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Introduction: Serum cortisol levels within the first days after pituitary surgery have been shown to be a predictor of post-surgical adrenal insufficiency. However, the indication of empirical glucocorticoids to avoid this complication remains controversial. The objective is to assess the role of cortisol in the early postoperative period as a predictor of long-term corticotropic function according to the pituitary perisurgical protocol with corticosteroid replacement followed in our center., Methods: One hundred eighteen patients who underwent surgery in a single center between December 2012 and January 2020 for a pituitary adenoma were included. Of these, 54 patients with previous adrenal insufficiency (AI), Cushing's disease, or tumors that required treatment with high-dose glucocorticoids (GC) were excluded. A treatment protocol with glucocorticoids was established, consisting of its empirical administration at rapidly decreasing doses, and serum cortisol was determined on the third day after surgery. Subsequent adrenal status was assessed through follow-up biochemical and clinical evaluations., Results: Out of the 64 patients treated, there were 56 macroadenomas and 8 microadenomas. The incidence of adrenal insufficiency after pituitary surgery was 4.7%. The optimal cut-off value that predicted an adequate corticotropic reserve, taking into account the best relationship of specificity and sensitivity, was ≥4.1 μg/dl for serum cortisol on the third day (sensitivity 95.1%, specificity 100%)., Conclusion: Serum cortisol on the third day predicts the development of adrenal insufficiency. We suggest a cortisol cut-off point of ≥4.1 μg/dl on postoperative on the third day after surgery as a predictor of the adrenal reserve in the long-term., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Aim: To determine the association and the prognostic value of soluble ST2 (sST2) levels in the development of diabetic retinopathy (DR), diabetic macular oedema (DMO) or diabetic nephropathy (DN), in a cohort of patients with type 1 diabetes (T1D)., Methods: A total of 269 individuals with T1D (154 males and 115 females) were recruited. The overall mean age was 43.2±14.9 years, and the diabetes duration was 17.1±12.1 years. Levels of sST2 in serum were evaluated, and the presence as well as the degree of DR, DMO and DN was recorded. Additionally, other clinical and analytical parameters including demographic variables were recovered from patients' electronic health record. Ten years later, the presence and stage of DR, DMO and DN were again recorded under the same criteria. The association between previously mentioned parameters with DR and DN was analysed by univariate and multivariate logistic regression. The variables in the final multivariate models were adjusted from complete models via backward elimination and maintained only when significant., Results: An increase of 10ng/ml in the levels of sST2 was associated with a 1.50 (1.02-2.19) and 1.48 (1.05-2.08) prevalence odds ratio (OR) in DMO and DR, respectively. There was no association between sST2 levels and DN. Meanwhile, sST2 levels did not display a prognostic effect in any of the microangiopathic diabetic complications studied., Conclusions: Levels of sST2 are associated with the presence of DR and DMO, they do not seem to be predictive for the development or deterioration of DR, DMO or DN., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Aim: To determine the association and the prognostic value of soluble ST2 (sST2) levels in the development of diabetic retinopathy (DR), diabetic macular oedema (DMO) or diabetic nephropathy (DN), in a cohort of patients with type 1 diabetes (T1D)., Methods: A total of 269 individuals with T1D (154 males and 115 females) were recruited. The overall mean age was 43.2±14.9 years, and the diabetes duration was 17.1±12.1 years. Levels of sST2 in serum were evaluated, and the presence as well as the degree of DR, DMO and DN was recorded. Additionally, other clinical and analytical parameters including demographic variables were recovered from patients' electronic health record. Ten years later, the presence and stage of DR, DMO and DN were again recorded under the same criteria. The association between previously mentioned parameters with DR and DN was analysed by univariate and multivariate logistic regression. The variables in the final multivariate models were adjusted from complete models via backward elimination and maintained only when significant., Results: An increase of 10ng/ml in the levels of sST2 was associated with a 1.50 (1.02-2.19) and 1.48 (1.05-2.08) prevalence odds ratio (OR) in DMO and DR, respectively. There was no association between sST2 levels and DN. Meanwhile, sST2 levels did not display a prognostic effect in any of the microangiopathic diabetic complications studied., Conclusions: Levels of sST2 are associated with the presence of DR and DMO, they do not seem to be predictive for the development or deterioration of DR, DMO or DN., (Copyright © 2021 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Given the higher rate of hospital admissions among diabetic patients, discharge should be used to optimize outpatient treatment. We evaluate a follow-up program for diabetic patients after hospital discharge to determine the evolution of glycemic control., Method: Retrospective collection of data on 375 diabetic patients enrolled in the follow-up program for optimization treatment: telephonic follow-up where treatment was adjusted if needed; and three months after discharge an in-person consultation was scheduled. Factors potentially associated with a 1% improvement in HbA1c were studied by multivariate logistic regression., Results: Seventy-three percent of enrolled patients completed the follow-up program; each patient received an average of 4.6 phone calls. Globally, basal mean HbA1c was significantly lower three months later regarding the initial value (8.6 vs. 7.2%); the most relevant lowering was found in the group of hyper-glycemia by poor metabolic control (from 9.9 to 7.7%), combined hyperglycemia (from 9.3 to 7.3%) and debut (from 8.3 to 6.4%). Twenty percent of patients reported capillary hypoglycemia, with two severe events. A shorter duration of diabetes, absence of corticotherapy and absence of hypoglycemia during the follow-up period were independent predictors for a 1% reduction in three-months HbA1c., Conclusion: In patients whose treatment is changed on hospital discharge, a program allowing frequent treatment adjustment would improve HbA1c levels. These results could help to organize health resources more rationally.

Introduction: The aim of this study was to ascertain the prevalence of carbohydrate changes in patients diagnosed with acromegaly, and to evaluate what happens two years after treatment. It was also intended to assess which factors are associated to the occurrence of such changes., Material and Methods: Sixty-six patients diagnosed with acromegaly at our center were enrolled and divided into groups with normal glucose metabolism, prediabetes, and diabetes. After 2 years of treatment of acromegaly, prevalence carbohydrate changes was assessed again depending on the patient condition (cured, controlled with medical treatment, or uncontrolled)., Results: At the time of diagnosis of acromegaly, 27.3% of the patients had diabetes (n=18), 39.4% had prediabetes (n=26), and 33.3% had no changes (n=22). Significant differences were found in IGF-1 and z-score of IGF-1 (median of 18.1 in diabetics and 10.6 in non-diabetics, P=.005). Two years after treatment, there was a significant decrease in the prevalence of diabetes and prediabetes in cured patients (from 29.2% to 8.3% and from 45.8% to 16.7%, respectively, P=.003), but not in patients controlled with medical treatment or not controlled., Conclusion: At our center, 66.6% of patients with acromegaly had changes in carbohydrate metabolism at diagnosis, with a prevalence of diabetes of 27.3%. Two years after treatment of acromegaly, prevalence of diabetes and prediabetes decreased in cured patients., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim. To determine the influence of age at onset of type 1 diabetes and of traditional vascular risk factors on the development of diabetic retinopathy, in a cohort of patients who have been followed up after onset. Methods. Observational, retrospective study. The cohort consists of 989 patients who were followed up after diagnosis for a mean of 10.1 (SD: 6.8) years. The influence of age at diagnosis, glycemic control, duration of diabetes, sex, blood pressure, lipids, BMI, and smoking is analyzed using Cox univariate and multivariate models with fixed and time-dependent variables. Results. 135 patients (13.7%) developed diabetic retinopathy. The cumulative incidence was 0.7, 5.9, and 21.8% at 5-, 10-, and 15-year follow-up, respectively. Compared to the group with onset at age <10 years, the risk of retinopathy increased 2.5-, 3-, 3.3-, and 3.7-fold in the groups with onset at 10-14, 15-29, 30-44, and >44 years, respectively. During follow-up we also observed an association between diabetic retinopathy and HbA1c levels, HDL-cholesterol, and diastolic blood pressure. Conclusion. The rate of diabetic retinopathy is higher in patients who were older at type 1 diabetes diagnosis. In addition, we confirmed the influence of glycemic control, HDL-cholesterol, and diastolic blood pressure on the occurrence of retinopathy.

Objectives: A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily inyections (MDI) with bolus calculator group., Material and Methods: This is a retrospective cohort study with following up during the first 12 months that CSII group (n=30) begins the use of "bolus wizard" and the MDI-calculator (n=30) group begins the use of the bolus calculator (Accu-Chek(®) Aviva Expert)., Primary Outcome: HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia)., Statistical Analysis: T Student and nonparametric tests., Results: The average reduction in HbA1c during the study was significantly higher in CSII group (-0.56±0.84%) compared with the MDI group (0.097±0.94%), P=.028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences were found between the 2 treatment groups after analyzing the EsDQOL, FH-15 and Clarke questionnaires. In the CSII group, perceived quality of life assessed by the EsDQOL questionnaire was found to be better at the end of the study than at the beginning of using the insulin pump., Conclusions: The average reduction in HbA1c was significantly higher in the CSII group. In the CSII group, perceived quality of life was better at the end of the study than at the beginning., (Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To provide practical and up to date recommendations for evaluation, differential diagnosis, and treatment of prolactinoma and hyperprolactinemia in various clinical settings., Participants: Members of the Neuroendocrinology Working Group of the Spanish Society of Endocrinology., Methods: Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system (GRADE) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (Pubmed) for each subject, and authors' considerations were added in areas where the literature provided scarce evidence. Finally, recommendations were jointly discussed by the Working Group., Conclusions: The document provides evidence-based practical and updated recommendations for diagnosis and management of hyperprolactinemia and prolactinoma, including drug-induced hyperprolactinemia, treatment options for prolactinoma (drugs, surgery, and radiotherapy), prolactinoma in pregnancy, adverse effects of dopaminergic agents, and drug-resistant and malignant prolactinomas., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Background: Advancing age is an independent predictor of increased mortality. Our purpose was to study morbimortality in very elderly inpatients (Eighty years and older) and to recognize risk factors of hospital-associated mortality., Methods: All consecutive eighty years and older patients admitted at the Hospital over a one year period were studied. On the first day we collected: symptoms, signs, presumed diagnostic, arterial blood pressure, pulse and respiratory frequency, level of alertness, hydration status, level of hemoglobin, plasma urea, creatinine, Na, K, albumin and arterial blood gases. We also collected end-stay diagnostic and outcome., Results: A total of 131 patients were included with a mean age 83.92 +/- 3.53 (+/-SD). The most frequent diseases were heart failure, chronic obstructive pulmonary disease, stroke and pneumonia. While inpatient 21 (16%) died (Mean age 85.42 +/- 4.46, p < 0.05). Patients whose admission symptoms were arthralgia, myalgia, diarrhea, anemia, syncope and hemiparesis (p < 0.05) and whose presumed diagnostic were rheumatic disease (p < 0.01) and nephrourological disorder (p < 0.001) had lower mortality. A presumed diagnostic on admission of pneumonia had higher mortality (p < 0.05). Risk factors associated with higher mortality were dehydrations signs, decreased alertness status, hypoalbuminemia and elevated plasma urea (p < 0.001). When analysed altogether in order to predict Hospital-associated death had sensitivity 80%, specificity 87%, truepredictive rate 44% and false-predictive rate 97%., Conclusions: Morbidity of the very elderly patients is caused by chronic disorders. Pneumonia is a leading cause of death mainly in patients with decreased level of alertness, dehydration, hypoalbuminemia and elevated plasma urea.