RESUMO
BACKGROUND: Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. AIM: To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. PATIENTS AND METHODS: This was a retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated. RESULTS: From a total of 384 adult CP patients, we selected 53 (13.8%) patients (27 women [50.9%], mean age 72.3 ± 5.1 years [range 65-83 years]) diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). The maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%), and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP and papillary CP were present in 51 and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9 to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs. 53.6%, p = 0.008). Patients were followed for 46.7 ± 40.8 months. The mortality rate was 39.6% with a median survival time of 88 (95% CI: 57-118) months. DI at last visit was associated with a lower survival. CONCLUSION: CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation, visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.
Assuntos
Envelhecimento , Craniofaringioma , Neoplasias Hipofisárias , Idoso , Idoso de 80 Anos ou mais , Craniofaringioma/diagnóstico , Craniofaringioma/mortalidade , Craniofaringioma/patologia , Craniofaringioma/terapia , Feminino , Humanos , Masculino , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/mortalidade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/terapia , Estudos Retrospectivos , Espanha/epidemiologiaAssuntos
Automonitorização da Glicemia , Glicemia , Diabetes Mellitus Tipo 1 , Hipoglicemiantes , Humanos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Glicemia/análise , Glicemia/metabolismo , Automonitorização da Glicemia/métodos , Hipoglicemiantes/uso terapêutico , Hipoglicemiantes/administração & dosagem , Feminino , Masculino , Adulto , Insulina/administração & dosagem , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Pessoa de Meia-Idade , Sistemas de Infusão de Insulina , Controle Glicêmico , Monitoramento Contínuo da GlicoseRESUMO
Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p < 0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.
Assuntos
Glicemia/metabolismo , Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/normas , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Adulto , Diabetes Gestacional/sangue , Diabetes Gestacional/terapia , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Gravidez , Estudos Retrospectivos , EspanhaRESUMO
CONTEXT: There are no data on mortality of acromegaly diagnosed in older individuals. OBJECTIVE: This work aimed to compare clinical characteristics, growth hormone-related comorbidities, therapeutic approaches, and mortality rate of patients diagnosed before or after 2010 and to assess overall mortality rate compared with the general Spanish population. METHODS: A retrospective evaluation was conducted among Spanish tertiary care centers of 118 patients diagnosed with acromegaly at age 65 or older. Kaplan-Meier curves were constructed to trace survival, and Cox proportional hazard models were used to assess the risk factors associated with mortality. We also compared mortality with that of the Spanish population by using age- and sex-adjusted standardized mortality ratios (SMRs). RESULTS: No differences were found in first-line treatment or biochemical control, between both periods except for faster biochemical control after 2010. Twenty-nine (24.6%) patients died, without differences between groups, and had a median of follow-up 8.6 years (103, [72.3] months). Overall SMR was 1.02 (95% CI, 0.57-1.54), (0.60; 95% CI, 0.35-1.06) for men and (1.80; 95% CI, 1.07-2.94) for women. The most common cause of death was cardiovascular disease (CVD). CONCLUSION: The mortality in patients with acromegaly diagnosed in older individuals was no different between both periods, and there was no overall SMR difference compared with the general Spanish population. However, the SMR was higher in women. As CVD is the leading cause of mortality, it seems advisable to initiate an intense CVD protective treatment as soon as acromegaly is diagnosed, particularly in women, in addition to tight acromegaly control to prevent excess mortality.
Assuntos
Acromegalia , Doenças Cardiovasculares , Hormônio do Crescimento Humano , Masculino , Humanos , Feminino , Idoso , Acromegalia/diagnóstico , Acromegalia/epidemiologia , Acromegalia/tratamento farmacológico , Estudos Retrospectivos , Espanha/epidemiologia , Hormônio do Crescimento Humano/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/tratamento farmacológicoRESUMO
Context: Some reports suggest that acromegaly in elderly patients has a more benign clinical behavior and could have a better response to first-generation long-acting somatostatin receptor ligands (SRL). However, there is no specific therapeutic protocol for this special subgroup of patients. Objective: This study aimed at identifying predictors of response to SRL in elderly patients. Design: Multicentric retrospective nationwide study of patients diagnosed with acromegaly at or over the age of 65 years. Results: One-hundred and eighteen patients (34 men, 84 women, mean age at diagnosis 71.7 ± 5.4 years old) were included. Basal insulin-like growth factor type 1 (IGF-1) above the upper limit of normal (ULN) and growth hormone (GH) levels (mean ± SD) were 2.7 ± 1.4 and 11.0 ± 11.9 ng/ml, respectively. The mean maximal tumor diameter was 12.3 ± 6.4 mm, and up to 68.6% were macroadenoma. Seventy-two out of 118 patients (61.0%) underwent surgery as primary treatment. One-third of patients required first-line medical treatment due to a rejection of surgical treatment or non-suitability because of high surgical risk. After first-line surgery, 45/72 (63.9%) were in disease remission, and 16/34 (46.7%) of those treated with SRL had controlled disease. Patients with basal GH at diagnosis ≤6 ng/ml had lower IGF-1 levels and had smaller tumors, and more patients in this group reached control with SRL (72.7% vs. 33.3%; p < 0.04) [OR: 21.3, IC: 95% (2.4-91.1)], while male patients had a worse response [OR: 0.09, IC 95% (0.01-0.75)]. The predictive model curve obtained for SRL response showed an AUC of 0.82 CI (0.71-0.94). Conclusions: The most frequent phenotype in newly diagnosed acromegaly in the elderly includes small adenomas and moderately high IGF-1 levels. GH at diagnosis ≤6 ng/ml and female gender, but not age per se, were associated with a greater chance of response to SRL.
Assuntos
Acromegalia , Hormônio do Crescimento Humano , Acromegalia/diagnóstico , Acromegalia/epidemiologia , Acromegalia/terapia , Feminino , Hormônio do Crescimento Humano/metabolismo , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Peptídeos Cíclicos/uso terapêutico , Receptores de Somatostatina/uso terapêutico , Estudos Retrospectivos , Somatostatina/uso terapêutico , Espanha/epidemiologiaRESUMO
OBJECTIVE: To analyze the effect of sodium glucose cotransporter 2 (SGLT2) inhibitors in a group of insulin-dependent type 2 diabetes mellitus (T2D) patients. PATIENTS AND METHODS: One hundred and five insulin treated T2D patients were enrolled. Primary endpoints were: fasting plasma glucose, HbA1c, weight, total insulin doses (TDI), total basal insulin (TDB) and total rapid insulin (TDR). Secondary variables were: total cholesterol, LDL cholesterol (cLDL), HDL cholesterol (cHDL), triglycerides and systolic (SBP) and diastolic (DBP) blood pressure. Safety and tolerance were evaluated through the appearance of severe hypoglycemia, ketoacidosis and infections. RESULTS: After 4 months follow-up, a 0.7 (1.0)% HbA1c reduction was found, accompanied by a -2.8 (11.5) UI/day TDI decrease. Weight dropped for 73.7% of patients, with an average -2.0 (2.7) kg reduction. A global cHDL increase was noted after treatment, while no differences were observed for total cholesterol, triglycerides or cLDL. SBP dropped significantly, but no change in DBP was observed. CONCLUSION: The use of SGLT2 inhibitors in insulin treated T2D patients resulted in reduction of HbA1c, which was associated to weight loss, cHDL increase and SBP decrease.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Adulto , Idoso , Compostos Benzidrílicos/administração & dosagem , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Canagliflozina/administração & dosagem , HDL-Colesterol/efeitos dos fármacos , Feminino , Glucosídeos/administração & dosagem , Hemoglobinas Glicadas/efeitos dos fármacos , Humanos , Insulina/análise , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Redução de Peso/efeitos dos fármacosRESUMO
People who develop type 2 diabetes (T2D) are known to have a higher mortality risk. We estimated all-cause, cardiovascular, and cancer mortality-risks in our patient cohort according to categories of impaired glucose metabolism. This 18-year retrospective analysis included a region-wide, representative sample of a population aged 30-75 years. Age- and sex-stratified hazard ratios (HRs) were calculated for 48 participants with diagnosed T2D, 83 with undiagnosed T2D (HbA1c ≥6.5%, fasting glycemia ≥126 mg/dL, or glycemia after 75 g glucose load ≥200 mg/dL); 296 with prediabetes (HbA1c 5.7%-6.4%, fasting glycemia 100-125 mg/dL, or glycemia after 75 g glucose load 140-199 mg/dL), and 607 with normoglycemia. Over 18,612 person-years, 32 individuals with undiagnosed T2D, 30 with diagnosed T2D, 62 with prediabetes, and 80 with normoglycemia died. Total sample crude mortality rate (MR) was 10.96 deaths per 1,000 person-years of follow-up. MR of the diagnosed T2D group was more than 3-times higher and that of newly diagnosed T2D was 2-times higher (34.72 and 21.42, respectively) than total sample MR. Adjusted HR for all-cause mortality was 2.02 (95% confidence interval 1.29-3.16) and 1.57 (95% CI 1.00-2.28) in the diagnosed T2D group and the newly diagnosed T2D group, respectively. Adjusted HR for cardiovascular mortality in the T2D group was 2.79 (95% CI 1.35-5.75); this risk was greatly increased in women with T2D: 6.72 (95% CI 2.50-18.07). In Asturias, age- and sex-standardized all-cause mortality is more than 2-times higher for adults with T2D than for adults without T2D. The HR for cardiovascular mortality is considerably higher in T2D women than in normoglycemic women.
Assuntos
Doenças Cardiovasculares/mortalidade , Complicações do Diabetes/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Estado Pré-Diabético/mortalidade , Adulto , Fatores Etários , Idoso , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taxa de SobrevidaRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0211070.].
RESUMO
INTRODUCTION: Current treatment of type 1 diabetes mellitus (T1DM) does not always achieve metabolic control because, among other things, the ocurrence of hypoglycemic events associated to insulin use. MATERIAL AND METHODS: A descriptive real life study of 247 T1DM patients, 55.5% male, aged 46.53 ± 16.23 years, and with a mean diabetes duration of 21.89 ± 11.99 years, who were switched from basal insulin glargine U100 to glargine U300. The primary endpoints were changes in Hba1c and number of hypoglycemic events, while secondary endpoints included changes in weight and insulin dose after 6 and 12 months. RESULTS: After one year, no changes were seen in HbA1c, but the proportion of patients with HbA1c values <7.5% increased at 6 months (33.5 vs. 40.5%; P<0.05) and remained stable during one year of follow-up. Hypoglycemic events significantly decreased after one year of treatment in patients with previous hypoglycemic events. No changes were seen in body weight. Total insulin dose (U/kg) increased 7.24% at 6 months of treatment and by 8.69% at one year, mainly due to basal insulin. No changes were seen between the doses given at 6 and 12 months. These changes were similar in the different metabolic control groups and in patients with or without hypoglycemia. This increase was not related with prior basal insulin dose, baseline HbA1c level, number of hypoglycemic events or baseline weight. DISCUSSION: Glargine U300 is a good basal insulin alternative to treat T1DM, improving metabolic control in patients with HbA1c levels >7,5 and decreasing hypoglycemic events in patients with history of hypoglycemia without increasing body weight.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina Glargina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal/efeitos dos fármacos , Preparações de Ação Retardada , Diabetes Mellitus Tipo 1/sangue , Relação Dose-Resposta a Droga , Substituição de Medicamentos , Seguimentos , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/farmacocinética , Insulina Glargina/efeitos adversos , Insulina Glargina/farmacocinética , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
AIMS/HYPOTHESIS: Failure in glucose response to insulin is a common pathology associated with obesity. In this study, we analyzed the genome wide DNA methylation profile of visceral adipose tissue (VAT) samples in a population of individuals with obesity and assessed whether differential methylation profiles are associated with the presence of type 2 diabetes (T2D). METHODS: More than 485,000 CpG genome sites from VAT samples from women with obesity undergoing gastric bypass (n = 18), and classified as suffering from type 2 diabetes (T2D) or not (no type 2 diabetes, NT2D), were analyzed using DNA methylation arrays. RESULTS: We found significant differential methylation between T2D and NT2D samples in 24 CpGs that map with sixteen genes, one of which, HOOK2, demonstrated a significant correlation between differentially hypermethylated regions on the gene body and the presence of type 2 diabetes. This was validated by pyrosequencing in a population of 91 samples from both males and females with obesity. Furthermore, when these results were analyzed by gender, female T2D samples were found hypermethylated at the cg04657146-region and the cg 11738485-region of HOOK2 gene, whilst, interestingly, male samples were found hypomethylated in this latter region. CONCLUSION: The differential methylation profile of the HOOK2 gene in individuals with T2D and obesity might be related to the attendant T2D, but further studies are required to identify the potential role of HOOK2 gene in T2D disease. The finding of gender differences in T2D methylation of HOOK2 also warrants further investigation.
Assuntos
Tecido Adiposo/metabolismo , Metilação de DNA , Diabetes Mellitus Tipo 2/genética , Proteínas Associadas aos Microtúbulos/genética , Obesidade/genética , Estudos de Coortes , Feminino , Humanos , MasculinoRESUMO
We describe the case of a 23 year old man who had undergone laparoscopic surgery in order to remove a residual mass secondary to a testicular embryonal carcinoma. 15 days after he attended the emergency department complaining about abdominal bloating and copious drainage via the two laparoscopic surgery incisions. Biochemical analysis was consistent with chylous ascites. Although this is uncommon, it is well known that there is more likely to develop chylous ascites after oncologic surgery if retroperitoneal lymph nodes dissection is performed1. We decide to start with conservative treatment (dietary modifications) but, as it is not enough, then we decide stop any oral intake and treat him with parenteral nutrition, achieving then total resolution of the ascites.
Describimos el caso de un varón de 23 años operado mediante laparoscopia de una masa residual secundaria a un carcinoma embrionario testicular. 15 días después acude al servicio de Urgencias por distensión abdominal y drenaje de líquido lechoso por las dos incisiones de la cirugía laparoscópica. Tras el análisis bioquímico del líquido que reflejaba un aumento de triglicéridos se llegó al diagnóstico de ascitis quilosa. Aunque es infrecuente, se describe que existe mayor probabilidad de ascitis quilosa después de cirugías oncológicas si se lleva a cabo la disección de ganglios linfáticos retroperitoneales1. Se decide tratamiento conservador inicialmente con modificaciones dietéticas y posteriormente con nutrición parenteral, con resolución total de la ascitis.