RESUMO
Silent corticotroph adenoma (SCA) is a non-functioning macroadenoma that has positive immunoreactivity for ACTH. Few studies have evaluated the biochemical behaviour of these tumours. We present the case of a 65-year-old male incidentally diagnosed with SCA, in which an exhaustive study of the corticotroph axis was conducted.
Assuntos
Adenoma Hipofisário Secretor de ACT/diagnóstico , Adenoma Hipofisário Secretor de ACT/metabolismo , Adenoma/diagnóstico , Adenoma/metabolismo , Hormônio Adrenocorticotrópico/metabolismo , Hidrocortisona/metabolismo , Adenoma Hipofisário Secretor de ACT/cirurgia , Adenoma/cirurgia , Idoso , Doenças Assintomáticas , Humanos , Achados Incidentais , MasculinoRESUMO
BACKGROUND AND AIM: Women with history of gestational diabetes mellitus (GDM) are at increased risk for diabetes. Ethnicity may modify such risk, but no studies have been conducted in our environment. The aim of this study was to assess the incidence of type 2 diabetes mellitus and prediabetes one year after delivery in women with GDM and in a multiethnic background and to identify the associated factors. PATIENTS AND METHODS: A retrospective analysis of a prospective, observational cohort of women with GDM who attended annual postpartum follow-up visits at Hospital del Mar from January 2004 to March 2016. RESULTS: Three hundred and five women attended postpartum follow-up visits. Of these, 47.2% were Caucasian, 22% from South-Central Asia, 12% from Latin America, and 10% from Morocco and East Asia. Incidence rates of type 2 diabetes mellitus and prediabetes in these patients were 5.2 and 36.6%, respectively. In a multivariate analysis, non-Caucasian origin (OR=3.15, 95% CI [1.85-5.39]), recurrent gestational diabetes (OR=2.26, 95% CI [1.11-4.59]), and pre-pregnancy body mass index (OR=1.09, 95% CI [1.04-1.15]) were independent predictors of impaired glucose tolerance. CONCLUSIONS: In a multiethnic Spanish population of women with GDM, incidence of impaired glucose tolerance in the first year after delivery was 41.8%, with a three-fold increased risk for women of non-Caucasian ethnicity.
Assuntos
Diabetes Gestacional/etnologia , Etnicidade/estatística & dados numéricos , Intolerância à Glucose/etnologia , Adulto , Ásia/etnologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Seguimentos , Humanos , Incidência , Marrocos/etnologia , Estudos Observacionais como Assunto/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
In a cohort of women with previous gestational diabetes mellitus (GDM), we aimed to ascertain whether women with abnormal glucose tolerance 1-year postdelivery had a more atherogenic lipid profile during and after pregnancy than those with normal glucose tolerance. A prospective cohort study with longitudinal design between January 2004 and March 2016 was conducted. Three hundred and six (56.8%) of 537 women diagnosed with GDM during the studied period attended a control visit during the first year after delivery. Of these, 112 (36.6%) had prediabetes and 16 (5.2%) had type 2 diabetes mellitus. No significant differences during pregnancy were found in total, low-density lipoprotein, high-density lipoprotein (HDL) cholesterol, and triacylglycerol (TAG) concentrations among the three groups. Only HDL cholesterol and TAG levels differed significantly among groups at 2 and 12 months after delivery. Logistic regression analysis revealed pregnancy HDL and glucose metabolism status to be associated with the HDL cholesterol concentration 1-year postdelivery. Furthermore, the only independent factor associated with TAG levels 1 year after delivery was the gestational TAG concentration. In summary, an overweight multiethnic group of women with prior GDM presented a high incidence of postpartum dysglycemia (41.8%). HDL-cholesterol and TAG levels, both components of the metabolic syndrome, differed significantly among the three study groups in the glucose-metabolism status at 2 and 12 months after delivery. Women with previous GDM must be followed up in the postpartum period for early detection and management of lipid and glucose disorders.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Diabetes Gestacional/metabolismo , Dislipidemias/complicações , Período Pós-Parto/metabolismo , Adulto , Aterosclerose/sangue , Aterosclerose/metabolismo , Glicemia/metabolismo , HDL-Colesterol/sangue , HDL-Colesterol/metabolismo , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Diabetes Gestacional/sangue , Dislipidemias/sangue , Dislipidemias/metabolismo , Feminino , Teste de Tolerância a Glucose , Humanos , Período Pós-Parto/sangue , Gravidez , Estudos Prospectivos , Análise de Regressão , Triglicerídeos/sangue , Triglicerídeos/metabolismoRESUMO
Antecedentes y objetivo: Las mujeres con antecedentes de diabetes mellitus gestacional (DMG) tienen mayor riesgo de diabetes. Si bien la etnia puede modificar este riesgo, no disponemos de estudios específicos en nuestro entorno. El objetivo del presente estudio fue determinar la incidencia de diabetes mellitus tipo 2 y prediabetes en el primer año posparto en mujeres con DMG y en un entorno multiétnico e identificar los factores asociados. Pacientes y métodos: Análisis retrospectivo de una cohorte observacional prospectiva de mujeres con DMG que acudieron al control posparto anual en el Hospital del Mar, entre enero de 2004 y marzo de 2016. Resultados: Trescientas cinco mujeres asistieron a las revisiones posparto. De estas, un 47,2% fueron caucásicas, un 22% del centro-sur de Asia, un 12% fueron de origen hispano y un 10% procedían de Marruecos y del este de Asia. La incidencia de diabetes mellitus tipo 2 y de prediabetes fue del 5,2 y el 36,6%, respectivamente. Los factores asociados al metabolismo alterado de la glucosa fueron la etnia no caucásica (OR=3,15, IC 95% [1,85-5,39]), los antecedentes previos de DMG (OR=2,26, IC 95% [1,11-4,59]) y el índice de masa corporal previo al embarazo (OR=1,09, IC 95% [1,04-1,15]). Conclusiones: En una población española de origen multiétnico, la incidencia de alteraciones del metabolismo hidrocarbonado en el primer año posparto de mujeres con antecedentes de DMG fue del 41,8%, siendo el riesgo 3 veces superior en las mujeres no caucásicas que en las caucásicas
Background and aim: Women with history of gestational diabetes mellitus (GDM) are at increased risk for diabetes. Ethnicity may modify such risk, but no studies have been conducted in our environment. The aim of this study was to assess the incidence of type 2 diabetes mellitus and prediabetes one year after delivery in women with GDM and in a multiethnic background and to identify the associated factors. Patients and methods: A retrospective analysis of a prospective, observational cohort of women with GDM who attended annual postpartum follow-up visits at Hospital del Mar from January 2004 to March 2016. Results: Three hundred and five women attended postpartum follow-up visits. Of these, 47.2% were Caucasian, 22% from South-Central Asia, 12% from Latin America, and 10% from Morocco and East Asia. Incidence rates of type 2 diabetes mellitus and prediabetes in these patients were 5.2 and 36.6%, respectively. In a multivariate analysis, non-Caucasian origin (OR=3.15, 95% CI [1.85-5.39]), recurrent gestational diabetes (OR=2.26, 95% CI [1.11-4.59]), and pre-pregnancy body mass index (OR=1.09, 95% CI [1.04-1.15]) were independent predictors of impaired glucose tolerance. Conclusions: In a multiethnic Spanish population of women with GDM, incidence of impaired glucose tolerance in the first year after delivery was 41.8%, with a three-fold increased risk for women of non-Caucasian ethnicity