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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 at6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level35 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 (p0.05). 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.

This study was aimed to identify the prevalence of gestational diabetes (GD) defined as any glucose intolerance detected in a pregnant women using the oral glucose tolerance test (OGTT) protocol, proposed by the World Health Organization (WHO) and to explore the effect of late pregnancy on the glucose tolerance test. Two groups of pregnant women20 years of age were evaluated with an OGTT, one group at the beginning, and the other one at the end of the third trimester, newborns weight and gestational age were recorded at the end of pregnancy.Group A (n = 152), was studied at 24-28 weeks and group B (n = 214) was studied at 32-36 weeks, after an overnight fasting a 75 g glucose load was provided and a blood sample was taken after 2 h. Glucose levels140 mg/dL were diagnostic of GD, women with glucose levels in the range of 140-199 mg/dL were prescribed dietary recommendations, but women with glucose levels200 mg/dL were treated with insulin. Newborns were considered macrosomic if weighted4,000 g and large for gestational age if exceeded the 97th percentile or the Lubchenko scale, both conditions are described as macrosomia in the text. Comparisons were done using the Chi-square and Fisher exact tests.In group A GD was diagnosed in 27 women (17.76%), but only three of them (1.97%) had glucose levels200 mg/dL and in group B-GD was diagnosed in 62 women (28.97%), but only eight of them (3.73%) had glucose levels200 mg/dL. The difference in rates between groups A and B was significant (p0.01). In group A, normal women had 19 (15.2%) macrosomic newborns and women with GD had nine (33.33%) macrosomic newborns, this difference was significant (p0.05); however, in group B women with GD vs. normal, had 10 (16.12%) and 19 (12.5%) macrosomic newborns, respectively (p = ns).The new criteria for GD diagnosis increases notoriously its prevalence in our population to 17.76% at the beginning of the third trimester, comparing with 1.97% of women with glucose levels200 mg/dL applying the WHO criteria for diabetes in nonpregnant adults, however, comparing the newborns weight of normal women vs. GD women the prevalence of macrosomia was almost the double, reflecting the importance of this diagnosis in perinatal health. Women screened at the end of pregnancy had a significant increase in GD prevalence, but macrosomia was not different of the normal women of this group suggesting that GD at this stage of pregnancy may help to detect women with a higher risk to develop diabetes, but have no impact on perinatal health.

Primary pigmented nodular adrenocortical disease is a rare cause of Cushing's syndrome in children and young adults. It is characterized by hypercorticolism resistant to dexamethasone suppression and at microscopic examination by multiple small black cortical nodules containing large cells with eosinophilic cytoplasm and lipofuscin with internodular cortical atrophy. Its pathogenesis is unknown. Bilateral adrenalectomy is the treatment of choice. We report a case of Cushing's syndrome due to primary pigmented nodular adrenocortical disease in a 32 year old female and review the literature.

To evaluate the prevalence of silent myocardial ischemia in patients with non-insulin dependent diabetes mellitus with no symptoms of cardiac disease.Tertiary care center.60 patients with non-insulin dependent diabetes mellitus; mean age 58 +/- 12 years, who had no symptoms of angina or any other clinical evidence of coronary artery disease and normal resting electrocardiogram. A control group of 57 healthy volunteers, matched for age and sex were included.All patients underwent a 24 hour electrocardiographic Holter monitoring test. An ischemic episode was defined as depression of the ST segmentor = 1 mm foror = 1 min.10 of the 60 diabetic (17%) were found to have silent myocardial ischemia and only 3/57 (5%) was detected in the controls. In a two years follow up, four diabetics developed symptomatic angina pectoris.Silent myocardial ischemia in asymptomatic diabetics occurs frequently; a lack of symptoms does not discard a myocardial ischemia, and the Holter recordings may help in its detection.

To determine the prevalence of gestational diabetes (GD) in an outpatient clinic in northeastern Mexico.732 consecutive pregnant women referred for prenatal care during a two-year period. INTERVENTION AND OUTCOME MEASURE: A 100 g glucose tolerance test was performed in the patients with sampling at 1, 2 and 3 hours postchallenge. The patients were classified according to the criteria of the American Diabetes Association as normal, abnormal, and a third category of those showing a single abnormal value in the tolerance test.Six percent of the women (44/732) had GD and 1.4% (10/732) had one abnormal value. A comparison group was made with a subset of 44 of the 678 women who showed a normal tolerance test. No group differences were seen in parity, and age, nor in body weight gain or changes in body mass index, the latter measured in the initial and final weeks of pregnancy. Significant differences versus the normal women were seen in the GD group for cesarean births (43% vs 30%) and in macrosomy (25% vs 7%). The group with one abnormal test showed high values in cesareans (50%) and macrosomy (10%) but did not reach significant difference with the other groups.GD was higher in our study than in the only paper on GD prevalence reported in Mexico (3.9%). The higher incidence of cesareans and macrosomy in GD makes it necessary to consider therapeutic interventions in these cases.