |tmia tr j atitr-
Its ttr 1 k| -| | j trt rt ttr 1 k| -| k .
|r |t s jtrrt s ]a It s st tt I rat ara
m a t sI ra 1t sar] rt j rt1 t sis, |at] t st
i rt t Iar 1 , t m] I|] tia |V, tt r
tt I ra ttit r 1t I matsI ra s j tsI1 t sis, ara
a |as \ |t ra s |a t I ra a |as |t ras. |r
|t s j trrt s 1t|t aIi|ita rst ara 1 t sis iri-
tia | 1 t 1 , m] I|] . |a 1t sis 1t m] I|]
st tmj |ta st|t taa r1 t |as tt rI i s t | t m i a s
rt st saj rimtr tr rt s j a t sIa a 1 ,
m ] I |] 1t 1 tta m tIa st ra . |a mt]a 1 t -
sis 1 t| t tmj | t a rst tt r taaIt|a tr
j t rrt s 1 ia |tIitts. |a jrat|a tsIa i1 ta -
1 a st |t j a ra ast tr a rima |ts |ij tra -
1 rtra |ts tt rIi rma 1 t s. | ra tt rI i s t | t m i a
mtrt r 1t| ! 1 X 1 t| ta |t r jrt1t sis a |as
\ a |t ras j t sI1t sis ts tt mj aIi| |t ttr
1 k | -| |. 1 a sIa t| I 1 t I ! X 1 t |t s
j t rrts tt r 1 k| -| | rt matsI ra r sajrt-
sitr tt r |a 1tta m tIa stra tr 1 t sis a |Ia
Ii] . . |t r |t Ia r It , |a Ia | Ia 1 t sajrt-
sit r a 1 ttaa1 a ttr 1 t sis a|Ia s rt st
j at1 t tt rsi1 tra r tt mt ara ttrIi rm a -
titr 1t 1 k| -| k . t rt | a i t rtr j rt t t 1 i-
m i t r It s a 1 itit ra |ts a ra |isis 1 t k| 1
t r 1 t ] trt t 1 ia ]rt sIitt j t r ima] t r .
k 1 iItrtrtia 1 t |t s j trrt s, tr |t s
] a It s |a saj rtsit r tt r 1 tta mtIa st ra
j a rttt ma s tt rIia | |t a | aIi|ita r ara
1 t sis 1 t 1 , m] I|] j a ra t| 1 ia ] rt sIitt
1 t |ij tra 1 rtrt tt rIitismt . |t r titrIt ,
st |a j at1 t j rtItrir tr |a] a r 1 t |a
saj rtsit r tr 1 t sis | a }a , mitrIra s | at
|a aIi|ita tit r 1 t |a mt] a 1 t sis
m] I|] rtsa|Ia a j rt j ia 1 a j a ra 1 istri-
mira r trIrt t| 1 k | -| | t 1 k | -| k .
Diagnstico por imagen
|r |a s ra 1 it ] ra Iia s a | 1 t mira |ts ar
Iamt r a 1 rtra | j at1 t a j a rtttr tt mt
ara 1 trsi1 a 1 1 t It}i1 t | |a r1 t | itr 1 t|imiIa 1 t t tt mt
ara ma sa mirtra |ita 1 a tr t| a rta 1 t |a ] |a r1 a|a a 1 rt-
ra | Ii] . 1 . |a ta |tiIita tit r a 1 rtra | ts ma j t tt Irt-
tatrIt tr j trrt s rt rma |ts t tr j trrt s tt r |ij tra 1 rtrt -
tt rIitismt j iIaiIa rit . | t| tr ta |t ra rst a 1 tma s ra 1 it ] ra -
Iia s It ra tita s j a ra tti1 trtia r mtIa sIa sis j a|mt ra rts 1 t
ar k | ta rtirt ma , |t taa | st ttriIita tr ar j t rttrIa }t
rt1 ati1 t 1 t Ia |ts trItrmt s.
| t r |a t t t ] r a I i a st j at1 tr i1 trIiIita r ma sa s a 1 rt-
ra |ts tr j trrt s Ia m| itr j trm i It tisaa |ita r |ij trj | a -
sia | i|a It ra| 1 t |a s ] |ar1 a|a s a 1 rtra|ts tr ta st 1 t
| i j t ra 1 rt r t t t rIitismt jiIaiIa rit . i st tisaa |ita r a 1 rt-
ra |ts 1 t Ia ma 1t rt rma | t a ] ra r1 a 1 a s tr ar j trrt t
] a It tt r 1 ia ] rt sIitt 1 t | as|ir] , tsIt st ttrsi1 tra
Ii rmt tti1 trtia a Ia tt r 1 t |ij trj |a sia a 1 rtra | t ri ] i r a -
1 a j t r 1 k| -| |. i taa || a i t ra 1 t |a s 1 t s a 1 rtra |ts tsIa
Fig. 8. Prueba de supresin con dexam etasona a dosis alta.
Patrn de las respuestas de la cortisolem ia durante la
supresin con dexam etasona en dosis alta en perros
con H A C -D P o por tum or adrenal (H A C -D A ). N tese
que la supresin es diagnstica de la dependencia de
pituitaria; si no hay supresin, no nos diagnosticar el
origen del problem a (adrenal o pituitaria).
ma a ] ra r1 a 1 a , irrt] a|a r t irta 1 i t r-
1 t I t t mj ri mitr1 t a |a s tsI ra t I a ra s
a 1 a t t r Its |a tt rIra | a It ra | r t
j at1t rtI ra Ia rst, a amtrIa |a st sj t-
t|a 1 t ar Iamt r a1 rtra | Iartit ra |.
1 Ira s Ittrita s 1 t 1 ia ] rt sIitt j t r
ima ] tr It mt ] ra Iia a tia | tt mj aIa rita-
1 a , rtst ra rtia ma ] rtIita Iitrtr ar
ast |imiIa 1 t 1 t| i1 t a |a tsta sa 1 isj t -
ri| i|i1 a 1 , t|tta 1 t tt sIt a | at rt| ait-
rtr a rtsItsia ] trtra |.
Dudas que se suelen plantear
con mayor frecuencia en el
diagnstico de la enfermedad
de Cushing
| aa | ts |a mt}t r j rat| a j a ra ||t -
ta r a ta | t ar 1 ia ] rt sIitt 1 t ar sir -
1 rt mt 1 t | as|ir] ra Iara | tsj t rIa -
rtt tr t| j trrt ! |s rttt mtr1 a | |t
tt mt |a mt}t r j rat| a iritia | |a saj rt-
sit r tt r 1 tta mtIa st ra a 1 t sis | a }a , a
mtrt s | at t| j trrt |a a rt t i | i 1 t
rttitrItmtrIt tsItrt i1 ts ttt ] trt s 1 t
taa || aitr It rma , irt|ai1 a |a It j ita , t
| itr tsIt rtti| itr1 t Itra j ia a rIitt rta|-
sita t Itr] a a |] ara trItrmt1 a 1 rt
a 1 rtra | imj t rIa rIt t}., 1 ia | t Its mt||i-
Ias, Ia ||t rtra |, tIt. . i a |] ara 1 t tsIa s
siIaa tit rts tsIa j rtstrIt, |a j rat| a 1 t
t|tttit r ts |a 1 t tsIima|a tit r tt r
k| 1 .
| aa | ts |a mt}t r j rat| a j a ra ||t -
ta r a ta | t ar 1 ia ] rt sIitt 1 t ar sir -
1 rt mt 1 t | as|ir] ra Iara | tr t| ] a It !
|a j rat| a 1 t t|tttit r ts |a saj rtsit r
tt r 1 tta mtIa st ra a 1 t sis a |Ia .
| aa rIt Iitmj t st 1t | t t sj tra r
1 tsj ats 1 t ara 1 t sis 1 t j rt1 ri st ra
j a ra |a ttr ara j rat| a 1 t saj rtsit r
tt r 1 tta mtIa st ra t rtsj atsIa a |a
k | 1 ! |a rt s j a t sIa Iitrt 1 t s j a rIts. |ri m t rt , |a j rt 1 -
rist ra , j rt1 rist |t ra t |i1 rt t t rIist ra Iitrt r rt a t t i t -
rt s trata 1 a s tt r t| trsa t 1 t| tt rIist |, j t r Ia r It st
1 t| t r tsj tra r j t r |t mtrt s I \ |t ras 1 tsj ats 1 t |a
a 1 m i r i sI ra tit r 1 t ara 1 t tsIa s 1 rt ] a s a rIts 1 t ||tta r
a ta | t ara 1 t tsIa s j rat| a s. |a 1 tta m tIa st ra , mtI i |-
j rt1 rist |t ra |a Iria mtirt |t ra rt Ii trtr rt a t t i t r t s
t rata 1 a s. | aa || aitr t sIt rt i1 t, sir tm| a r] t , j at1 t
s a j rimir |a ] |a r1 a|a a 1 rtra |. i ar a rima | |a tsIa 1 t
rtti| tr1 t taa || aitr It rma 1 t tsIt rt i1 t, irt|ast tr
It rma It j ita , 1 ara r It stma ra s a mtst s, taa || a i t r
j rat| a j at 1 t a |It ra rst 1 t| i1 t a |t s t It t It s 1 t |a
rt I rt a | i m t r Ia tit r. | | Iitmj t rtttsa rit sir It ma r 1 rt -
] as ta | t ra r t| t}t j iIaiIa ri a -a 1 rtra | 1 tj tr1 t 1 t |a
1 a ra ti t r 1 t| Ira Ia m i t r It |a It rma 1 t t sIt rt i 1 t
t mj |ta 1 a . | | Ira Ia m i t r It tsIt rt i1 t t j at1 t j rt 1 a t i r
si] rt s t|iritts 1 t trIt rmt 1 a 1 1 t | as|ir] a I rt ] t r i-
tt j at1 t j rt 1 atir a Irt Iia 1 t |a tt rItta a 1 rt r a | .
| sIt jat 1 t 1 ia ] rt sI i t a rst asa r1 t |a j rat| a 1 t tsI i-
ma|a tit r tt r k| 1 .
| aa rIt Iitmj t st 1 t| t tsj tra r j a ra ||tta r a ta | t
ara j rat| a 1 t saj rtsit r tt r 1 tta mtIa st ra ara 1 t
tsIima|a tit r tt r k | 1 ! i |a saj rtsit r tt r 1 tta mtIa st -
ra ts a 1 t sis | a }a , 1 t| tr tsj tra rst j t r |t mtrt s \
|t ra s. i ts a 1 t sis a |Ia , st |a r 1 t tsj tra r j t r |t mtrt s
! 1 ia s ttttj It si st |a tt ara j rat| a tt m| ira 1 a |a
k| 1 si] at a ara t|tta 1 a 1 t sis 1 t 1 t ta mtIa st ra a |a s
\ |t ra s .
| t | at rt s irIt rma |a j rat| a 1 t| tt rIist | arira rit .
ra Iit tt rIist |Itrta Iirira ! |sIa j rat| a j at1 t tmj |ta rst
j a ra 1 ttirrt s | at ar j trrt K 1 Iitrt ar sir1 rt mt 1 t
| as|ir] . k j rt tima 1 a mtrIt t| 1 1 X 1 t |t s j trrt s tt r
| as|ir] s tsj t rIa rtt s Iitrtr ar ra Iit | I| t|tta 1 t . ir
tm| a r] t , mat|t s j trrt s tt r ar ra Iit | I| t|tta 1 t rt
Iitrtr | as|ir] s. i t| ra Iit ts rt rma |, |t ma s j rt | a | |t ts
| at t| j trrt rt Itr] a | as|ir] . i t| ra Iit ts t|tta 1 t , ts
j t si| |t | at t| j trrt Itr] a | as|ir] . | ra j rat| a ma s
tsj ttiIita Ia | tt mt |a saj rtsit r tt r 1 tta mtIa st ra t
tsIima|a tit r tt r k | 1 1 t| t rta |ita rst j a ra 1 tItrmira r
si rta |mtrIt tsIa j rtstrIt t rt ar | as|ir] .
at It rma 1 t 1 tta mtIa st ra st j at1 t tmj |ta r j a ra
|a j rat| a 1 t saj rtsit r tt r 1 tta mtIa st ra ! t j at1 t
tmj |ta r taa || aitr It rma 1 t 1 t ta mtIa -
st ra t 1 tta mtIa st ra It sIa It st 1 ita ,
j trt |a 1 t sis st 1 t| t | a sa r tr |a ta r-
Ii1 a 1 1 t 1 tta mtIa st ra a tIita 1 t |a
st |atit r. |a 1 tta mtIa st ra st j at1 t
a 1 mirisIra r | V t | M , a ar| at ts j rtItri-
| |t |a raIa | V.
i trttmt s | at st |a j atsIt |a
1 tta mtIa st ra Iatra 1 t |a ttra . at
st 1 t| t |a ttr! |s mt}t r tsj tra r \
|t ra s 1 tsj ats 1 t ara | a }a 1 t sis t I I
|t ra s 1 tsj ats 1 t ara 1 t sis a |Ia ,
rtj tIir |a j rat| a .
|a 1 t sis 1 t 1 tta mtIa st ra ts ma
j t| at1a j a ra ar a rima|. at st
1 t| t |a ttr! |s imj t rIa rIt 1 t siIita r
tt r j rttisit r |a 1 t sis. t 1 i|at |a
1 tta mtIa st ra a 1 j t r t}., 1 ,I m|
1 t 1 tta mtIa st ra tr , 1 t st |atit r
sa |ira t a ] aa tsItri| st a 1 mirisIra |a
1 tta mtIa st ra 1 i|ai1 a .
K tttsiIa t| a rima | a ara r a rIts 1 t
ara j rat| a 1 t saj rtsit r tt r 1 tta mt -
Ia st ra t tsIima|a tit r tt r k | 1 ! ||
a art rt ts a | st |aIa mtrIt rtttsa rit ,
j trt |t s a rima |ts 1 t| tr tsIa r Ira r| ai -
|t s 1 ara rIt |a j rat| a . | ra |ij tmia
ttttsita j at1 t a IttIa r |t s rtsa|Ia 1 t s
1 t |t s trsa t s 1 t| tt rIist |.
t j at1 tr |a ttr t Ira s jrat| a s
1 ia ] rt sIita s taa r1 t tsIa mt s |a titr1 t
|a s j rat| a s 1 ia ] rt sIita s 1 t | as|ir] !
|s mt}t r mirimita r t| ma rt}t 1 t| a ri-
ma |. |s mt}t r rt |a ttr ra 1 it ] ra Iia s. |r
ar j a titrIt 1 ia | tIitt , 1 t| t mt riIt ri-
ta rst |a ] |attmia 1 ara rIt |a j rat| a .
|a |ij t ] |attmia ts ar tsI i m a | a 1 t r
ttIrtma 1 a mtrIt j tItrIt 1 t |a |i| tra -
tit r 1 t k | 1 , |a |ij t ] |attmia Ia rIt
tr |a tsIima|a tit r tt r k | 1 t tr |a
s a j rtsitr tt r 1 tta m tIa st ra j at1 t
rtsa|Ia r tr Ia |st j t siIitt .
i |t s rtsa|Ia 1 t s 1 t ara j rat| a 1 t tsIima|a tit r tt r
k | 1 t saj rtsit r tt r 1 tt a mtIa st ra a 1 t sis | a}a st r
rt rma |ts, st 1 t sta rIa ara trItrmt 1 a 1 1 t | as|ir] tr
t | 1 1 X 1 t |t s ta st s! K ir] ara j rat| a ts 1 1 X tIt t-
I i ta . |a saj rtsit r tt r 1 tta m tIa st ra ts strsi| |t tr
a j rt t i m a 1 a m t r It t| 1 ! X |a tsIima|a tit r tt r k| 1
ts strsi ||t tr a j rtt i m a 1 a m t r It t| ! X . | r t I ra s
j a | a | ra s, |a 1 tta m tIa st ra a 1 t sis | a }a stra rt rm a |
t r I rt ar ! - 1 X 1 t |t s j atitrIt s tt r | as|ir] |a tsI i-
ma|a tit r tt r k | 1 stra rt rma | tr a j rt t i m a 1 a m t r It
t| ! X . i ara j rat| a | at |a ] a mt s ts rt rma | a ar
s t s j t t|a mt s | at t| a rima | It r ] a ar | as|ir] , trIt r-
tts st 1 t| t |a ttr t I ra j rat| a 1 ia ] rt sI i t a .
| aa |ts st r |a s j rat| a s | at rt s 1 iIt rtrtia r ar
| as|ir] 1t j tr1 itrIt 1 t j iIaiIa ria 1 t art 1 t j tr1 itrIt
1 t a 1 rtra | tr t| j trrt ! |a j rat| a 1 t saj rtsit r tt r
1 tta m tIa st ra a 1 t sis a |Ia t mt] a 1 t sis t t| ritt | 1 t
k | 1 tr1 t ] tra. | r a j rt t i m a 1 a m t r It t| I ! X 1t |t s
j t rrt s j at1 t 1 iIt rt r t i a rst tmj |ta r1 t |a saj rt s i t r
tt r 1 tta m tIa st ra a 1 t si s a |Ia . i |t s j t rrt s saj ri m t r ,
t | 1 ia ] rt sIitt ts 1 tj tr1 itrIt 1 t j iIaiIa ria . i rt |a
s a j rtsit r, t| j trrt jat1 t Itrtr taa || a i t ra 1 t |a s 1 t s
It rma s 1 t | as|ir] 1 t| t mt1 irst t| ritt| 1 t k| 1
t r 1 t ] tra . | r t I ra s j a |a | ra s, |t s rt s a | Ia 1 t s 1 t |a
s a j rtsit r tt r 1 tta m tIa st r a a 1 t sis a |Ia st |t j at1 tr
i 1 t r I i Iita r j trrt s tt r | as|ir] s 1 tj t r1 itrIts 1 t j iIai-
Ia ria . i |t s ri tt|ts 1 t tt rIist| rt st saj rimtr tt r ara
1 t si s t |tta 1 a 1 t 1 tta m tIa st ra tr ar j trrt tt r ar
| as|ir] tt rIi rma 1 t , |a s j rt | a | i |i1 a 1 ts 1t 1 tj tr1 itr-
It 1 t j iIai Ia ria Irt r It a |t s 1 tj tr1 it rIts 1 t a 1 rt r a | t s
st r ! 1 . ! 1 .
ENFERMEDAD HIPOADRENAL
|| |ij t a 1 rt r t t t rIitismt 1 k j at1 t str ara 1 t |a s
t r It rmt1 a 1ts ma s 1 tsa Ii a r It tr |t | at rt s j t t Ia a
1 i a ] r t sIitt It ra j taIita , tt rIasa Ira sI ra r It, | a t
1 t| t trIrt r Ia r t| t|i ritt 1 t jt| at1t s a rima |ts. | | 1 k
ts ar sir1 rt mt | at rt s a | Ia tt r ara 1 tIi t i t r It sttrt t i t r
Ia r It 1 t ] | a t t t t rIitt i1 ts tt mt 1 t mirtra | t t t rI i t t i 1 t s
j t r j a rIt 1 t |as tt rItta s a 1 rtra |ts. |a 1 tsI rattit r 1 t
ma s 1 t| 1 ! X 1 t a m| a s tt rItta s a 1 rtra |ts j rt 1 a t t
Necrosis adrenocortical inducida por el
tratamiento con mitotane
k ar| at t| miIt Ia rt rt rma |mtrIt rt a IttIa |a tt ra
] |t mtra|t sa , j t r Ia rIt |a sttrttit r 1 t mirtra |t tt rIi-
tt i1 ts, sir tm| a r] t a |] art s ta st s 1 t Ia ||t a 1 rtrt tt rIi-
ta | tt mj |t It j at1 tr t tarrir t ta sit ra |mtrIt.
Adrenalectoma bilateral
Hemorragia o infarto de las glndulas adrenales
|s j t tt IrttatrIt j trt j at1 t j rt 1 atir irsaIititrtia
a 1 rtrt tt rIita | a ] a1 a .
Micosis o neoplasia que afectan a las
glndulas adrenales
|a j a It |t ] ia a 1 rtrt tt rIita | j rt 1 att ara 1 tIititrtia
1 t ] |att tt rIitt i1 ts mirtra |t tt rIitt i1 ts. |a a |1 t sItrt -
ra ts t| j rirtij a | mirtra |t tt rIitt i1 t sa 1 tIititrtia j rt -
1 att ara ira 1 ttaa 1 a ta j a ti1 a 1 j a ra tt rstrta r t| a ] aa
st 1 it ar Ia ||t j a ra tttrtIa r t| j t Ia sit , j t r |t | at st
tsIa | |ttt ara |ij t ra Irtmia 1 tIititrtia 1 t st 1 it t
|ij tr|a |tmia ttttst 1 t j t Ia sit . |a |ij t ra Irtmia ir1 a-
tt |tIa r] ia , 1 tj rtsit r ra asta s, tt r1 att a | 1 tsa rrt ||t
1 t |ij t tt |tmia , |ij t Itrsit r, rt1 attit r 1 t| ] a sIt ta r1 ia -
tt 1 ismiratit r 1 t |a j trIasit r rtra |. |a |ij tr|a |tmia
j rt 1 att 1 t| i|i1 a 1 masta|a r, |ij t rrtI|ttia ara ira 1 t-
taa 1 a tt r1 attit r ta r1 ia ta . |a 1 tIititrtia 1 t ] |att tt rIi -
tt i1 ts j rt 1 att ara irIt |tra rtia a | tsIrts, j tr1 i1 a 1 t
a j tIiIt a rtmia rt rmt tiIita rt rmt trt mita .
Hallazgos clnicos
|| |ij t a 1 rtrt tt rIitismt t tarrt j rirtij a |mtrIt tr a ri -
ma |ts }tttrts t 1 t t1 a 1 mt1 ia ts ma s IrttatrIt tr
|tm| ra s. k ar| at rt |a a amtrIt 1 t| rits] t | a sa 1 t tr
|a ra ta t Ia ma 1t , ttisIt titrIa tti1 trtia 1 t Itr1 trtia
Ia mi|ia r tr t| | a rit|t tsIa r1 a r, |tIritttr |a | ra 1 t r
j a rit| 1 t a ] aa j t rIa] ats.
ara 1 tIititrtia t|irita 1 t It 1 a s |a s
| t rmt ra s a 1 rt r t t t rIita |ts st 1 trt -
mira |ij t a 1 rtrt tt rIitismt j rima rit
1 k | t trIt rmt1 a 1 1t k 1 1 ist r . ||
|ij t a 1 rt rt tt rIitismt sttar 1 a ri t
1 k tsIa j rt 1 ati1 t j t r ara 1 tIi-
titrtia tr |a k | 1 , |t taa | j rt 1 a t t
ara a Irt Iia 1 t |a s tt rItta s a 1 rt r a | t s
ara sttrttit r ira 1 ttaa 1 a 1 t ] | a t t -
t t rIitt i1 ts. |a j rt 1 attit r 1 t mirtra -
| t t t rIitt i1 ts, sir tm| a r] t , sat|t j tr-
ma rtttr a1 ttaa 1 a .
Hipoadrenocorticismo primario
(enfermedad de Addison)
|| 1 k | t tarrt tr t| j trrt ma s Irt-
t a t r It m t r It 1 t |t | at st |t rt t t r t t t
j t rt ts It 1 a tia mat|t mtrt s tt mar
| at t| |ij tra 1 rt r t t t rIitismt t r I t r -
mt1 a 1 1 t | a s | i r ] . || 1 k ts ma s
ra rt tr ] a It s .
Causas de
hipoadrenocorticismo
|| |ij t a 1 rtrt tt rIitismt tr |t s a ri-
ma |ts st |a a st tia 1 t tt r |a s si] aitrIts
tt r1 itit rts.
Insuficiencia adrenocortical
primaria
|sIa ts |a ta asa ma s IrttatrIt tr t|
j trrt st j itrsa | at ts t| rtsa|Ia 1 t
1 t |a 1 tsIrattit r irmart mt1 ia 1 a 1 t |a
] |a r1 a|a a 1 rtra |. |r |ama rt s, t| |ij t-
a 1 rtrt tt rIitismt st |a a st tia 1 t tt r
t Irt s Ira sIt rrt s irmart mt1 ia 1 t s tt mt
|a Iirt i1 iIis, 1 ia | tIts mt||iIas, |ij t j a ra -
Iirt i1 ismt , Ia ||t ] t ra 1 a | j rima rit
] a sIriIis a Irt Iita .
st s si] rt s Ia |ts tt mt jt r1 i 1 a 1 t j tst , 1 t| i|i1 a 1 , a rt -
rttia , tt m i It 1 ia rrt a .
|t s |a ||a t] t s tt marts 1 t| tta mtr Iisitt , a j a rIt 1 t |a
1 tj rtsit r 1 t| i|i1 a 1 , irt|atr 1 ts|i1 ra Ia tit r, | ra 1 i-
ta r1 ia j a|st Itmt ra | 1 t| i|.
|a j rt ] rtsit r 1 t |a irsaIi t i t r t i a
a 1 rt r t t t rIita | j at1t str a ] a1 a t
t rt r i t a .
Hipoadrenocorticismo
primario agudo
|a j rtstrIa tit r t|irita 1 t |a It rma
a ] a1 a ts ar s|t t| |ij t tt |tmitt trisis
a 1 rt r t t t rIita | . | | a rima | st sat|t
trtt rIra r tr ar tsIa 1 t 1 t tt |a j st
taa r1 t st tsIrtsa . 1 Irt s si] rt s irt|a-
tr j a|st 1 t| i|, | ra 1 ita r1 ia j rt Iar1 a ,
1 t |t r a | 1 t mira |, tt miIt s, 1 ia rrta , 1 ts-
|i1 ra Ia tit r t |ij t Itrmia . |a tt r1 itit r
j rt ] rtsa ra j i1 a mtrIt |a ti1 a tsIa
tt mj rt mtIi1 a . | r Ira Ia mitr] t a ]rtsi-
tt tt r I|ai1 t s a a1 a ra a |a ma t ria 1 t
|t s j a titrIts rt s j trmiIira ma s Iitm-
j t j a ra |a ttr ar 1 ia ] rt sIitt Ii] . 1 .
primario crnico
|t s si] rt s t|iritt s tr |a It rma trt ri-
ta st r tt r Irttatrtia ta ] t s t irtsj t-
tiIitt s Ia | |a | | .
|t s si] rt s t|i ritt s ma s tt rsisIt r It s
i r t | a tr a rt rtti a , tt m i It s, |tIa r] i a ,
1 t j rtsit r It 1 t| i|i1 a 1 . |a sttt ri-
1 a 1 1 t ta 1 a si] r t j a t1 t ta ri a r
1 a ra r It t | tarst 1 t |a trIt rmt1 a 1
j at1 t a |It rr a rst tt r j trit 1 t s 1 t
| atra sa |a1 a j a rt r It, tt r Irt t a t r t i a
st] ai1 t s j t r ar Ira Ia m i t r It irtsj tti-
Ii tt , | at rt rm a | m t r It tt rsisIt t r |a
a 1 m i r i sI ra tit r 1 t tt rI i t t sIt rt i 1 t s
It I|ai1 t s. || |i j t a 1 rt r t t t rI i t i s m t
j at1 t tt rIar1 i rst ttr Ia ti|i1 a 1 tt r
ara irsaIititr tia rtra| trt rita , Ira s-
It rrt s rtart m a s t a | a rts j ri m a rit s
t I ra s trIi1 a 1 ts | at tarstr tt r 1 itt r-
Fig. 9. C aniche con un shock hipovolm ico de origen hipo-
adrenocortical en donde un tratam iento agresivo con
fluidos nos perm ite m s tiem po para hacer un diag-
nstico.
TABLA II
Anorexia
Letargia/depresin
Debilidad, normalmente episdica
Vmitos peridicos
Diarrea o constipacin peridica
Prdida de peso
Polidipsia y/o poliuria
Deshidratacin
Bradicardia
Sncope
Inquietud/temblores
Dolor abdominal
Hallazgos laboratoriales de rutina
|t s | a ||a t] t s ma s tt mar ts st
ttj rtsa r tr |a Ia | |a | | | .
Hematologa
|t s ta m| it s |t ma It |t ] itt s j at1 tr
irt|air |irIt t i It sis, tt si rt Ii|ia a rt-
mia rt rt ] t r t ra I i ta rt rmt tiIita rt r-
m t t rt rita . ir tm| a r] t , tsIt s |a ||a t-
] t s rt st r Ia r tt rsisIt r Its tt mt |t s
ta m| it s tisIt s tr t| |ij t ra 1 rt r t t t rI i-
tismt . |t s tt rIa }ts 1 t |irIt t i It s
t t s i r t Ii|t s 1 t rt rma | a t|tta 1t tr ar
a rima | trIt rmt ttr si] rt s tt mj a I i-
| |ts tt r ar |ij t a 1 rt r t t t rIitismt st r
s i ] r i Ii t a I i tt s, j t r| at |a rt s j a t sIa
| at st tsj tra a | tsI rts rt s a | Ia ria tt r
| i r It j tria tt sirt jt ria . | ra a rtmi a
| ttt j at1 t rt str t |tia |a sIa | at t|
a rima | st rt | i 1 ra It 1 t| i1 t a | tIt t It
1 t |tmt tt rttrIra tit r j t r |a 1 ts|i-
1 ra Ia t i t r .
Bioqumica
|t s |a ||a t] t s 1 t |a | t ra It rit ma s
tt rsIa rIts tr t| |ij t a 1 rtrt tt rIitismt
st r a tt Itmia j rtrrtra |, |ij t ra Irtmia
t |ij tr|a |tmia . ir tm| a r] t , a j rt ti-
ma 1 a mtrIt t| 1 X 1 t j trrt s tt r |ij t-
a 1 rt r t t t rIitismt Iit rtr ritt|t s 1 t
t|ttIrt |iIt s rt rma |ts.
| rt a sa r ] ai rt a . t t rta t r Ira
i r t rt m t r Ia 1 a , tt rsttat rIt tt r ar
ra Iit 1 t Ii | I ra tit r ] | t m t ra|a r 1 i smi -
rai1 t ara j trIasit r rt ra | rt 1 a t i 1 a .
|a j trIasi t r rtra | rt1 ati1 a rt s a | Ia
1 t |a |ij t tt |t mia , ] a sIt ta r1 i a t t
rt1 ati 1 t t |i j t Itrsit r, |a taa | st
a ] ra ta tt r |a j tr1 i1 a trt rita 1 t I| a i-
1 t s a Ira tts 1 t |t s ri1t rts, j tr1 i 1 a s 1 t I|ai1 t s a ] a-
1 a s tt r tt m i It s It 1 ia rrta s t ir] t sIa ira 1 ttaa 1 a 1 t
| i | a i 1 t s .
|a a tt Itmia j rt rrtra | rt rm a | m t r It st a st tia tt r
t ri ra tt rttrIra 1 a j tst tsj ttiIitt - . 1 1 1 mitrIra s
| at |a t rira tr ar Ia ||t rtra | j ri m a rit tt r Irt t a t r t i a
ts ist sIt r a rita t st |t |i] t ra m t r It tt rttrIra 1 a . 1 1
a . 1 I ! . |r a |] art s ta st s 1 t |ij t a1 rt r t t t rI i t i s m t
s ttt rt , sir tm| a r] t , j at1 t 1 tsa rrt | | a rst ara ira 1 t-
taa 1 a ta j a ti1 a 1 1 t tt rttrIra tit r 1 t| i1 t a |a s jtr1 i-
1 a s trtrita s 1 t st 1 it , j t r |a rt1 attit r 1 t| ] ra 1 i t r It
1 t tt rttrIra tit r mt1 a|ar. | t taa || aitr mt1 t , tt r ar
a 1 ttaa 1 t Ira Ia m i t r It 1 t I|ai1 t s, |a arta sa r] airta
rtIt rr a ra a ritt|ts rt rma |ts tr |t s ta st s 1 t |ij t a 1 rt-
r t t t rI i t i s m t .
t 1 it . K t rma |mtrIt ts irItrit r a 1 ! mmt |I|.
|t Ia sit . at|t tsIa r j t r trtima 1 t ! ,! mmt |I|.
|| ra Iit st 1 it Ij t Ia sit j at1 t str 1 t ma t r ta |t r | at
|t s ta |t rts a | st |aIt s. || ra Iit rt rma | ta ria trIrt I I.
\ 1 . , mitrIra s | at tr j a titrIts tt r |ij t a 1 rtrt tt rIitis-
mt , tt marmtrIt t| ra Iit st trtatrIra j t r 1 t| a }t 1 t
TABLA III
Hematologa Linfocitosis
Eosinofilia
Neutropenia relativa
Anemia no regenerativa, normocti-
ca, normocrmica
Bioqumica Urea sangunea incrementada
Hiponatremia (<135 mmol/L)
Hiperkalemia (>5,5 mmol/L)
Ratio sodio: potasio reducido (<25/1)
Hipercalcemia
Hipoglucemia
Urianlisis Peso especfico
(normalmente >1.025)
I ! . j at1 t str irItrit r a I 1 . . ir
tm| a r] t , ar 1 X 1 t |t s ta st s j at1 tr
Itrtr ritt|ts 1 t t|ttIrt |iIt s rt rma |ts.
| a |tit . 1 i j t rta |ttmia 1 t |ttt a
mt 1 tra 1 a st tt tr a j rttima 1 a mtrIt
ar Itrtit 1 t |t s ta st s 1 t |ij t a 1 rtrt -
tt rIitismt , st | rt It 1 t tr a | at||t s a ri-
ma |ts ma s stttra mtrIt a IttIa 1 t s. |a
|ij trta |ttmia st j rt 1 att j t r |a |tmt -
tt rttrIra tit r, |a rta | st rtit r Ia| a|a r
rtra | irtrtmtrIa 1 a j t r |a 1 ismira-
tit r 1 t |a Ii|Ira tit r ] |t mtra|a r.
| |att sa sa r] airta . |r |t s ta st s 1 t
| i j t a 1 rt r t t t rIitismt , a ar| at j t tt
IrttatrIt, |a ara Itr1 trtia a | at st
1 tsa rrt ||t |ij t ] |attmia 1 t| i1 t a |a
1 t Iititrtia 1 t ] | a t t t t rIitt i1 ts | a t
rt1 att |a j rt 1 attit r 1 t ] |att sa j t r
j a rIt 1 t| |i] a 1 t |t s rtttj It rts tt|a-
|a rts j triItritt s st r ma s strsi| |ts a |a
irsa|ira .
Hallazgos electrocardiogrficos
|a |ij tr|a |tmia j tr}a1 ita |a tt r-
1 attit r ta r1 ia ta , |a taa | j at1 t ta |t-
ra rst j t r t|ttIrt ta r1 it ] ra Iia || | .
k ar| at |t s ta m| it s tr t| || | rt st
t t rrt|a tit ra r 1 i rt t Ia m t r It tt r |t s
ritt|ts 1 t j t Ia sit stritt , |a si] aitrIt
] aia j at1 t str 1 t a a1 a .
-! , ! mmt |I|. a tt rIa m i t r It 1 t|
irItrta |t -, a amtrIt 1 t |a a mj |iIa1
1 t |a t r1 a .
-t ,! mmt |I|. irtrtmtrIt 1 t |a 1 ara -
tit r 1 t| tt mj |t}t | .
- I, 1 mmt |I|. 1 ismiratit r 1 t |a
a mj |iIa1 1 t |a t r1 a |, irItrta |t |-|
j rt |t r] a 1 t .
- ,! mmt |I|. a astrtia 1 t |a t r1 a
|, | ra 1 i t a r1 ia sttt ra .
|a t|ttIrt ta r1 it ] ra Iia st j at1 t Ia m| itr tmj |ta r
j a ra mt riIt rita r a | j a titrIt 1 ara rIt t| Ira Ia mitrIt .
|t s a rima |ts tt r |ij t a 1 rt r t t t rIitismt j at1 tr mt s-
I ra r si] rt s ra 1 i t ] ra Iitt s 1 t |ij t tt |tmia , |t s taa |ts
i r t | a tr. mitrt t a r1 ia , rt1 attit r 1 t| Ia ma 1t 1 t |t s
ta st s j a|mtra rts Ia ma 1t rt1 ati1 t 1 t |a ttra ta ta
ta a1 a |. k |] art s a rima |ts tt r |ij t a1 rt r t t t rI i t i s m t
1 t s a rrt ||a r 1 i|a Ia tit r 1 t| tst Ia ]t tt mt rt s a | Ia 1 t 1 t
|a 1 t| i|i1 a 1 masta|ar ] t r t ra |ita 1 a tsIt j at1 t a j rt-
t i a rst tr |a s ra 1 i t ] ra Iia s It ra t i t a s .
Confirmacin del diagnstico
Prueba de estimulacin con ACTH
|a s tt rIist |tmi a s | a sa |ts st r 1 t tsta st ta |t r 1 ia ] -
r t sIitt rt 1 t| tr t mj | t a rst tt mt aritt tri It rit j a ra
t | tsIa | | t t i m i t r It 1 t| 1 ia ] rt sIitt . |a rta |ita tit r 1 t
ara tsIima|a tit r tt r k| 1 ts t| aritt mt It 1 t ti] t r It
j a ra tt rIi rma r t| |ij t a 1 rt r t t t rIitismt tr j trrt s
] a It s. | | tsIa1 it st ir 1i ta Ia r j rt r It st st sj t t|a t |
1 i a ] r t sIitt sir imj t rIa r t | mt mtrIt 1 t| 1 i a. i st st s-
j t t|a t| 1 i a] rt sIitt ts rtttsa ri t a 1 mirisI ra r ar Ira -
Ia m i t r It tt r ] | a t t t t rIitt i1 ts a rIts 1 t |a j rat | a, |a
1 rt ] a rttt mtr1 a 1 a t s |a 1 tta m tIa st ra j t r| at rt
i r It rIi t rt tt r t| a ra |isis.
|| t sIa1 i t st rta |ita tt mt timt s j a ra t| 1 ia ] rt sI i-
tt 1 t | as|ir] . |t s rt s a | Ia 1 t s 1 t tsIa j rat| a tr
j t rrt s ] a It s ttr trIt rmt 1 a 1 1 t k 1 1 ist r 1 a r ritt -
|ts | a sa |t s tr t| ra r] t rt rma | | a }t | at rt a amtrIa r
I ra s |a 1 t sis 1 t k | 1 . |t s ta | t rts j t sIt sIima|a tit r a
mtra1 t st r simi|a rts a |t s ritt|ts | a sa |ts t tsIa r j t r
1 t | a }t 1 t t||t s. k |] art s a rima |ts j at1 tr Itrt r ar
| i ] t rt irtrt m t r It tr |t s ta | t rt s j t sIt sIima|a tit r, j trt
rar ta saj tra r |t s ta | t rt s mirimt s rt rma |ts. |t s ta | t -
rt s 1 t tt rIist | j t stsIima |a ti t r rt ] a | a rm t r It st r
m t r t rts 1 t ! 1 r] Im| ! j ] I1 | tr |ts j trrt s tt r
k 1 1 i s t r .
Concentracin de ACTH
endgena
|t s rt s a | Ia 1 t s 1 t |a tsI i m a | a t i t r
tt r k | 1 rt 1 iIt rtrtia r trIrt |ij t a -
1 rt r t t t rIitismt j ri m a rit sttar1 a -
rit . |sIt 1 tma r1 a |a mt1 itit r 1 t |a
t t r t t r I ra tit r j |a sma Iita 1 t |a k | 1
t r 1 t ] tra . |a ma ri j a|a tit r 1 t |a
m a t sI ra ts 1 ttisita j a ra tsIa |t rm t -
ra j t r| at ts mat|t ma s |a | i | | at t|
t t rIist |. | s Iar1 a mtrIa | | at t| |a | t -
ra It rit samirisI rt |a s 1i rt t I i ta s j a ra
|a ma rij a|a tit r 1 t |a s matsI ra s. |r
] t r t ra |, |a s mat sI ra s 1 t| t r tt I ra t r-
st ttr Iri I a ] a rst 1 t i r mt1 i a It ,
a |ma ttra r1 t |a s tt r] t|a 1 a s tr Ia| t s
1 t j |a sIitt . | | ta |t r rt rma | 1 t |a
k | 1 tr1 t ] tra sat|t trtt r Ira rs t
t r I rt I 1 1 1 j ] Im|.
|a k| 1 t r1 t ] tra | a sita mtrIt
ts 1 t ta |t r t r |t s a ri ma |ts a It t Ia 1 t s
tt r 1 tIititrtia 1 t ] | a t t t t rIitt i1 ts rt |a rt s j a t sIa
a |a tsIima|a tit r tt r k| 1 j trt |t s t|ttIrt | i It s st r
r t rma |ts . k |] art s j trrt s tt r 1 k | st |t Iitrt r si] rt s
1 t 1 tIitiI tsIt rt i1 t |tIa r] ia , 1 tj rtsit r, a rt rtt i a ,
tt m i It , 1 ia rrta 1 t| i |i1 a 1 , sas ta | t rts 1 t st 1 it ,
j t Ia sit t|t ra rt st r rt rma|ts. |t s ta | t rts 1 t |a k| 1
t r 1 t ] tra 1 t| tria r str a |It s tr |ts j trrt s tt r 1 k |,
j t r| at rt |a ara rtI rt a |itmIra tit r rt] a I i ta a j a rI i r
1 t| tt rIist |. |a j rt strtia 1 t tt rtt rIra titr ts a |Ia s 1 t
k | 1 tr1 t ] tra tt rIi rma | at |a j iIaiIa ria tsIa Iartit -
ra r1 t | at |a |tsit r j ri m a ria st |t ta |ita tr |a ] | a r-
1 a|a a 1 rtra |. | sIt s a rima |t s st r tt rIrt |a 1 t s a Ira tt s
1 t sas t|t tIrt | i It s ta 1 a 1 -\ mtsts, j a ra a rIitij a rst a
|a 1 tsI rattit r j rt ] rt s i ta 1 t| It}i1 t a 1 rtra |, si st
t sIa | |ttt ar 1 tIitiI 1 t mirtra | t t t rIitt i1 ts st 1 t| t
j t rtr ara It ra j i a sasI i I a I i ta .
i |t s t|t tIrt | i It s tsIima|a ti tr tt r k| 1 st r a rt r-
ma |ts, st tt rIi rma t| 1 k |. |t s a rima |ts tt r irsaIi t i t r-
tia |ij t Ii s a ria | at t ta si t ra Ia ||t a 1 rtr a| 1 t| tr It r t r
k | 1 t r1 t ] tra s | a }a s t ir1 t It t Ia | |ts, |t taa | t ri ] i r a
a I rt Iia a 1 rtra | | i|a It ra |. | sIt t tarrt tr t| 1 k
a I rt ] t r i t t .
| |a sIa ir | | . |ta |aa Iit r t I I|t |j t I|a |a -
mit j iIaiIa r a tis ir t|irita || sIrtsst1
1 t ] s. ! k m k rim 1 t sj , k sst t. I I .
\ 1 ! , 1 t .
|t|1ma r || . k1 rtra | ] |a r1 1 ista st. |r.
| I I i r ] tr ! t1 . ttI|t t| t I VtIt ri r a r
| r It rra| M t1 itirt. ||i|a 1t |j |ia , w|
a a r 1 t rs, I I , 1 1 .
|t|1 ma r || . 1 ij tra 1 rtrt tt rIitismt . |r.
|IIir] tr. ra Ia 1 t 1 t M t1 itira | rItrra
VtItrira ria . |rItrmt1 a 1 ts 1 t| j trrt
t| ] a It . | rItr M t1 ita . ! , 1 1 I.
|t|1 ma r || M a t| | |. | rirt tt rIist |. trt -
a Iirirt ra Iit a s a strttrir] ItsI It r
| j t ra 1 rt r t t t rIitism ir 1 t ] s.
!.k .V.M .k . I 1 1 . t 1I, 1 1 I .
|t|1mar || K t|st r |w. 1 j tra 1 rt -
r t t t rIitism. |r. | a r ir t a r1 |t | i r t
| r 1 t t rirt |t ] a r 1 | t j rt 1 a t I i t r .
||i|a1tj |ia, w| aar 1trs, 1I, 1 I.
| a |a t , 1 tt isI ra 1 , t s |t |, |i} r | t r| k.
| ri r a r tt rI i t t i 1 I t rtaIirirt ra Iit s ir I| t
1 i IIt rtrIiaIit r | tI ttr jiIaiIa r-1 t j t r-
1trI | j t ra 1 rt r t t t rIitism a r1 | j t ra-
1 rt r t t t rIitism 1at It a1 rt r t t t rI i t a |
Iamt ar ir I|t 1t ] . VtI , 1 . . 1 1I.
| rttt | |tItrst r M . |t|irt |j t a 1 rt-
rt tt rIitism. |r. | ir| | t1 . . | arrtrI
VtItrira r |tra j 1 . ma || k rima |
|ra tIitt. ||i|a 1 t|j |ia , w| a ar1 trs,
1 \ I , 1 1 .
1 trrIa ] t M |. |t a 1 rtra | ] |a r1 s. |r.
M a r aa | t I ma || k rima |
|r1 t trirt |t ] . | ..k .V.k ., I 1 , 1 1 1 .
| i IIt r !, |t s|t | | l tr| t | k .
| |att tt rIitt i1 1 tIititrI |j t a 1 rtrt -
tt rIitism ir 1 t ] s. ta sts 1 t -
1 1 ! . ! t arra | t I I| t k mtri t a r
VtItrira r M t1 ita | k sst tia Iit r, I 1 1 .
I 1 It , 1 1 t .
M a t| | | |t|1ma r || . | t mj a rist r t I It
| t 1t st 1tta m t I|ast rt sajj rt s i t r
j rt It tt |s a s strttrir] a r1 1 istri m i r a-
Iitr It sIs ir 1 t] s iI| | j t ra 1 rt r t t t r-
Iitism. !.k . V. M . k . 1 I. t 1 1 , 1 1 1 .
K t|st r |. | ist r1 t rs tI I|t a 1 rtra| ] | a r 1 .
|r. K t|st r | ar1 | taIt | t1 s. . tsstr-
Iia |s tI sma || arima| irIt rra | mt1 itirt.
I |tais, M t s|-Ytar | t t|, ! I, 1 1 I .
|t Itrst r M |. 1 j tra 1 rtrt tt rIitism. Vt I
| |ir K t rI| k m ma || k r |ra tI, \ .
I 1 , 1 \ .
|tItrst r M |. |r1 t trirt 1 ist r1 trs ir ta Is.
|t ar tmtr] ir] 1 ista sts. | t mj | t rI
| t |ra tI Vt I., 1 , 1 ! 1 , 1 .
|t It rst r M | , | irIttr || ||i|ij 1 | .
|rtIrta ImtrI t|irita | a r1 |a | t ra It r
Iir1 ir] s ir 1 t ] s iI| |j t a 1 rtrt tt rIi-
tism. I I ! ta sts 1 I 1 - 1 1 1 . !t arra |
t I I|t k mtrita r VtItrira r M t1 ita |
k sst tia Iit r, I 1 . ! -1 , 1 1 t .
mi|t || |tItrst r M |. |ta |aa Iit r t I a
arirt tt rIist |. trta Iirirt ra Iit a s a
strttrir] ItsI It r |j tra 1 rtrt tt rIi-
tism ir 1 t ] s. ! VtI | rItrr M t1 , tt | I.
t 1 , 1 1 1 .
j a r|ts k 1 , k 1 a ms | , | t aI|a iIt !k
| ra II1 1 -! t r ts | . k sstssmt rI t I
a 1 rtra | IartIit r ir ta Is. rtsj t rst It
irIra ttrt as srI|tIit k | 1 . ! ma ||
k rim |ra tI, tt | 1 ,I , 1 1 1 .
Va r |it | 1 , | rttt | , a |ma r M | .
| t mj a rist r t I rtsa|Is t I a 1 rtrt tt rIi-
tt Irt j it |t rmt rt sIima|a Iit r a r1 |t -
1 t st 1 tta m t I|a st rt sa j j rt s s i t r
ItsIs iI| rttrt j s Iir1 ir] s ir 1 t ] s.
ta sts 1 ! - 1 1 ! . ! k m Vt I M t1
k sst t, I .1 . 1 1I.
BIBLIOGRAFA
C APTULO III LAS G LN DULAS PARATIRO IDEAS
a glndula paratiroides segrega la hormona paratiroidea (PTH ). Esta hormona, junto a la cal-
citonina (segregada por la glndula tiroides), participa en la homeostasis del calcio y f0sfo-
ro y tienen un importante significado en la fisiologa sea. En pequeos animales puede pre-
sentarse tanto el incremento (hiperparatiroidismo) como la disminucin (hipoparatiroidismo)
de PTH y ambos son causantes de importantes trastornos en el animal.
O. FERRER QUINTANA
M. C. MUOZ OJEDA
U.D. Patologa General y Mdica
|
|
|a tt rttrIra tit r 1 t| ta |tit stritt It Ia |, |a tt rttrIra tit r
1 t| ta |tit it rita 1 t sat|t j trma rtttr ira |Itra 1 a . |a a |ta -
|t sis, a | irtrtmtrIa r |a j rt j t rtit r 1 t| ta |tit ari1 t a |a
a || amira , j at1 t tIttIita mtrIt 1 ismirair |a tt rttrIra -
tit r 1 t| ta |tit it rita 1 t . | ra It rma|a j a ra tt rrt] ir t|
ta |tit stritt It Ia | st | a sa tr |a tt rttrIra tit r strita 1 t
|a a || amira .
TRASTORNOS DE LA FUNCIN PARATIROIDEA
Hiperparatiroidismo primario
|| |ij trj a ra Iirt i1 ismt j rima rit 1 || st 1 ia ] rt sIita
tr j trrt s ma t rts ] trtra |mtrIt j t r trtima 1 t - 1
a 1t s , rtsa|Ia r1 t tt r ara ttttsita sttrttit r 1 t |1 j t r
tt|a|a s rtt j |a sita s t |ij trj |a sita s 1 t |a j a ra Iirt i1 ts. |r
|t s j trrt s |a ta asa ma s IrttatrIt ts ar a 1 trt ma Iartit -
ra | | at a IttIa a ara arita ] |a r1 a|a . 1 ta sit ra |mtrIt, t|
It}i1 t j a ra I i rt i1 t t atttst rit ttIt j itt , 1 tsj |a ta 1 t
|a tia t| mt1 ia sIirt a rIt rit r 1 ara r It t| 1 tsa rrt | | t
tm| rit ra rit 1 t| Iimt , j at1 t Ia m| itr ||t] a r a str rtt -
j |a sitt . imi|a rts |tsit rts tr |t s ] a It s st r ra ra s.
|a |ij trj|asia jara I i rti1 ta, a ar|at st jat1t 1 ar tt mt
t r It rmt1 a1 j ri m a ria ] t r t ra | m t r It a It t Ia a ma s 1t ara
] |a r1a|a ja ra I i rti1ta, |t mas ttmar, sir tm|a r]t , ts |a t
sta sttar1 a ria a ara trIt rmt1a 1 rtra | t raIri t i t r a | ,
tt mt tt rtmt s ma s a 1 t|a rIt .
Clnica
|t s si] rt s t|iritt s 1 t| |ij trj a ra Iirt i1 ismt j rima rit
st r irsi1 it st s t irtsj ttiIitt s st 1 t| tr a |a s Iartit rts
1 t |a |1 a |t s tIttIt s 1 t |a |ij trta |ttmia st | rt |a Iar-
tit r rtra |. |t s si] rt s sisItmitt s a j a rtttra r tr |t s a ri-
ma |ts taa r1 t j a 1 tttr |ij trta |ttmia stttra 1 ara rIt
j trit 1 t s j rt |t r] a 1 t s st 1 t| tr a |t s tIttIt s 1 irttIt s
1 t| ta |tit st | rt |a Iartit r Ia| a|a r rtra |. |s j t r t||t | at
a |] art s 1 t |t s si] rt s t|iritt s st a st tia r tt r Ia ||t rtra |
| a a } a sIa1 t m] I1 | =
= | a It Ia | m]I1 | a||amira ]I1 | 1 ,!
INTRODUCCIN
k ] |ar1 a|a s j a ra I i rt i 1 t-
a s 1 ts ] |a r1 a|a s a st -
tia1 a s tt r ta 1 a |t | a|t
I i rt i1 tt , mt1 ia rIt |a
s t t rttit r 1 t sa aritt
j rt 1 a t It |t rmt ra ja -
ra I i rt i1 ta |1 , str strsi||ts a |ts
mirimt s ta m|it s tr |a tt rttrIra t i t r
s t rita 1 t| ta |tit it rita 1t . |a s a ttitrts
i r It ] ra1 a s 1 t |a |1 st |rt |a rt s t rt i t r
t sta , rt a | s t rtit r Ia| a|a r 1isIa| 1t ta |-
tit |a a | strtitr irIt sIira| 1t ta |tit
mt1ia1 a j t r |a tiIa mira | str rt s j t r-
sa | |ts 1 t |a rt] a|atit r 1 t| ta |tit it ri-
ta 1t tr satrt .
|a ta |ttmia ts t| j rirtij a | Ia tIt r tr
|a rt] a|a tit r 1 t |a sttrttit r 1 t |1 . ||
sisItma Iartit ra tt mt si ttisIitra ar
ta |tit sIa It | at t j tra a ar j arIt 1 t
a }asIt 1 t ta si 1 ,! m] I1 |. | aa r1 t |a
ta |ttmia 1 ismirat j t r 1 t| a }t 1 t tsIa
tt rttrIra tit r, st irtrtmtrIa |a sttrt-
tit r 1 t |1 , taa r1 t |a ta |ttmia saj t-
ra t| j arIt 1 t a }asIt, st saj rimt |a
sttrttit r 1 t |1 .
Interpretacin de los niveles
del calcio srico
|a mt1 itit r 1 t| ta |tit stritt It Ia |
irt|at t| ta |tit ari1 t a |a a || amira
! 1 X , t| ta |tit it rita 1 t |i| rt \ 1 X
sa |ts 1 t ta |tit rt it rita 1 a s 1 X . ||
ta |t r st 1 t| t irItrj rtIa r tr a st tia tit r
tt r |a a || amira strita tsIa 1 t a ti1 t -
| a st 1 t| j a titrIt. t |t |a Ira ttit r it ri-
ta 1 a ts Ii s i t | t ] i t a m t r It a tIita .
k ar| at |a |ij t a || amirtmia 1 ismirat
|
|
sir1 rt mt artmitt , Ia |ts tt mt . 1 tj rt-
sit r, j t |iaria , j t |i1 ij sia , tt miIt s, 1 ia-
rrta s tt r Irttatrtia mt|tra s 1 t| i1 t
a |a 1 isIartit r j |a | atIa ria , a|ttra s
t ra |ts, a rtmia rt rt] trtra Iita , 1 ts-
|i1 ra Ia tit r |a |iIt sis.
|t s a rima |ts a It t Ia 1 t s tt r Irt-
tatrtia st r j t |iaritt sIj t |i1 ij sitt s a
| at |a |ij trta |ttmia trtrita a It t Ia |a
ta j a ti1 a 1 1 t tt rttrIra tit r rt rm a |
1 t |t s Ia| a|t s rtra |ts a | a |It ra rst sa
rt s j a t sIa a |a |t rmt ra a rIi1 iart I i t a
1 i a | tIts irsij i1 a rtIrt ] trita . |a
ttt i Ia |i |i1 a 1 1 ismirai1 a 1t |a masta-
| a I a ra |isa ] a sI rt i r It sIir a | j at 1 t
rt s a | Ia r tt r tt m i It s tt rsI i j a t i t r .
1 I rt s si] rt s ma s irtsj ttiIitt s irt|a-
tr aj a Iia , 1 tjrtsit r, ira j tIt r t i a ,
1 t| i|i1 a 1 , It m | | t rts tt rIra t t i t r t s
m a s t a | a rts. |t s tIt t It s Iisit |t ] itt s 1 t
ara ttt t s i ta sttrttit r 1 t |1 st | rt
|t s |atst s j at1 tr rt s a | Ia r tt r tt }t-
ra s, Ira t I a ra s j a It |t ] ita s, irI| a m a t i t r
1 t |t s |atsts Ia tia |ts |ij trt sIt sis t ,
tr |t s ta st s a ta rta 1 t s, mar1 i| a|a
1 t ] t ma .
|r t| tta mtr Iisitt rt st sat|tr
j a |j a r |a s ] |a r 1 a|a s j a ra I i rt i 1 t a s
a ] ra r1 a 1 a s. |a ta asa ma s ttmar 1 t
| i j t rta |ttmia ts |a |ij trta |ttmia 1 t|
ta rttr 1 t rt mira 1 a Ia m| itr j s t a -
1 t | i j t r j a r a I i r t i 1 i s m t . |s j t r t||t
| at ar tta mtr Iisitt tt mj | tIt 1 t| t
irt|air ar tta mtr rt t Ia | j a |j a tit r
1 t |a s ] |ar1 a|a s ma ma ria s 1 t It 1 t s
|t s ] a r ] |it s |irIa Iitt s saj trIi t i a | t s
j a ra ttt|air |t s a 1 trt ta rtirt ma s 1t
] |a r1 a|a s aj t trira s 1 t |t s sa tts a ra -
|ts, a 1 trt ta rtirt ma ma ma rit |irIt -
s a rtt ma tt mt ta asa s rtt j |a si ta s 1 t
| i j t rt a | t t m i a .
Hallazgos laboratoriales
|a |tma It |t ] ia raIira ria rt sat|t str ma irIt rma Iita
|a s a rt rma |i1 a 1 ts t st r irtsj ttiIita s t tsIa r rt|a tit -
ra 1 a s tt r ar Ia ||t rtra | ir1 ati1 t j t r |a |ij trta |ttmia .
| t| i1 t a |t s ta rit s Ia tIt rts | at j at1 tr mt 1 iIita r |a ta |-
ttmia |t s 1 ittrst s 1 ia ] rt sIitt s 1 iItrtrtia |ts j a ra |a
|ij trta |ttmia , ta 1 a j a ra mtIrt 1 t| j trIi| | it | aimitt
Iitrt imj t rIa rtia . | t ma rtra tsj ttiIita , |a ta |ttmia
1 t| tria tta |aa rst tr rt|a tit r tt r |a a || amirtmia
tt rrt|a tit ra 1 a tt r |a It sIa Itmia , t| riIrt ] trt artitt
sa r] airtt K | |a trta Iirira .
|as a rt rma |i1 a 1 ts | it | aimita s tt rsisItr tr ara
|ij trta |ttmia j trsisItrIt tt r ara tt rttrIra tit r 1 t It s-
Ia It stritt | a }a t rt rma | | a }a . k |] art s a rima |ts st r
ma r] ira |mtrIt |ij trt|t rtmitt s 1 t| i1 t a |a rta | st rtit r
Ia| a|a r j rt tima | irtrtmtrIa 1 a 1 t| t|t rt . |a |ij trta |tt-
mia j rt |t r] a 1 a rtsa|Ia tt r ar 1 a 1t rtra | rtIrt ta |tirt -
sis tt r irtrtmtrIt s 1 t| K | , trta Iirira It sIa It s. |a
It sIa Ia sa a |ta |ira strita j at1 t tsIa r t|tta 1 a tr |t s
ta st s 1 t trItrmt1 a 1 t sta a ta rta 1 a .
Electrocardiografa
|a s a |Itra tit rts t|ttIrt ta r1 it ] ra Iita s tr rtsj atsIa a
ara |ij trta |ttmia stttra irt|atr | ra 1 ita r1 ia I
j rt |t r] a tit r 1 t| irItrta |t |-| tt r a tt rIa mitrIt 1 t|
irItrta |t -.
| sIt s rt st r tsj ttiIitt s 1 t |ij trj a ra I i rt i1 ismt jri-
m a rit . |a 1 tsmi rtra |ita tit r 1 t| ts| a t | tIt j at1 t ma ri-
It sIa rst tt mt ara 1 ismiratit r ] t r t ra |ita 1 a tr |a 1 tr-
si1 a 1 t sta . |t s ta m| it s iritia |ts tt rsisItr tr ara
ra 1 it |ati1 tt 1 t |t s a |ttt |t s 1 t |t s 1 itrIts, 1 t |t s tatr-
j t s tt rIt | ra |ts |t s j rt ttst s tsj irt st s 1 t rsa |ts 1 t
|a s tt rIt | ra s. |a rt a | s t rtit r tt rIita | sa| j tri t sIita 1 t
|t s |atst s |t s | a i sIts t stt s t sIti Iis Ii | rt sa | a i sI i t a ,
st j at1 t tisaa |ita r tr |t s |atst s |a r] t s tsj ttia |mtr-
It |as Ia | a r ] t s .
j rt |t r] a 1 a 1 t tiIa mira | tr |ij t j a ra Iirt i1 ismt 1 t
j trrt s ] a It s. |a |ij trta |ttmia st a tt mj a 1a tt r |ij tr-
It sIa Itmia tt rtarrtrIt, a | at |a tiIa mira | irtrtmtrIa
|a a | st rtit r irItsIira | 1 t ta |tit It sIa It s.
|a |ij trta |ttmia tr |a trIt rmt1 a 1 1 t k 1 1 i s t r
sat|t st r |ttt rttt rsi | |t tt r ar Ira Ia m i t r It a 1 ttaa -
1 t j a ra t| |i j t a 1 rt r t t t rIiti smt . |a s tt rttrIra t i t r t s
1 t ta|tit st ritt tr |t s a rima |ts tt r Ia ||t rtra | trt r i t t
st r rt rm a | m t r It | a }a t rt rma | | a }a st a st tia r tt r
ar ] ra r1 t ta ria | |t 1 t |ij trIt s Ia Itmi a. | r j t| a t 1 t
j t rt t r Ia }t 1 t tsIt s j trrt s tt r Irttatr tia j trrt s }t tt -
r ts tt r t rIt rmt1 a 1 rtra | tt r] t r i Ia 1 tsa rrt | | a r
| i j t rt a | t t m i a .
|a mirtra |ita tit r 1 t| It}i1 t | |a r1 t
j at1t t tarri r, a ar| at ts ar si] rt
mat|t ma s IrttatrIt 1 t| |ij trj a ra Ii-
rt i1 ismt sttar1 a rit rtra |.
Diagnstico diferencial
|| 1 ia ] rt sIitt 1 iItrtrtia | 1 t| |ij tr-
j a ra Iirt i1 ismt j rima rit irt|at t Ira s
ta asa s 1 t |ij trta |ttmia tr t| j trrt
Ia | |a s | | | .
|r |a |ij trta |ttmia 1 t| ta rttr,
ta asa ma s tt mar 1 t |ij trta |ttmia , t|
tt mitrtt 1 t |t s si] rt s t|iritt s sat|t
1 tsa rrt ||a rst ma s ra j i1 t , tt rsttatrIt-
mtrIt |a 1 tsmirtra |ita tit r t sta rt
sat|t str Ia r tti1 trIt. || Itrmirt j sta-
1 t |ij trj a ra Iirt i1 ismt st rtstrta j a ra
ar sir1 rt mt 1 t |ij trta |ttmia a st tia -
1 t tt r Iamt rts ma |i] rt s 1 t t ri] tr rt -
j a ra Iirt i1 tt , sir mt Ia sIa sis t sta s, | at
sttrtIa r ar j tj Ii1 t simi|a r a |a |t rmt -
ra j a ra Iirt i1 ta .
|a |ij t rta |ttmia a st tia 1 a tt r
|ij trtiIa mirt sis | j at1 t rtsa|Ia r 1 t
ara tt mj |ita tit r 1 t |a a 1 mirisIra tit r
TABLA II Diagnstico diferencial de hipercalcemia: anormalidades bioqumicas
Ca srico PO
4
srico BUN Fosf. alcalina
HPP
Hipercalcemia
del cncer
Enf. renal variable normal
Hipervit. D normal normal
Tumores seos normal o
metastsicos (leve) ligeramente normal
TABLA I Diagnstico diferencial de
hipercalcemia
Hiperparatiroidismo
Hipercalcemia del cncer
Fallo renal
Tumores seos metastsicos con ostelisis
Hipervitaminosis D
Lipemia
Concentraciones sricas de
calcio ionizado
|a It rma | ita tIita 1t| ta |tit 1 trIrt
1 t |a tirta|atitr ts |a Ira ttitr it rita1a .
| sIt mt1it 1 ia ]rtsIitt jat1t str ta | i t-
st tr |a tta|aa titr 1t |a |ij trt a | t t m i a ,
|ij tta|ttmia t irsaIititrtia rtra|. |r |a
| i j t rta|ttmia j tr 1 || t sttar1a ria a |
t a r t t r, t| ta|tit it rita 1t Iam|itr st
i r t rt m t r Ia. |r t| Ia||t rtra | trt r i t t ,
mtrt s 1t| 1 X 1 t |t s j trrt s Iitrtr
i r t rt m t r It 1t| ta |tit itrita1 t, t| \ 1 X
|t Iitrtr rt1ati1t tr ma s 1 t| ! 1 X ts
r t rma|. |r |a |ijt ta|ttmia 1t|i1a a
|ij t a || amirtmia , t| ta |tit it rita 1 t
s t ra rt rma|, a 1 iIt rtrtia 1 t |a ttrttr-
I ra tit r rt1ati1 a t| Itri1a tr t| |ijtj a-
ra I i rt i1 ismt jri m a rit , tt|amjsia j ar-
t rtaIiIis, jtr t}tmj |t . k si, tsIt mtIt 1 t
strti||t jat1t strtir tt mt ara |trra-
m i t r Ia 1 ia ]rtsIita si] riIi t a I i ta .
Concentraciones de PTH
(paratohormona)
|a ra |a marija|atit r 1 t |a matsI ra
st 1 t}a tt a ] a|ar |a sa r] rt trIt ra a It m-
j t ra I a ra a m|itrIt, st ttrIri I a ] a 1 ara r-
It ! - 1 miraIt s, st stja ra t| satrt tr ar
Ia| t |imj it st a |mattra a \ | |a sIa
t| a ra|isis. | tmt tr |a ma t ria 1 t |ts
a ra|isis |trmtra |ts, |a tta|aatitr a i s | a -
1 a 1t |a ttrttrIra titr strita j at1 t str
t r ] a 1t sa. ir tm|a r]t , tr t| tt rItt It
a 1 ttaa 1t t| a ra |isis st Ira r s It rma tr
ar Ii rmt tt mj | t m t r It j a ra t| 1 ia ]rt s-
Iitt . |a tt rttrIra titr strita 1t |a |1
1 t|t tta | a a rst tt r rt|atitr a | ta|tit
It Ia | t, i1ta |mtrIt, itrita 1 t . |r |t s ari-
ma|ts rt rma |ts, taar1 t st irtrt m t r Ia
|a ta |ttmia, 1ismirat |a |1 strita. |r
rt|a titr tt r sa |ijtrta |ttmia tmj |tar1 t ta|tit rt rma | t
it rita1 t ta si It1 ts |t s jtrrt s ]a It s ttr 1 || Iitrtr tt r-
t t r I ratitrts ttt t s i tas 1 t |1 , ttmj a Ii| |ts tt r ar j rt t t-
st ja It|t] itt a st tia1 t tt r |a sttrttit r a aIt rt ma 1 t |a
| t rmt ra. | t i] aa| ma rtra, |ts a rima|ts |ijt ta|ttmitt s
tt r |1 strita a rtrm a | m t r It rt1ati1 a jrt | a | | t m t r It
t sItr a It t Ia 1 t s j t r |ij t j ara I i rti1 ismt jri m a ri t .
|a tt rttrIra tit r 1 t |1 tr |t s j trrt s ttr |ij trt a | t t-
mia ast tia 1 a a | ta rttr Iij itamtrIt ts | a }a t ir1tIt t Ia-
||t. | r j t rt t r Ia }t rt1 ati1t 1 t |as tt rttrIratit rts 1t
|1 1 t Ia |ts jtrrt s j at1t str rt rma | t tsIa r a amtrIa 1 a .
|a mt1 itit r 1 t |a |1 rt 1 t| tria sasIiIair a |a ra 1 i t | t ] i a
It ratita , ttt ] raIia a | 1t mira | t taa|| aitr tI rt j a ra m tI rt
t | a tt, sirt str tt rsi1 tra 1 a tt mt ar tt mj | t m t r It 1 t
t I rt s tt mj t r t r Its rtttsa rits tr |a tta | a a t i t r .
|r |t s j trrt s tt r rtIrt j a Iia t |ij trta |ttmia , j at1 t
str 1 iIiti| tsIa | |tttr si t| Ira sIt rrt j rima rit rtsi1 t tr |a s
j a ra Iirt i1 ts t tr t| ri1t r. |r taa || aitra 1 t |a s 1 t s siIaa -
tit rts, |a tt rttrIra tit r 1 t |1 |a ta |ttmia j at1 tr
tsIa r a amtrIa 1 a s.
Ensayo medicamentoso
i |a tta |aa tit r 1 ia ] rt sIita rt |a |t ] ra 1 t i1 trIiIita r
|a ta asa 1 t |a |ij trta |ttmia , st 1 t| t It ma r ara 1 ttisit r
1 ia ] rt sIita . |t r |t ] trtra |, | at1 a r 1 t s 1 ia ] rt sIitt s
ma t rts tr |t s | at j trsa r. 1 || t |ij trta |ttmia a st tia -
1 a a | ta rttr. || |irIt sa rtt ma ts t| ta rttr ma s j rt | a | |t.
t j at1 t 1 tti1 ir ar trsa t mt1 ita mtrIt st tt r ar | ai-
mit Itra j itt tIita t tt rIra t| |irIt sa rtt ma j a ra tt mj rt -
| a r si st rt1 att |a |ij trta |ttmia .
i |a |ij trta |ttmia st 1 t|t a |irIt s a rttma a t I rt s Iamt -
rts |tmaIt j ttIitt s , ara raj i1a tai1 a 1t |a ta |ttmia
1 t|tria a 1tt rI i rst 1trIrt 1t |a s \ |tras 1tsjats 1 t iri-
tiar |a ttrI i t t It raj ia. | tsa It rI a r a 1 a m t r It, a |]arts 1t |ts
t It t Its 1t |ts ttrIitti1ts st |rt |a |tmttsIasis ta|tita str
i r t s j t t i Iitt s jat1tr taasar 1 tt|iratitr Ira r s i It ria |ttt
1 t |a ta|ttmia tr t| j a titrIt tt r jara I i rt ja Iia j ri m a ri a .
| t| i1t a tsIt , st |a rttt mtr1a 1t t| ast 1t ar arIi| |asI i-
tt mas tsjttiIitt ttmt |a |-a s j a ra] ira sa, ma s | at |t s ttr-
Iitti1 ts ja ra |a It ra jia 1 t j ra t | a .
t j t ra tr It rma 1irt t Ia a ritt| ja ra I i rti1tt strtt m t t a-
rismt rt] a I i tt ja ra rt] a|ar |a sttrttitr 1 t |1 . |a rt 1 a t-
tit r 1 t |a tiIa mira | |a tt j tr1 tr |a rtI rt a | i m t r Ia t i t r
r t ] a I i ta taasa r1 t |ijtrs t t rttit r 1t |1 . |a sttrt t i t r
j rt | t r ] a1 a irtrt m t r Ia1a 1 t |a |1 rt s a | Ia tt r ara rt a | -
s t rtitr tsta tsIt t t | a sIita ara sttt ra t sIt t 1 i sI rt Iia Ii | rt -
sa . |sIt ts tsjttia |mtrIt rt | tta r It tr |t s |atst s tra r t a | t s
1t |t s a rima |ts }tttrts mtrts 1 t ! mtsts 1 t t1a1 tt r
ar Ia||t rtra | trt ritt ttmt ttrsttatrtia 1 t art rm a | i 1 a-
1ts rtra |ts 1t Iij t tt r] t r i It Ii] . .
|ts si]rt s t|iritts 1 t| Ia||t rtra | trtritt st r Iijitts 1 t
ar sir1rt mt artmitt 1 tjrtsit r, || I|| , tt m i Its, 1ia rrt a s ,
a | t t ra s tra |ts, artmia , 1 ts|i1ra Iatitr Ii]. I . |r |t s ta sts
a tarta 1 ts st j itr1 tr |t s 1itrIts |t s |atst s 1t |a mar1 i-
|a|a st |a ttr I| tti||ts ma r1i| a|a 1 t ] tma .
Hallazgos de laboratorio
|| ta |tit stritt ] trtra |mtrIt ts rt rma | t irt|ast
| a }t , a ar| at ar j t| at1t j t rttrIa}t 1 t a rima |ts j at-
1 tr str |ij trta |ttmitt s. 1 Irt s |a ||a t] t s | it | aimitt s
irt|atr riIrt ] trt artitt sa r] airtt | | K irtrtmtrIa -
Hiperparatiroidismo secundario
a enfermedad renal
|| |ijtrj a ra I i rti1ismt sttar1 arit ts ar
|a ||a t] t tt rsisIt r It tr arima|ts tt r ar
Ia||t rtra| trt ritt ||| . || |ijtrj a ra I i-
rti1ismt sttar1arit rtra | st ta ra t It ri t a
j tr ara ttt t s i ta sttrttitr, j trt rt
a a It rt ma , 1 t |1 j t r tt|a|a s |ijtrj | a-
sita s 1 t |a ja ra I i rti1ts. |a ja It ] t r t s i s
1 t| |ij trj a ra I i rt i1 ismt sttar1 ari t
rtra| ts ttmj |t}a , |a trIt rmt1a 1 rt r a |
j rt ] rt s i ta tt r1att a ara rt 1 a t t i t r
j rt ] rt s i ta tr t| ra Iit 1 t |a Ii | I ratitr ] | t-
m t ra|ar 1ismirat |a ttt rttitr rt r a |
1t It s Ia It , rt s a | Iar1t tt r ara |ijtrIt s-
Ia Itmia . t |a 1 tmtsI ra 1t rt t i t r It m t r-
It | at |a , I ! -1 i | i 1 rtt i t i Ia mira | ta |-
t i I rit | }at] a ar imj t rIa r It j aj t| tr
t sIa trIt rmt1a 1 . |ts arima|ts ttr ar
| | | a ta rta 1 t Iitrtr |a }as ttrttrIra -
titrts 1t| ta |tiIrit| j rt 1ati1 t j t r ara
s i r Itsis rtra | 1 ismirai1a ir1ati1 a jt r |ts
t It t It s ir|i|iIt rit s 1t |a |ij trIt s Ia It m i a
s t | rt |a I ! -|i1rtt i t i Iamira | ---| i 1 rt -
ti|asa ara jtr1i1 a jrt ] rt s i ta 1t |as
tt|a|as tj iIt|ia |ts rtra |ts. |r tsIa tir-
t a r sIartia, st jrt1 att 1 tIitiI 1 t tiIa m i-
ra | 1 t|i1t a |a j t||atit r 1 tt|irarIt
1 t Ia| a|t s j rttima|ts | at sirItI i t a r
t sIa tiIamira tr t| Ira r s t a rst 1 t| Ia | | t
rtra | trt ritt . |a rt1 attit r 1t| ta |tit
tt I ra tt|a|a r ts t| rt s a | Ia1 t 1 t |a mtrt r
a | s t rtitr irIt sIira |, |at tsIa mt1 ia 1 a
j tr |a tiIa mira | . k1tmas, |a rt 1 a t t i t r
1 t |a tiIa mira | jrttt1 t t| irtrt m t r It
1 t |a It s Ia Itmia tr j trrts ] a Its ttr
Ia||t rtra | trt ritt. |r t| tarst ata r t a-
1t 1t| Ira ta st rtra |, |a |ijtrIt s Ia It m i a
tr rta|i1 a1 ir|i| t mat|t ma s |a sirIt s i s
1 t tiIa mira | . |a tiIamira | ts |a | a t
Fig. 1. Radiografa lateral de la cabeza de un Presa Canario de
8 m eses de edad con hipoplasia renal congnita e hiper-
p a r a t i roidism o secundario renal asociado. La secre c i n
p rolongada de PTH resulta con una re a b s o rcin sea
osteoclstica y una severa osteodistrofia fibro s a .
I 1 stma ra s 1 t t1 a 1 , tt r si sItr tr Ii t | rt tt }tra s
a st tia 1 a s tt r 1 t |t r t stt It Ira t I a ra s j a It | t ] i t a s .
|t s a ri ma |ts a It t Ia 1 t s mat sI ra r 1 t| i|i1 a 1 1 t |t s
m i t m | rt s Ira s t rt s ar a rt | a t Ia r tia a | mt t i m i t r It .
|a t1 t r mt sI ra r |t r1 t sis t r sa tsj ira 1 t rs a | .
1 t , trta Iirira strita irtrtmtrIa 1 a , It s-
Ia It stritt irtrtmtrIa 1 t t ta sit ra |-
mtrIt It sIa Ia sa a |ta |ira irtrtmtrIa 1 a
tr |t s ta st s 1 t trItrmt1 a 1 t sta ma ri-
IitsIa . | ra a rtmia rt rmt tiIita , rt r-
mt trt mita rt rt] trtra Iita st sat|t
tti1 trtia r tr |a |tma It |t ] ia 1 t raIira .
|| j tst tsj ttiIitt 1 t |a t rira ts simi|a r
a | 1 t| j |a sma Ii|Ira 1 t ] |t mtra|a r
ist sItraria .
|a 1 i t ] ra Ii t a m t r It st j at1t ajrt-
tia r rt a | s t rtit r 1t| |atst a|ttt |a r a|rt-
1 t1 t r 1t |a s ra itts 1trIa ria s ttr jtr1 i-
1 as 1 t |a |amira 1 ara . |a s a rtas | a i sI i-
tas t ra 1 it |ati1a s | at st tisaa|ita r tr
|ts |atsts tra rta |ts rt s a | Ia r ttr ar
a s j t t It aj t|i||a 1 t . |as ta |tiIi t a t i t r t s
m tIa sIa sita s tr It}i1 ts | |a r1t s st jat-
1 tr tti1 trtia r tr |t s j |it] ats ra ] t s t s
1 t |a mattsa ] a sI rita, sa| taIis, It } i 1 t s
j t ri a rI i t a | a rts, j |tara, tr1 t ta r1 i t ,
ta sts a rIt ria |ts j a|mtra rt s .
Hiperparatiroidismo secundario
nutricional
|| |ij trj a ra I i rt i1 ismt sttar1 a ri t
raIritit ra | ts ara trItrmt1 a 1 1 t a ri-
ma |ts }t ttrts tr trttimitrIt a |imtrIa -
1 t s tt r 1 itIa s a | a st 1 t ta rrt t ta rrt
ttrta |ts tt r 1 tIititrtia s 1 t ta |tit , t
| itr tt r ritt|ts rt rma |ts t | a }t s 1 t
ta |tit j t r art s ritt|ts ttttsitt s 1 t
It sIt rt s.
Signos clnicos
|t s si] rt s t|ir itt s, |t s ta a |ts sat-
|tr | a ttrst a j a rt r It s trIrt |a s
Fig. 2. Bxer, m acho, de 10 aos de edad, con signos clni-
cos de fallo renal crnico e hiperparatiroidism o secun-
dario (poliuria/polidipsia, deshidratacin, anem ia,
anorexia).
Fig. 3. H allazgos radiogrficos de un Bxer con hiperparati-
roidism o secundario renal en el que se aprecia una
prdida generalizada de la densidad sea y un adel-
gazam iento de las corticales de los huesos.
|t s |a ||a t] t s st r ar j t tt j a rtti-
1 t s a a | at||t s tisIt s tr t| |ij trj a ra Ii-
rti1 ismt sttar1a rit rtra |, tt r ara
j tr1 i1 a ] trtra |ita 1 a 1 t |a 1 trsi1 a 1
t sta ar a 1 t|] a ta mitrIt 1 t |a s tt rIi-
ta |ts 1 t |t s |atst s Ii] . 1 .
Hipoparatiroidismo
|| |i j t j a ra I i rt i1 ismt j ri m a ri t
|j j t i1 it j a Iitt ts ar Ira sIt rrt mtIa -
| t |itt rt|a Iita mtrIt j t tt IrttatrIt, t|
taa | j at1 t a IttIa r a j trrt s ma 1 art s
1 t It 1 a s |a s ra ta s. |a ta asa ma s Irt-
t a t r It 1 t |ij t j a ra I i rt i1 ismt ts |a
It rma a Irt ] trita tt rsttatrIt tt r |a
t|imira tit r 1 t |a s ] |a r1 a|a s j a ra Iirt i-
1 ta s 1 ara rIt |a tira] ia Iirt i1 ta tr
] a It s tt r |ij trIirt i1 ismt .
|a trItrmt1 a 1 st ta ra tItrita j t r
ara 1 tIititrtia j trma rtrIt t Ira rsiIt-
ria 1 t |a sttrttit r 1 t |a |1 rtsa|Ia r-
1 t tt r ara ira 1 ttaa 1 a mt ti|ita tit r
1 t| ta |tit 1 ts1 t |t s |atst s, ara 1 ismi-
ratit r 1 t |a rta | st rtit r 1 t| ta |tit tr
t| Ia| a|t rtra | ara a | st rtit r 1 ismi-
rai1 a 1 t| ta |tit 1 ts1 t t| Ira tIt ] a s-
Irt irItsIira |. t 1 t t||t tt r1 att a | at
st tsIa | |ttta ara |ij t ta |ttmia . k |a
ttt, |a rta | st rtit r Ia| a|a r rtra | irtrt-
mtrIa 1 a 1 t It sIa It j rt 1 att ara |ij tr-
It sIa Itmia . K t rma |mtrIt t| |ij t j a ra Ii-
rt i1 ismt rt| aitrt Ira Ia mitrIt 1 t j t r
ti1 a j a ra ma rItrtr |a rt rmt ta |ttmia .
|t s tta mtrts |isIt |t ] itt s 1 t It}i1 t
j a ra Iirt i1 tt ttIra i1 t 1 t j trrt s tt r
|ij t j a ra Iirt i1 ismt tt rIirma 1 t t st s-
j tt|t st |a r mt sIra 1 t 1 t It rma tt r-
sisItrIt ara irIi|Ira tit r j |a smt tiIita
|irIt tiIita tt r 1 tj t sitit r 1 t It}i1 t Ii| rt st tt mj a Ii| |t
tt r arIra sIt rrt irmart mt1 ia 1 t 1 t |a ] |a r1 a|a .
Signos clnicos
i] rt s rtart masta|a rts K |
|a |ij t ta |ttmia rtsa|Ia tt r ara |ij trtttiIa | i|i1 a 1 1 t|
sisItma rtrtit st ttrIra | j triItritt . |t s si] rt s t|iritt s
irt|atr Itm| |t rts masta|a rts It ta |ts t ] trtra |ita 1 t s,
|t s taa |ts j rt ]rtsa r a tsj a smt s ItIa ritt s tt rta|sit rts
ItIa ria |ij t ta |ttmita . |t s j rt | |tma s rtart masta|a rts
st r Ia r j rt rartia 1 t s | at a |] art s a rima |ts, a ar| at rt
tt rta|st s, rt st r ta j a tts 1 t ta mira r t irtt rj t ra rst.
|t s a rima |ts a IttIa 1 t s, tt r Irttatrtia st r It| ri|ts 1 t| i-
1 t a |a a tIiti1 a 1 masta|a r irtrtmtrIa 1 a .
| a Ia ra Ia s
|a s ta Ia ra Ia s sat|tr str ara sttat|a 1 t |ij t ta |ttmia s
j rt |t r] a 1 a s. |sIa s tt rsisItr tr j t| at1a s t j a ti1 a 1 ts
| |a rta s, j arIiIt rmts a |irta |ts, tr |a rt] it r sa| ta j sa|a r
tt rIita | a rItrit r j t sItrit r 1 t| trisIa |irt . K t sat|t
|a | tr j tr1 i1 a 1 t |a tisit r.
1 Irt s si] rt s
1 Irt s si] rt s ta ] t s t irtsj ttiIitt s 1 t| |ij t j a ra Iirt i-
1 ismt irt|atr a rt rttia , |tIa r] ia , a j a Iia , 1 t| i|i1 a 1
] trtra |ita 1 a , tt miIt s, 1 ia rrta j tr1 i1 a 1 t j tst . t
j at1 tr t | strta r ta m| it s 1 t tt mj t rIa m i t r It Ia | t s
tt mt ir| aitIa1 , a ] rtsiti1 a 1 1 tst ritrIa tit r. |a |ij tr-
ttrIi|a tit r }a 1 tt s j rt |t r] a 1 t s 1 ara rIt |t s tj ist 1 it s
ItIa ritt s j at1 tr j rt 1 atir a |ta |t sis rtsj ira It ria , |a taa |,
a | irtrtmtrIa r t| j t rttrIa }t 1 t ta |tit ari1 t a |a a || ami-
ra , 1 ismirat t| j t rttrIa }t 1 t ta |tit |i| rt it rita 1 t
tta ttr| a |t s si] rt s t|iritt s 1 t |a |ij t ta |ttmia .
Hallazgos de laboratorio
|a |ij t ta |ttmia jtrs i sIt r It attmj a 1a 1a 1 t |ij trIt s-
Ia Itmia tr ar jtrrt tt r ara Iartit r rtra | rtrma | ts ma
s a ] t rt r It 1t |ij tj a ra I i rt i1 ismt jri m a rit. | r | a}t ritt |
|ijtta |ttmia. |a tt|amjsia t tarrt st |t a | Iira| 1t |a ] t sIa -
titr t 1ara r It |a |a tIa titr. |ts Ira sIt rrts | at rt s a | Iar ttr
|ij ta ||amirtmia rtrm a | m t r It rt st jrt s t r Iar tt r si] rts
t|iritts 1 t |ijt ta |ttmia a | at |ts ritt|ts 1t ta |tit it ri-
ta1 t jtrmartttr rt rma |ts. t |t t| |ijt ja ra I i rt i1ismt
|a trIt rmt1 a1 rtra | st j at1 tr jrt s t r Iar tt r |ijt ta |ttmia
t |ij trIt s Ia Itmia. | r Ia||t rtra | a] a1t t trtritt st attm-
ja1a a1tma s 1t| irtrt m t r It 1 t It s Ia It stritt, 1t irtrt-
m t r Its 1 t| | | K , trta Iirira jt Ia sit. |a |ijtr|a | t m i a
j t Itrtia |t s tIt t It s 1 t |a |ij tta |ttmia |ts arima|ts jat-
1 tr ttasitra |mtrIt Itrtr tt rt a | s i t r t s .
1 t ta |tit stritt 1 t| t rt j tI i rst t irIt r-
j rtIa rst tr ast tia tit r ttr |a tt rttrIra -
titr 1 t a||amira stri t a .
Electrocardiografa
|| j rirtij a| tIt t It 1t |a |ij tta |ttmia
s t | rt t| || | ts |a j rt | t r ] atitr 1 t| irIt r-
ta|t -. |as t r1 as j at1 tr |a ttrs t
mas art|as jrt Iar1as. || tIt t It st| rt
t| ra Iit 1t| ttrattr ts mirimt , ja1itr1t
tt i 1 t r t i a rst ara |ra 1 i t a r1 i a .
Diagnstico
|| 1 ia ] rtsIitt 1t |ij t j a ra I i rt i 1 i s m t
j ri m a rit st | a sa tr |a |isIt ria, si] rts t|i-
ritt s, |a||a t]t s 1 t |a |t ra It rit tr |a
ttt|asitr 1 t t I ra s ta asas 1 t |ijtta|tt-
mia Ia | |a || | . |as tt rttrIra titrts ir1 t-
It t Ia ||ts 1 t |1 tr |t s a rima |ts ma
|ij tta|ttmitts tt rIi rmar |a 1 ia ]rt sis
1t |jj , j rtsamitr1 t | at t| a ra |isis aIi|i-
ta 1t ts ttrIia| |t ta | i 1 a 1 t .
| t |as ttr1ititrts |isIa1 as tr |a Ia | | a
|| |, st|t t| |ijt j ara I i rt i1ismt j ri m a rit
|a tt|amj sia str |as ta asa s ma s jrt | a -
| |ts 1t j rt s t r Ia rst ttr si] rt s t|iritt s 1t
TABLA III Diagnstico diferencial de
hipocalcemia
Hipoparatiroidismo (yatrognico o adquirido)
Fallo renal agudo y crnico
Tetania puerperal (eclampsia)
Hipoalbuminemia (enteropata con prdidas de pro-
tenas, sndrome de malabsorcin, enfermedad
heptica, sndrome nefrtico)
Pancreatitis aguda
Carcinoma medular tiroideo (excesiva secrecin de
calcitonina)
Enemas que contienen fosfatos
Muestras de sangre recogidas con EDTA
Trasfusin con sangre citratada
k rra a1 | | |t|| |1 . |t ta |titI rtj it |t rm t -
r ts a r 1 mt Ia | t |it | t rt 1 ista st. |r.
| rtt rsj ar | t1 . |a sit a r1 t|irita |
| r 1 t t ri r t | t ] . |t s k |It s, | k , |a r ] t
M t1 ita | |a||ita Iitrs, I \ I, 1 1 .
| i|tti|ia r !|. |rima r |j trj a ra I|rt i1 ism.
|r. | a r1 ir | w t1 . | arrtrI |tra j ir
tr1 t trirt |t ] a r1 mtIa | t |ism, \ I| 1 t
||i|a 1 t|j |ia , | | | tt|tr, \ \ , 1 1 .
| i|tti|ia r !|. 1 j trta |ttmit sIa Its. |r. | t t
|| tI a | t1 s. . | ist r1 trs t I | t rt a r1
M irtra | M tIa | t |ism. K t Yt r|, |a ttr
|rtss, \ 1 1 , 1 1 I .
|t|1mar || . |rIt rmt1 a1 ts j ara I i rt i1tas. |r.
| I I i r ] tr ! |t|1 ma r || t1s . ra Ia 1 t 1t
M t1itira | rIt rra VtIt ri r a ria tt |. I ,
||i|a 1 t|j |ia , w| aar 1trs, I\ , 1 1 I.
|t|1 ma r || K t|st r | w. | a rirt a r1 |t|irt
t r 1 t t rir t |t ] a r 1 | t j rt 1 a t I i t r .
||i|a 1 t|j |ia , w| a ar1 trs, 1 I.
|t|1 ma r || , wisrtr || , K t|str |w, |t | 1 m a r
M , |trrt1 || . | tmj a rist r t I rtsa|Is tI
| t rmtra | a ra |sis tI samj|ts t|Iairt1 Irt m
s t | t t It1 ttrtas siIts tt rsas ttrtita | a|Ira s t -
r t ]ra j | Itr |tta |itir] jara I| rt i1 ma ssts
ir 1t] s. ! km VtI Mt1 ksstt, I . . 1 1 I.
K a ] t 1 t | k , | |t | !, |t 1 t|| M . | trtIiIs t I
ta |tiIrit | I|tra j a r1 stram j |t sj |t ras
tt rIrt | ir 1 t ] s a r1 ta Is iI| t|rt rit
rtra | Ia i|art. VtI | |ir K t rI| k m ma ||
k rim |ra tI, I t .t , 1 1 t .
|tIt rstr M |. 1 j tj a ra I| rt i1ism ar 1 tI| t rs
taa st s tI |jt ta |ttmia ir taIs. |r. | ir|
|w | t r a ]a ra !| t1 s . | arrt r I
VtIt ri r a r |tra j X| . ||i|a1 t|j |ia, w|
a a r 1 t rs, 1It , 1 1 I .
| t str 1 K , | a r| tr !, M t rta a , | |a r] a a
1 K , |a ||t IIa !, j a r| | , | rttrsj a r ,
| t str| |a II M , | |t rt M . |t tIIttI t I
|1 a rIa ] t risI | | M -\ \ 1 1 I t r stram ta |-
tiam a r1 |1 |ttt|s ir |j trta |ttmia
|j trj a ra I|rt i1 j a IitrIs. | a |tiI issat
| rI, t . t , 1 1I.
|t st| ! | ajtr | | . |a I| t j |sit |t ] t I ta|-
tiam, j|tsIt ras ar1 ma]rtsiam mtIa | t | i s m
irarima|s. |r. |a s|ir || M ttr | | t1s .
|t VtIt ri r a r | |irts tI K t rI| k mtri t a ,
| j 1 a It tr | |irita| |a I| t | t ] , ! ! , 1 1 t .
| t st | ! , | | t | ! , K a ] t 1 t |k t I a |.
|a I| t j | sit |t ] t I ta |tia m mt Ia | t -
|ism. Vt I | | ir |a I| t |, I \ . \ 1 , 1 1 ! .
|a rt |. 1 j trta |ttmia . 1 iIItrtrIia | 1 ia ] rt -
sis a r1 ma ra ] tmtrI. |r. a tas M ! t1 .
k | M | |rimt r t r M tIa | t |it | t r t
| ist a st . | it|mt r 1 , Va , wi||ia m | r1
|rtss, 1 I, 1 1 1 .
| t||ir] tr | |, | a |as , 1 a astr, | | tast| | .
| iIItrtrIia | 1 ia ] rt sis t I |j trta |ttmia .
k rtIrt sj ttIitt sIa1 t I \ t 1 t ] s. t|tit
k rt| itr|ti||1 , \ 1 .! . 1 1
BIBLIOGRAFA
C APTULO IV DIAG N STIC O DEL H IPO TIRO IDISM O C AN IN O
A que las nuevas tcnicas de imagen para el diagnstico de hipotiroidismo son prctica-
mente inexistentes en M edicina Veterinaria, los tests laboratoriales son de extrema impor-
tancia para el diagnstico de esta enfermedad. Este diagnstico laboratorial del hipotiroi-
dismo no es fcil, sobre todo porque existen muchos tests de funcin tiroidea, y todos estn
sujetos a ciertas controversias
40
. Recientemente (1996) sali publicado en nuestro pas un
fenomenal trabajo de revisin y actualizacin en el diagnstico del hipotiroidismo, de nuestros compa-
eros M .C . M arca et al. en la revista C lnica Veterinaria de Pequeos Animales, donde creo que que-
daba claro lo que haba hasta entonces. N o tendra sentido hacer otra revisin sobre este tema si no
fuera porque desde la aparicin del test para la medicin de la TSH endgena canina, se est llegan-
do a unos resultados que antes de la aparicin de este test no existan. Luego sobre esta base, he inten-
tado elaborar otro trabajo, pero siendo consciente de que con el ritmo de aparicin de publicaciones
que estn surgiendo en esta materia, las deducciones que aqu se hagan podrn ser reafirmadas o
rechazadas incluso dentro de un periodo de tiempo bastante corto.
C omo en este trabajo se habla de los distintos tipos de hipotiroidismo, creo que es conveniente pun-
tualizar que se sigue la clasificacin anatmica de los diferentes tipos de hipotiroidismo, es decir, existe
el hipotiroidismo primario por enfermedad propia de la glndula tiroides (supone el 95% de los casos),
el hipotiroidismo secundario por trastorno en la glndula pituitaria (supone el 5% de los casos) y el hipo-
tiroidismo terciario por trastorno en hipotlamo (prcticamente inexistente hasta la actualidad).
J. RODN VERNET
Vet. Lab. S. L.
Laboratorio Veterinario de Referencia. Barcelona
|
|
mtIa | t |ismt 1 t |a s |t rmt ra s Iirt i1 ta s. || t 1 t | at
ir] rtsa tt r |a a |imtrIa tit r, Ira s sa ta j Ia tit r mt Ia | t -
|ismt a ritt| 1 t |t s It |ita|t s Iirt i1 tt s, 1 a |a] a r a |a It r-
ma tit r 1 t 1 t s |t rmt ra s mtIa | t |ita mtrIt a tIita s. Irit -
1 t Iirt rira
1
ItIra t 1 t Iirt rira t Iirttira
\
, ara
It rma ira tIita . 1 ,1 , ! Irit 1 t Iirt rira r
1
t
1
rtttr-
st
I 1 ,I !
. |r t| j trrt rt rma |, |a ma t ria 1 t |a |t rmt ra
Iirt i1 ta sttrtIa 1 a j t r |a ] |a r1 a|a Iirt i1 ts ts
\
- 1 X
sitr1 t t| rtsIt ara s j t| at1a s ta rIi1 a 1 ts 1 t
1
t Ira s
mtrt rts 1 t r
1
. | ra ttt sttrtIa 1 a s a |a tirta|a tit r ma s
1 t| 1 1 X 1 t
\
ma s 1 t| 1 1 X 1 t
1
tsIa ari1 t a j rtIti-
ra s j |a sma Iita s st | rt It 1 t | | a |a a || amira j trt tr
mtrt r j rt j t rtit r. |a |t rmt ra |i| rt rt ari1 a a j rt Iti-
ra s I
\
ts |a | it |t ] ita mtrIt a tIita 1 t| i1 t a sa ta j a ti -
1 a 1 1 t trIra r a It}i1 t s, j trtIra r a |a s mtm| ra ra s tt|a-
|a rts t irItra tIaa r tt r |t s rtttj It rts. | trIrt 1 t |a tt|a-
|a |a I
\
saIrt ara 1 tst 1 ita tit r j a ra It rma r | itr
1
t
r
1
, 1 tj tr1 itr1 t 1 t |a s 1 tma r1 a s mtIa | t |ita s 1 t |t s
It}i1 t s tr ta 1 a mt mtrIt . |a
1
st j rt 1 att st | rt It 1 t tr
tsIa 1 t s mt Ia | t |itt s rt rma |ts, mitrIra s | at |a r
1
, | at
ts | it |t ] ita mtrIt ira tIita , j a rttt j rt 1 atirst 1 ara rIt
j trit 1 t s 1 t trItrmt1 a 1 , tsIa rta tit r t tsIa 1 t s ta Ia | t -
|itt s ttttsitt s.
I !
|a |t rmt ra ari1 a a j rt Itira a tIaa
tt mt ar rtstrtt rit | aIItr j a ra ma rItrtr ara s tt rttr -
Ira tit rts tsIa | |ts 1 t |t rmt ra tr j |a sma , a j tsa r 1 t |a s
| | i j t I i rt i1 ismt ts
ara 1 t |a s tr1 t tri r t -
j a Iia s ma s tt marts
1 t| j trrt . k a r | at st
1 t Iirt ttmt ara Ia | Ia
1 t sttrttit r t 1 t
a tti t r |t rmt ra |, t|
| i j t I i rti1 ismt ts st |rt It 1 t t| rt s a | Ia -
1 t 1 t ara 1 ismiratit r tr |a sttrt t i t r
1 t |t rmt ra j t r |a ] |a r1 a|a Iirt i 1 t s .
|| taa1 rt t|iritt ts ma ta ria | |t ta si
t a a | | ai tr sisItma tt rj t ra | j at 1 t
t sIa r a It t Ia 1 t
1
. k a r | at t| |ij t I i rt i-
1 ismt ts ra ra m t r It ar 1 ia ] rt sIitt 1 t
t m t r] trtia , si | at ts imj t rIa r It st s-
j t t|a r 1 t tsIa trIt rmt1a 1 taa r1 t
t sIa mt s Irt r It a sir1 rt mts a st tia 1 t s
a ara irsaIititrtia Iirt i1 ta , a | a t
j at1 t str |a ta asa 1 t a rt rm a | i 1 a 1 t s
| t m a It |t ] itas, irItttit rts rt t a rrt r-
Its, Ira sIt rrt s masta|t ts| at|tIitt s
a r t rma|i1 a 1 ts rt j rt 1 a t It ra s ] a s-
I rt i r It sIira |ts. k 1 tma s, 1 t| t j rt sIa r-
st tsj ttia | a Itrtit r a | 1 ia ] rt sI i t t
j rttist 1 t tsIa trIt rmt1 a 1 a | a t
tt i sItr trIt rmt1 a1 ts | at a It t Ia r a
|t s rt s a | Ia 1 t s 1 t |t s It sIs |a| t ra It ri a -
| t s .
1
DIAGNSTICO DEL
HIPOTIROIDISMO
|a ra ar tt rrttIt 1 ia ] rt sIitt 1 t|
|ij t Iirt i1 ismt trtt | at ts imj t rIa rIt
rttt r1 a r a |] art s a sj ttIt s ] trtra |ts
1 t| Iartit ra mitrIt 1 t |a ] |a r1 a|a Iirt i-
1 ts Ii] . .
|| Iirt i1 ts ts ara ] |a r1 a|a tt r ar
Iartit ra mitrIt tt mj |t}t | at irItrtit-
rt tr |a a | st rtit r aIi|ita tit r 1 t|
t 1 t , a si tt mt tr t| tt rIrt |, sttrttit r
Fig. 1. Esquem a de la regulacin tiroidea.
|
|
ra j i1 a s a |Itra tit rts tr t| a j t rIt 1 t
|t rmt ra Iirt i1 ta a |t s It}i1 t s.
I 1 ,I !
|a
I
\
st ma rIitrt j t r ar mttarismt
rt ] a|a 1 t r 1 t It t 1 -| a t| tr t | t }t
1 i j t Ia | a m t -| i I a i Ia ri a - i rt i 1 t s .
| t rIt rmt |a Ira ttit r I
\
a amtrIa t
ta t, t| Itt1 -| a t| rt] a Iitt 1 t |a I
\
tr
t| |ij t Ia |a mt |a j iIaiIa ria , ||tta ra a
ara ta i1 a t a amtrIt tr |a 1 rtsa|-
Ia r1 t tr ara a |Itra tit r 1 t |a sttrttit r
Iirt i1 ta |a sIa |a |a I
\
a | st |aIa st rt r-
ma |ita .
|a ra t| 1 ia ] rt sIitt 1 t| |ij t Iirt i1 is-

mt rt ttisIt ar aritt ItsI |tma It |t ] i-
tt t | it | aimitt | at sta tt rt|atrIt, t
irt|ast |t s It sIs |t rmt ra |ts 1 t| tr
irItrj rtIa rst }arIt tt r |a |isIt ria si] -
rt s t|iritt s.
I, ,I t
k tIaa |mtrIt 1 isj t rt-
mt s 1 t ta ria s j rat| a s | at rt s j trmi-
Itr 1 ia ] rt sIita r t| |ij t Iirt i1 ismt ,
| at j t 1 tmt s a ] raj a r tr 1 t s a j a rIa -
1 t s t|a ra mtrIt 1 iItrtrIts. |a s j rat| a s
1 t t ritrIa tit r 1 ia ] rt sIita |a s 1 t
1 ia ] rt sIitt 1 tIiriIitt .
I 1
PRUEBAS DE ORIENTACIN
DIAGNSTICA
| r t | a tr tt j | t ratitrts ra I i r a ria s | a t
rts j trm i Itr 1tIt t Iar ara strit 1 t ta m-
| its irtsj ttiIitts | at st jrt 1attr tr
] ra r ja rIt 1t |t s j trrts |ijt I i rt i 1 t t s .
I 1
Signos clnicos
k ar| at rt sta t| t | }tIitt 1 t tsIt
Ira | a }t , ts imj t rIa rIt rttt r1 a r | at
ara 1 tIititrtia tr |a |t rmt ra Iirt i1 ta
a IttIa |a Iartit r mtIa | t |ita 1 t ta si
It 1 t s |t s t r] a rt s, j t r |t Ia rIt |t s si] -
rt s t|iritt s st r ramtrt st s, ta ria | |ts,
a mtra1 t rt tsj ttiIitt s ma ra ra mtrIt a |] t j a It ] -
rt mt ritt s j a ra |ij t Iirt i1 ismt .
I,I
Hematologa y bioqumica
k ar| at rt st r tsj ttiIita s 1 t |ij t Iirt i1 ismt j at1 tr
tsIa r a st tia 1 a s a t Ira s trItrmt1 a 1 ts, ttisItr titrIa s
a rt rma |i1 a 1 ts |a | t ra It ria |ts a st tia 1 a s a | |ij t Iirt i1 is-
mt . |r mat|t s ta st s ttisIt ara a rtmia rt rt] trtra Iita
rt rmt tiIita rt rmt trt mita tt mt rtsa|Ia 1 t 1 t ar tt rsa-
mt rt1 ati1 t 1 t t ti] trt | at ||tta a ara 1 ismiratit r tr
|a j rt 1 attit r 1 t triIrt j t itIira . |a |ij trtt |tsItrt |tmia ,
a ar| at Ia mj t tt ts tsj ttiIita 1 t |ij t Iirt i1 ismt , ts ar
|a ||a t] t IrttatrIt tr tsIt s a rima |ts st 1 a j t r 1 ismi-
ratit r 1 t| mt Ia | t |ismt 1 t |ij i1 t s.
I, , 1 ,I 1 ,I t
PRUEBAS DE DIAGNSTICO DEFINITIVO
|a ] ra r ta rit1 a 1 1 t si] rt s t|iritt s |a Ia |Ia 1 t a rt r-
ma |i1 a 1 ts tsj ttiIita s tr |t s ItsIs |a | t ra It ria |ts raIira -
rit s, |a ttr | at t| 1 ia ] rt sIitt 1 t |ij t Iirt i1 ismt st |a ] a
| a sa r1 t st tr j rat| a s |a | t ra It ria |ts tsj ttiIita s.
I t
|a
Iartit r 1 t |a ] |a r1 a|a Iirt i1 ta st tta |aa j t r |a mt1 itit r
1 t tt rttrIra tit rts | a sa |ts 1 t a |] ara s |t rmt ra s t tta-
|aa r1 t |a rtsj atsIa 1 t |a ] |a r1 a|a a a |] ara s tsIima|a -
tit rts
I !
, ts 1 ttir, |t s ItsIs 1 t Iartit r Iirt i1 ta j at1 tr ir,
1 ts1 t ara simj |t mt1 itit r 1 t a |] ara |t rmt ra tr ara
arita matsIra sa r] airta |a sIa |t s ItsIs 1 ira mitt s 1 t| t}t
1 ij t Ia |a mt -1 ij t Iisis-irt i1 ts.
\ 1
Determinacin de los niveles
de tiroxina (T
4
) en sangre
Ya | at It 1 a |a |t rmt ra Iirt i1 ta
\
I
\
titrt 1 t |a
] |a r1 a|a Iirt i1 ts, |a 1 tItrmira tit r 1 t
\
1 t| t str |a
mt}t r tia j a ra tta |aa r |a Iartit r Iirt i1 ta . k | tt rIra rit ,
|a ma t ria 1 t
1
r
1
st It rma j t r 1 tt 1 ita tit r 1 t
\
tr siIit s ttIra Iirt i1 tt s, st | rt It 1 t |i] a 1 t , ri1t r mas-
ta|t .
I !
| tsa It rIara 1 a mtrIt |a s tt rttrIra tit rts | a sa |ts
1 t
\
,
1
r
1
a sta r |i| rts t ari1 a s a j rt Itira s tsIa r
irI|atrtia 1 a s j t r mat|t s Ia tIt rts | at a IttIa r |a Iia | i|i-
1 a 1 1 t sa 1 tItrmira tit r j a ra t| 1 ia ] -
rt sIitt 1 t |ij t Iirt i1 ismt .
I
| a si It 1 t s |t s a aIt rts tt irti1 tr tr
| at |a s 1 tItrmira tit rts 1 t
\
I
\
| a sa |ts st r, tr ] trtra |, |t s mtIt 1 t s
j rtItri1 t s j a ra t| 1 ia ] rt sIitt 1 t |ij t -
Iirt i1 ismt , a ar| at j at1 t ttisIir titrIa
1 istt r1 a rtia a |a |t ra 1 t tstt ] tr ara
a t Ira .
\
|a tt rttrIra tit r strita | a sa | 1 t
\

\
ts |a sama 1 t |a s tt rttrIra tit rts
1 t |a |t rmt ra |i] a 1 a a |a j rt Itira ,
1 t |a |i| rt tirta|a rIt. |t s a ra |isis 1 t
M t1 itira 1 ama ra , a ar| at j rtstrIa r
ara | atra rta ttit r trata 1 a , rt| ait-
rtr ara ta |i1 a tit r, a | at |a s j rt Iti-
ra s 1 t Ira rsj t rIt 1 iIitrtr trIrt |a s
1 iItrtrIts tsj ttits, tsIt j at1 t irItr-
It rir tr a |] ar t s i rmart t rsa t s .
k 1 tma s, |a s tt rttrIra tit rts strita s
1 t
\
tr j trrt s st r I1 t I\ |a s 1 t
|ama rt s. |sIt rtttsiIa t| ast 1 t 1 iIt-
rtrIts tarta s tsIa r1 a r j a ra j t 1 tr |ttr
tr art s ra r] t s irItrit rts
I
. |a Iirttira
ts ara |t rmt ra | a sIa rIt tsIa | |t, a
| at ts rtsisItrIt a |a 1 t] ra 1 a tit r j t r
t| tt rIa tIt tt r |a s tt|a|a s sa r] airta s,
a | a |ma ttra mitrIt 1 tsj ats 1 t |a ttr-
IriIa] a tit r, t a tt r] t|a tit rts 1 ts-
t t r ] t|a tit rts rt j t Ii1 a s. k 1 t m a s ,
j at1 t a |ma ttra rst 1 ara rIt ta si 1 ia s
a Itmj tra Iara a m| itrIt
I
. k ar| at tr
j trrt s rt t tarrt t| tit|t tirta r1 ia rt , si
| at tt i sItr I|atIa a tit rts Ia r It tr
j trrt s rt rma |ts tt mt tr trItrmt s,
tsIa s I|atIaa tit rts st r IrttatrIts j trt
ta si sitmj rt 1trIrt 1 t |t s ra r ] t s
| a }t s
I
. |a tt rttrIra tit r strita rt rma |
1 t
\
tr j trrt tr ratsIrt |a | t ra It rit , ts 1 t -\ !
rmt |I| tsIt s ta |t rts 1 tj tr1 tr 1 t| a ra |isis 1 t| |a | t ra -
It rit . |t ] ita mtrIt, taa r1 t |a ara irsaIititrtia Iirt i-
1 ta , |t s ritt|ts 1 t
\
stra r irItrit rts a |t s rt rma |ts
I 1
,
Itt rita mtrIt, |a irItrj rtIa tit r 1 t |t s rtsa|Ia 1 t s 1 t| t-
ria str simj |t, ts 1 ttir, |t s j trrt s tt r |ij t Iirt i1 ismt
1 t| tria r Itrtr ta |t rts ma s | a }t s | at |t s j trrt s rt rma -
|ts. |trt 1 ts] ra tia 1 a mtrIt, a 1 tma s tr | a sIa rIts t ta -
sit rts, |t s ta |t rts 1 t
\
tsIa r j t r 1 t| a }t 1 t |t s ta |t rts
1 t rtItrtrtia tr j trrt s tt r Iartit r Iirt i1 ta rt rma |
I I
, ts
1 ttir, |t s ta |t rts 1 t
\
1 t a rima |ts rt rma |ts 1 t a ri-
ma |ts |ijt I i rt i1 tt s st st |aj a r tt r mat|a Irt t a t r-
tia .
I I,1
|tisItr mat|a s tirtarsIa rtia s Ia rIt Iisit |t ] ita s
tt mt j a It |t ] ita s | at j at1 tr ir1 atir 1 tsttrst s tr |a
\
strita sir | at ttisIa ara a |Itra tit r tr |a ] |a r1 a|a Iirt i-
1 ts
I 1
, st | rt It 1 t taa r1 t |t s a rima |ts rt rma |ts saIrtr
1 t a |] ara trItrmt1 a 1 rt Iirt i1 ta , a | at st |a t | str-
ta 1 t | at tiIt | aira s tt mt | |-I st r imj t rIa rIts tr |a
j a It ] trtsis 1 t tsIa a rt ma |ia .
I,I
I
\
|a I
\
ts |a Irattit r |i| rt 1 t |a |t rmt ra , rt tsIa
ari1 a a j rt Itira tsIa 1isj t ri| |t a |t s It}i1 ts, ts |a | it -
| t ] i t a m t r It a tIita ta j a t 1 t trIra r tr |a tt|a|a , j t r
t t r s i ] a i t r It ts j rt j t rtitra | a |a a ttit r, mtIa | t |ismt
t|imira tit r 1t tsIa |t rmt ra. |t r |t Ia r It , sa mt1 itit r
1 t| tria j rt j t rtit ra r ar tt rt timitrIt 1 t| tsIa 1 t 1 t |a
Iartit r Iirt i1 ta mt}t r |at |a mt1 itit r 1 t
\
. |a ma t -
ria 1 t |ts Ia t It rts rt Iirti1 tt s | at a |It rar |a arit r 1 t
|a |t rmt ra a j rt Itira s rt a It t Ia r a |a s tt rttrIra t i t -
rts 1 t I
\
I t
, |at] t , tr Itt ria , t| st|a j a mitrIt 1 t ta | t -
rts tt i sIt r It trIrt |t s a rima |ts rt rma |ts |ts |ij tI i rt i-
1 tts t tarrt tt r mtrt s Irttatrtia tt r |a mt1itit r 1 t
I
\
| at tt r |a 1 t
\
. k 1 tma s, |a tt rttrIra titr 1 t I
\
rt tsIa Ia r irI|atrtia 1 a j t r trIt rmt1 a 1 ts rt Iirt i 1 t a s
t It ra j ia s ttr 1 rt ] a s, |t s ta | t rts 1 t rt It rtrtia str
s i m i | a rts a |t s ta | t rts 1 t |ama ra , j t r |t | at |ts |iIs 1 t
|ama ra st j at1tr asa r tasi sir mt 1 iIi t a t i t r t s .
, 1
|a ra
sa tta |aa tit r tt i sItr 1 itt rsa s Ittrita s, |a | at st ttr-
s i 1 t ra ma s a 1 ttaa1 a ts |a 1 ia |isis 1 t t| a i | i | rit tt rsi-
1 t ra 1 a t| mtIt 1 t 1 t rt It rtrtia , a ar-
| at ts It t r i t a m t r It 1iIiti|
I 1
j ra t I i-
t a m t r It irtt i sIt r It tr ratsI rt ja is
j t r |t | at 1 t| tmt s Itrtr j rt t a a t i t r
taa r1 t tt rsa|Ia mt s titrIas | i| |it ] ra-
Iia s . |a ra a |] art s a aIt rts ts |a j ra t-
| a ma s Iia| |t j ara t| 1ia ] rt sIitt 1 t
| i j t I i rt i 1 i s m t .
, I , I !
|t s t I rts sisIt-
ma s 1 t mt1 itit r, st r || k ||| k
I , \ 1
| t t i t r It m t r It st |a sa] t ri1t | at |a
1 tIt rmira tit r 1 t I
\
j t r | a i m i t | a m i-
risttrtia j rt s t r Ia ara mt}t r Ii a | i | i-
1 a1 1 ia ] rt sIita | at mat|t s 1 t |t s
m t It 1 t s 1t | | k ||| k | at Iitrt
ara ttt t | t r It tt rrt|a tit r tt r |a mt1 i-
1 a j tr 1 ia |isis 1 t t| a i | i | rit , st | rt
It 1 t tr a rima |ts rt rma |ts tt r trIt r-
mt1 a 1 ts sisItmita s rt Iirt i 1 t a s .
I 1
| r
] t r t ra | |a mt1 itit r 1t I
\
rt a j t rIa
m t } t ra s 1 ia] rt sIita s si] riIi t a I i ta s a |a
1 tIt rmira tit r 1 t
\
I, I ! , 1 I
Ii] . I si
ts | at rt st asa t| mtIt 1 t 1 t 1ia |isis
1 t t| a i | i | rit tt r t| taa | si | at st
m t } t ra |a Iia| i|i1 a 1 1 ia ] rt sI i t a .
|r ] t r t ra |, jt 1tmts 1 ttir |at, si
|a s tt rttrIra tit rts stritas 1 t
\
t sIa r 1 trIrt 1 t |t s ta | t -
rts rt rma|ts t a|It s, |a tt i sItrtia 1 t |ij tI i rt i1 ismt ts
ma j t tt j rt | a | |t. i |a s ttrttrIra tit rts strita s |a sa -
|ts 1 t
\
st r art rm a | m t r It |a }a s, t| 1 ia ] rtsIitt 1t |ijt -
I i rt i1 ismt ts j rt | a | |t t irt|ast tsIa ria }asI i Iita1 a ara
j rat| a 1t rt s j a t sIa a |a It ra j ia , a ar| at |t s si] rt s t|iri-
tt s 1t| tria r str ttrsisIt r Its tt r t| |ijt I i rt i1 ismt st
1 t|tria r t|imira r |t s tIt t Its 1 t trIt rmt1 a1 ts rt -Iirt i 1 t-
a s saj rtsit rts 1 t |a
\
j t r titrIa s 1 rt ] as. |t r |t Ia r It ,
j tr si st|a, tsIa tta|aa tit r Iitrt tt r1 a 1 t rt ta |t r 1 ia ] -
r t sIitt arita mtrIt si |ts rt s a | Ia 1 t s t | Itri1 t s st r rt rm a -
|ts t t|tta1 t s
\
- I 1 -I ! rmt|I| , tr tat ta st, j t 1 t-
mt s ttt|air |a tt i sItrtia 1 t ar |ij t I i rt i 1 i s-
m t .
I, 1 , I 1 , I I , I ! , I t , 1 , \ I
|t s ta | t rts rt rma|ts 1 t
\
j a t 1 t r
ta ria r trIrt ra tas Ia ma 1t s 1 t j trrt s, a ar| at tsIt
] ra1t 1 t ta riatit r rt ts 1 t si] riIita titr t|irita 1 ia] rts-
I i t a .
I 1
k t I a a | m t r It rt ts rttt mtr1 a | |t asa r ar st |t
ta |t r 1 t
\
j a ra stja ra r |t s a rima |ts |ij t I i rt i1 tt s 1 t |t s
t a I i rt i1 tt s. |t a jrt j ia 1t ts irt|air t| ta |t r t| Itri1 t
\
a
|a a ra mrtsis, tta mtr Iisitt tI rt s 1 a It s |a |t ra It ri a | t s
t | Itri1 ts. |sIa tt m| ira titr 1 t 1 a It s rt s aj t rIa ar ir1 i-
tt ra tt ra ||t j a ra st sj tt|a r t 1tstarIar |a j rtstrtia 1 t
| i j t I i rt i1 ismt . i |t s sirItma s t|iritt s tt rrtsj t r1tr a
| i j t I i rt i1 ismt, tt i sItr tt rttrIra titrts | a }a s 1 t
\
Fig. 2. C oncentraciones de fT
4
en
36 perros sanos, 30 perros
con hipotiroidism o y 35
perros eutiroideos con der-
m atopata
7
. N otar el solapa-
m iento de valores entre los 3
grupos de perros.
It st | rt It 1 t 1t I
\
, st j at1 t a samir
|a jrtstrtia 1 t |ijt I i rt i1 ismt, |a tt i s-
Itrtia 1 t t I ra s tt r1 itit rts rtttsiIa ra
t I rt s j rt t t 1 i m i t r It s 1 ia ] rtsI i t t s .
I, 1
Determinacin de los niveles de
triodotironina (TT
3
) en sangre
Ya | at |a
1
ts |a |t rmt ra ma s
j t ItrIt a ritt| tt|a|a r, j a rtttria |t ] i-
tt mt1 ir sa tt rttrIra tit r j a ra Iirts
1 ia ] rt sIitt s, j trt st |a 1 tmt sIra 1 t
| at sa tta |aa tit r rt t Irttt rir] ara
ttrIa }a st | rt |a
\
1 ts1 t t| j arIt 1 t
t i sIa 1 t Iia | i|i1a 1 tr t| 1 ia ] rt sI i-
tt .
I,I 1 ,1
| a sIa rIts j trrt s tt r trItr-
mt1 a 1 ts rt Iirt i1 ta s Iitrtr ritt|ts
| a }t s 1 t
1
, t irt|ast |a sIa t| ! 1 X 1 t
|a s matsIra s 1 t j trrt s |ij t Iirt i1 tt s
j at1 tr Itrtr |a
1
rt rma | Ii] . 1 ,
mitrIra s | a sIa rIts j t tt s Itr1 ra r |a
\
rt rma |. | ra arita 1 tItrmira tit r 1 t
1
| a sa | ts irItrit r a ara arita 1 tItrmi-
ra tit r 1 t
\
| a sa | j a ra t| 1 ia ] rt sIitt
1 t |ij t Iirt i1 ismt .
I, , 1 ,I t ,I I
|| |tt|t 1 t | at |a
1
sta mtrt s imj t rIa rIt j a ra
i1 trIiIita r t| |ij t Iirt i1 ismt , j at1 t str j t r
I, , 1 ,I t ,I I
.
|a ] |a r1 a|a Iirt i1 ts rtrma | sttrtIa ma s
\
| at
1
,
sitr1 t tsIa st | rt It 1 t irIra t t | a | a r. || I 1 X 1 t
1
t i t r t
1 t |a sttrttit r Iirt i1 ta, ar 1 X titrt 1 t |a tt rtt r-
sit r j tri It rita , j t r |t | at sa ttrttrIra tit r 1 tj tr1 tra
1 t ta rit s Ia t It rts, mitrIra s | at t| 1 1 X 1 t |a
\
, a ar-
| at rt sta |a |t rmt ra a tIita , titrt 1 t |a sttrt t i t r
I i rt i1 ta st |t 1 tj tr1 tra 1 t tsIa sttrttit r. || satrt ,
st|t Ira r s j t rIa t| ! - 1 X 1 t| tt rItri1 t tt rj t ra | It Ia| 1 t
1
, j t r |t Ia r It , Iitrt ar tt|amtr 1 t 1 isI ri | a t i t r
mtrt r | at |a
\
, |at] t |a tt rttrIra titr 1 t
1
ts ar
j t | rt ir1 ita 1 t r 1t |a Iartit r Iirt i1 ta j tr sa |t ta |ita -
tit r jrt 1 t m i r a r It trIrt |a s tt|a|a s |a j t ta ta rIi1 a 1
1 t
1
s t t rtIa 1 a j t r |a ] |a r1 a|a tr tt mj a ra tit r a |a
\
.
|tr |t Ia r It , |a t| strta tit r 1 t ara
1
| a }a sir t I ra tt i-
1 trtia , ts 1 t ar ta |t r tatsIit ra| |t tr t| 1 ia] rt sIitt 1 t
| i j t I i rt i 1 i s m t .
|tisIt ara ma t r sttrttit r 1 t
1
tt r |a j tr1 i1 a j rt -
] rtsita 1 t Iartit r 1 t |a ] |a r1 a|a . tr Ia sts Itmj ra ra s
1 t| |ij t Iirt i1 ismt , t| a amtrIt 1 t sttrttit r 1 t Iirt Irt j i-
ra ||tta a ara j rtItrtrtia tr |a sttrttit r 1 t
1
st | rt |a
1 t
\
, ma rItritr1 t st art s ritt|ts rt rma |ts | a sa |ts 1 t
1
, mitrIra s | at |a
\
tsIa ra 1 ismirai1 a .
Fig. 3. C oncentraciones basales de
T
3
en 35 perros sanos, 35
perros con hipotiroidism o y
30 perros con derm atopa-
ta
7
. N otar el solapam iento
de valores entre los 3 grupos
de perros.
Determinacin de los niveles de
tirotropina (TSH) en sangre
|s 1 t |ts a ta rtts ma s imj t rIa r Its tr
t| tsIa1it 1t |a Iartitr Iirti1ta . |a 1
tr jtrrts t1 ts simi|a r, tr taarIt a
|a Iartit r a |a tsI ra t I a ra, a |a 1 1t
tI rt s mamiIt rt s irt|atr1 t a |t s |ama-
rts. |a 1 ts ara ]| a t t j rt Itira jrt 1 a-
ti1 a jtr |a jiIaiIa ria a rIt ri t r, a Ira tt s
1 t sa a ttit r tr |a ] |ar1 a|a Iirti1 ts t}tr-
tt ar j ajt| imj t rIa r It tr t| marIt r i-
m i t r It 1t |t s ritt|ts tirt a | a r Its 1t
\
1
. |a j rt1attitr sttrttitr 1t |a 1
t sIa r tt rIrt |a 1 a s j t r ar I t t 1 -| a t |
r t ] a I i tt jt r |as
1

\
t i rt a | a r Its j t r
|a |t rmtra |ijt Ia|amita |1 . |a mt|t-
ta|a 1t 1 tsIa tt mj a t sIa 1t 1t s sa|a-
ri1 a 1 ts 1 iIt rt r Its, a |Ia | tIa, | a t
t sIar ari1 as 1t It rma rt ttta | t r It .
| r I rt |as tsjttits, |a sa|ari1a 1 |tIa ts
| t rm t r a -t s j t t i Iita tt rIi t rt a |as |t r-
mt ras sas atIiti1a 1ts |it|t] itas ari-
t a s .
I, I I
|a rtattitr trata 1 a tt i sIt r It
ttr t I ra s |t rmt ra s jiIaiIa ria s ttmt |1
|1 ts tasi irtt i sIt r It, j trt si |at ts
i mj t rIa r It |a rtattitr trata1a ttr |a
1 | ttira |1 , jt r |t | at tsIt It sI
rt st j at1 t asar tr jtrrt s tsI i m a | a 1 t s
tt r | 1 .
\ 1
K t tt i sItr ta riatit rts 1 iar-
ras 1 t sttrttit r 1t tsIa |t rmt ra , ts
1 t t i r, |at t| mtmtrIt 1 t tt I rattit r 1t
|a matsI ra rt a It t Ia |ts ta | t rts 1t 1 ,
a a r | at si | at tt i sItr titrIas I| a t I a a t i t-
rts imj rt1 tti||ts tr arima|ts | at tsIa r
1 t s a rrt||a r1 t t| |ijt I i rt i 1 i s m t .
1 , !
| a
1 ts ara |t rmtra tsIa| |t, a | a t
a ] a a r Ia art s \ 1ia s a It mj t ra I a ra
a m | i t r It a si ttmt ttr] t|atitrts 1ts-
t t r ]t|a tit rts rt j tI i 1 a s .
I \
|r |t s a|Iimt s a 1t s, 1 ts1 t |a tt mtr-
tia |ita tit r 1 t| |iI j a ra |a mt1 itit r 1 t t1 tr1 t ] tra ,
st Itr1 ria | at |a | tr mt}t ra 1 t Itt rita mtrIt mat|t tr
t| a ta rtt 1 t| 1 ia ] rt sIitt 1 t tsIa trItrmt1 a 1 . |a rt|a -
tit r rttij rt ta ttisItrIt trIrt |a s tt rttrIra tit rts 1 t
\
1 t I
\
tt r |a 1 tr j trrt s |ij t Iirt i1 tt s 1 t| tria ||t-
ta r a ara ma t r Iia | i|i1 a 1 tr t| 1 ia ] rt sIitt 1 t |ij t Ii-
rt i1 ismt | at |t s ItsIs ttisItrIts |a sIa a |t ra tr ara st |a
matsIra 1 t satrt . |r |ij t Iirt i1 ismt j rima rit , 1 t r1 t 1 is-
mirat |a j rt 1 attit r 1 t
\

1
, st 1 t| tria tsj tra r ar
a amtrIt 1 t 1 . |r t| |ij t Iirt i1 ismt sttar1 a rit t Itr-
tia rit , 1 t r1 t |a j rt 1 attit r 1 t |t rmt ra Iirt i1 ta ts | a }a
tt mt tt rsttatrtia 1 t trItrmt1 a 1 |ij t Ia |a mita t j iIai -
Ia ria , st 1 t| tria tsj tra r art s ritt|ts | a }t s 1 t 1 .
k 1 tma s, tr |ama rt s, |a ma t ria 1 t |a s siIaa tit rts | at
ta asa r 1 ismiratit r 1 t
\
tr ir1 iti1 at s taIirt i1 tt s tsIa r
a st tia 1 a s a tt rttrIra tit rts rt rma |ts t 1 ismirai1 a s 1 t
1 . |r ] trtra |, |a mt1 itit r 1 t I
\
}arIt a |a 1 t 1 ts
t| mtIt 1 t 1 t t|tttit r j a ra t| 1 ia ] rt sIitt 1 t |ij t Iirt i-
1 ismt tr |ama rt s.
I,I I
|r M t1 itira VtItrira ria , ttisItr
titrIa s 1 istrtj a rtia s tr |t s tsIa1 it s rta |ita 1 t s a ttrta
1 t |a Iia | i|i1 a 1 1 t tsIa 1 tItrmira tit r. |r mi t j irit r
tsIa s 1 istrtj a rtia s st 1 t| tr a ta rit s mt Iitt s, st | rt
It 1 t a | at tr It 1 t s st asa r 1 iItrtrIts Ittrita s 1 t mt1 i-
tit r ||| k , | | M k , | aimit |amiristtrtia , }arIt a 1 iItrtr -
Its mtIt 1 t s 1 t tt rIirma tit r 1 t| |ij t Iirt i1 ismt Ittrita
] t |1 sIa r1 a r1 .
1 ,t , , ! - ,I ,1 \ -\ 1 ,\ \
|| ta |t r 1 t ar ItsI
1 ia ] rt sIitt j a ra |ij t Iirt i1 ismt rt st j at1 t }at] a r a
mtrt s | at |t s rtsa|Ia 1 t s st tt mj a rtr tt r ara | it j sia
Iirt i1 ta , t st | a str tr t| ttiIt 1 t ara rtsj atsIa a |a
a 1 mirisIra tit r 1 t |t rmt ra Iirt i1 ta .
1 1
|r ] trtra |, st] ar
|a s rttisit rts | i| |it ] ra Iita s tr | a st a ratsIra ttj t-
ritrtia , 1 t r1 t asa mt s t| mtIt 1 t ||| k
I,1 !
, j t 1 tmt s
1 ttir | at |a t1 st trtatrIra a amtrIa 1 a tr t| I 1 - 1 X
1 t |t s j trrt s tt r |ij t Iirt i1 ismt , ts 1 ttir, j at1 t |a | tr
trIrt I 1 -1 1 X 1 t Ia |st s rt] a Iitt s, mitrIra s | at tsIa
a amtrIa 1 a tr ttrta 1 t| 1 - X 1 t |t s j trrt s tt r trItr-
mt1 a 1 rt Iirt i1 ta , ts 1 ttir, | at stra r Ia |st s j t siIi-
tt s.
t ,I ,1 \ ,1 1
|t r |t Ia rIt , |a mt1 itit r 1 t |a t1 tr1 t -
] tra Iitrt ara tsj ttiIiti1 a 1 rt|a Iita mtrIt | atra j trt
Iitrt ara strsi| i|i1 a 1 1 ia ] rt sIita | a }a t| 1 ia ] rt sIitt
1 t |ij t Iirt i1 ismt rt st j at1 t ttt|air st | rt |a | a st 1 t ar
st |t ta |t r 1 t 1 trIrt |t s ra r] t s 1 t
rtItrtrtia
,1 1
|a s ra tt rts 1 t tsIt
rtsa|Ia 1 t trIrt |t s ta |t rts 1 t rtItrtr-
tia tr a |] art s a rima |ts |ij t Iirt i1 tt s
j at1 tr str ta ria s
1
.
at t| ItsI rt sta |t saIititrIt-
mtrIt strsi| |t | at st rtttsiItr a |] a -
ra s mt}t ra s Ittrita s.
at t| ItsI rt 1 tIttIt It 1 a s |a s
ist It rma s 1 t 1 | at, tt mt st |a
tisIt , tr |t s ItsIs 1 t |ama ra , j at1 tr
a |Itra r |a irmart rrta tIiti1 a 1 .
at ttisIa ara ma t r j rt j t rtit r
1 t |a tsj tra 1 a 1 t |ij t I i rt i 1 i s m t
sttar1 a rit j iIaiIa rit . aita tr ar
IaIart |a mt1 itit r 1 t t1 tr1 t ] tra
j t sI-tsIima|a tit r tt r | 1 rt s a a1 a ra
tr tsIt 1 i|tma .
k ] t Ia mitrIt 1 t |a j rt 1 attit r 1 t
1 j t r |a j iIaiIa ria rt 1 ia ] rt sIita 1 t
rarta tr rir] ara tsj ttit tt mt ta asa
1 t 1 | a }a }arIt a ara 1 ismiratit r 1 t
\
I
\
. |t s j trrt s tt r |ij t Iirt i1 is-
mt rt 1 tmatsIra r ar a amtrIt saj |t-
mtrIa rit 1 t 1 1 tsj ats 1 t a 1 miris-
Ira r | 1 , ir1 ita r1 t | at tsIa r sttrt-
Ia r1 t 1 a | |imiIt 1 t sa ta j a ti1 a 1 1 t
j rt 1 attit r.
a j rirtij a | irItrts st | a sa tr t|
|tt|t 1 t | at a | a 1a 1 ir |a 1 tItrmira -
tit r 1 t 1 a ara
\
It I
\
| a }a s, st
mt}t ra | a sIa rIt |a tsj ttiIiti1 a 1 1 ia ] -
rt sIita a ar| at rt mt}t ra mat|t |a
s t r s i | i | i 1 a 1
t , I , 1 \ , 1 t , 1 1
, ts 1 tti r, |a
1 tItrmira tit r 1 t t1 ts ar ItsI ta |i-
1 t tr j trrt s st sj tt|t st s 1 t |ij t Iirt i-
1 ismt sitmj rt | at st tt m| irt tt r
\
It I
\
1 \ ,1 !
, j trt tr a |] art s ta st s
1 t r1t t |It r ] a mt s rt s a | Ia 1 ts j t tt
t|a rt s 1 rt rma |
\
It I
\
| a }a s t rtsa|Ia 1 t s 1 is-
tt r1 a rIts 1 t|tta 1 a
\
It I
\
rt rma | t t|tta 1 a ,
1 t | t rtmt s rt t a rrir a It sIs 1 i ra mitt s 1 t t sI i m a | a -
tit r
1 t ,\ \
t a j trsa r | at ttisIa r a aIt a rIitatrj t s a rIi-
|t rmt ra Iirt i1 ta .
\
|t s ta |t rts 1 t rtItrtrtia tr ratsIrt
|a | t ra It rit st r 1 t 1 ,1 I -1 ,! 1 r] Im|
I I
a ar| at j a ra
a amtrIa r |a Iia | i|i1 a 1 1 t| ItsI ts mt}t r a amtrIa r t| |imi-
It a |It |a sIa 1 ,I r] Im|.
1 I
FACTORES QUE AFECTAN LAS
MEDICIONES DE HORMONAS
|t s ta |t rts 1 t |a s |t rmt ra s Iirt i1 ta s tsIa r irI|ai1 t s
j t r ara ma|IiIa1 1 t Ia tIt rts.
I 1
k ar| at, tr ] trtra |, |a
ma t ria 1 t |a s siIaa tit rts 1 t r1 t ttisItr tt rttrIra tit -
rts | a }a s 1 t
1

\
tr j trrt s taIirt i1 tt s st r trItrmt-
1 a 1 ts sisItmita s rt Iirt i1 ta s, |a a 1 mirisIra tit r 1 t titr-
Ia s 1 rt ] a s
I 1
I|atIaa tit rts 1 t |a s tt rttrIra tit rts | a sa -
|ts. |tisItr t Irt s Ia tIt rts tsj ttiIitt s 1 t ta 1 a j a titrIt
| at st 1 t| tra r Itrtr tr tatrIa a |a |t ra 1 t irItrj rtIa r
|t s rtsa|Ia 1 t s.
I
|rItrmt1 a 1 rt Iirt i1 ta. |a trItrmt1 a 1 rt Iirt i1 ta ts
ara ta asa tt mar 1 t 1 ismiratit r 1 t
\

1
, st tt rt tt
rt rma |mtrIt tt mt sir1 rt mt 1 t| taIirt i1 tt trItrmt .
I t
|a a |Itra tit r tr |a s tt rttrIra tit rts j at1 t str 1 t| i1 a s a
ara 1 ismiratit r tr |a sttrttit r 1 t 1 j t r ta asa |ij t -
Iisa ria t |ij t Ia |a mita , 1 ismiratit r 1 t |a sirItsis 1 t
\
,
1 ismiratit r tr |a tt rttrIra tit r 1 t j rt Itira s strita s 1 t
arit r t 1 t |a a Iiri1 a 1 tr |a arit r, It ir|i| itit r 1 t |a
1 tit 1 ita tit r 1 t
\
a
1
.
I
a j a It ] trtsis ts | a sIa rIt
tt mj |t}a , st |a r a st tia 1 t sasIa rtia s tt mt a |] ara s
tiIt | aira s.
I t ,I
|a tt rsttatrIt 1 ismiratit r 1 t |a s tt r-
ttrIra tit rts 1 t tsIa s |t rmt ra s, st trtt | at ts ara
a 1 a j Ia tit r Iisit |t ] ita 1 t| t r] a rismt a ar tsIa 1 t 1 t 1 is-
miratit r 1 t| mtIa | t |ismt tt|a|a r tr j trit 1 t s 1 t trItr-
mt1 a 1 .
I
|r ] trtra |, t| Iij t ma ] riIa1 1 t |a mat ria 1 t
|a s a |Itra tit rts tr tsIa s tt rttrIra tit rts |t rmt ra |ts rt
st r aritt s j a ra ar 1 tst r1 tr tsj ttiIitt , sirt | at ma s
| itr rtI|t}a r |a ]ra tt1 a 1 1 t |a trItrmt1 a 1 j at1 tr
tsIa r ta ria r1 t tt rIiraa mtrIt.
I
k aIt a rIitatrj t s a rIi-|t rmt ra Iirt i -
1 ta . |sIt s a aIt a rIitatrj t s irItrIitrtr
tr |a ta |t ra tit r 1 t |t s ritt|ts tr sa r-
] rt 1 t tsIa s |t rmt ra s. a |ts irItrIt-
rtrtia s 1 tj tr1tr Iar1 a mtrIa | m t r It
1 t| j rt tt1 imitrIt a ra |iIitt asa 1 t
j at1 tr 1 a r |a] a r a rtsa|Ia 1 t s Ia |sa-
mtrIt | a }t s, irt|ast ir1 tIttIa | |ts, t
j t r t| tt rIra rit , a rtsa|Ia 1 t s Ia |sa mtr-
It t|tta 1 t s.
I 1
|sIa s a |Itra tit rts tr |t s
ta |t rts rt rtI|t}a r t| tsIa 1 t 1 t |a ] |a r-
1 a|a Iirt i1 ta .
I t
k ar| at tsIt s a rIitatr-
j t s j at1 tr str 1 tIttIa 1 t s tr a |] art s
a rima |ts rt rma |ts
\ ,II
, ir1 ita r |a j rt-
strtia 1 t trItrmt1 a 1 Iirt i1 ta a aIt ir-
mart tt mt Ia |, |t s j trrt s a IttIa 1 t s
Iitrtr ma s j rt | a | i|i1 a 1 ts 1 t 1 tsa rrt-
||a r |ij t Iirt i1 ismt tr a |] ar mt mtrIt
1 t sa ti1 a .
I I
|r matsIra s tt r t|tta tit -
rts 1 t 1 , ir1 tj tr1 itrItmtrIt 1 t|
ta |t r 1 t
\
, st |a sa] tri1 t | at ttisIt
ar titrIt rits] t 1 t Itrtr tsIt s a rIi-
tatrj t s, 1 t |tt|t , t| 1 1 X 1 t |a s
matsIra s tt r t|tta tit rts 1 t
\
1 t
1 j rtstrIa r tsIt s a rIitatrj t s.
\
| rt ] a s. |tisItr mat|a s 1 rt ] a s | at
j at1 tr a IttIa r |a s tt rttrIra tit rts 1 t
tsIa s |t rmt ra s. aita s |a ma s imj t r-
Ia rIt sta |a a ttit r 1 t |t s ] |att tt rIi-
tt i1 ts
I 1
. k ar| at sas tIttIt s st r ta ria-
| |ts, |t s ] | a t t t t rIitt i1 ts j rt 1 a t t r
rt rma |mtrIt ara 1 ismiratit r 1 t |a s
| t rmt r a s Ii rt i 1 t a s .
I t
a t It t It
1 tj tr1 t 1 t |a 1 t sis, 1 ara tit r 1 t si
ttisIt t rt a |] ara trItrmt1 a 1 .
I I
|r
taa || aitr ta st , tr |t s j a titrIts | at
rtti| tr ] |att tt rIitt i1 ts rt 1 t| tra r
mt1 irst |t s ritt|ts 1 t |t rmt ra s Iirt i-
1 ta s |a sIa j a sa 1 t a |] ar Iitmj t 1 ts-
j ats 1 t sasj tr1 tr |a Itra j ia .
I 1
|r
tsIt s a rima |ts | aita s sta ma s Iia | |t
|a ttr mt1 itit rts 1 t 1 , | at tr Itt ria tsIa mtrt s a Itt-
Ia 1 a .
\ , 1
|| Itrt | a r| iIa | Ia m| itr j rt 1 att 1 ismiratit r tr
|a s tt rttrIra tit rts 1 t
\
I
\
a amtrIt s 1 t 1 a j a r-
Iir 1 t |a s ! stma ra s 1 t| iritit 1 t |a Itra j ia , |a s ta asa s 1 t
tsIa s a |Itra tit rts rt tsIa r t|a ra s.
I ,I 1
|a a 1 mirisIra tit r
1 t Irimt It j rim-sa|Ia mi1 a s a 1 t sis 1 t 1 1 m] I|] Ia m| itr
j rt 1 att 1 ismiratit rts 1 t |a s |t rmt ra s Iirt i1 ta s.
1 I
ESTIMULACIONES
|a sttrttit r 1t |trmt ra Iirt i1 ta ts irrt] a|ar ttr j a|-
st s ta ria | |ts. |a Ittrita tr ] t r t ra | ttrsisIt tr |a tsI i m a-
|atit r 1t |a ] |ar1 a|a Iirt i1 ts asar1 t sasIa rtias |a i m i t a s
a r a | t ] a s a |a 1 j iIaiIa ria t a |a | 1 |ij tIa|a mita , tt r
t| Iir 1t aamtrIa r |a sttrttit r Iirti1ta |t matimt jt si| |t.
|a mt1 ititr 1 t |trmtra Iirt i1 ta tr sar] rt 1 tsjats 1t
t sIas tsIima|a tit rts st asa jara 1 iIt rtrtia r t| taIirt i 1 i s m t
1 t| |ijt I i rt i 1 i s m t .
\ 1
T
4
srica en respuesta a TSH
t | a sa tr |a a 1 mirisIra tit r 1 t 1 | t tira | 1
|a mt1 itit r 1 t
\
a rIts a ar Iitmj t 1 tItrmira 1 t 1 ts-
j ats 1 t |a tsIima|a tit r. k ar| at t| j rttit , |a 1 iIita|Ia 1
1 t t | Itrtit r |a 1 tstrij tit r 1 t titrIa s rta ttit rts a ra -
Ii|a tIita s t tarri1 a s |a r |tt|t | at tsIt ItsI sta mtrt s
asa 1 t , tt rIiraa sitr1 t st] ar mi t j irit r t| mtIt 1 t rt
irta sitt 1 tIiriIitt j a ra t| 1 ia ] rt sIitt 1 t |ij t Iirt i1 ismt .
|tisIt ara ]ra r ta rit1 a 1 1 t j rt It tt |t s j a ra t| ast 1 t
tsIt ItsI | at ta ria r st | rt It 1 t tr |a 1 t sis 1 t 1 asa 1 a
t| Iitmj t 1 t ttIra ttit r 1 t |a matsIra j t sI-tsIima|a -
tit r.
I, ,I 1 ,1 1
|t ] ita mtrIt, sas rtsa|Ia 1 t s ta ria ra r tt rsi-
1 tra | |tmtrIt 1 tj tr1 itr1 t 1 t |a 1 t sis 1 t j rt 1 atIt aIi|i-
ta 1 a , tia 1 t a 1 mirisIra tit r Iitmj t s 1 t rttt ] i1 a 1 t |a s
matsIra s.
I 1
|| Iitmj t j a ra | at a j a rttta t| j itt 1 t |a
rtsj atsIa tsIa a IttIa 1 t j t r |a 1 t sis |a tia 1 t a 1 miris-
Ira tit r. |a tia 1 t a 1 mirisIra tit r j at1 t str sa| taIa rta ,
irIra masta|a r t irIra ttrt sa | V , j trt |a rtsj atsIa ma s
ra j i1 a tt rsisItrIt |t 1 a |a tia | V.
I
|r |a | i| |it ] ra Iia , t|
j rt It tt |t ma s asa 1 t ts |a a 1 mirisIra tit r 1 t 1 , ari1 a -
1 ts | I|] |a sIa ar ma timt 1 t ! | . |trt j a ra mirimita r
|t s tt sIts, st 1 t| tria tmj |ta r |a miri-
ma 1 t sis | at j at1 a a j t rIa r ara tsIi-
ma|a tit r t|irita mtrIt ta |i1 a .
1 1
t |a
sa] tri1 t | at j at1 t asa rst ara 1 t sis
It Ia | 1 t | Ij trrt , ir1 tj tr1 itrItmtr-
It 1 t| j tst ItsI a 1 t sis | a }a s 1 t | 1
ttisItr tsIa1 it s | at ta |t ra r t| tam-
j |imitrIt 1 t |t s triItrit s rtttsa rit s
j a ra | at ttisIa ara rtsj atsIa a 1 ttaa -
1 a 1 t |a ] |a r1 a|a a |a | 1 , 1 tmats-
Ira r a si |a tIttIiti1 a 1 1 t |a 1 t sis | a }a
1 t | 1 tr tta |aa r |a Iartit r Iirt i-
1 ta .
,1 1
| r1 tj tr1 itrItmtrIt 1 t| j rt -
It tt |t asa 1 t , st sa | t | at tt r 1 t sis
| a }a s 1 t | 1 t| j itt 1 t |a rtsj atsIa
ts 1 t mtrt r ma ] riIa1 a j a rttt a rIts
| at tt r 1 t sis ma t rts. k | a amtrIa r |a
1 t sis 1 t | 1 , st rtIra sa t| Iitmj t 1 t
|a a j a ritit r 1 t| j itt 1 t
\
st a |ta r-
ta ara ma t r rtsj atsIa 1 t
\
ar
j | a Itaa | at st ma rIitrt 1 ara r It
ma s Iitmj t .
I, , 1
k 1 tma s, tr 1 ittrst s
tsIa1 it s, st 1 tmatsIra | at |a aIi|ita -
tit r 1 t | 1 t | 1 j t r j trrt ir1 att
ar a amtrIt mtrt r 1 t |a tt rttrIra tit r
1 t
\
j t sI-| 1 | at asa r1 t ! | , j trt
| at st j at1 t t | Itrtr ara matsIra
rtj rtstrIa Iita tt r Iirts 1 ia ] rt sIitt s
trIrt |a s \ t |t ra s, a | at rt |a
1 i It rtrtia tr t | a amt rIt asa r1 t
a m| a s 1 t sis rttt ] itr1 t |a matsIra
j t sI-| 1 a |a s \ |t ra s.
,1 1 ,\
Ii] . \ .
|t s ta |t rts 1 t rtItrtrtia j a ra rats-
Irt |a | t ra It rit st r, tr j trrt s rt rma-
|ts, |a matsIra 1 t
\
j t sI-| 1 1 t| t
str 1 rmt |I| It a amtrIa r 1
rmt |I| j t r trtima 1 t| ta |t r | a sa |. |r
|ij t Iirt i1 ismt j rima rit , |a tt rttrIra -
tit r 1 t
\
strita j t sI-| 1 , j at1 t j tr-
ma rtttr irt|ast j t r 1 t| a }t 1 t |t s
ta |t rts 1 t rtItrtrtia j a ra |a
\
| a sa | - rmt |I| ,
ma ra ra mtrIt a amtrIa ma s 1 t 1 rmt |I| j t r trtima 1 t|
ta |t r | a sa |. |a irItrj rtIa tit r 1 t tsIt ItsI 1 t| t | a sa rst
sitmj rt tr |t s ta |t rts a | st |aIt s 1 t
\
. K t ts rttt mtr-
1 a | |t |a tta |aa tit r 1 t |a Iartit r Iirt i1 ta | a sa r1 t st ari-
ta mtrIt tr ar a amtrIt tI t t1 1 t |a tt rttrIra tit r 1 t
\
tr |a matsIra j t sI-tsIima|a tit r tr tt mj a ra tit r tt r |a
j rt-tsIima|a tit r, a | at j at1 t ||tta r a trrt rts, st | rt
It 1 t taa r1 t tsIa mt s IrtrIt a ta |t rts 1 t
\
| a sa | a |It s t
| a }t s. |t r t}tmj |t , t| |tt|t 1 t 1 t | |a r |a tt rttrIra tit r
1 t
\
trIrt |a matsIra j rt- j t sI-tsIima|a tit r, st trtt
| at ts tt mj a Ii| |t tt r taIirt i1 ismt , j trt 1 tsa It rIara -
1 a mtrIt t| |tt|t 1 t 1 t | |a r ara tt rttrIra tit r | a sa |
ma | a }a , j at1 t str It 1 a tia tt mj a Ii| |t tt r |ij t Iirt i1 is-
mt si |a matsIra j t sI-1 j trma rttt j t r 1 t| a }t 1 t |t s
ta |t rts 1 t rtItrtrtia . | t| mismt mt 1 t , t| 1 t | |a r ara
tt rttrIra tit r 1 t
\
j at1 t | at rt t tarra , tr ar j a titr -
It rt rma |, si t| ta |t r 1 t
\
| a sa | ts a |It .
I, ,I 1 ,1 1
k| i] aa| |at tr tI ras trIt rmt1a 1 ts, t| |ij t I i rt i 1 i s m t
rt ts ara siIaatitr 1 t It1 t t ra1 a , sirt | at st ta ra t It ri-
ta j tr ara j tr1 i1 a ] ra1 aa | 1t |a Iartit r Iirt i1ta j t r |t
Ia r It 1 t ara j tr1i1a ] ra1 aa| 1 t |a strsi|i|i1a 1 a |a 1 .
I
| tmt rt ] |a ] t r t ra|, st jat1t 1 ttir | at tsIt It sI j at1 t
1 i It rtrtia r trIrt |ij t I i rti1ismt j ri m a rit 1t t I ras ta asa s
Fig. 4. G rfica de la estim ulacin con 1 U de bTSH ( G a rnier A.
C.E.S. hemat ology et biochimie animal Toulouse 1995).
1 tr1t |a ] |a r1a|a ts a |]t strsi||t 1 a
rt s j a t sIa s trIrt rt rma | t |ij t .
M i t r I ra s | at |t s jtrrts tt r |ij t I i rt i 1 i s-
mt j ri m a rit rt rtsj tr1 tr, |ts j trrt s
ttr
\
| a sa| 1ismirai1a 1t| i1 t a t I rt s
Ia t It rts ttmt trIt rmt1 a1 , 1 rt ]a s
] | a t t t t rIitt i1 ts, rt rm a | m t r It rt s j t r-
1tr a |a 1 a ar| at a tttts |a rt s-
j a t sIa j at1 a tsIar 1 ismirai1 a .
I, \ \
| r It rmt1 a 1ts sisItmitas ] ra tts j at1tr
|a ttr |at |a s ttrttrIratit rts 1t
\
s t rita s jt sI -| 1 tsItr tr t| ra r]t tt r-
s i 1 t ra 1t tt mt 1ia] rtsIitt 1t |ijt I i rt i-
1 ismt. |a ta ja ti1a1 1 t tsIt It sI ja ra
1 i It rtrtia r t| |ij t I i rti1ismt j ri m a ri t
1 t| sir1rtmt 1 t| taIirti1tt trIt rmt , ts
tt i 1 t r It m t r It a |] t sa| }tI i tt , 1 tj tr-
1 t ra 1 t |a taj ati1 a 1 1 t| t|iritt tr st s-
j t t|a 1 t |ij tI i rti1ismt , ] ratt1 a 1 1 t
|a trIt rmt1 a 1 , It 1 t| rt s a | Ia 1t 1 t |a
It ra j ia 1t j ra t | a .
I
| rt 1 t |t s rt s a | Ia 1t s ma s 1iIiti|ts 1 t
i r It rj rtIa r, tr a rima|ts st sj tt|t sts, ts
ara ttrttrIratit r | a sa| | a }a ara tt r-
t t r I ra tit r jt sI -| 1 rtrma |. |sIt a|Ii-
mt rt s a | Ia 1 t sa] itrt taIirti1ismt, j trt
tt i sItr j trrts tt r tsIt rt s a | Ia 1 t | a t
st r a |Ia m t r It stsj tt|t sts 1 t |ij t I i rt i-
1ismt st]ar t| tta mtr t|iritt , a 1t-
ma s, rtsj t r1tr a | Ira Ia m i t r It . | r a
ttj |itatit r j ara tsIt Itrt mtrt stria |a
tt i sItrtia 1 t |ij t I i rt i1 ismt sttar1 a ri t
t It rt i a rit. |sIt s j trrts Iitrtr ara rt s-
j a t sIa a |a | 1 ta ria||t, |at 1tj tr-
1 t 1 t |a ]ra tt1a1 1 t |a a Irt Iia 1 t |a
] |ar1 a|a , taarIt mat r ts |a 1aratit r
|a ]ra tt1 a1, mtrt r ts |a rt s j a t sIa .
|a ra |a ma t ria 1 t jtrrt s, t| a amtrIt
tr |a matsI ra jt sI -| 1 ts simi|ar a |a
t i sIa tr t| sir1rt mt 1 t| taIirt i1 tt trIt r-
mt t tr |a 1ismiratit r 1t
\
|a sa | j tr 1 rt ]a s. k|] art s
j t rrts, sir tm| ar] t , Iitrtr ara rt s j a t sIa a rt rma| ||tta r-
1t a ar Ia|st 1 ia ] rtsIitt 1 t |ijt I i rti1ismt tr ar jtrrt
r t rm a | .
I
| t mt tt rt|asit r j t 1 tmt s 1 ttir | at |a j rirtij a | ttr-
Ia }a 1 t tsIt ItsI, ts | at mi1 t |a rtstrta sttrtIt ra 1 t |a
] |a r1 a|a , sas j rirtij a |ts ir1 ita tit rts st r.
I,
| aa r1 t t| 1 ia ] rt sIitt rt st |a tsIa | |tti1 t j t r |a
|isIt ria , tta mtr Iisitt , j rat| a s tt mj |tmtrIa ria s mt1 i-
tit r 1 t
\
| a sa | It 1 .
|tisItrtia 1 t a |] ara trItrmt1 a 1 sisItmita | at
j at1 a a IttIa r |a tt rttrIra tit r 1 t
\
| a sa |.
| aa r1 t tsIt tt rIra ir1 ita 1 a |a rtsj atsIa a |a Itra -
j ia tt mt mtIt 1 t 1 t 1 ia ] rt sIitt .
Estimulacin con TRH
|| It sI 1 t tsIima|a titr tt r |1 st |a sa] t ri1t tt mt
ara a|It rr a I i ta a |a 1 iIi t a | Ia 1 tr |a t| Itrtit r 1 t |a | 1 ,
st asa j a ra tta|aa r |a rt s j a t sIa jiIaiIa ria a |a | 1 t|
ta m| it | at tsIt sajtrt tr |a t1 . |a tsIima|atit r tt r
|1 ir1 att ara j rt 1 attit r 1 t 1 j tr |a j iIaiIa ria , jt r
t t r s i ] a i t r It, ara sttrttit r 1 t
\
.
, , I t
k|]arts irtt sI i ] a -
1 t rts trttr | at tsIt It sI ts ma s strsi||t ja ra t| 1ia] rt s-
Iitt 1t| |ijt I i rt i1ismt a | at ta asa ara |i| tratit r Ii s i t | t -
] ita 1 t 1 Irt r It a |a t|tta 1a ttrttrIra titr 1t 1 |a t
st t |Iitrt tt r t| It sI 1 t tsIima|a tit r ttr | 1 .
t
|r Itt ria |a a 1 mirisIra tit r 1 t | 1 1 t| tria ||tta r a ar
a amtrIt 1 t |a
\
st |a mtrIt si t| t}t j iIaiIa ria -Iirt i1 ts
tsIa irIa tIt .
|r |ij t Iirt i1 ismt j rima rit ttisIt ara tt r-

ttrIra tit r t|tta 1 a 1 t 1 a Iri| ai1 a a |a j tr1 i1 a 1 t|
Itt1 -| a t| rt] a Iitt | at |a s |t rmt ra s Iirt i1 ta s j rt 1 attr
tr |a j iIaiIa ria , |a tsIima|a tit r tt r | 1 rt 1 t| tria
a amtrIa r |a sttrttit r 1 t 1 a | at sir tsIt Itt1 -| a t|
rt] a Iitt , |a j iIaiIa ria tsIa sttrtIa r1 t 1 a | |imiIt 1 t sa
j rt 1 attit r, j t r |t Ia rIt rt 1 t| tria a amtrIa r |a sttrt-
tit r 1 t |t rmt ra Iirt i1 ta .
|t r |t Ia rIt |a rtsj atsIa a |a

| 1 1 t| tria t | strta rst tr j trrt s rt rma |ts tr j trrt s
tt r |ij t Iirt i1 ismt Itrtia rit |ij t Ia |a mitt .
|sIt ItsI rt
ts ma ta |i1 t j a ra t| 1 ia ] rt sIitt 1 t| |ij t Iirt i1 ismt j t r-
| at ttisIt ar ramtrt imj t rIa rIt 1 t a rima |ts sa rt s | at
1 t m a t sI ra r ara rt s j a t sIa a rtrm a |-
m t r It |a }a a tsIa tsIima|a tit r, ts
1 ttir, | at ar ta |t r | a }t rt imj |ita
|ij t Iirt i1 ismt , a ar| at ar ta |t r 1 trIrt
1 t |t s ta |t rts 1 t rtItrtrtia si | at ir1 i-
ta taIirt i1 ismt , j trt tt r i] aa | Iia | i|i-
1 a 1 1 ia ] rt sIita | at ara st |a 1 tItrmi-
ra tit r 1 t
\
.
,\ I
| ra mtr tit r a j a rIt mt rttt |a
mt1 ititr 1 t t 1 j tsI -t sI i m a | a t i t r
tt r | 1 . tt rita mtrIt, |a a 1 mirisIra -
tit r 1 t | 1 ttt ] tra 1 t| tria a a1 a r
tr t| 1 ia ] rt sIitt 1 t |a s Ia sts Itmj ra -
ra s 1 t |ij t Iirt i1 ismt j rima rit 1 t r1 t
| a j tr1 i1 a s |i] t ra s 1 t I t t 1 -| a t |
rt] a Iitt tr |a |i| tra tit r 1 t 1 1 t |a
j iIaiIa ria .
\ I
k tIaa |mtrIt, tr M t1 itira
1 ama ra ra ra mtrIt st asa r |a s tt rttr-
Ira tit rts | a sa |ts 1 t 1 j a ra tta |aa r
t| tsIa 1 t 1 t |a ] |a r1 a|a Iirt i1 ta tr
j a titrIts | a }t Itra j ia s t tt r trItrmt-
1 a 1 ts ttIra -Iirt i1 ta s ] ratts. || |ij t Ii-
rt i1 ismt mt1 it st i1 trIiIita j t r ara
|ij tr-rtsj atsIa 1 t |a sttrttit r 1 t 1
j t sI-tsIima|a tit r tt r | 1 .
!
k 1 tma s,
Iam| itr st Itr1 ria | at rttt rt ttr t| |ij t I i rt i 1 i s m t
sttar1 a rit mt1 ia rIt ara 1 ismiratit r 1 t |a rtsj atsIa 1 t
|a 1 j t sI-tsIima|a tit r tt r | 1 .
\ I
|t s tsIa1 it s, It 1 a tia
ma rttitrIts, ir1 ita r | at |a 1 tItrmira tit r 1 t t1
j t sI-| 1 rt a j t rIa ttrIa }a s st | rt |a 1 tItrmira tit r 1 t
t1 }arIt a
\
It I
\
tr t| 1 ia ] rt sIitt 1 t| |ij t Iirt i-
1 ismt j rima rit , a | at |a j iIaiIa ria tsIa sttrtIa r1 t 1
a | ma timt 1 t sa j rt 1 attit r, sir tm| a r] t , si | at strtiria
tr |a a a1 a 1 t| 1 ia ] rt sIitt 1 t| |ij t Iirt i1 ismt sttar1 a -
rit 1 t r1 t rt s trtt rIra ria mt s art s ta |t rts | a }t s 1 t
t1 j t sI-| 1 .
t ,1 t ,1
| tmt |tmt s tisIt, tt i sIt titrIa ttrIrttt rsia tr t| ast
|a irIt rj rtIa tit r 1t |ts It sIs 1t Iartitr Iirt i1ta . k tsIt tt r-
I ri | a t t| ast ir1istrimira1t 1 t tsIts It sIs tr j atitrIts sir
si] rts t|iritts 1t |ijt I i rti1 ismt. | t mt taa || aitr t I rt It sI ,
|t s It sIs 1t Iartitr Iirt i1 ta st 1t| tr asar |a }t titrIt s tri-
It rits. |1ta|mtrIt, ar It sI ja ra |ijt I i rt i1 ismt 1t| tria
.
tr asa 1 t st |t j a ra tt rIirma r ara st sj tt|a t|iri-
ta 1 t |ij t Iirt i1 ismt . t| 1 ia ] rt sIitt 1 t| |ij t Iirt i1 ismt rt
1 t| tria | a sa rst st |a mtrIt tr ar rtsa|Ia 1 t Iatra 1 t |t s
ta |t rts 1 t rtItrtrtia .
|sIa ||tttr t| tsIa1 t 1t |a ] |a r1a|a Iirt i1ts. mt1ia rIt
|a 1 tIt rmira tit r 1 t |a 1 , | aita ttr tsIa1it s 1ira mitt s.
| isIir] air trIrt t| a rima | |ij t Iirt i1 tt 1 t| taIirt i1 tt
sa rt 1 t| taIirt i1 tt trItrmt .
. | t a |t | M , 1 t |m |! | t is|ir ] | .
| t mj a rist r t I It 1 t sts t I a | att as
| t tirt I|rt Irt j ir It r I|rt i1 ItsIir]
ir rt rma | 1 t ] s. !kVM k Vt |. 1 I j j .
t ! , 1 1 1 .
I . | trtiI |, |tt| t r tI !, | a rritr |. | tsa ] t
1 t \ |i| rt t|tt |t t|irt. |ra t I i t a | i | i It ,
ta | t a rs asat||t s tI irIt rI 1 ia]rt sI i | a t .
| raI. mt1 it. tI | |ir. | t | krima | 1t
| t mja ]. Vt|. I \ r. I jj. t ! , 1 1 .
1 . | rartr !M , tt II-M t rtritII !| , wi||ia ms
| k . |IIttI t I Iimt t I sa mj |t tt ||ttIit r
t r stram I|rt i1 -sIima|a Iir] |t rmt rt
t t r t t r I ra Iit rs ir t aI| rt i1 a r1
| j t I| rt i1 1 t ] s. ! kVM k Vt | .
I I 1 j j . ! I I , ma t , 1 1 .
\ . | a mirtI . | rI|atrtt t I j rt1 rist rt a r1
j |trt | a r| iIa | t r ta rirt I|rt i1 Iart-
Iit r |V| M . k rraa | | t r] rtss 1 1I.
! . | itt r | M , K a t|rtirtr | |, | tIsa | | | ,
| ra |a m |k , M t t rt | . 1 j tI|rt i1
a r 1 Irt a It 1 | j t I| rt i1 1 t ] s.
| kVk . k rraa | | t r] rtss 1 1I.
t . | itt r | M , | ra | a m |k , 1 a rtit ! ,
M t t r t . | tmj a rist r t I tr1t] t r t a s
s t ram I| rtI rtj ir t1 ttrttrIra I i t r s
i I| | ttirt 1 rt sj trst It sI rtsa|Is ir
t a I| rt i1 a r 1 | j t I| rt i1 1 t ] s.
k| V| M . krraa| | t r] rtss, 1 1 I.
I. |t |1 ma r || , K t |st r w. | a rirt
| j t I| rt i1 ism. | a r irt a r1 |t | i r t
|r1 t trirt |t ] a r1 | tj rt 1 atIit r w.| .
a ar1 trs 1 1 t , I . t1 itit r.
. |tr] ast r | | . | j 1 a It t r 1 ia ] rt sis t I
ta rirt | j t I| rt i1 ism. VtI. | |ir. t I
K t rI| k m. Vt |. I \ r. 1 , j j . ! ! ,
ma t , 1 1 \ .
1 . |tr] ast r | . | t mmtrIs t r Vt Itrira r
| rIt rma Iit r K tIt r|, 1 1I.
1 . |tr] ast r | | , 1 t trir] . 1 j t I|rt i-
1 ism. ma || a rima | M t 1 t tirt !. | .
|ij irtt II, 1 1 .
. |ra r| | k . | t mj a rist r t I | 1 It 1
sIima|a Iit r It r tta |aa Iir] I| rt i1 Iart-
Iit r ir 1 t ] s. !k k 1 k Vt |. 1 I j j . \
K t tI| tt, 1 1 t .
I . | a s|i|| | , | arIt r , | ||t , M i||tr !,
|a | , | ri| | k . |IIttI t I j |trt | a r-
| iIa | t r stram I|rttrt a r1 I| rt i1
sIima|a Iit r |t rmt rt tt rttrIra Iit rs ir
t j i | t j Iit 1 t ] s. k| V| M . k rr aa |
| t r] rtss, 1 1 .
1 . | ra |a m |k , | tIsa | | | , K a t|rtirtr
| |. 1 ra | j rt1 rist rt 1 i1 rt I saj j rtss
stram I|rt Irt j ir ir ra 1 it I|rt i1 ttIt -
mitt1 | ta ] |ts. k | V| M k r raa |
| t r] rtss, 1 1 .
\ . | ra|am |k , K a t| rtirtr ||. | rt i1 |t r-
mt rt aaIta rIi| t1it s ir I|t 1t]. 1 isI ri-
|aIitr iI| stram tt rttrIraIitrs t I I|-
rttirt ar1 I| rt I rtj ir ir a |a|t ra It r
s a rtt k| V|M . krraa | | tr]rtss, 1 1 .
! . 1 t tri] M , |tr] ast r | | . | t mj a rist r
t I | 1 sIima|a It1 t1 -sIima|a It1 \
ir taI| rt i1 , | j tI| rt i1 a r1 sit|
1 t ] s. k | V| M . k rraa | | t r]rtss 1 1I.
t . 1 t j j tr 1 1 , |t | ma r |, t| tIt ,
| a t r t t | -kj t| k|, M at||tr-| t trir] k ,
| rat raa |, 1 a tmmtr|ir] |, |ti1 i1 r] t r
BIBLIOGRAFA
| , M trisst |, K t | It | . | it mtssar] tt r
ta rirtr 1 tar | ia] rt sIi| 1 tr | j t I|-
t rt st 1 ts | ar1 ts. | tr j ra |sI i t| t
i t ra rtI Vt |. I , r. jj . 1 , 1 1 I.
I. | tt rstr |, 1 t itr | , !t rstr k|,
| 1 s ] a a r1 M , | t t| !. |ta |aaIit r t I
I|t ara |Iita| jtrIt rmartt t I a r trt-
mt immartmtI rit assa || k 1tsi]rt1
It mtasart tr 1t] trt as 1 ir ta rirt
s t ram sa mj |ts l trIra|||. VtIt ri r a rm t 1
k Vt |. \ ! r.I jj . 1 1 M artt , 1 1 .
. !t r st r k |, | tt rstr |, 1 t itr | ,
| risItrstr |, 1 trri|str |. |ta |aa Iit r
t I a r immart ra 1 it mtIrit a ssa It r
I|rt Irt j ir ir stram a r1 j |a sma sa m-
j |ts t I 1 t ] s iI| j rima r |j t I|rt i-
1 ism. !t ar. | t mj . |a I|t |. Vt |. \ r1
j j . 1 1 1 k | ri| 1 1 t .
1 . | ra II w, | itI| k . t Ia | I|rttirt a r1
Irtt |rt tirt ir |j t I|rt i1 ism a r1
r t r t I| rt i1 1 ist a st s t I 1 t ] s.
itra rtI| |ra t Vt |. I I r.! j j . \ I I
1 tIa| rt, 1 1 \ .
I 1 . M a rta M | , |t sIt k , art M | , att ,
Vt r1t M , | amts !!. 1 ijtI i rti1ismt tari-
rt . rttisitr atIaa|ita titr 1t sa 1ia] -
r t sIitt. | |irita tt It ri r a ria 1t jt| a t 1 t s
arima|ts. Vt|. t r. I , jj. , 1 1 t .
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|ta |aa Iit r t I Irtt
\
a r1 tr1 t ] trt as
t1 a s a 1 ia ] rt sIit ItsI It r |j t I|-
rt i1 ism ir 1 t ] s. k | V| M k r ra a |
| t r] rtss, 1 1I.
I I . M i|t r ia | a r irt 1 a j j |i ta Ii t r
s | t tI .
I 1 . M a||tr || , wt |Is|timtr | !, a | t a 1 a
!, 1 t s] t t 1 | . |IIttIs t I |t r] Itrm
j |trt | a r| iIa | Irta ImtrI t r I|t I|-
rt i1 a tis ir 1 t ] s. k| V| M k rraa |
| t r] rtss, 1 1 .
I \ . K a t|rtirtr | |, |t rs| tr] M , !|t rst rr
| k , | tIsa |i | | . Va |i1 a Iit r t I a r a ssa
It r ta rirt 1 k | V| M k r ra a |
| t r] rtss, 1 1 ! .
I ! . K t|st r |w. |t 1 ia ] rt sIit ta |at t I
I rtt
\
t t r t t r I ra Iit rs ir 1 t ] s.
K kV| k rraa | tt r] rtss, 1 1 ! .
I t . |a r t i t ra | |. | a r ir t | j t I| rt i-
1 ism. M a ra a | t I sma || a r ima | tr 1 t -
t ri r t | t ] . I . t 1 i Ii t r | k Vk
| a | | i t a I i t r s .
I I. |a rtitra | |. |rt i1 IartIit r ItsIir] . | s
I|t IaIart |trt! VtI. M t1 . r. j j . ! 1
!a raa r, 1 1I.
I . |a r t i t ra | |, 1 t|Iar1 | , ttr] t| k .
kt a It t IIttIs tI ttrIirat s irIasit rs tI
| amar rttt m| ira rI ir It r|ta|ir-I t r
s t ram I| rti1 |t rmtrt ttrttrIra I i t r s
ir 1t ] s. |ts. ir Vt I. tit. Vt|. ! , jj.
1 t , 1 1 ! .
I 1 . |a ra 1 is M , |a ] t K , |a ri t i t rt K ,
|t r Iair t M . tra m -I rt t I| rttirt tt r-
t t r I raIit rs, mta sart1 | t| t m i | a m i r i s-
ttrtt assa | tIt rt a r 1 a IItr I| rt I rt i-
j ir a1 mirisI raIit rs ir |at |I| 1 t ]s,
| j t rI| rt i1 1t ] s a r1 taI| rt i1 1 t ] s
i I| 1t rm a I| t j a I| its. | a r Vt I !t ar
Vt |. 1I jj . I 1 , M a t , 1 1 t .
1 1 . |a ra 1 is M , |a j trritrt |, |a rititrtrt
K . |IIttIs t I a 1 mirisIra Iit r t I a |t
1 t st t I Irt ttr I|rt Irt j ir t r stram
It Ia | I|rt tirt tt rttrIra Iit rs ir t|iri-
ta || rt rma | 1 t ] s. | a r VtI !t ar. Vt |.
1 ! j j . 1 t I, }arit , 1 1 \ .
1 . |a ra 1is M , |tjirt , |t rra , |t r a I i r t
M . Ia1 its tI ta ritas 1 ia ] rt sIit mtI-
|t 1 s It r ta rirt | j tI| i rt i1ism. VtI
| t rm. Vt|. I j j. I ! , 1 1 .
1 I . |a ra 1 is M . | t marita tit r j trst ra |.
1 1 . |tItrst r M |. 1 sIima|a Iit r ItsIir]
It r | j t I| rt i1 ism. K kV| k rr aa |
tt r] rtss, 1 1 I .
1 \ . |tItrst r M |, M t|ia r | , K it|t |s | .
M ta sartmtrI t I stram It Ia | I|rt ti-
rt, Iriit 1 t I| rt rirt, Irtt I|rttirt,
a r1 I| rt I rt j ir tt rtt rIra Iit r s It r
1 ia ] rt sis t I |j t I|rt i1 ism ir 1 t ] s.
!kVM k . Vt |. I , r. j j . .1 1 t ,
| tttm| tr, 1 1I.
1 ! . |a m s t | | , 1 trrIa ] t M |. k jrt | i m i r a r
asstsmtrI t I I|t ta|at tI mtasarir] tari-
rt 1 |kVk krraa| ttr] rtss, 1 1I.
1 t . |a mst | | , |ta rs 1 , 1 trrIa ] t M |.
|rt i1 sIima|a Iir] |t rmt rt a r1 It Ia |
I|rt tirt tt rttrIra Iit rs ir taIrt i1 ,
sit| taI|rt i1 a r1 |j t I|rt i1 1 t ] s.
!t ar. ma || k rim. |ra tI. Vt |.1 , r. I
j j . ! \ 1 , | tttm| tr, 1 1 .
1 I. |ast|i] , | ra II w. | tItrmira Iit r t I
ta rirt 1 ir | |t t 1 stram t I 1 t ] s
a r1 iIs rta tIit r It I|t | 1 sIima|a Iit r
ItsI itra rtI| |ra t Vt |. I \ r.! , j j .
\ I 1 , t tI. 1 1 t .
1 . t t I I -M t r t ri t II ! | , K t|st r | w.
| |a r] t ir stram 1 tt rttrIra Iit r ir
rtsj t rst It a 1 mirisIra Iit r t I | 1 It
|ta |I| 1 t ] s, |j t I|rt i1 1 t ] s a r1
taI|rt i1 1 t ] s iI| tt rtarrtrI 1 ista -
st !kVM k . Vt |. I 1 , r. 1 j j . .\ 1 ! ,
K tt. 1 1 .
1 1 . t t I I -M t r t ri t II !| , K t|st r | w, | ra r t r
!M , wi||iams | k . | t mj a rist r tI stra m
t t r t t r I raIit rs t I 1 ir |ta |I| 1 t ]s,
| j t I| rt i1 1t] s, ar1 taI| rti1 1t ] s
i I| tt rtarrtrI 1istast. !kV M k . Vt | .
I I , r.1 jj. 1 I, |t| . 1 1 .
\ 1 . i|iarI |, aIm| t a|i |. K t It sIs It r I| t
a sstsmtrI tI I| rti1 IartIit r ir 1t]s.
| t mj. 1 atmaI. |rIt rr. r.I. |j. ! I,
1 1I.
\ . j a r|ts k 1 , | raII1 -!t rts !, wt IIt r
|| , | |ta 1 i|| k , |ta rs 1 , wa ||tr M !.
k sstsmtrI t I 1 t st a r1 Iimt rtsj t rsts
It | 1 a r 1 I| rt I rt j ir ir |ta |I|
1 t ] s. !t ar. ma || k rim. |ra tI. Vt |. 1 t ,
r.t , j j . I \ ! , }arit , 1 1 ! .
\ I . |t 1 a | |, | t marita tit r tr ttI1 trm-
|isIstrt, 1 1I.
\ 1 . |t rtstr | , wtr] t|a r1 | , M t r|ri1 |,
It ||t 1 . |ta |aa Iit r t I a r trtmtIit
immart a ssa It r Irtt I|rt tirt 1 tItr-
mira Iit r ir ta rirt stram. Vt I. | ts.
| t mmar. Vt |. I 1 , r.! j j , \ , 1 1 t .
\ \ . wt| | |!, t rra rtt k | , arIt r k ,
| |tta |m | k . tram 1 a r1 Irtt
\
tt mj a rt1 ir I t t ta rirt sa mj |ts sa| -
miIIt1 It r a sstsmtrI t I I|rt i1 sIa Ias
| kVk . k rraa | | t r] rtss, 1 1I.
C APTULO V G LUC EM IA: C O N TRO L Y TRASTO RN O S
N este captulo abarcaremos las dos posibilidades de alteracin que nos encontramos en el
laboratorio, la hipoglucemia y la hiperglucemia. Respecto a la hipoglucemia proponemos un
abordaje diagnstico sencillo pero donde deberemos conocer las causas que pueden ori-
ginarla para llegar al diagnstico definitivo. En cuanto a la hiperglucemia, como la causa
ms comn es la diabetes mellitus, no entraremos en los detalles del tratamiento ya que cre-
emos que es un tpico especfico de endocrinologa, sino que abarcaremos las partes de esta enfer-
medad donde el laboratorio es imprescindible, como son la monitorizacin de la insulinoterapia y el
diagnstico de los desrdenes asociados.
J. RODN VERNET
Vet. Lab. S. L.
Laboratorio Veterinario de Referencia. Barcelona
|
|
] |att sa , a | at sa aIi|ita tit r ts tt rIiraa . |a tt rttrIra -
tit r 1 t ] |att sa ts ma rItri1 a j t r t| |i] a 1 t . | ara rIt |a s
j rimtra s I \ |t ra s 1 t a art , |a ] |att rtt ] trtsis |tj a Ii-
ta ts |a IatrIt j rirtij a | 1 t j rt 1 attit r 1 t ] |att sa .
| tsj ats 1 t tsIt j trit 1 t |t s 1 tj t siIt s 1 t ] |att ] trt st
a ] t Ia r tmj itta |a ] |att rtt ] trtsis |tj a Iita a j a rIir
1 t |a tIa It , a mirt a ti1 t s ] |ittrt | j a ra t| ma rItrimitrIt
1 t |a ta] |attmia . || ma rItrimitrIt 1 t |a s tt rttrIra tit -
rts 1 t ] |att sa 1 tj tr1 t, j ats, 1 t |a rt rma |i1 a 1 tr |a
sirItsis 1 t ] |att ] trt |tj a Iitt , ] |att ] trt |isis a ] |att rt -
t ] trtsis, a si tt mt 1 t |a 1 isj t ri| i|i1 a 1 1 t |t s j rttarst -
rts |t rmt ra s a 1 ttaa 1 a s. |tisItr ta ria s |t rmt ra s | at
a amtrIa r |a ] |att sa sa r] airta | itr j rt mt titr1 t |a ] |a-
tt rtt ] trtsis t ] |att ] trt |isis t j t r ir|i| itit r 1 t |a aIi|i -
ta tit r tt|a|a r 1 t ] |att sa . |sIa s |t rmt ra s st r ] |ata ] t r,
] |att tt rIitt i1 ts, ta Ittt |a mira s, |t rmt ra 1 t| trttimirt-
It j rt ] tsItrt ra . | aa r1 t 1 ismirat |a tt rttrIra tit r
1 t ] |att sa sa r] airta st a amtrIa |a |i| tra tit r 1 t ] |ata -
] t r j t r |a s tt|a|a s a |Ia -j a rtrta Iita s st saj rimt |a
sttrttit r 1 t irsa|ira j t r |a s tt|a|a s | tIa -j a rtrta Iita s.
|r rtsj atsIa a |a sa| i1 a 1 t ] |att sa sa r] airta , st |i| tra
irsa|ira j t r |a s tt|a|a s | t Ia -j a rtrta Iita s. |a irsa|ira
| a }a |t s ritt|ts 1 t ] |att sa j t r ir|i| itit r 1 t |a ] |att rt-
t ] trtsis j t r| at a amtrIa |a ta j Ia tit r 1 t ] |att sa j t r
|a s tt|a|a s irsa|irt -1 tj tr1 itrIts, It rma r1 t Iri] |ittri1 t s
tr It}i1 t a 1 ij t st j rt mt titr1 t |a sirItsis 1 t j rt Itira s
] |att ] trt st | rt It 1 t masta|t . 1 Ira s tt|a|a s tt mt |a s
1 t| K | ri1t rts, rt rt| aitrtr irsa|ira j a ra |a ta j Ia -
tit r 1 t ] |att sa
I,1 , ,1 I ,1 1
.
HIPOGLUCEMIA
|a |ij t] |attmia st 1 tIirt tt mt ara tt rttrIra tit r sa r-
] airta 1t ]|attsa j tr 1 t| a }t 1 t |a taa | st tsj tra |a tt i s-
Itrtia 1t si]rts t|iritt s rtrm a | m t r It - t 1 m] I1| . |r
] t r t ra|, |a |ijt ] |attmia ts ara tt rsttatrtia Iij ita 1 t.
ara aIi|itatitr ttt t s i ta 1 t ]|attsa j tr tt|a|a s rt rma|ts t
rtt j |a sitas, ] | a t t r t t ] trtsis ] | a t t ]trt |isis |tj aIita s
i mjt1i1as, ara 1tIititrtia tr |trmt ra s 1ia |tIt ] t r a s ,
ara ir] t sIa ira1 ttaa1 a 1 t ] |att sa t I rts sasI ra It s
rt | a t ri1ts j ara |a ] | a t t r t t ] trtsis, t a ara tt m| ira tit r
INTRODUCCIN:
RECUERDO FISIOLGICO
| j a rtrta s tr1 t trirt
t sIa tt mj a t sIt 1 t
a tama|t s 1 t tt|a|a s
tt rt ti1 a s tt mt is|t-
Its 1 t |a r] tr|a rs, |t s
taa |ts saj t rtr ar
I 1 X 1 t |a ma sa tt|a-
|a r j a rtrta Iita , sttrtIa r irsa|ira ,
] |ata ] t r, st ma It sIa Iira j t |ij tj Ii1 t
j a rtrta Iitt . |a irsa|ira ts ara |t rmt -
ra a ra | t |ita rIt a amtrIa t| a |ma tt-
ra mitrIt 1 t ] |att sa , a ti1 t s ] ra st s
a mirt a ti1 t s, mitrIra s | at t| ] |ata ] t r
tsIima|a st | rt It 1 t |a ] |att ] trt |isis
] |att rtt ] trtsis |tj a Iita s |a ttIt ] t-
rtsis. |a stma It sItIira atIaa ttmt
a ] trIt ir|i| i1 t r 1 t |a |i| tra tit r 1 t
irsa|ira ] |ata ] t r, j t r |t Ia rIt
mt 1 a|a sa a ttit r
I
. |a ] |attmia ts t|
rtsa|Ia 1 t rt It 1 t |a j rt 1 attit r aIi|i-
ta tit r ttrj t ra |. |a ta] |attmia st
ma rIitrt jt r ar | a |a rtt 1 ira mitt
trIrt |a j rt 1 attit r, a |ma ttra mitrIt
|i| tra tit r 1 t ] |att sa . |a s IatrIts 1 t
] |a tt sa st r tt t ] tra s tt mi 1 a
tr1 t ] tra s ] |att ] trt |isis ] |att rtt -
] trtsis
I,1 , ,1 I ,1 1
.
| tsj ats 1 t |a ir] t sIit r 1 t ara
tt mi1 a , |a tt rttrIra tit r 1 t ] |att sa ,
a mirt a ti1 t s |t rmt ra s ] a sIrt irItsIi-
ra |ts a amtrIa . k j rt tima 1 a mtrIt |a
miIa 1 1 t |a ] |att sa a | st r| i1 a ts a |ma-
ttra 1 a tt mt ] |att ] trt tr t| |i] a 1 t ,
mitrIra s |a miIa 1 rtsIa rIt st 1 isIri| at
a |t s It}i1 t s. | aa r1 t rt |a tt mi1 a
1 isj t ri| |t 1 ara rIt t| a art , rt st
a | st r| t ] |att sa 1 t| irItsIirt , st
rt| aitrt ara j rt 1 attit r tr1 t ] tra 1 t
|
|
1 t tsIt s mtta rismt s
I, 1 , , 1 I , 1 1
.
| t r It rmt st 1tsarrt ||a |a |ijt ] | a t t-
mia, |a s |trmtra s tt rIra rrt ] a | a 1 t ra s
] | a t a ] t r, ta Ittt |a miras, ttrIist | |tr-
mtra 1 t| trt t i m i t r It a amtrIar, j rt -
m ttitr1 t ar irtrt m t r It tr |a tt rttr-
I ratit r 1t ] |attsa mt1 ia rIt |a ir|i| i-
titr 1 t |a aIi|ita titr j tri It rita 1 t ]| a-
ttsa, aamtrIt 1 t |a ] | a t t ] trt |isis
] | a t t r t t ] trtsis |tja Iita , t ir|i| ititr
1 t |a sttrttit r 1 t irsa|ira . |a jri m t ra
rt s j a t sIa a |a |ij t] |attmia, ts j t r |a
a ttit r 1 t |a tj irtIrira ] | a t a ] t r ,
m i t r I ra s | at t| ttrIist | |a |tmtra 1t|
t rt t i m i t r It str |i| tra 1a s j tta s |t ra s
1 tsjats, j trt sas tIt t It s 1 arar trIrt \ -
t |t ras. || ttrt | rt Iitrt ara rtttsi1 a 1
t | | i ] a It ria 1t ] |att sa . || It}i1 t ttrt-
| ra | Iitrt art s 1 tj t siIt s mirimts 1 t
] | a t t ] trt, ts irta j at 1 t aIi|ita r tI rt s
s a | sI ra Its tt mt IatrIt 1 t trtr] i a .
| t|i1t a tsIa rtttsi1 a1 t ||i] a It ri a ,
|ts si]rt s 1 t |ij t] |attmia st mariIi t s-
Iar st| rt It 1t jt r ara 1isIartitr ttrt-
| ra | tt mt tsI a j t r, tt ma , tt rt a | s i t r t s ,
tam| it s 1t ttmj t rIa m i t r It , 1 t|i|i1 a 1
m a s t a | a r, a Ia tia tt |a jst . |a ma riIt s-
Iatit r 1 t tsIts si] rt s t|iritt s 1tjtr1 t
1 t |a 1 aratit r, 1 t| ]ra1 t 1 t| riImt 1 t
|a 1 ismiratitr 1 t |a ] |att sa sar] ai-
r t a
I, 1 , , 1 I , 1 1
. K t ts ra rt trtt rIra r
j a t i t r Its tr tsIa1 t 1t a |trIa mtrIa |-
m t r It irIa t It s, ttr ara tt rttrIra t i t r
1 t ]|att sa 1 t 1 1 m] I1 | jt r |ijt ] | a t t-
mia s trt r i t a s
!
.
Abordaje diagnstico
|r jrimtr |a]a r, 1 t|tmt s ttrIi rm a r
| at tt i sIa Ia | |ij t] |attmia . |a jrt s t r-
tia 1 t ara |ij t ]|attmia t|iritamtrIt
s i ] r i Ii t a r It st jat1 t stsj tt|a r j t r |a a ramrtsis t| tta -
mtr Iisitt. a m| itr j at1t str ar |a ||at]t tasaa| |a |tra -
It ria|, 1 t r1t tr j rimtr |a] ar 1 t|trtmt s t|imirar |a s ta a-
sa s jt si| |ts 1 t trrt r. | ra ttt t|imira1a s |as ta asa s 1 t
t rrt r rt|a tit ra1 as tt r |a matsI ra |as taasa s a I rt ] t r i-
ta s, |a tta |aa tit r 1ia] rtsIita 1tj tr1tra 1t |a t1 a 1 1t|
a rima |, |t s si] rts t|iritts t I rt s 1a It s |a |tra It ri a -
| t s
I , 1 I , 1 1
. |a |ij t ] |attmia jat1t str mas 1 iIiti| 1 t
1 t m t sI rar tr a rima |ts a ja rt r It m t r It rt rma |ts, j at1 t
rt | a t rir a ra|isis stria1 t s 1t ] |att sa 1 ara r It a arts tt r-
It s t |ar] ts. i |a stsj tt|a t|irita 1t |ij t ] |attmia ts Iatr-
It j trt t| ta|tr 1 t ] |att sa ts rt rma |, st 1t|tr rt a | i t a r
ta rit s a art s ta ria s 1tIt rmiratit rts. || mtIt 1t Ira 1 i-
tit ra | 1 t a art ttrIrt|a 1t tr t| a rima | a 1a|It ttrsisIt tr
1 tIt rmira tit rts 1t ] |att sa ta 1 a I |t ra s mt riIt ri t a-
tit r 1 t| j atitrIt tr taarIt a |a a jarititr 1 t si] rts t|iri-
tt s. || j trit1t 1 t a art j at1 t tt It r 1 t rst |a sIa I I
| t ras, st| rt It1t si st stsjtt|a 1 t ar irsa|irtma
! , 1 , 1 I , 1 1
.
| ra ttt tt rIirma 1 a |a |ij t ] |attmia , st 1 t| tr rta |i-
ta r It rtj tIir |a |isIt ria , tta mtr Iisitt ItsIs |a | t ra It -
ria |ts raIira rit s j a ra trIt ta r t| 1 ia ] rt sIitt |a ||a r |a
ta asa . |r ta t|t rrt s, |a ta asa rt rma |mtrIt ts j t r |ij t -
] |attmia i1 it j a Iita , tsIa rta tit r, irsaIititrtia |tj a Iita
s|arIs t stj sis. |r a rima |ts }tttrts, ts j t r irsaIititr-
tia |tj a Iita , |ij t a 1 rtrt tt rIitismt t stj sis. |r a rima |ts
1 t t1 a 1 a ta rta 1 a , j t r irsaIititrtia |tj a Iita , rtt j |a sia
1 t tt|a|a s | tIa , rtt j |a sia ttIra -j a rtrta Iita , |ij t a 1 rt-
rt tt rIitismt stj sis. | t r |a ttttj tit r 1 t |a |ij t ] |att-
mia a Irt ] trita ta asa 1 a j t r st | rt1 t sis 1 t irsa|ira tr
j a titrIts 1 ia | tIitt s, j t si| |tmtrIt |a |ij t ] |attmia -
ttIt raria tr |tm| ra s ] tsIa rIts t |a |ij t ] |attmia 1 t|
j trrt 1 t ta ta . |a ma t ria 1 t |t s ta st s 1 t |ij t ] |attmia s
tr a 1 a|It s rt| aitrtr tta |aa tit rts 1 ia ] rt sIita s saj |t-
mtrIa ria s
1 ,1 1
.
Yatrogenia (diabetes)
|a |ij t ] |attmia ts |a j rirtij a | rta ttit r It tita a st -
tia 1 a a |a irsa|irt Itra j ia . |t s si] rt s 1 t |ij t ] |attmia
t tarrtr rt rma |mtrIt 1 tsj ats 1 t ta rit s a amtrIt s tr |a
1 t sis 1 t irsa|ira , st |a j a mitrIt ttttsitt 1 t |a a ttit r 1 t
ara |ij t ] |attmia si] riIita rIt
1 ,1 1 ,1 \
. || j rtIt tt |t 1 ia ] -
rt sIitt sa] tri1 t ts
I 1
. sa ta r ara matsIra 1 t sa r] rt j t r
|a ma 1a ra , rtIira r |a tt mi1 a st] air t | Itritr1 t mats-
Ira s ta 1 a |t ra , 1 tItrmira r |a ] |att sa tr It 1 a s t||a s.
| aa r1 t |a ] |att sa ts t 1 m] I1 |, t | Itrtr matsIra j a ra
] |att sa t irsa|ira tt |ttr a a |imtrIa r a | a rima |. |t s
ta |t rts rt rma |ts 1 t irsa|ira st r ! -I 1 | Im|, |a ] |att sa
tr a ara s ts 1 t I 1 - 1 1 m] I1 |. t] ar tsIt s ta |t rts, t|
irsa|irt ma ts ma j rt | a | |t taa r1 t |a ] |att sa ts - t 1
m] I1 | |a irsa|ira 1 t |a misma matsIra tsIa j t r trtima
1 t |t rt rma |, t| irsa|irt ma ts j t si| |t taa r1 t |a ] |att sa
ts - t 1 m] I1 | |a irsa|ira ts rt rma |, t| irsa|irt ma ts
j t tt j rt | a | |t taa r1 t |a irsa|ira ts ir1 tIttIa | |t }arIt
tt r |ij t ] |attmia .
Enfermedad heptica congnita
|a s a rt ma |ia s jt rIt -ta s t a | a rts st r |a ta asa ma s tt mar
1 t |ij t ] |attmia ttr] t r i Ia 1t ta asa |tj aIita . kj art t t
ara |ijt ] |attmia a j tsar 1 t ara a 1ttaa 1a rt1 attitr 1 t
irsa|ira tirt a | a r It 1 t|i1t a arts a |ma ttra mitrIt s ira 1 t-
taa1 t s 1t ] | a t t ] trt |tj aIitt a ara Iartit r |tj aIita
ira1 ttaa 1 a tt mt j ara st j trIa r |a ] | a t t r t t ] trtsis. |t s
j t rrt s ] a It s ttr a rt ma |ias j trIt -ta s t a | a rts sat|tr
Itrtr mtrt s 1 t 1 a 1ts 1t t1 a 1, jat1 tr jrt s t r Ia r taa|-
| a i t ra 1 t |t s si]rt s Iij itt s 1 t |ijt ] |attmia . k1 tmas 1 t
t sIt s si] rt s t|iritt s jat1 tr j rt s t r Ia r Ia m|itr a stiIis, t1 t-
ma s tt mj t rIa m i t r It tt I ra1t trttIa |t j a Iia |tja Iita .
|as a rt rma|i1 a1ts 1t tt mj t rIa m i t r It a amtrIa r jt r |a
i r ] t sIa 1 t jrt Itira |a a 1mirisI ratit r 1 t a |] aras 1rt ] a s .
|ts It sIs 1t s t r t t r i r ] s a ] t sI i tts 1t tsIts 1 tst r1trts irt|a-
tr |ij t a || amirtmia , |ijt tt |tsIt rt |tmia , | a}a ttrttrIra -
titr 1 t arta rt s a | Ia 1t s art rma |ts tr |ts It sIs 1t Iartit r
| t j a I i t a
1
. |as trIt rmt1a 1 ts 1 t a |ma ttramitrIt 1 t ] | a-
t t ] trt st r ar ] raj t 1 t ma ra ra a ja rititr tr |a s | at |a
| i j t ] |attmia st j rt1 att j t r ara irta j ati1 a1 1 t ttrtt r-
Iir ] | a t t ] trt a ] |att sa 1t| i1 t a ara 1tIititrtia ttr]t r i-
Ia a | st |aIa t rt | a I i ta 1 t ara 1 t |a s trtima s rtttsa ri a s
j a ra t| taIa | t|ismt 1t| ] | a t t ] trt. || It sI 1t It | t ra rtia a |
] | a t a ] t r ts art 1 t |t s It sIs asa1 t s tr t| 1 ia ] rtsIitt 1 t
t sIas ja It|t] ias. |a ] |attmia rt a amtrIa 1 tsjats 1t |a
|a irsa|ira tr a rima |ts | at rtti| tr 1 t s
1 t sis 1 t irsa|ira 1 ia ria s, tr a rima |ts
1 ia | tIitt s tt r t}trtitit s ttttsitt s
j rt |t r] a 1 t s t tr j trit 1 t s 1 t a j tItr-
tia |a r] t s, tr ] a It s t tr j trra s t ta -
rit |isItrttIt mita 1 a s Ira Ia 1 t s tt r irsa -
|ira | at j a sa r a ar tsIa 1 t 1 t rt
irsa|irt -1 tj tr1 trtia . |r tsIa s siIaa tit -
rts j at1 t t tarrir ara |ij t ] |attmia
] ratt a rIts 1 t | at |a s |t rmt ra s tt r-
Ira rrt] a|a 1 t ra s sta r ta j a tts 1 t tt m-
j trsa r tsIa |ij t ] |attmia
1 ,I I
.
Insulinoma
|s t| Iamt r ma s tt mar 1 t| j a rtrta s
tr1 t trirt . || ra r] t 1 t irti1 trtia ts tr
a rima |ts 1 t ! - ! a 1t s, sir j rt1 i|tttit r
1 t sttt . |a ma t ria 1 t irsa|irt ma s
t 1 -1 ! X st r ta rtirt ma s Iartit ra |ts,
|a mtIa sIa sis tisttra | ts tt mar, st | rt
It 1 t tr |t s ] a r] |it s |irIa Iitt s rt] it ra -
|ts t |i] a 1 t , t tarrtr tr ar j trit 1 t
iritia | 1 t |a trItrmt1 a 1
1 \
. |a ra Iara |t-
ta Iartit ra | 1 t tsIt s ta rtirt ma s ||tta
a |ij trirsa|irismt s. |t s si] rt s t|iritt s
st r tt mt rtsa|Ia 1 t 1 t |a rtart ] |att -
j tria a amtrIt 1 t |a tt rttrIra tit r
sa r] airta 1 t ta Ittt |a mira s. |a 1 ara -
tit r 1 t |t s si] rt s ts ta ria | |t, ta
1 ts1 t 1 ia |a sIa ta rit s a 1t s
1 ,1 1 ,1 \
. ||
1 ia ] rt sIitt st |a tt 1 tmt sIra r1 t ara
tt rttrIra tit r ira j rt j ia 1 a mtrIt t|t-
ta 1 a 1 t irsa|ira tirta|a rIt tr j rtstr-
tia 1 t |ij t ] |attmia . t sa ta ara
matsIra 1 t sa r]rt taa r1 t |a tt rttr-
Ira tit r 1 t ] |att sa ts t 1 m] I1 | st
1 t It rmira r |a s tt rttrIra tit r ts 1 t
irsa|ira ] |att sa . |at1 t str rtttsa rit
|a ttr a art s 1 t I \ t irt|ast \ |t ra s
tr a rima |ts st sj tt|t st s j a ra ||t] a r a
a 1 m i r i sI ratitr 1 t ] | a t a ] t r tr j trrt s
ttr tsIas trIt rmt1 a 1ts. |a ttrIi rm a-
tit r rt | a i t rt |a |it j sia |tj aIita
1 tIt rmira titr 1 t trtima s tsj ttiIi t a s
1
.
Disfuncin heptica adquirida
|a |ij t ] |attmia j at1 t str tt rst-
tatrtia 1 t ara 1 tsIrattit r ] ra tt 1 t|
| i ] a 1 t j t r rtt j |a sia s j ri m a ri a s ,
mtIa sIa sis, irItttit r | a tItria ra , |tj a -
It Ittira s, Ira ama s t ma s tt marmtrIt
Ii| rt sis |tj a Iita tirrt sis 1 tsa rrt ||t
1 t s|arIs a 1 | airi1 t s. |tisItr ramtrt -
sa s ta asa s j tItrtia |ts j a ra t| 1 tsa rrt -
||t 1 t Ii| rt sis |tj a Iita s st | rt It 1 t tr
j trrt s ] a It s tit}t s. |a |ij t ] |attmia
ts 1 t| i1 a a ara ta rIi1 a 1 ira 1 ttaa 1 a
1 t It}i1 t |t j a Iitt Iar tit r a | j a ra
st j t rIa r ar a |ma ttra mitrIt 1 t ] |att -
] trt t ara ] |att rtt ] trtsis a 1 ttaa -
1 a j a ra st j t rIa r ar a art . |a s tt r-
t t r I ra tit rts 1t irsa|ira j |a sma Iita
1 tt|ira r a j rt j i a 1 a m t r It tt rIt rm t
tmj tt ra |a |ij t ] |attmia
1
.
Insuficiencia adrenocortical
|a |ij t ] |attmia tr j trrt s tt r
k11 ist r ts taasa 1a j tr ara sttrt t i t r
i r s a Ii t i t r It 1 t ] | a t t t t rIitt i1ts rtttsa-
rits ja ra tsIima|a r |a mtti|ita tit r |tja-
Iita j rt 1attit r 1t ] |att sa . |r tsIa
t r It rmt1 a1 |a |ij t] |attmia tt i sIt a
j tsa r 1t |a |tr ara rt1attit r a1ttaa1a
1 t |a tt rttrIra tit r 1 t irsa|ira . ||
k 11 istr ts mas ttmar tr j trrts }ttt r t s
1 t t1a 1 mt1ia. M as 1t| I 1 X 1t |ts
j t rrts a It t Ia 1ts str |tm|ras. |a s art r-
ma |i1 a1 ts tr |t s It sIs 1t s t r t t r i r ] t t m-
j aIi| |ts 1 t tsIa trIt rmt1 a1 str |irIt t i-
Itsis ttsirtIi|ia rt | a I i tas, artmia t rt ] t r t ra I i ta mt 1tra -
1 a, att Itmia jrt rrtra | mt1 ia-]ratt, |ijtr|a|tmia, |ij tra -
I rtmia t |ij trta|ttmia. || 1 ia]rt sIitt st ttrIi rma jt r t|
It sI 1 t tsIima|a titr 1 t k| 1
1
.
Hipopituarismo
|| Ia ||t j iIaiIa rit ts sttrtIar k| 1 ||tta a |a a Irt Iia 1 t
|a tt ra Iastita|a1 a 1 t |a ttrItta a 1rtra |, jt r |t Ia r It
st a |It ra |a sttrttitr 1t ] | a t t t t rIitt i1 ts, art 1t |t s
m a t rts tsIima|ts 1 t |a sirItsis sttrttitr |tj aIita 1 t
] |att sa . k1 tmas, tsIt s a rima |ts jat1tr str irta j atts 1 t
s t t rtIa r |trmt ra 1 t| trt t i m i t r It , t I ra imj t rIa r It |t rm t -
ra ] | a t t r t t ] trita . |at] t t| ma rIt r i m i t r It 1 t |a ]| a t t-
mia tr a ara s tsIa imj t1 i1 t . |a sttrttit r 1 t irsa|ira 1is-
m i r a t a jrt j i a 1 a m t r It, j trt tsIt j at1 t | at rt sta saIi-
t i t r It tt mt j ara j rtttrir |a a ja rititr 1 t |ts sirIt ma s. |s
ara ta asa ra ra 1 t |ijt ]|attmia , rt rm a | m t r It 1ia]rt sI i-
ta 1t tr |a sIt rts k|tmarts }tttrts ttmt 1tIt t It tt r]t-
r i It , t tr j trrt s tt r 1 tIititrtia jiIaiIa ria a1| a i ri1 a sttar-
1 a ria a |a 1tsI rattit r jt r ta rttr, Iraama t irI| a m a t i t r .
K t st t| strta r a rtrma |i1a 1ts t|a sitas tr |t s It sIs 1t
s t r t t r i r ] | a | t ra It ria|. |t s It sIs 1 t tt rIi rmatit r irt|at r
a r t rma|i1 a 1ts tr t| It sI 1 t tsIima|a tit r 1 t k| 1 1 ismi-
ratit rts tr |a ttrttrIra tit r 1t stmaItmt1ira |
1
.
Tumores de clulas no-beta
t |a 1 tstriIt ara ta rit1 a 1 1 t Iamt rts | at ta asa r
|ij t ] |attmia tr j trrt . |a j a It ] trtsis 1 t tsIa |ij t ] |a-
ttmia rt tsIa t|a ra , sir 1 a1 a ts ma|IiIa tIt ria |. |r tsIa s
|ij t ] |attmia s, |a s tt rttrIra tit rts 1 t irsa|ira sat|tr str
ir1 tIttIa | |ts t tr t| ra r] t | a }t . |t s a rima |ts tt r |ij t -
] |attmia s ir1 ati1 a s j t r tsIa s rtt j |a sia s, j at1 tr j rt-
strIa rst j t r sirIt ma s rt|a tit ra 1 t s tt r |a |ij t ] |attmia ,
t |a |ij t ] |attmia j at1 t str ar |a ||a t] t ta saa |
1
.
Hipoglucemia neonatal y juvenil
|| ItIt st a |imtrIa ttrIiraa mtrIt 1t ] |att sa a j arIir 1t
|a j|attrIa rt 1 tjtr1t 1t sa taj a ti1a 1 ]| a t t r t t ] t r i-
ma t|a ra , j trt st trtt | at ts 1 t| i1 a a ar a amtrIt 1 t
|a aIi|ita tit r 1 t ] |att sa Iisa|a r }arIt a ara 1 ismiratit r
1 t |a j rt 1 attit r |tj a Iita 1 t ] |att sa . |a s ta asa s ma s
tt marts 1 t tsIa |ij t ] |attmia st r j a rtt tiras, a | sttst s
j rt sIa Iitt s t |tj a Iitt s, ] a sIrt trItriIis |tmt rra ] ita s,
j it It ra t, j it mtIra s stj Iittmia s ]ra mrt] a Iita s. a
1 ia ] rt sIitt st | a sa tr |a i1 trIiIita tit r 1 t ara irItttit r
] ra tt tr ar a rima | tt r ara |ij t ] |attmia , |a rtst |a-
tit r 1 t tsIa |ij t ] |attmia 1 tsj ats 1 t| Ira Ia mitrIt a 1 t-
taa 1 t 1 t |a irItttit r
! ,1 , ,1 1 ,1 I
.
Artefacto
i rt tt i sIt tt rttr1 a rtia trIrt |t s si]rts t|iritt s |a s
a r t rma|i1 a 1ts |a | t ra It ria |ts, 1 t| tmts tt rsi1 trar sitm-
j rt t| trrtr |a|t ra It ri a |
1 ,
. || ma rt}t iraj rt j ia 1 t 1 t |a s
m a t sI ra s sa r] airtas ts t| trrt r ma s tt mar, j at1 t ||tta r
a ar 1 ia ] rtsIitt Ia |st 1 t |ijt ] |attmia . |a ra mirimita r
t sIt s trrt rts ts rttt mtr1a | |t mt1 ir |a ] |att sa sar] airta
tr sar] rt trIt ra irmt1 ia Ia m t r It 1tsj ats 1 t sa tt I ra t-
tit r, asar1 t |ts ] | a t t s i m tI rt s ma raa|ts tt i sIt r Its. |a
m a t ria 1t tsIt s mtIt 1 t s 1a r art s ta | t rts 1t ] | a t t s a
m t r t rts | at |t s 1tIt rmira1t s j tr mtIt1t s 1 t ] | a t t s a
tti1 asa , |t | at |a | at Itrtr tr tatrIa a |a |t ra 1 t |a
i r It rj rtIa tit r 1 t |ij t] |attmia s. kIt rI a r a 1 a m t r It, tt i sIt
ara | atra ttrrt|atit r trIrt |a ] ra tt1 a 1 1 t |a |ij t ] | a t t-
mia |a 1 istrtj artia trIrt |t s ta | t rts mt1 it s |t s ta | t rt s
tt r1 a 1 t rts tt i sIt r Its. | aa rIt ma s ] ra tt ts |a |ij t] | a t t-
mia mas a Iira 1a st |a tt |a mt1ititr tt r tsIt s ] | a t t s i m t-
I rts. |t s ta | t rts t|Itri1 t s 1 iIi t rtr - 1 m] I1| taa r1 t |as
t t r t t r I ratit rts sa r] airtas 1 t ] |att sa st r - ! 1 m] I1|.
1
|a ] |att sa j at1 t mt1 irst | itr tr satrt s rtIri] tra 1 t s
t tt r] t|a 1 t s. |a s matsIra s rtIri] tra 1 a s 1 t| tr str a ra -
|ita 1 a s j rtItri| |tmtrIt a rIts 1 t |a s I \ |t ra s 1 t |a
ttIra ttit r. |a sa r] rt 1 t| t ttrIriIa] a rst 1 ara rIt |a j ri-
mtra |t ra 1 tsj ats 1 t |a ttIra ttit r. |a tt rttrIra tit r 1 t
] |att sa j at1 t 1 ismirair a ar riImt 1 t 1 m] I1 |I| tr
sa r] rts trItra s a |ma ttra 1 a s a Itmj tra Iara a m| itrIt
1 t| i1 t a | tt rsamt 1 t ] |att sa j t r |a s tt|a|a s j rtstrIts
tr |a sa r] rt. |r sa r] rts rtIri] tra 1 a s I \ |t ra s j at1 t
|a | tr ara rt1 attit r 1 t I 1 m] I1 |
1
.
ta. k | ttrIra rit | at t| ItIt, t| arima |
r t t r a It 1 tjtr1 t 1 t sas ] | a t t ] t r t | i s i s
] | a t t r t t ] trtsis j ara ma rItrtr |a
t a ] |attmia tr jtrit 1t s 1 t a art , irt|a-
st si st r | rttts trIrt tt mi1 as . | t|i1 t
a |a |imiIa titr 1t |a s rt s t rta s 1 t ]| a t t -
] trt , jt ta ma sa masta|a r, Ia | Ia 1 t It } i-
1t a 1 ij t st 1 ismiratitr 1t| ast 1t ati-
1 t s ] rasts |i| rts tt mt IatrIts a|It rr a I i-
ta s 1t trtr] ia , t| rtt ra It Iitrt ar titr-
It rits] t j a ra 1 tsa rrt||ar |ij t ]| a t t m i a
tr jtrit 1 ts 1t a art . |r tsIt s a rima -
|ts, |a |ij t ] |attmia t tarrt a mtra1t
} a r It tt r tI ras a |It ra titrts tt mt str
| i j t It rmia , stjsis, tsIa rtatit r It t|
s i r 1 rtmt 1 t |a |tt|t Ittita . k |ts rtt -
r a It s trIt rmts st |ts 1 t|t 1 tIt rm i r a r
s i t mj rt |a ] |attsa . |a |ij t] |attmia 1 t
|t s jtrrt s miria Iara mtrt rts 1 t t
mtsts 1 t t1a 1 ts tt mar. |ts ta t| t rrt s
ttr |ij t ] |attmia }attri| tsIa r rt rm a |-
m t r It tt j a t sIt s a ar tsI rts tt I rt m t ,
r t rm a | m t r It sa |isIt ria ts 1t ttmj ra
rt t i t r It, ta m|it s 1 t am|itrIt 1 itIa .
|a s a |It ra tit rts ]a sI rt i r It sIira |ts str
Iijita s j at1tr tsIa r ast tia1 t s t rt a
j a ra s i Its. |sIt s ta t| t rrt s sat|tr str
ma Ira ]i|ts, str j rt s t r Ia 1t s a |as
t t r s a | Ia s tt r si]rts ta ria||ts tt mt
1t| i|i1 a1 , tt|ajst , 1tj rtsit r, a Ia t i a ,
t sI a j t r, tt rta|si trts t |ij t It rm i a .
| sIts 1 tst r1 trts 1tsa ja rtttr rt rm a |-
m t r It a | a |ta rta r |a t1 a1 t| jtst 1 t
a 1 a | It s, si |t s si]rt s jtrs i sItr, 1t|tr
| a s t a rst tI ras ta asas 1 t |ij t ] | a t t-
m i a
! , 1 , , 1 1 , 1 I
.
Sepsis
K t ts ara It rma ma tt mar 1 t
|ij t ] |attmia . a j a It ] trtsis rt tsIa
t 1 t| t asar I| a t ra rt st 1itt ttmt
t t r s t rta r It 1t ] |att sa . |sIt jrt 1 a t It
ir|i|t |a aIi|itatit r 1t |a ] |att sa j tr |as
tt|a|a s sa r]airta s. | ts1 it| a 1 a m t r It
t sIt j rt 1 a t It jrt1 att |tmt |isis ttr Irt-
tatrtia, |a |tmt|isis j rt 1att aras |i] t-
ra s 1 ismiratit rts tr |as 1tIt rm i r a t i t r t s
1 t ] | a t t s a
1
.
HIPERGLUCEMIA
Abordaje diagnstico
|| jrimtr ja st ts t|imirar |a s ta a-
sa s 1 t |ij tr] |attmia rt j a It | t ] i t a
tt mt jat1tr str |as |ij tr] | a t t m i a s
ta a sa 1 a s j t r mit 1 t , ttt i Ia ti t r
t sI rts st| rt It 1 t tr t| ] a It t |a
| i j t r]|attmia j t sI -j a r 1 ria |. || mit1 t
|a ttt i Ia tit r ta asar |a |i| tra titr 1 t
t a Ittt |a mira s | at j rt1 attr ] | a t t ] t-
rt|isis |tj a Iita. | | tsI rts j rt 1 att |a
s t t rttit r 1 t ] | a t t t t rIitt i1 ts j t r |a
] |a r1a|a a 1 rtra| | at ||tta a |a ] | a t t -
r t t ] trtsis |tj a Iita . | r st] ar1 t |a] a r
| a | at t|imira r ta asa s a I rt ] t r i t a s
tt mt j at1 tr str |a s irIasit rts 1 t sat-
rt s ] |attsa 1 ts t 1 rt ] a s |ij tr] | a t t-
m i a r Its. | ra ttt tt rIi rma 1 a |a |ij tr-
] |attmia , |a | at |a||a r sa ta asa ,
1t trIrt t||a s, Ia | |a | |a ma s tt mar
ts |a 1 ia | tIts mt||iIas | .M . j t r |t
| at rts tt It r 1 t rmt s arita mtrIt tr
t sIa trIt rm t 1 a 1 .
Diabetes mellitus
|a | M ts ar 1tstr1 tr 1t| mtIa | t | i s-
mt 1t |t s |i1 ra Its 1t ta r|trt 1 t tI i t | t-
] ias ma|Iij |ts, | at imj|ita ara 1 tIi-
titrtia rt | a I i ta t a |st|aIa 1 t irsa|ira t
i r s a | i r t rrt s i sItrtia t a m| as. || ja jt| 1t| |a| tra It rit tr |a
| M st |asa st| rt It1 t tr Irts a sjttIt s. |r j rimtr |a] a r,
tr t| jrtjit 1ia] rt sIitt 1t |a | M , tr st]ar1t |a] ar tr |as
Iasts 1t tsIa| i|itatit r mtriIt ritatit r 1t| Ira Ia m i t r It
tr It rttr |a]a r tr t| 1 ia] rtsIitt 1t |ts 1 tst r1 trts a st tia -
1 ts a |a | M .
Diagnstico
|t s j i|a rts | a sitt s j a ra t| 1 ia ] rt sIitt 1 t tsIa trItr-
mt1 a 1 st r.
i] rt s t|iritt s. || 1 ia ] rt sIitt 1 t |a | M st | a sa tr |t s
si] rt s 1 t j t |iaria , j t |i1 ij sia || I|| , j t |iIa ] ia j tr1 i-
1 a 1 t j tst . |a sirIt ma It |t ] ia ta ria mat|t tr sa irItrsi-
1 a 1 1 t art s a rima |ts a t Irt s a tttts j at1 t j a sa r
1 tsa j trti| i1 a 1 ara rIt mat|t Iitmj t
I 1
.
|rat| a s |a | t ra It ria |ts tsj ttiIita s. |a |ij tr] |attmia
tr a ara s ts ara ta ra tItrisIita Iar1 a mtrIa |. |a ra tt r-
Iirma r t| 1 ia ] rt sIitt , ts imj rtstir1 i| |t mt1 ir |t s ritt|ts
1 t ] |att sa tr sa r]rt tr t rira . a rIt tr j trrt tt mt tr
] a It |a ] |att sa t sti|a trIrt 1 - I 1 m] I1 |. |r |t s a rima-
TABLA I Causas de hiperglucemia
Diabetes mellitus
Estrs (gato)
Postpandrial
Hiperandrenocorticismo
Acromegalia
Diestro (perra)
Pancreatitis
Neoplasia exocrina pancretica
Insuficiencia renal
Terapias (drogas): glucocorticoides, progestgenos
Infusiones con glucosa
Error laboratorio
|ts 1 ia | tIitt s tsIt s ta |t rts a amtrIa r
j t r trtima 1 t |t s I 1 1 -I ! 1 m] I1 |
I 1
.
|s imj t rIa rIt rttt r1 a r | at t| ] a It ts
ma sasttj Ii| |t a 1 tsa rrt ||a r |ij tr] |a-
ttmia s 1 t tsIrts | at j at1 tr a |ta rta r
ta |t rts 1 t 1 1 1 -\ 1 1 m] I1 |
I 1
| at st r
1 t| i1 a s a ar a amtrIt 1 t |a j rt 1 at-
tit r 1 t ] |att sa tr |a] a r 1 t ara 1 ismi-
ratit r 1 t |a aIi|ita tit r j triItrita 1 t |a
] | a t t s a
. k1 tmas, |a |ij tr] | a t t m i a

j t sI-j a r1 ria | rt t tarrt tr ] a It s 1 ia-
| tIitt s a |imtrIa 1 t s tt r |a s Iij ita s 1 it-
Ia s It|ira s, j t r |t | at tr tsIt s a rima -
|ts rt ts rtttsa rit t| a art j a ra |a
mt1 itit r 1 t |a ] |att sa | a sa |
I \
. |a ] |a-
tt saria a j a rttt taa r1 t |a ] |attmia
a |ta rta tt rttrIra tit rts - 1 -I 1 1
m] I1 |. |sIa ] |att saria a 1 tma s 1 t tr
|a | M , Ia m| itr j at1 t a j a rtttr tr
j rt ttst s tt mt |a trItrmt1 a 1 Ia| a|a r
rtra | rt ttisIt |ij tr] |attmia tr |a
|ij tr] |attmia 1 t tsIrts
I 1
. |at1 t ttis-
Iir t rt ttIt raria , |a ] ratt1 a 1 tsj t-
tiIita j at1 t str rt rma |, a j tsa r 1 t |a
j t |i1 ij sia , 1 t| i1 t a |a ] |att saria . ||
ItsI 1 t It |tra rtia a |a ] |att sa irIratt-
rt sa , a ar| at ts ma |a | t rit st
rt| aitrt ara s tt r1 itit rts ma tsj tti-
Iita s 1 t |t sj iIa |ita tit r, si] at sitr1 t
Ia 1 tia ar ItsI ta |i1 t , a | at j at1 t str
t| aritt mtIt 1 t 1 t rta |ita r 1 ia ] rt sIi-
tt s tr |ij tr] |attmia s mt1 ia s tr
i1 trIiIita r |a irIt |tra rtia a |a ] |att sa
tr a |] art s ] a It s. 1 a sIa t| 1 X 1 t |t s
] a It s j rtstrIa r tsIa irIt |tra rtia | at,
a 1 tma s, tmj tt ra tt r |a t1 a 1
t ,I
.
Estabilizacin y monitorizacin
| ra ttt 1 ia ] rt sIita 1 a t|a siIi t a 1 a
|a trIt rmt1 a 1 , st irsIa a ra t| Ira Ia m i t r-
It . Ya | at j rtItr1tmt s | at tsIt Ira | a }t sta ttt | a s i ta -
m t r It 1 t 1ia ] rt sIitt , 1 t| i1 t a | at tt i sItr 1 itt rs t s
j rt It tt |t s 1 t Ira Ia m i t r It, rt trIra rtmt s tr |t s 1 tIa | | t s
j rt jits 1 t |a Ia st 1 t tsIa | i|ita titr 1 t tsIt Ira Ia m i t r It ,
sirt | at rt s tt It r 1 t rtmt s tr |a ja rIt 1 t| mismt 1 tr1 t
t| |a | t ra It rit t}trtt sa j a j t| ma s imj t rIa r It, tt mt st r
|a mtriIt rita titr 1t |a irsa|irt It ra j ia t| 1 ia ]rt sIitt 1 t
1 t s t r1 trts a st tia 1 t s a tsIa trIt rmt1 a 1 a sa Ira Ia -
m i t r It . | t mt rt ] |a ] t r t ra |, j t 1tmt s 1 ttir |at t| t | }t-
I i tt 1 t |a irsa|irt It ra jia ts marItrtr |a ]|attmia trIrt
1 1 - 1 m] I1 | j a ra j trrt s 1ia| tIitt s sir ta Ia ra Ia s, 1 1 -
I ! 1 m] I1 | tr jtrrt s tit]t s j tr ta Ia ra Ias 1 1 -1 1 1
m] I1 | tr ] a It s 1ia| tIitt s
1
. |a ] |attmia Iatra 1t tsIt s
rar] t s ts ara ir1 itatit r j a ra rta|itar a } a sIts tr |a irsa-
| i r t It ra j ia , tsj ttia |mtrIt si t| a rima | Iitrt si] rt s 1 t
|ij t t |ij tr] | a t t m i a
1
.
Monitorizacin
ta taa | sta t| j rt It tt |t 1 t Ira Ia mitrIt asa 1 t j a ra
|a Ia st 1 t tsIa | i|ita tit r, a rIts 1 t j a sa r a |a Ia st 1 t
mt riIt rita tit r, ts imj t rIa rIt rttt r1 a r | at a | Iira | 1 t |a
Ia st 1 t tsIa | i|ita tit r |t s a rima |ts 1 t| tria r Itrtr ara
rtsj atsIa tt rsisItrIt ta |t ra 1 a mt1 ia rIt tarta s 1 t ] |a-
tt sa a ara 1 t sis ma s t mtrt s Ii}a 1 ara rIt 1 -\ 1 ia s a rIts
1 t str tt rsi1 tra 1 t s tt mt tsIa | |ts, a | at st j at1 tr
Ia r1 a r -1 1 ia s j a ra a |ta rta r tsIa rtsj atsIa
1
. |sIa Ia st
1 t mt riIt rita tit r |a 1 iti1 irtmt s tr 1 t s, ara j rimtra
Ia st 1 t mt riIt rita tit r a tt rIt j |a tt t irmt1 ia Ia mtrIt
1 tsj ats 1 t |a | tr 1 a 1 t 1 t a |Ia a | a rima |, t Ira Ia st a
|a r] t j |a tt , tr |a | at, ara ttt t| a rima | tsIa | itr tt r -
Irt |a 1 t , st rta |ita r rttisit rts ta 1 a j t ta s stma ra s t
mtsts, a | at rt] a|a rmtrIt st rtttsiIa r j t| at1t s rta -
}asIts tr |a 1 t sis 1 t irsa|ira 1 ara rIt It 1 t t| tarst 1 t |a
trItrmt1 a 1
1
.
M t riIt rita tit r a tt rIt j |a tt . |r tsIa Iast 1t| Ira Ia-
m i t r It st ta | t ra |a rt s j a t sIa t|irita 1t| a rima| 1 ia |tIitt
j t r |t s si] rts t|iritts j tr |a mt1itit r 1 t ] | a t t s a ria
t tIt r a ria. || jrt j i tIa rit 1 t| t mt1 ir |a ] | a t t s a ria 1 ara r-
It I -\ tttts a | 1 ia mt}t r a rIts 1 t |a a 1 mirisI ra tit r 1 t
| ra ttt t| a rima | tsIa tt rIrt |a 1 t , st rt tta |aar |a s 1t sis
1t irsa|ira mt1 ia rIt rttisit rts a| arima | ta1 a 1 I -\
mtsts ir1 tjtr1 itrIt m t r It 1 t| tt rIrt | ta strt . |a rt t a-
rrtrtia t j trs i sItrtia 1 t |t s si]rt s t|iritt s, st r | aita s |a
t t mj |ita tit r ma s tt mar 1t |a irsa|irt It raj ia sa] itrt r
ara irsa|irt rrt s i sItrtia , t ara irtIitatia 1t |a irsa|ira
1 , 1
.
| |att saria . |a mt1 itit r 1 t |a ] |att saria , a ar| at
rt j at1 t asa rst tt mt | a st j a ra |a ttr ta m| it s tr |a
irsa|irt Itra j ia , Iitrt It 1 a tia ar j a j t| a |] t imj t rIa rIt.
|a j rirtij a | ttrIa }a ts | at st j at1 t asa r |a a j a ritit r 1 t
Ira ta s tr |a s Iira s rta tIita s j a ra 1 tIttIa r Ira sIt rrt s 1 t
rt] a|a tit r 1 t It rma ma Itmj ra ra . | tsj ats 1 t ara
| atra tsIa | i|ita tit r rt] a|a rita tit r 1 t| Ira Ia mitrIt , ts
saIititrIt mt1 ir |a ] |att saria I -1 tttts j t r stma ra , tr
ta ria s matsIra s. || a rima | | itr tt rIrt |a 1 t rt 1 t| t j rt-
strIa r ] |att saria 1 ara rIt ta si ar j trit 1 t 1 t I \ |, si
r t Ia mt s aamtrIts tr ] | a t t s a ria trItrtts 1 t|tmt s
j a sa r a mt1 itit rts ma s IrttatrIts I -1 tttts j t r 1 ia
| aita s a tIttIaa r mt1 itit rts 1 t ] |attmia
I , 1 , 1
.
|ra t It samira |tmt ] |t |ira ] |att si|a1a. | t |a s jra t-
| as |it| aimita s | at jt1 tmts asar st|t str rt | tta r Its |a
I ra t It sa mira |tmt] |t |ira ] |attsi|a1 a, a | at |ts It sI s
1 t | it| aimita |tjaIita tt mt It s Ia Iasa a|ta |ira, k | k,
rt st r ta|i1t s tr t| ttrIrt| a j tsa r 1 t |a ||ar tt rttrIra t i t -
rts t|tta 1a s 1 t tsIas trtimas Ia r It tr j atitrIts rt Ira Ia-
1ts ttmt tr Ira Ia1t s irtsIa | | t s
I
. || It rmirt I r a t I t s a m i r a
|a tt rt It rtrtia a | jrt 1 a t It 1 t |a rta ttitr rt trtimaIita
t r I rt |a ]|attsa ]raj ts amirtjrt Ititt s, sa ttrttrIra -
titr rt s 1 a i1ta 1 t |a ] |att si|atit r 1 t It 1a s |as j rtIt i r a s
s t rita s. | t trIrt t||as, |a a ||amira ts |a j rtItira ma t ri Ia -
ria Iam|itr |a | at ma s ra j i 1 a m t r It st ] |att si|a, jt r |t
Ia r It ts t| jrirtij a| ttrsI i I a t r It 1 t| ] rajt 1 t j rt It i r a s
]|attsi|a1 as. |a Iasa 1 t ]|att si|atitr 1t |a s jrt It i r a s
1tjtr1t Iar1a mtrIa | m t r It 1 t 1t s Ia t It rts. |tr ara j arIt ,
1 t |a tt rttrIratit r mt1ia 1 t |a ] |attsa tr t| It rrt r It tir-
t a | a It rit, j tr t I ra ja rIt, 1 t |as jrtj ias ta ra t It r i sIita s 1t
|a s mt|tta|a s jrt Itita s, jri r t i j a | m t r It sa ti1 a mt1ia tr
t i rta|atitr, jtrit 1t tr t| | at tsIa r tr tt rIa t It 1 irt t It tt r
|a ] |attsa tr sar] rt. tritr1t tr tatrIa |at |a ti1 a mt1ia
1 t |a a|| amira tirt a | a r It ts 1t a jrtt i m a 1 a m t r It 1 ias tr
|t s tarr i tt rts, |a tt rttrIra tit r 1 t |ra t It samira rts 1a ra
|a irsa|ira \ - |tra s jt sI -i rt t t i t r .
| 1 t a | m t r It, rt 1 t| tr tt i sIir ta | t rts 1 t
] | a t t s a ria t ttIt r a ria tt mt mat| t
j t s i I i tt s ma | a }t s , |t | at ir1 ita ria
| at |a 1t sis ts tt rrt t Ia t ttt t s i ta. |a
j rtstrtia 1t a |It s ta | t rts 1 t ] | a t t s a ri a
ir1 ita ria ara 1t sis irsaIi t i t r It
I , 1
. |s
i mj t rIa r It rttt rt ttr |a s |imiIa tit rts 1t
t sIas mt1 itit rts | at sa irIt rj rtIa t i t r
1 t| t str tri t r Ia I i ta rt asa r tsIt j a ra -
m tI rt tt mt | a st ri] i1 a j ara |attr
ta m| it s tr |a 1 t sis 1 t irsa|ira , a | a t
tt i sItr t I ras taasas 1 t ] | a t t s a ria a
j a rIt 1 t |a 1 t sis irsaIi t i t r It 1 t irsa|ira ,
tt mt jat1tr str t| mtIa |t |ismt ra j i 1 t
1 t irsa|ira |a st |rt1 tsis 1 t irsa|ira
tt r |ij tr] |attmia 1 t rt | tIt. k1 t m a s ,
|a ] | a t t s a ria rt j at1 t 1iIt rtrtia r |a
t a ] |attmia 1t |a |ij t] |attmia , a | a t
|a s 1 t s tarsa r tt r ] | a t t s a ria s rt]a I i-
ta s
I , 1
. | tsj ats 1 t I -1 stma ra s 1 t Ira-
Ia m i t r It st 1 t| t rt tta |aa r a | a rima |
rta |ita r t| ttrIrt | j t r tarta s 1 t ] | a t t-
sa , a |at ja ra tta |aa r a 1ttaa 1a mtr-
It |a tIita tia tr t| ttrIrt | It ra jtaIitt st
1 t| t sa | tr t| iritit , t| jitt |a 1 ara-
tit r 1 t |a attit r 1 t |a irsa|ira
I , 1
.
M t riIt rita tit r a |a r] t j |a tt . | ra
ttt t| a rima | tsIa | itr tt rIrt |a 1 t st
1 t| tr rta |ita r tta mtrts t|iritt s mtr-
saa |ts t | imtrsaa |ts j a ra j t 1 tr i1 trIi -
Iita r |t ma s j rt rIt j t si| |t, Ira sIt rrt s
1 t| tt rIrt | 1 ia | tIitt
1
. |sIa s rttisit rts
1 t tt rIrt | tt rsisItr tr.
i] rts t|iritts. |t ma s imj t rIa r It
st r |a s imj rtsitrts 1 t| jrt j i tIa rit a ttr-
ta 1t |t s si] rt s t|iritt s 1 t| arima |, si
t sIt s Ia t It rts tsIa r tt rrt t It s t| arima |
1 ia |tIitt tsIa ]t r t ra | m t r It ttrIrt | a 1 t .
mt1ia 1t |ts ] |t |a|ts rt}t s ts aj rtt i m a 1 a m t r It 1t I 1
1 ia s, jt r |t | at tt r t| a ra|isis 1t 1 |k
t
jt 1tmt s |attr-
rt s ara i1 ta 1 t |as tt rttrIra tit rts mt1 ias 1t ]|attsa sa r-
] airta 1ara r It |a s ! -1 stmaras a rIt ri t rts a |a j ra t | a
I 1
.
| tsjats 1t art s a1ts 1tr1 t sa 1tIt rmiratit r saj tria
t i t rIa 1 iIi t a | Ia1 jt r mtI i tts Ittritts, |tmt s ||t]a 1t a ar
t sIa1 t 1t r1t a tt i sItr jrat|a s ta |i1 a1 as Iia||ts ja ra
sa 1tIt rm i r a t i t r .
t , I
| arta s 1 t ] |att sa Ii]. . |as 1tIt rmira titrts stri a-
1as 1 t ] |att sa st asa r Irt t a t r It m t r It jara mtriIt ritar |a
i r s a | i r tIt raj ia. |sIa s tartas 1t ] |att sa str rtttsari a s
1 a ra r It |a rt]a|atitr iritia|, tr |a mtriIt ritatit r a |ar] t
j |a tt a ar|at t| tt rIrt| tr tasa sta tt rrt t It, taar1 t st
r t t t s i Ia rt sIa| |tttr t| tt rIrt | mt1iarIt a } a sIts tr |a irsa|i-
r t It ra jia, 1tsjats 1 t tjist1it s 1 t |ijt t |ij tr] | a t t-
m i a
1 , 1
. k a r |at |as tarta s 1t ] |attsa str atIaa |mtrIt t|
mt}tr mtIt1 t j ara ta | t ra r t| tt rIrt| 1ia |tIitt, |ts rt s a | Ia -
1 ts j at1 tr str a It t Ia1 ts jt r ta rits Ia t It rts imj t rIa r It s
ttmt st r t| tsI rts jt r |a |tsj iIa |ita tit r, ira jtIt r t i a ,
s t t rttitr 1 t |t rmtra s ttrIra rrt ] a | a 1 t ras |a tt i sIt r t i a
1 t a|] ara trIt rmt1a 1 ast tia1 a. k j tsa r 1t tsIts jrt | | t-
mas |as tarta s 1 t ] |attsa ttrIiraar sitr1t , st]ar t| a aIt r,
ara i1 ta 1t |t s ritt|ts 1t ]|att sa tr t|
a rima| 1 ara r It -1 stmara s arIts 1t|
a ra |isis. k si jats, jt 1tmts 1ttir | at |ts
r i tt|ts 1 t Ira t Itsa mira strita a amtrIa-
rar tr siIaa titrts 1t |ij tr] |attmia jrt-
| t r ] a1 a s, mitrIra s | at 1 ismiraira r
taar1 t |a a ar ta Ia |t |ismt jrt It i t t
a t t | t ra 1t t tr tasts 1t |ijt ]| a t t m i a
t rtrita , ttrsi1trar1t st ar |atr ir1ita-
1 tr 1t |as a|It ratit rts mtIa |t |ita s 1t |a
] | a t t s a
I 1
. | |iritamtrIt sa 1tIt rm i r a -
tit r st asa j ara t| 1ia ]rtsIitt 1t |a
| M , st |rt It 1t tr ] a It s j ara 1isI i r ] a i r
t r I rt | M t |ij tr] |attmia 1t tsI rts
j a ra t| ttrIrt | 1t| Ira Ia m i t r It , aar| a t
tr tsIt ajarIa1 t st 1t| a attmja 1ar 1t
t I rt s j ara m tI rts tt mt |ts si] rt s t|iritts
1 t| a rima|
, \ , t
. |r ] a It ar rt s a | Ia 1 t
r t rma| rt ttt | a t |a | M , a | at |a Ira t-
It samira j at1 t Ia r1 ar trIrt 1 -I 1 ia s tr
t | tta rst ttr |ijtr] |attmias ] ra tts
ara s t stma ra s tt r |ij tr] | a t t m i a s
m t 1 i a s
I I
. k1tmas, tt i sItr siIaa titrts
tt mt |a |ij tj rt Itirtmia j trrts
] a Its , |a attItmia t |ij tr|ij i1tmia tr
j t rrts 1 tr1 t sa 1tIt rmiratit r rt ts
ta|i1 a, mitrIras | at |a |ijtr|i|irra | i r t-
mia |a |ijtrj rt Itirtmia rt aIt t Iar sa
ast t|iritt
1
. |a |tmt] |t |ira ]| a t t s i | a -
1 a st It rma mt1 iarIt ara rtattit r rt
trtimaIita trIrt |a ] |att sa |a s mt|t-
ta|a s 1 t |tmt] |t |ira tr t| irIt ritr 1t
|t s tri I rt t i Its. |a 1 |k
t
ts |a Ira t t i t r
] |att si|a 1a mas imj t rIa r It 1t |a |tmt-
] |t|ira k, |a taa | sajtrt t| tasi t|
1 1 X 1t |ts tri I rt t i Its ta rirt s. |a ttr-
t t r I ratitr 1t 1 |k
t
tr sar] rt j tri It ri-
ta 1tj tr1 tra 1t |a ti1a mt1ia 1 t |ts
t ri I rt t i Its tirt a | a r Its 1 t |a ]| a t t m i a
mt1ia 1ara r It tsIt jtrit 1t 1t Iitmj t .
|r |ts ta rr i tt rts 1tmtsIitts |a ti1 a
Fig. 1. C urva ideal. M antenim iento de las concentraciones
de glucosa entre 180-220 m g/dl durante las 24 horas
del da y un nadir m ayor de 80-100 m g/dl.
ara |trra m i t r Ia imj rtstir1i||t tr t|
t t r I rt| 1t |a irsa|irtIt ra j i a
1
. |t mas
i mj t rIa r It 1 t tsIas tarta s str |as ttr-
1 ititrts irIra | t s j i Ia | a ria s 1t mart}t 1t|
a rima|, | at 1 t|tr str |t ma s tta t Ia s
jtsi| |ts a| ma rt}t | at st tsIa rt a | i t a r-
1 t tr t| 1tmiti|it 1 t| arima|, ts 1ttir,
t sIas tarta s st 1t| tr rta|ita r st]ar t|
rt] imtr a|imtrIitit |as ttr1 itit rts 1t
a 1 m i r i sI ratitr 1t |a irsa|ira atIaa |ts,
1 tIt rmira r |a ] |attmia a jrtt i m a 1 a m t r-
It ta 1a I |. |sIt a a1a a | t|iritt tr |a
1 tIt rmira tit r 1t| Iitmjt tr | at ttarrt
t| j itt 1t| tIt t It 1t |a irsa|ira , |a 1 ara-
titr 1 t| tIt t It t| ] ra1t 1 t I| a t I a a t i t r
tr |a s ttrttrIra tit rts 1 t ] | a t t s a
1 , 1
.
|| j rimtr Ia t It r a tsIa1iar tr |a tarta
1 t ]|attsa ts |a tIttIiti1 a1 1 t |a irsa|i-
ra j a ra 1ismirair |a s ttrttrIra t i t r t s
1 t ] |att sa. |sIt st tta|aa mt1iarIt |a
t | s t rtatitr 1t |a It rma 1t |a tarta
ta|ta|a r1 t t| 1iIt rtrtia| 1 t |as tt rttr-
I ratitrts 1 t ] |attsa 1iIt rtrtia trIrt t|
ta|tr ma timt t| mirimt t| Itri1ts , si
|a tarta ts ttt t s i ta m t r It j|a ra t rt
| a mat|a 1 iIt rtrtia trIrt |t s ta | t rt s
matimts mirimts 1 iIt rtrtia | | a } t ,
ts | at |a irsa|ira rt ts tIt t I i ta
1 , I !
. |r
t sIa ta | t ra tit r st 1 t| tr Itrtr tr tatr-
Ia |t s ta | t rts t | Itri1t s, a | at ar 1 iIt-
rtrtia| |a }t tr tt rttrIra tit rts stri a-
1 a s 1t 1 1 a 1 m]I1 |, ir1ita ar |atr
t t r I rt |, mitrIras | at ar 1 iIt rtrtia | | a } t
tr ttrttrIra tit rts - I ! 1 m] I1 | ir1 ita
ara tIitatia jt | rt 1 t |a irsa|ira
1 , I !
. i
rt tt i sIt tsIa tIitatia , st 1t|t j trsar
tr ara Ittrita 1 t a 1mirisI ratit r ira-
j rtj ia 1 a , 1 tsis | a}a 1t irsa|ira , ma
j t tt j rt | a| |t si t| a rima| tsIa It m a r-
1 t -I ,I | I|] jtrma rttt |ij tr] | a t t-
mitt |a ma tria 1t| 1 ia
I 1
jt ta 1 ara -
tit r 1 t| tIt t It , ara t|ttatit r Ia |sa 1 t |a ] |attmia ast tia -
1 a a tsI rts ] ra tt 1ara r It |a tt I ra ttitr 1 t |a matsI ra, ara
a | s t rtit r 1 tIi t i t r It 1 t |a irsa|ira tr t| siIit 1 t |a irt t-
titr st| rt It 1t tr irsa|ira a|Ira | t r Its , t irsa|irt rrt s i s-
It r t i a
I , 1 , 1 , I !
.
|| si] aitrIt j a st ts |a 1 tItrmira tit r 1 t| ra 1 ir t|
ta |t r 1 t ] |att sa ma s | a }t t | Itri1 t 1 ara rIt |a s I \ |t ra s
1 t| 1 ia t| taa | ts 1 t a a1 a tr |a tta |aa tit r 1 t |a 1 t sis
1 t irsa|ira . |sIt ra 1 ir 1 t| t tsIa r trIrt 1 - I ! m] I1 |,
|a | ra | at a amtrIa r t 1 ismirair |a 1 t sis si tsIa mt s j t r
trtima t j t r 1 t| a }t rtsj ttIita mtrIt 1 t tsIt ra 1 ir,
tta |aa r |a rtsj atsIa a | ta m| it 1 t 1 t sis a |t s I - 1 1 ia s
1
.
k tttts ar a rima | j at1 t mt sIra r 1 t s ta |t rts ra 1 ir tt r
ara st |a 1 t sis 1 t irsa|ira , |t | at ts ara | atra ir1 ita -
tit r j a ra j a sa r a I irtttit rts 1 ia ria s
I , 1 , 1 ,I !
.
|a 1 ara tit r 1 t| tIttIt st asa j a ra tta |aa r |a Irttatr-
tia 1 t a 1 mirisIra tit r 1 t |a irsa|ira . | 1 ta |mtrIt, |a ] |a-
tt sa 1 t| t tsIa r trIrt 1 -I ! 1 m] I1 | t| 1 -1 1 X 1 t| Iitm-
j t . |a 1 ara tit r 1 t a ttit r st 1 tIirt tt mt t| Iitmj t Ira rs-
tarri1 t 1 ts1 t |a irtttit r 1 t |a irsa|ira |a sIa | at st
a |ta rta r ta |t rts 1 t ] |attmia - a I ! 1 m] I1 |. |sIa t ta -
|aa tit r rt| aitrt ar ra 1 ir tt rrttIt , 1 tsj ats 1 t tsIt
ra 1 ir, |a ] |attmia 1 t| t a amtrIa r j rt ]rtsita mtrIt tsj t-
t i a | m t r It j t sI -j a r 1 ri a | m t r It. | t rtra | m t r It r t st
1 t| tr j |a rIta r a }asIts tr |a Irttatrtia 1 t a 1 mirisIra-
tit r |a sIa t | Itrtr ar ra 1 ir a ttj Ia | |t. |r a rima |ts tt r
ar ra 1 ir - 1 m] I1 |, rt st j at1 t tta |aa r |a 1 ara tit r 1 t|
tIttIt , j t r t| j t Itrtia | 1 t ir1 attit r 1 t ar tIttIt
t mt ] i | at ttisIt | at j t 1 ria 1 ismirair Ia |sa mtrIt |a
1 ara tit r 1 t tIttIt , a 1 tma s, j at1 t str | at rt st t | Itr-
] a ar ra 1 ir a ttj Ia | |t tr a rima |ts | at tsIa r rtti| itr1 t
1 t s 1 t sis 1 t irsa|ira j t r tt rIa 1 ara tit r 1 t tIttIt , tsIt
j at1 t str 1 t| i1 t a |a ] ra tt1 a 1 1 t |a |ij tr] |attmia | at
ttisIt tr |a ma 1a ra si] aitrIt a |a j trsisItrtia 1 t |a s
] |att ] trt |isis ] |att rtt ] trtsis |tj a Iita s
I , 1 , 1 ,I !
.
Diagnstico de
desrdenes asociados
|as tt mj |ita titrts 1 t |a irsa|irtIt ra j ia ||tta r rt rm a |-
m t r It a |a rt t a rrtrtia 1t |ts si] rt s t|iritt s 1t 1 ia | tIts t
mtta rismt s | at irItrIitrtr tt r |a a ttit r 1 t |a irsa|ira ,
st tt rsi] at ara |ij tr] |attmia . || j trit 1 t 1 t |ij t ] |a-
ttmia titrt st] ai1 t 1 t ara ra j i1 a |ij tr]|attmia j t r
trtima 1 t I ! 1 -I 1 m] I1 | tr ar tt rIt tsj a tit 1 t Iitm-
j t . Ya | at |t s a rima |ts 1 ia | tIitt s rt Iitrtr irsa|ira
tr1 t ] tra j a ra rt rma |ita r tsIa |ij tr] |attmia st j at-
1 tr a |ta rta r tt rttrIra tit rts 1 t \ 1 1 - 1 1 m] I1 | mitr-
Ira s | at |t s a rima |ts 1 ia | tIitt s rt Ira Ia 1 t s sat|tr Itrtr
|ij tr] |attmia s irItrit rts a \ ! 1 m] I1 | . |t r tt rsi] aitr-
It, |a ] |att saria 1 t |a ma 1a ra stra imj t rIa rIt, si t|
a }asIt 1 t |a irsa|irtItra j ia st | a sa tr |a s ta ria tit rts 1 t
|a ] |att saria ma Iira | a rIts 1 t |a a 1 mirisIra tit r 1 t |a
irsa|ira , st a amtrIa ra |a 1 t sis 1 t irsa|ira st ||t] a ra a
ar tit|t 1 t |ij tr] |attmia s ir1 ati1 a s j t r irsa|ira . || 1 ia ] -
rt sIitt rt| aitrt t| |a ||a t] t 1 t ara |ij t ara |ij tr] |a-
ttmia tr t| j trit 1 t 1 t I \ |t ra s
I , 1 , 1 ,I !
Ii] . 1 .
Insulinorresistencia (IR)
|a || ts ara ttr1itit r 1 tr1 t ara tarIi1 a 1 rt rma | 1 t
irsa|ira j rt 1 att ara rt s j a t sIa | it|t] ita j tr 1t| a }t 1t |t
r t rma |. K t tt i sIt ara 1 tsis 1t irsa|ira | at 1 tIira tsIt
j rtttst . | aa r1 t st tta|aa |a tIttIiti1a 1 1 t |a irsa|ira tr
si] rts 1 t |ij t ] |attmia . |a rt t a rrt r t i a
1 t si]rt s t|iritt s sa] itrt |a iratIita t i t r
t ta 1ati1a 1 1 t |a irsa|ira , j rt | | t m a s
tt r |a a 1 mirisI ra tit r, 1 ara tit r 1t
a ttit r ira 1 ttaa 1 a , st | rt1 t sis 1 t irsa-
|ira t irsa|irt rrt s i sItrtia . || a |t r1 a } t
1 i a ] r t sIitt iritia | tt rsisIt tr tta | a a r
|a Ittrita 1 t a 1 mirisI ratit r j t r ja rIt
1t| j rt j i tIa rit ]t r t ra r ara tarta 1 t
] |att sa . |t s rt s a | Ia 1 ts 1 t |a s tarta s 1 t
] |att sa 1tIt rmirar |a tIttIiti1a 1 1 t |a
irsa|ira tr | a }a r |a ] |attsa a jt rIa r
|a ] aia ja ra |t s si] aitrIts j a sts 1 ia ] -
r t sIitt s t It ra j t a I i t t s
1 , 1
.
Metabolismo rpido insulina
K t rm a | m t r It |a 1ara titr 1t |a s irsa-
|ira s ts mtrt r 1 t I \ |t ra s j tr |t Ia r It
j at1 t jrt s t r Ia rst ara |ijtr]| a t t m i a
-I ! 1 -I 1 m] I1 | 1ara r It ta rias |t ra s
a | 1 ia a tttts irt|ast a |as t - |t ra s
j t sI i r s a | i r t It raj ia . | t rsttatrIt m t r It ,
|t s a rima|ts It r 1 rar ] | a t t s a ria ma Iira |
j t rs i sIt r It || I|| . || 1ia ]rt sIitt st
| asa tr t| |a||at]t 1 t ara |ijtr] | a t t-
mia t|ara trIrt |as |t ra s t mtrts
1tsj ats 1t |a a1 mirisI ratitr 1 t irsa|ira
s i t mj rt | at t| ta |tr mirimt a|tarta1 t
sta t| attjIa | | t
I , 1 , 1 , I !
Ii] . I .
Efecto Somogyi
|s t| rtsa|Ia 1 t 1 t ar ttttst tr |a
a 1 m i r i sI ratit r 1 t irsa|ira . | aa r1 t
tsIa st | rt1 t sis j rt 1 att ara 1 ismira-
tit r 1 t ] |att sa j t r 1 t| a }t 1 t t !
m] I1 |, t ara 1 ismiratit r ra j i1 a 1 t
] |att sa ir1 tj tr1 itrItmtrIt 1 t| ra 1 ir,
st ||t] a a ara tsIima|a tit r 1 t |a s |t r-
mt ra s tt rIra rrt ] a | a 1 t ra s 1t |t s
Fig. 2. M etabolism o de insulina rpido. Existe hiperg l u c e m i a
(m ayor de 250 m g/dl) y un nadir de 80-100 m g/dl antes
de las 24 horas post-adm inistracin de la insulina.
ar a rima|, st 1t|tr tsIa1iar sima|Ia r t-
a m t r It |a 1t sis 1 t irsa|ira ttr rt | a t i t r
a | j tst ttrj t ra| t| tt rIrt| ] | a t t m i t t
a 1 ttaa 1t . |a || st stsj tt|a taa r1 t |a
1 tsis 1 t irsa|ira tsIa j tr trtima 1 t I
| I |] jt r irtttitr j trrt t t | j t r
i rtttit r jt r arima | ] a It It1 a s |as
t t r t t r I ratitrts 1t ] |att sa tsIa r j t r
trtima 1 t 1 1 1 m]I1 |, t taa r1 t st
r t t t s i Iar tarIi1a 1 ts ttt t s i ta s 1t irsa|i-
ra - I ,I | I|] j ara ma rItrtr |a s tt r-
t t r I ratit rts 1 t ]|attsa j tr 1 t|a }t 1 t
1 1 1 m] I1 |
1 , I t , I
Ii] . \ .
k| tr1a }t 1 ia ] rtsIitt. |t r ara j a rIt
| a | at tt rIi rmar | at t| jrt ||tma ts
rt a | m t r It ara irsa|irt rrt s i sItrtia . 1 a
| at 1 tsta rIa r tr j rimtr |a] ar |t s j rt -
| |tma s | at j a1 itra |a|tr tr rt|a tit r a
|a a 1 mirisI ra tit r It a tIiti1a 1 1t |a
irsa|ira . 1 a | at ast] ara rst 1t | at |a
a 1 m i r i sI ra titr 1 t |a irsa|ira j t r ja rIt
1 t| j rt j i tIa rit ts |a tt rrt t Ia | at |a
irsa|ira a 1mirisI ra1 a sta |a a1 ttaa1 a
t sIt tr |atras tt r1 ititrts 1t ttrstr-
ta t i t r
1 , I t , I
. | ra ttt t|imira 1t s |ts
j t si| |ts j rt | |tma s 1 t mart}t, st
1 t| tr rta |ita r tarta s 1t ] |attsa ja ra
1 t s t a rIar t I ras jt si| |ts ta asa s 1 t irts-
Ia| i|i1 a 1 It rajtaIita tt mt t| mtIa | t | i s-
mt ra j i1 t 1 t irsa|ira t| tIt t It
t mt] i, ttrIi rmar asi |a irsa|irt rrt-
s i sIt r t i a
1 , I t , I
. |tr |a t I ra ja rIt, |a
| at |a ||ar |a taasa 1t tsIa irsa|irt rrt-
s i sItrtia Ia ||a | | . |a s taasa s 1 t | | |as
j t 1tmt s a ] raj a r tr.
| aa || aitr j rt ttst | at a |Itrt |a
1 isj t ri| i|i1 a 1 1 t |a irsa|ira tr |a tir-
ta|a tit r.
|t | rt a | st rtit r sa| taIa rta 1 t |a
irsa|ira . a ar| at rt tsIt | itr 1 t ta-
mtrIa 1 t tr M t1 itira VtItrira ria , si | at st j at1 t a Iir-
ma r | at mtrt s 1 t| ! 1 X 1 t |a irsa|ira a 1 mirisIra 1 a ||t-
] at a |a tirta|a tit r, tsj ttia |mtrIt si st r irsa|ira s 1 t
|a r] a 1 ara tit r
1 ,I t ,I
.
| tsa rrt||t 1 t a rIitatrj ts a rIi-irsa|ira kk | . tt i sIt r
ta rit s tt mj t r t r Its 1t |a irsa|ira | at j at1 tr str a rIi] t-
ritt s j rt 1atir a rIitatrj t s
I
. |t s k k| st 1 a r j t r irt t-
tit rts rt j tIi1 a s 1 t ara j rtItira tt I ra 1a irsa|ira .
Fig. 3. Efecto Som ogyi. Existe hipoglucem ia e hiperglucem ia
dentro de las 24 horas.
Fig. 4. Insulinorresistencia. N o hay efectividad de la insulina.
C urva casi totalm ente plana en perro con H A C antes
y despus del tratam iento con m itotane.
tr |a aIiri1a 1 1t |a arit r |trm t r a -rt t t jIt r. | trIt rm t
|a t | tsi1 a 1 tmj t t ra , aj a rttt ar rattt 1tIt t It 1t j t s-
I rt t t j It rt s
I t , I
.
| rItttit r. |a 1 ia | tIts rt1 att |a ta j a ti1 a 1 1 t rtsis-
Itrtia a |a s irItttit rts, a | mismt Iitmj t , |a irItttit r
ir1 att t| a amtrIt tr |a sttrttit r 1 t |t rmt ra s a rIa ] t -
risIa s 1 t |a irsa|ira
I
.
ttrttit r 1 t |t rmt ra s ttrIra rrt ] a | a 1 t ra s t I rt s
Ia t It rts mtIa | t |itts a |t rmt ra |ts. |a sttrttit r 1 t |tr-
mt ra s 1 ia | tIt ] tra s ] | a t t t t rIitt i1 ts, ] | a t a ] t r, |t r-
mtra 1 t| trt t i m i t r It | 1 ta Ittt |a mira s | at t tarrt
1 a ra r It t| tIt t It tmt ] i j at1 t ir1 atir ara | |, | a t
j at1 t 1 ara r I \ -I I |t ra s si] aitrIts a | j trit 1 t 1 t |ij t -
] |attmia. i st rta |ita |a tarta 1 t ] |att sa t| mismt 1ia
1 t |a |ij t ] |attmia, st i1 trIiIita t| tIt t It t mt ] i st
1 t | t ra rt1 atir |a 1 tsis 1 t irsa|ira , a |t ra | itr, si st
rta |ita |a tarta 1 tsj ats 1 t |a sttrttit r 1 t |a s |t rm t -
ra s 1 ia| t It ] tra s, st 1 ia ] rt sI i t a ra ara | | Ia|sa , st
a a m t r Ia ra |a 1 t sis 1 t irsa|ira ||tta r1 t a | tmj t t ra -
m i t r It 1t| tIt t It t mt ] i
1 , I
.
|a |ij trs t t rttitr trt rita 1 t | 1 ||tta a ara atrt m t ] a | i a .
|r j trrt s, |a atrt m t ]a |ia ts taasa 1a rt rm a | m t r It j tr
j rt ] t sIa ] trts tr1 t] trts t tt t ] trts | at ir1attr ara
s t | rt j rt 1attit r 1t | 1 . |r tam|it , tr ] a It s |ts j rt ] t s-
Ia ]trts rt tsIima|ar |a sttrttitr 1t | 1 ja rttt str | a t
| a a r It ma s 1 iIt rt r It sta |a mt |tta|a
1 t irsa|ira a 1mirisI ra 1 a a |a 1t| a rima |
I ra Ia 1 t , ma t r j rt | a | i|i1 a 1 |a 1 t
|a ttr tsIt s k k|
I I
. |a sttatrtia 1 t a mi-
rt a ti1 t s 1t |a s irsa|iras ta riras, j t rt i-
ra s |ama ra s rt t t m | i r a r It, st r ma
j a rtti1a s, mitrIra s | at |a irsa|ira 1t|
] a It ts ma s ja rtti1 a a |a 1 t ta t a
I I
. ||
1 t s a rrt ||t 1 t |a | | ast tia 1 a a |a aj a ri-
titr 1 t tsIt s a rIitatrj t s rt tsIa ma
t | a ra
I
. || 1 ia ] rtsIitt 1t |a | | ta asa 1 a
j tr k k | rt ts Ia ti| a | at, a ar| a t
m a t|ts a rima |ts j at1 tr 1 tsarrt | | a r
t sIt s kk | , rt | a i t rt 1 ttir |at It r ] a r
| at j rt 1 atir | |
I
. | t |tt|t , tr ] a It s
1 ia | tIitt s Ira Ia 1 ts tt r irsa|ira, |a jrt-
ta |trtia 1 t tsIt s k k | ts ra ra , tr |t s
arima |ts | at |t s 1tsa rrt ||a r rt j a rt-
tt a It t Iar t| tt rIrt | ] |attmitt , mitr-
I ra s | at tr jtrrt s |a aj a ritit r 1t tsIt s
k k | ts ma s tt mar tr a rima |ts Ira Ia 1 t s
tt r irsa|ira 1 t ta t a I t t r1 t | at tr |t s
I ra Ia 1 t s ttr irsa|ira |ama ra rt t t m | i-
r a r It, tr a |] arts a rima |ts | at 1 tsa -
rrt ||ar tsIt s k k| , si | at st a It t Ia t|
t t r I rt| ]| a t t m i t t
\ , ! , I I
. |r tsIt s a ri-
ma |ts t| tt rIrt| ] |attmitt taria irt|ast
1 ia a 1 ia , |a s tt rttrIra tit rts 1 t ] | a-
ttsa I|atIaa r trIrt I 1 1 -\ 1 1 m] I1 |,
a a r | at rt st a j rttia ara t|a ra | | ] | a-
ttmia s ma t rts 1 t \ 1 1 m] I1 |
I I
. |a ra
sa 1ia] rt sIitt st rt | a i t rtr a ra |isis
t a a r I i Ia I i tt s 1 t mt1 itit r 1 t tsIt s a rIi-
t a t rj ts, 1 isjt ri| |t mt1 ia rIt It t r i t a s
1 t ||| k
I I, I
.
| aa || aitr tt r1 itit r | at a |Itrt |a
a ttit r 1 t |a irsa|ira a ritt| tt|a|a r.
1 |tsi1 a1 . |a t |tsi1 a1 ts ara
taasa ttmar 1 t | |. |ts mtta rismts
t s j t t i Iitt s st r 1 itt rsts t irt|atr ara
1ismiratitr tr t| ramtrt 1 t rt t t j It rt s
TABLA IICausas de insulinorresistencia
Absorcin subcutnea pobre de la insulina exgena
Insulinorresistencia inmunolgica (AAI)
Cetoacidosis
Enfermedad concurrente (pacreatitis, enfermedad
renal, insuficiencia heptica)
Obesidad
Trastornos endocrinos (acromegalia, diestro, HAC,
hipotiroidismo)
Droga-inducida (glucocorticoides, progestgenos)
|a taasa ma s tt mar 1t a trt m t ] a|ia ts
ar Iamtr tr jiIaiIa ri a
I
. t1 ts |t s ] a It s ,
mat|ts j trrts, 1 tsa rrt ||ar || , a |a t
|a | 1 jrttt ta |ijtr] |attmia ir1 atitr-
1 t irsa|irtrrt s i sItrtia jtri It ri t a
I
. |r
|t s j trrt s aIt t Ia 1t s 1t 1ia| tIts asttia-
1a a mtIa t sI rt, tt i sIt ara ttmj t r s a -
tit r aamtrIar1 t |a jrt 1attitr 1t irsa-
|ira jtrt |at ts irsaIi t i t r It ja ra ttm-
j trsa r |a rt s i sItrtia. |r a|]arts 1t
t sIts tasts a | at||t s tr |t s | at |a irsa-
|ira tsIa trIrt I 1 -\ 1 mt|| Im| |a tta-
ri t | i sIt rt t Itmia jat1t str ma aIi| a rIt s
1 t | at ttarra t| a ]t Ia m i t r It 1 tIi r i I i tt
1t |as tt|a|a s ja rtrtaIita s t |at |a Itt i-
ti1 a1 j tr |a ] |attsa sta j trm a r t r It
.
Ya | at |t s It sIs 1t mt1 ititr 1t | 1 str
1 t ara ta |i1a titr 1iIiti|, st 1t|t rt a | i t a r
t| 1 ia ] rtsIitt j t r st sj tt|a t|irita .
k t I a a | m t r It st rta|itar tsIa1it s jrt m t-
It 1 t rts ttr |a mt1itit r ir1irt t Ia 1 t | 1
m t 1 i a r It |a tta |aa tit r 1t |a stmaIt m t-
1 ira |
I
.
|| |ijtra 1 rt r t t t rIitismt 1 k| ts
ara ta asa tt mar 1 t || .
k j rtt i m a 1 a m t r It t| \ 1 -t 1 X 1t jtrrt s
ttr 1 k| Iitrtr |ijtr]|attmia tr a a-
ras, mitrIra s | at st |t t| ! -I 1 X 1t ari-
ma |ts tt r 1 k| Iitrtr a 1tmas ara | M
t | a ra
1 , I , 1 !
. |as mariIt sIa tit rts t|iri-
ta s 1 t |a | | |a irIt | t rartia a |a ]| a t t s a
str jtr t| ttttst 1 t ]| a t t t t rI i t t i 1 t s ,
|t s taa|ts jat1tr a|It ra r |a Ia st 1t
aritr a rt t t jIt rts t |a 1t rt s j a t sIa
tt|a|a r a |a irsa|ira
I , 1 !
. |a ma t ria 1 t jtrrt s ttr 1 k|
t t mjtrsar |a | | trta1 a jtr |t s ] | a t t t t rIitti1ts aamtr-
Iar1t |a sttrttitr 1t irsa|ira ja rtrta Iita, ||t]ar1t a
ara |ij trirsa|irtmia | at irIt r Ia marItrtr |a ta] | a t t m i a .
|r j trrts sasttjIi||ts tt r ara rt s t rta jartrtaIita |imi-
Ia1 a 1t irsa|ira , t| ttttst trt ritt 1t ] | a t t t t rI i t t i 1 t s
jat1t jrt 1 atir ar a ]t Ia m i t r It 1t |as tt|a|as | tIa ara
| M . k|] art s arima|ts jt1 ra r str ta ja tts It 1 a tia 1t jrt -
1 atir a |] t 1 t irsa|ira, jtrt ara ttt aj arttt t|irita mtrIt
|a | M , st rtttsiIa ]t r t ra | m t r It |a irsa|irt It ra jia , taa r-
It mas st 1tIt ri t rt |a jrt 1attit r 1t irsa|ira tr1t ]t r a
mas tt i ]trtia |a| ra 1 t irsa|ira tt t ] t r a
1 , I , 1 !
.
|a | M j at1 t str ar j rt | |tma ttisItrIt tr t| mt mtr -
It 1 t| 1 ia ] rt sIitt 1 t| 1 k | , t j at1 t str | at a j a rttta
1 tsj ats
1 !
. || 1 ia ] rt sIitt 1 t 1 k | tr j trrt s tt r | M rt
ts Ia ti|, a | at ttisItr mat|t s sirIt ma s | at st r ta ra t-
ItrisIitt s 1 t a m| a s trItrmt1 a 1 ts, j t r |t Ia rIt rt s 1 t| t-
rtmt s a j ta r tr |a a j a ritit r 1 t sirIt ma s Iij itt s 1 t 1 k|
tr a rima |ts tr |t s | at |a a mt s 1 ia ] rt sIita 1 t a rItrit r-
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rt j a rtrta s. tm. ir VtI. M t1 . &
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1 1 I.
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| rsa|ir strsitiI ir rt rrma | a r1 1 ia | t -
Iit ta Is a r1 rt rma |ta Is ar1 tr sIrtss.
k| V| M k rraa | | t r] rtss, 1 1 .
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| t j rt 1 atIit r. I . t1 iIit r w. | .
a ar1 trs | t mj a r .
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M t||iIas | a rir t a r 1 |t | i r t
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t1 iIit r. w| a ar1 trs | t mj a r .
. | ra |a m |k , K k 1 k . M t ItsIras-
a s s t t i a It 1 1 ia | t Its mt||iIas ir I| t
1 t ] . k | V| M k rraa | | t r] rtss, 1 1I.
I . | ra |a m |k , K k 1 k . |t triIita |
tta |aa Iit r t I ItsIs It r mt riIt rir] ] |-
ttmit tt rIrt | ir ta rirt 1 ia | tIts mt||i -
Ias. k | V| M k rraa | | t r] rtss 1 1I.
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| t r -tt t| a r ] t mitrt t| rt m a It ] ra j |
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I|t mta sartmtrI t I ta rirt ] |ta It1
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r \ j j . 1 .
. !a tt | s | M . 1 j t ] ttmia sma || a ri-
ma | mt1 ttir t | . | . k ||t r | t . !|
|ij j irtt I, 1 1 .
1 . | a | a It M k , M a rrir ] k M .
M a r a ] t mtr I t I I|t ar tt mj | i t a It 1
ta rirt 1 ia | tIit. tm. | r VtI. M t1 . &
ar] . Vt |. I r \ rt titm| rt, 1 1I.
I 1 . |arIt. k 1 rtra | a r1 |a r t rt a Iit sar-
] tr. K kV| k rraa | | t r]rtss, 1 1 1 .
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rt1 ] |att st It |tra rtt ir ta Is. k | V| M
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sa mir t tt rttrIra Iit r ir ta Is iI|
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1 ia | tIit 1 t ] a r1 ta I. Vt I. | |ir. t I
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ma t , 1 1 ! .
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Vt Itrira r |tra j X| | w.| . a ar1 trs
| t mj a r j j . 1 1 1 , 1 1 ! .
I I. K t|st r | w. | t mj |ita Iit rs t I irsa|ir
I| t ra j ir 1 ia | t Iit 1 t ] s. K k V|
k rraa | | t r] rtss, 1 1 1 .
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mtrI t I irsa|ir rt s i sIartt ir 1t]s a r1 ta Is
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VtI. | |ir. t I K t rI| k m. Vt |. I ! r.1
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1 1 . | t] r itr k . 1 j t ] |ttia . K kV| ,
1 1 I .
1 . | t a s t| | | , t msa | , 1 a | t rt r | .
|ta |aa Iit r t I I|t IratIt sa mirt ItsIs ir
1 t ] s a r1 ta Is iI| |j t t r |j trj rt -
Itirtmia , a tt Itmia , | j t r| i j i 1 t m i a ,
|j tr| i|irra| irtmia , a r1 ir ta Is iI|
| j t rI| rt i1 ism. k| V| M . k rr aa |
| t r] rtss, 1 1 .
1 I . imj st r | w, | t t | k . 1 j t ]|ttmia .
M a r aa | t I ma || a rima |
| r 1 t t ri r t | t ] . I t1 iIit r | k Vk
j a| |ita Iit rs.
1 1 . a rra |1 | 1 , rt | | .
1 j t ] |tt mia . | a r| t | 1 ra It mtIa -
| t |ism a r1 |a | t ra It r tta | a a I i t r .
| t mj . | t rI. |1 . Vt |. ! , r , rt titm-
| rt, 1 1 .
1 \ . wt ||t r | |. | ia ] rt sis t I tr1 t tri r t
rtt j |a sia s. k | V| M k rraa | | t r] rtss,
1 1 ! .
1 ! . K it|t |s | . | t rtarrtrI i||rtss a r1 tt m-
j |ita Iit r s a sst tia It1 iI| ta r irt
| j t ra 1 rt r t t t rIitism. tm. ir VtI .
M t1 . & ar] . Vt |. 1 r 1 j j . 1 I ,
a ] t sIt , 1 1 \ .
INTERVET PANACUR
NOVARTIS CLOMICALM
PURINA CNM
SALVAT ADO-DERM

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