Performance of the Eversense versus the Free Style Libre Flash glucose monitor during exercise and normal daily activities in subjects with type 1 diabetes mellitus.

INTRODUCTION: Accurate blood glucose measurements are important in persons with diabetes during normal daily activities (NDA), even more so during exercise. We aimed to investigate the performance of fluorescence sensor-based and glucose oxidase-based interstitial glucose measurement during (intensive) exercise and NDA. RESEARCH DESIGN AND METHODS: Prospective, observational study in 23 persons with type 1 diabetes when mountain biking for 6 days, followed by 6 days of NDA. Readings of the Eversense (fluorescence-based continuous glucose monitoring (CGM); subcutaneously implanted) and of the Free Style Libre (FSL; glucose oxidase-based flash glucose monitoring (FGM); transcutaneously placed) were compared with capillary glucose levels (Free Style Libre Precision NeoPro strip (FSLCstrip)). RESULTS: Mean average differences (MAD) and mean average relative differences (MARD) were significantly different when comparing exercise with NDA (reference FSLCstrip); Eversense MAD 25±19 vs 17±6 mg/dL (p<0.001); MARD 17±6 vs 13%±6% (p<0.01) and FSL MAD 32±17 vs 18±8 mg/dL (p<0.01); MARD 20±7 vs 12%±5% (p<0.001).When analyzing the data according to the Integrated Continuous Glucose Monitoring Approvals (class II-510(K) guidelines), the overall performance of interstitial glucose readings within 20% of the FSLCstrip during exercise compared with NDA was 69% vs 81% for the Eversense and 59% vs 83% for the FSL, respectively. Within 15% of the FSLCstrip was 59% vs 70% for the Eversense and 46% vs 71% for the FSL. CONCLUSIONS: During exercise, both fluorescence and glucose oxidase-based interstitial glucose measurements (using Eversense and FSL sensors) were less accurate compared with measurements during NDA. Even when acknowledging the beneficial effects of CGM or FGM, users should be aware of the risk of diminished accuracy of interstitial glucose readings during (intensive) exercise.

Recommendations for somatic and germline genetic testing of single pheochromocytoma and paraganglioma based on findings from a series of 329 patients.

BACKGROUND: Nowadays, 65-80% of pheochromocytoma and paraganglioma (PPGL) cases are explained by germline or somatic mutations in one of 22 genes. Several genetic testing algorithms have been proposed, but they usually exclude sporadic-PPGLs (S-PPGLs) and none include somatic testing. We aimed to genetically characterise S-PPGL cases and propose an evidence-based algorithm for genetic testing, prioritising DNA source. METHODS: The study included 329 probands fitting three criteria: single PPGL, no syndromic and no PPGL family history. Germline DNA was tested for point mutations in RET and for both point mutation and gross deletions in VHL, the SDH genes, TMEM127, MAX and FH. 99 tumours from patients negative for germline screening were available and tested for RET, VHL, HRAS, EPAS1, MAX and SDHB. RESULTS: Germline mutations were found in 46 (14.0%) patients, being more prevalent in paragangliomas (PGLs) (28.7%) than in pheochromocytomas (PCCs) (4.5%) (p=6.62×10(-10)). Somatic mutations were found in 43% of those tested, being more prevalent in PCCs (48.5%) than in PGLs (32.3%) (p=0.13). A quarter of S-PPGLs had a somatic mutation, regardless of age at presentation. Head and neck PGLs (HN-PGLs) and thoracic-PGLs (T-PGLs) more commonly had germline mutations (p=2.0×10(-4) and p=0.027, respectively). Five of the 29 metastatic cases harboured a somatic mutation, one in HRAS. CONCLUSIONS: We recommend prioritising testing for germline mutations in patients with HN-PGLs and T-PGLs, and for somatic mutations in those with PCC. Biochemical secretion and SDHB-immunohistochemistry should guide genetic screening in abdominal-PGLs. Paediatric and metastatic cases should not be excluded from somatic screening.

Valoración del estado de nutrición yódica y niveles de tiroxinemia en mujeres embarazadas de diferentes áreas geográficas de Castilla y León / Assessment of iodine nutritional status and thyroxine levels in pregnant women from different geographic areas of the Castile and Leon

Fundamento y objetivos El estado nutricional de yodo de las embarazadas es importante para el desarrollo neuronal del feto. Esta situación puede ser distinta según la zona geográfica estudiada, por lo que hemos valorado la función tiroidea y la excreción de yodo urinario en gestantes de tres provincias diferentes de una extensa comunidad autónoma. Pacientes y método Estudio descriptivo, llevado a cabo en tres áreas sanitarias de Burgos, zona urbana, Ávila, zona rural y Ponferrada, zona rural valorada previamente. Se estudiaron 1.200 mujeres en el primer trimestre de la gestación, se realizo encuesta, se midieron hormonas tiroideas y contenido de yodo en orina. Resultados Declararon consumir sal yodada el 40% de las embarazadas y compuestos yodados el 17%. La mediana de yoduria del grupo total fue de 121 mcg/L, con concentraciones más bajas de yodo en orina en Burgos (117 mcg/L) y Ponferrada (118 mcg/L) y mejores en Ávila (130 mcg/L). La yoduria fue inferior a 100 mcg/L en el 34% de las gestantes y presentaron niveles indetectables el 3,3%. El 69,8% de las mujeres presentaron yodurias menores de 150 mcg/L. Se constató hipotiroxinemia en un 1,1% de las gestantes y la tirotropina se encontró aumentada en un 4,7%.ConclusionesEn la actualidad existe déficit de yodo en las embarazadas de diferentes zonas de nuestra amplia comunidad autónoma. El consumo de sal yodada y de compuestos farmacológicos de yodo no está ampliamente establecido. Es necesario suplementar el consumo de yodo en las mujeres que programen embarazo y lo antes posible en las que ya se encuentran embarazadas una vez conocida la gestación. Sería conveniente llevar a cabo estudios de otras áreas no valoradas (AU)

Background and objectives: Iodine nutritional status in pregnant women is important for neuronal development of the fetus, and may vary depending on the geographic area. Thyroid function and urinary iodine excretion were therefore assessed in pregnant women from three different provinces of a large Spanish autonomous community. Patients and methods: A descriptive study was conducted in the three healthcare areas of Burgos, Avila, and Ponferrada on 1,200 women in the first trimester of pregnancy The study consisted of a survey and thyroid hormone and urinary iodine measurements. Results: Use of iodized salt and iodine-containing pharmacological compounds was reported by40% and 17% of pregnant women respectively. Median urinary iodine excretion in the total group was 121 mcg/L, with lower values in Burgos (117 mcg/L) and Ponferrada (118 mcg/L) and higher levels in Avila (130 mcg/L). Urinary iodine excretion was less than 100 mcg/L in 34% of women and was undetectable in 3.3%. Excretion levels lower than 150 mcg/L were found in 69.8% of women. Low thyroxine levels were detected in 1.1%, and thyrotropin levels were increased in4.7%.Conclusions: Iodine deficiency currently exists in pregnant women from different areas of ourlarge autonomous community. Consumption of iodized salt and iodine-containing pharmacologicalcompounds is not widely established. It would be of great interest to conduct studies in other geographic areas and to advise an increased iodine intake in women who plan to become pregnant and in pregnant women from the very start of pregnancy (AU)

[Assessment of iodine nutritional status and thyroxine levels in pregnant women from different geographic areas of the Castile and Leon]. / Valoración del estado de nutrición yódica y niveles de tiroxinemia en mujeres embarazadas de diferentes áreas geográficas de Castilla y León.

BACKGROUND AND OBJECTIVES: Iodine nutritional status in pregnant women is important for neuronal development of the fetus, and may vary depending on the geographic area. Thyroid function and urinary iodine excretion were therefore assessed in pregnant women from three different provinces of a large Spanish autonomous community. PATIENTS AND METHODS: A descriptive study was conducted in the three healthcare areas of Burgos, Avila, and Ponferrada on 1,200 women in the first trimester of pregnancy The study consisted of a survey and thyroid hormone and urinary iodine measurements. RESULTS: Use of iodized salt and iodine-containing pharmacological compounds was reported by 40% and 17% of pregnant women respectively. Median urinary iodine excretion in the total group was 121 mcg/L, with lower values in Burgos (117 mcg/L) and Ponferrada (118 mcg/L) and higher levels in Avila (130 mcg/L). Urinary iodine excretion was less than 100 mcg/L in 34% of women and was undetectable in 3.3%. Excretion levels lower than 150 mcg/L were found in 69.8% of women. Low thyroxine levels were detected in 1.1%, and thyrotropin levels were increased in 4.7%. CONCLUSIONS: Iodine deficiency currently exists in pregnant women from different areas of our large autonomous community. Consumption of iodized salt and iodine-containing pharmacological compounds is not widely established. It would be of great interest to conduct studies in other geographic areas and to advise an increased iodine intake in women who plan to become pregnant and in pregnant women from the very start of pregnancy.

Priapismo secundario a la administración de testosterona en el tratamiento del retraso puberal / Priapism following testosterone administration for the treatment of delayed puberty

OBJETIVO: Presentamos un caso de priapismo secundario a la administración de testosterona. MÉTODO: Varón de 14 años de edad tratado con testosterona por un retraso puberal, que presentó un episodio de priapismo. RESULTADOS: El paciente presentó un episodio de priapismo relacionado con la administración de una dosis de testosterona depot de 100 mg. Fue necesario realizar la punción-aspiración de los cuerpos cavernosos para el tratamiento y la resolución del priapismo. CONCLUSIONES: El tratamiento con testosterona para el retraso puberal, en general es seguro pero pueden presentarse casos con priapismo secundario (AU)