Rosiglitazone as an option for patients with acromegaly: a case series.

INTRODUCTION: In the patient with acromegaly, pituitary surgery is the therapeutic standard. Despite undergoing surgery, a significant number of patients with acromegaly continue to have uncontrolled growth hormone secretion. These patients require other treatments such as external irradiation and/or drug therapy. CASE PRESENTATION: We present the clinical and laboratory responses to six months of treatment with rosiglitazone in four cases. In all four cases, the patients had persistent growth hormone overproduction despite previous surgical treatment and other conventional therapy. Case 1 is a 57-year-old Caucasian woman, case 2 is a 51-year-old Hispanic man, case 3 is a 32-year-old Hispanic woman, and case 4 is a 36-year-old Hispanic man. In three of these patients, basal and nadir growth hormone and insulin-like growth factor 1 levels were significantly decreased (P < 0.05 and P < 0.01, respectively). CONCLUSION: Rosiglitazone could be a treatment option in select patients with acromegaly.

[Treatment of macroprolactinoma with cabergoline during pregnancy]. / Tratamiento del macroprolactinoma con cabergolina durante el embarazo.

OBJECTIVE: Management of macroprolactinomas in women who plan to get pregnant is controversial and when this happen there is a risk of pituitary enlargement, if this happens bromocriptine has a safe profile to be used during pregnancy, but if it is not tolerated cabergoline is a good alternative. CLINICAL CASES: We describe two patients with macroprolactinomas who intended to get pregnant. One of them had been previously treated surgically and the second one was treated with bromocriptine and got pregnant before the tomographic studies were checked. Both patients developed during pregnancy symptoms of macroprolactinoma enlargement and were initially treated with bromocriptine but this was not tolerated and were switched to cabergoline. Both pregnancies ended with a normal full term newborn. CONCLUSION: Pregnant women with symptoms of pituitary enlargement must be treated with bromocriptine, but if it is not tolerated cabergoline is a good choice.

[Neonatal morbidity associated to gestational diabetes. A descriptive study on 74 patients]. / Morbilidad neonatal asociada a diabetes gestacional. Estudio descriptivo de 74 pacientes.

INTRODUCTION: women with gestational diabetes have an increase risk for maternal and neonatal metabolic complications. OBJECTIVE: to evaluate detection, treatment and close surveillance. METHODS: we recruited all women with gestational diabetes whose pregnancies ended in this hospital between September to November of 2005. All newborns were examined by a neonatologist and initiated early feeding with infant formula or glucose solution. RESULTS: a total of 74 patients with gestational diabetes were included. The age was 31.03 +/- 4.79 years, and the body mass index before pregnancy was 32.31 +/- 6.41. Eighteen patients developed third-trimester complications, in fourteen of them it was hypertensive disease of pregnancy. All were single pregnancies that ended in 71 term and 3 preterm newborns. There were not fetal or perinatal deaths. There were four small newborns for gestational age, 18 large for gestational age and 52 normal weight newborns. Eleven neonates had metabolic complications, eight of them had idiopathic respiratory distress syndrome, four had hypoglycaemia and one large for gestational age had obstetric trauma. Also two neonates with cardiovascular malformations were diagnosed. Thirty-six mothers returned for revaluation, eight had type 2 diabetes, six glucose intolerance. CONCLUSIONS: this group of patients shows the maternal and neonatal morbidity associated to gestational diabetes in patients under close surveillance. Systematic early screening in women at risk and close surveillance are required to obtain healthy newborns.

[Hypoglycemia in the newborns of women with diabetes mellitus]. / Hipoglucemia neonatal en hijos de madres con diabetes mellitus.

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean +/- standard deviation) was 30.5 +/- 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.77%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

Hipoglucemia neonatal en hijos de madres con diabetes mellitus / Hypoglycemia in the newborns of women with diabetes mellitus

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean ± standard deviation) was 30.5 ± 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.7%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

La hipoglucemia neonatal es un evento frecuente en las primeras horas de vida del recién nacido (RN) de madres que padecen diabetes mellitus (DM). Para conocer su prevalencia estudiamos los hijos de mujeres con DM y embarazo (n = 85) y cuyos nacimientos ocurrieron en el periodo de reclutamiento de cuatro meses. A estos neonatos se les determinaron las concentraciones de glucosa en sangre venosa realizando una toma en las primeras seis horas, la segunda toma entre las seis y las doce horas y una tercera toma entre las 12-24 horas de vida, usando como criterio de hipoglucemia el propuesto por Cornblath para RN con factores de riesgo para hipoglucemia neonatal (glucosa < 35 mg/dL). Además, en 19 de estos niños se determinó la concentración de calcio en suero en la primera muestra de sangre venosa, tomando como criterio de hipocalcemia < 7 mEq/L. La edad de las madres fue de 30.5 + 5.5 años (media ± DE) de 30.5 ± 5.5 años, con una banda de variación de 16-41 años, 43 (50.6%) padecían DM gestacional, 40 (47.1%) DM tipo 2 y dos DM tipo 1 (2.4%). Setenta y ocho embarazos (91.8%) terminaron por cesárea y siete (8.2%) por parto, obteniéndose 85 RN vivos, de los cuales 20 (23.5%) fueron pretérmino y 65 (76.5%) de término. De acuerdo con el peso al nacer, hubo 27 (31.7%) RN macrosómicos y siete (8.2%) prematuros. Un total de 55 (64.7%) neonatos presentaron hipoglucemia, uno de los cuales desarrolló un episodio convulsivo, el resto no tuvo signos clínicos. La hipoglucemia ocurrió en 18 (66.6%) de los macrosómicos, 33 (64.7%) de los neonatos de peso normal y en cuatro (57.1%) de los prematuros. La comparación de la prevalencia de hipoglucemia por grupos de peso neonatal no mostró diferencias significativas entre los tres grupos, pero la comparación de la prevalencia de hipoglucemia con relación a la variante del tipo de diabetes materna mostró una mayor prevalencia en los hijos de mujeres con diabetes gestacional (p < 0.05). Hubo además cinco niños (7.25%) que presentaron hipocalcemia asintomática. Estos resultados muestran la alta prevalencia de hipoglucemia neonatal asintomática y la necesidad de establecer una vigilancia activa de la glucemia durante las primeras horas de vida en los RN de madres que padecen DM.

Diabetes and pregnancy.

Diabetes in pregnant women is associated with an increased risk for maternal and neonatal morbidities and remains a significant medical challenge. Fortunately, the prognosis has changed dramatically, related to an increased clinical awareness of the potential risks for the mother and the infant, better health care and intensive treatment strategies to maintain the closest to normal metabolic milieu. Diabetes and pregnancy may be divided into pregestational diabetes (women previously diagnosed with type 1 or type 2 diabetes) and gestational diabetes defined as any glucose intolerance detected during pregnancy that has evolved from a diagnosis associated with the metabolic risk of type 2 diabetes to a clinical condition associated with higher risks for maternal and perinatal morbidity. Early diagnosis of gestational diabetes is an important step to improve outcomes and systematic or selective screening with the OGTT should be established. Associated with the global epidemic in diabetes, pregnancy associated with diabetes is saturating high-risk obstetric clinics and neonatal intensive care units, becoming a heavy burden to the health care systems around the world.

Prevención de la infección por el complejo Mycobacterium avium. ¿Una necesidad en nuestros pacientes con SIDA? / Prevention of infection due to Mycobacterium avium complex. A need in our AIDS patients?

Antecedentes: el complejo Mycobacterium avium (CMA) está compuesto por dos especies que poseen poca virulencia en el huésped normal, ya que la inmunidad celular da protección. Objetivo: conocer la frecuencia de la infección diseminada por el complejo Mycobacterium avium en nuestra población de pacientes con SIDA. Material y métodos: se estudiaron todos los pacientes que tuvieron cuadro clínico sugestivo y linfocitos CD4 < 200 células/mm3; también se les efectuó cultivo de médula ósea para procesarse en medio de Lowenstein Jensen. El grupo total estuvo constituido por 33 pacientes. Resultados: en ningún caso se aisló la micobacteria después de doce semanas de incubación. Dos enfermos (6 por ciento) fallecieron debido a sarcoma de Kaposi y otras infecciones oportunistas, y 31 individuos (94 por ciento) se encontraban en buenas condiciones después de seis meses de seguimiento. Conclusiones: la infección diseminada por el complejo Mycobacterium avium no es común en nuestro medio, por lo cual, al parecer, la profilaxis rutinaria no es imprescindible.