Accuracy of new recommendations for adrenal incidentalomas in the evaluation of excessive cortisol secretion and follow-up.

OBJECTIVE: To evaluate whether the 2016 European Society of Endocrinology (ESE) recommendations for the management of adrenal incidentalomas accurately classifies those patients who do not require further follow-up. DESIGN AND METHODS: Single centre retrospective study. From 2010 to 2015, 130 patients with adrenal incidentaloma were evaluated and followed-up. Clinical, analytical and radiological data were recorded and the presence of comorbidities was assessed. Patients were grouped as nonfunctional or subclinical Cushing syndrome according to American guidelines; and nonfunctional, possible autonomous cortisol secretion and autonomous cortisol secretion, according to ESE guidelines. RESULTS: Based on American guidelines, 94% of patients had nonfunctional adrenal incidentalomas and 6% had subclinical Cushing syndrome. Based on ESE guidelines, patients were classified into nonfunctional (54%), possible autonomous cortisol secretion (40%) and autonomous cortisol secretion (6%) groups. No differences were observed in demographic characteristics and comorbidities between groups in either classification. Following ESE guidelines, no patient in the nonfunctional group was reclassified into the possible autonomous or autonomous cortisol secretion groups during follow-up, but one patient in the possible autonomous cortisol secretion group was reclassified into the autonomous cortisol secretion group. Also, 30 patients included in the groups of possible autonomous or autonomous cortisol secretion experienced progression of a comorbidity associated with cortisol excess, with diabetes mellitus as the most frequent comorbidity observed. CONCLUSION: Although adrenal incidentalomas with an excess of cortisol secretion were more frequently diagnosed with the new ESE recommendations, patients who did not require longer follow-up after first evaluation were accurately classified.

Estudi de la relació entre el nivell d'activitat física i el control de la diabetis mellitus tipus 1 determinat pels valors d'hemoglobina glicosilada / Relación entre nivel de actividad física y control de la Diabetes Mellitus tipo 1 / Evaluation of the association of physical activity with metabolic control of type 1 Diabetes Mellitus

Fonament: els principals beneficis que l'activitat física aporta a la salut dels pacients diabètics tipus 1 s'han estudiat en diverses publicacions prèvies. Tot i això, l'evidència que l'exercici físic millora els controls metabòlics dels pacients no ha estat totalment demostrada i hi ha resultats controvertits. Objectiu: l'objectiu del treball és conèixer la relació entre el nivell d'activitat física dels pacients amb diabetis mellitus tipus 1 (DM1) i el control metabòlic de la malaltia, definit pels valors de l'hemoglobina glicosilada (HbA1c). Mètode: en l'estudi s'han inclòs 44 pacients diagnosticats de DM1 nascuts entre els anys 1998 i 2009, i que, per tant, tenen una edat compresa entre 7 i 18 anys. Les dades dels pacients s'han extret de la revisió de les històries clíniques. Tots els pacients de l'estudi han omplert els qüestionaris PAQ-C o PAQ-A (Physical Activity Questionnaire) per tal de registrar l'activitat física setmanal. Resultats: tant en l'anàlisi univariable com en l'anàlisi multivariable ajustada per factors de confusió, s'ha obtingut una relació estadísticament significativa entre el nivell d'activitat física i els valors d'HbA1c (Beta -0,510, p<0,01). Conclusió: l'activitat física millora el control glicèmic dels pacients diabètics tipus 1

Fundamento. Los principales beneficios que la actividad física aporta a la salud de los pacientes con diabetes tipo 1 se han estudiado previamente. Aún así, la evidencia de que el ejercicio físico mejora los controles metabólicos no se ha demostrado totalmente y existen resultados controvertidos. Objetivo. El objetivo de este trabajo es conocer la relación entre el nivel de actividad física de los pacientes con diabetes mellitus tipo 1 y el control metabólico de la enfermedad, definido por los valores de HbA1c. Método. En el estudio se han incluido 44 pacientes diagnosticados de diabetes mellitus tipo1 nacidos entre los años 1998 i 2009. Los datos se han obtenido de la revisión de las historias clínicas. Todos los pacientes del estudio han rellenado el cuestionario PAQ-C o PAQ-A para registrar la actividad física semanal. Resultados. El análisis univariable y el multivariable ajustado por factores de confusión muestran de manera estadísticamente significativa el efecto beneficioso del nivel de actividad física sobre los valores de HbA1c (Beta -0,510, p>0,01). Conclusión. La actividad física mejora el control metabólico de los pacientes diabéticos tipo 1 (AU)

Background. The benefits of physical activity in patients with type 1 diabetes mellitus have been previously reported. However, the association between physical activity and HbA1c levels is controversial, and studies have not shown consistent results. Objective. The aim of this study was to evaluate the association between the level of physical activity and the metabolic control of the disease, as defined by HbA1c levels. Method. Forty-four patients with type 1 diabetes mellitus and born between 1998 and 2009 were included in the study. Patient data were extracted from clinical records, and all patients completed the PAQ-C or PAQ-A questionnaire to document the weekly physical activity. Results. The analysis adjusted for possible confounding factors (Beta -0.510, p<0.01) showed that physical activity had a significant effect on the metabolic control of the HbA1c levels. Conclusion. Physical activity improves metabolic control of type 1 diabetes mellitus (AU)

Afectación tiroidea por enfermedad de Rosai-Dorfman / Thyroid involvement by Rosai-Dorfman disease

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Documento de consenso sobre el tratamiento con infusión subcutánea continua de insulina en el medio hospitalario / Position statement on continuous subcutaneous insulin infusion in the hospital setting

En España hay un número creciente de personas con diabetes tipo 1 tratadas con la terapia de infusión subcutánea continua de insulina (ISCI), pero no hay directrices nacionales sobre cómo manejar la terapia con bomba de insulina en el ámbito hospitalario. El Grupo de Nuevas Tecnologías de la Sociedad Española de Diabetes ha revisado la literatura y varias directrices internacionales y propone un documento de consenso sobre el manejo de la terapia con bomba de insulina para los pacientes hospitalizados. El documento contiene recomendaciones sobre las indicaciones, las contraindicaciones y los requisitos necesarios para el mantenimiento de la terapia con ISCI en el hospital. Esta revisión proporciona una guía para el manejo de pacientes ISCI en entornos especiales, tales como la sala de urgencias, cirugía, parto y para pacientes pediátricos. Por último, el grupo propone un conjunto de documentos necesarios para establecer una política ISCI en el hospital. En conclusión, la terapia con ISCI se puede utilizar con seguridad en el hospital en pacientes seleccionados después de haberse implementado un protocolo estandarizado

There is an increasing number of people with type 1 diabetes treated with continuous subcutaneous insulin infusion therapy (CSII) in Spain, but there are no national guidelines on how to manage insulin pump therapy in the hospital setting. The Group on New Technologies in Diabetes of the Spanish Diabetes Society has reviewed the literature and several international guidelines, and proposes a consensus document on the management of insulin pump therapy for inpatients. The document contains recommendations on indications, contraindications and the requirements needed to maintaining CSII therapy. This review provides a guide for the management of CSII patients in special settings such as the emergency room, surgery, delivery, and for pediatric patients. Finally, the group proposes a set of documents needed to establish a CSII policy in the hospital. In conclusion, CSII therapy can safely be used in the hospital in selected patients after the implementation of a standardized protocol

Reduced circulating levels of TWEAK are associated with gestational diabetes mellitus.

BACKGROUND: To evaluate the inflammatory axis mediated by tumour necrosis factor-like weak inducer of apoptosis (TWEAK) and its scavenger receptor CD163 during pregnancy and their influence on insulin sensitivity in normal pregnancy and in gestational diabetes mellitus (GDM). MATERIALS AND METHODS: One hundred and thirty seven women with one singleton pregnancy, 71 with normal glucose tolerance (NGT) and 66 with GDM were studied. Glucose metabolism was assessed by oral glucose tolerance test. Serum concentrations of soluble TWEAK (sTWEAK) and CD163 (sCD163) and insulin resistance (HOMA-IR index) were determined in maternal blood drawn at recruitment, in the early third trimester. Offspring weight and height were assessed at birth. RESULTS: Women with GDM had lower circulating sTWEAK concentrations than control NGT group (237·8 (192·1-301·0) pg/mL vs. 277·2 (206·4-355·7) pg/mL; P = 0·013). sTWEAK was negatively associated with the presence of GDM (r = -0·212; P = 0·013), HOMA-IR index (r = -0·197; P = 0·021) and ponderal index of the newborn (r = -0·196; P = 0·025), but positively with HDL cholesterol (r = 0·283; P = 0·001). In multiple regression analysis, sTWEAK concentration emerged as one of the main predictors of insulin resistance, along with BMI, triglycerides and low concentrations of HDL cholesterol (R(2)  = 0·486; P < 0·001). No relationship was found between HOMA-IR index and sCD163 or sCD163/sTWEAK ratio. CONCLUSIONS: sTWEAK concentrations are lower in patients with GDM compared with healthy pregnant women, and low concentrations of sTWEAK are associated with insulin resistance. These findings suggest that insulin resistance during pregnancy is closely linked to inflammatory imbalance and sTWEAK may represent a new candidate associated with GDM.

Serum activin A and follistatin levels in gestational diabetes and the association of the Activin A-Follistatin system with anthropometric parameters in offspring.

CONTEXT: The Activin A-Follistatin system has emerged as an important regulator of lipid and glucose metabolism with possible repercussions on fetal growth. OBJECTIVE: To analyze circulating activin A, follistatin and follistatin-like-3 (FSTL3) levels and their relationship with glucose metabolism in pregnant women and their influence on fetal growth and neonatal adiposity. DESIGN AND METHODS: A prospective cohort was studied comprising 207 pregnant women, 129 with normal glucose tolerance (NGT) and 78 with gestational diabetes mellitus (GDM) and their offspring. Activin A, follistatin and FSTL3 levels were measured in maternal serum collected in the early third trimester of pregnancy. Serial fetal ultrasounds were performed during the third trimester to evaluate fetal growth. Neonatal anthropometry was measured to assess neonatal adiposity. RESULTS: Serum follistatin levels were significantly lower in GDM than in NGT pregnant women (8.21±2.32 ng/mL vs 9.22±3.41, P = 0.012) whereas serum FSTL3 and activin A levels were comparable between the two groups. Serum follistatin concentrations were negatively correlated with HOMA-IR and positively with ultrasound growth parameters such as fractional thigh volume estimation in the middle of the third trimester and percent fat mass at birth. Also, in the stepwise multiple linear regression analysis serum follistatin levels were negatively associated with HOMA-IR (ß = -0.199, P = 0.008) and the diagnosis of gestational diabetes (ß = -0.138, P = 0.049). Likewise, fractional thigh volume estimation in the middle of third trimester and percent fat mass at birth were positively determined by serum follistatin levels (ß = 0.214, P = 0.005 and ß = 0.231, P = 0.002, respectively). CONCLUSIONS: Circulating follistatin levels are reduced in GDM compared with NGT pregnant women and they are positively associated with fetal growth and neonatal adiposity. These data suggest a role of the Activin-Follistatin system in maternal and fetal metabolism during pregnancy.

A common gene variant in STK11 is associated with metabolic risk markers and diabetes during gestation.

OBJECTIVE: To assess whether the common rs8111699 (C528G) variant in STK11 is related to metabolic risk markers in pregnant women and to gestational diabetes mellitus (GDM). DESIGN: Cross-sectional study. SETTING: Hospital. PATIENT(S): A total of 561 pregnant women: 318 without and 243 with GDM (National Diabetes Data Group criteria). INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): rs8111699 variant in STK11 (Taqman technology). Fasting glucose, insulin (homeostatic model assessment of insulin resistance and ß-cell function [HOMA-IR and -ß]) and C-peptide assessed at 24-28 weeks' gestation. RESULT(S): In non-GDM women, the G allele in rs8111699 was associated with lower HOMA-IR (CC: 1.3 ± 0.1 mIU/L; GG: 0.9 ± 0.1 mIU/L) and HOMA-ß (CC: 165 ± 20 mIU/L; GG: 118 ± 10 mIU/L). In GDM women, the G allele was related to lower body mass index (BMI; CC: 27.9 ± 1.0 kg/m(2); GG: 24.5 ± 0.6 kg/m(2)) and C-peptide (CC: 2.3 ± 0.1 ng/mL; GG: 1.6 ± 0.1 ng/mL). The GG genotype was less frequently observed in GDM women (18% vs. 26%), particularly in heavier GDM women (BMI > median: 14% vs. 28%). CONCLUSION(S): In pregnant women, the G allele for the rs8111699 variant in STK11 is associated with a more favorable metabolic phenotype and may protect against the development of GDM, particularly in heavier women.

Gender determines the actions of adiponectin multimers on fetal growth and adiposity.

OBJECTIVE: We sought to analyze the role of cord blood adiponectin and its multimeric forms in neonatal adiposity and fetal growth velocity (FGV) during the third trimester of pregnancy according to fetal gender. STUDY DESIGN: This was a prospective analytical observational study conducted at the Diabetes and Pregnancy Unit, University Hospital Joan XXIII, Tarragona, Spain. In all, 96 healthy pregnant women were included in the early third trimester and were followed up until delivery. Maternal blood was obtained upon recruitment, and cord blood was obtained at delivery. Serial fetal ultrasounds were performed during the third trimester to assess FGV. Skinfolds were measured after birth to assess neonatal adiposity. Adiponectin multimers were determined in maternal and cord blood. RESULTS: In female neonates, adiposity and FGV in the late third trimester were correlated positively with cord blood insulin (r = 0.343, P = .015 and r = 0.430, P = .002, respectively) and maternal pregravid body mass index (r = 597, P < .001 and r = 0.428, P = .002, respectively), and negatively with maternal high-molecular-weight (HMW)/total adiponectin ratio (r = -0.269, P = .035 and r = -0.387, P = .005, respectively), but in the stepwise multiple regression model, the main determinants were cord blood insulin, pregravid body mass index, and cord blood HMW adiponectin. Otherwise, in male neonates, adiposity and fetal growth were correlated with cord blood low-molecular-weight adiponectin (r = 0.486, P = .003 and r = 0.394, P = .020, respectively), and it was this multimeric form that emerged as an independent determinant in the stepwise regression model. CONCLUSION: Adiponectin seems to determine fetal growth and adipose tissue accretion, and low molecular weight is more specifically implicated in males, whereas the HMW isoform may be more important in females.