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Objectives We aimed to evaluate fetal cerebral circulation using three-dimensional power Doppler (3DPD) vascular indices and to study their relationships with maternal lipid and glycaemic profiles. Methods Case–control study in women with and without gestational diabetes mellitus (GDM) at 28–32 weeks in which feto-maternal Doppler study and 3DPD cerebral vascularization indices (FI, VI and VFI) were determined. Maternal lipid and glycaemic profiles were also analysed. Both groups were compared and the correlations of the 3DPD indices with studied variables were analysed. Results There were significant differences between groups in cerebral FI ( p= 0.02), mean maternal Uterine artery PI ( p= 0.009) and glucose levels ( p= 0.001), being higher in the GDM group. Significant negative correlations were found in GDM group between VFI and MCA PI ( p = 0.02) and between VI and MCA PI ( p= 0.01). In the GDM group we found a negative significant correlation between FI, VI, VFI and maternal glucose (r= −0.52, pConclusions Fetal cerebral FI values were higher in GDM pregnancies. All 3DPD vascular indices showed an inverse correlation with maternal glucose levels. These findings support the view that GDM may also represent a fetal vascular disorder influencing fetal neurodevelopment.

AIMS To determine the fetal and maternal outcomes in pregnant women with Glucokinase-Maturity onset diabetes of the young (GCK-MODY). METHODS We studied the obstetric and perinatal outcomes in 99 pregnancies of 34 women with GCK-MODY. The mutation status of the offspring was known in 29 and presumed in 33. Clinical outcomes were determined and compared between affected (n = 39) and unaffected (n = 23) offspring. RESULTS 59% of pregnancies were treated with diet alone and 41% received insulin. Birthweight, percentage of large for gestational age (LGA) and caesarean section (CS) in GCK-unaffected offspring was significantly higher than in GCK-affected offspring (4.0 ± 0.7 vs. 3.4 ± 0.4 kg, p = 0.001), 15 (65%) vs. 5(13%) (p = 0.00006) and 17 (74%) vs. 11 (28%) (p = 0.001), respectively. We observed an earlier gestational age at delivery on insulin in unaffected offspring (38.3 ± 1.0 vs. 39.5 ± 1.5 weeks, p = 0.03) with no significant change in LGA (9 (82%) vs. 6 (50%); p = 0.12), and a higher rate of CS (8 [73%] vs. 3 [11%]; p

Gestational Diabetes Mellitus (GDM) is characterised by insulin resistance accompanied by reduced beta-cell compensation to increased insulin demand, typically observed in the second and third trimester and associated with adverse pregnancy outcomes. There is a need for a biomarker that can accurately monitor status and predict outcome in GDM, reducing foetal-maternal morbidity and mortality risks. To this end, circulating microRNAs (miRNAs) present themselves as promising candidates, stably expressed in serum and known to play crucial roles in regulation of glucose metabolism. We analysed circulating miRNA profiles in a cohort of GDM patients (n = 31) and nondiabetic controls (n = 29) during the third trimester for miRNA associated with insulin-secretory defects and glucose homeostasis. We identified miR-330-3p as being significantly upregulated in lean women with GDM compared to nondiabetic controls. Furthermore, increased levels of miR-330-3p were associated with better response to treatment (diet vs. insulin), with lower levels associated with exogenous insulin requirement. We observed miR-330-3p to be significantly related to the percentage of caesarean deliveries, with miR-330-3p expression significantly higher in spontaneously delivered GDM patients. We report this strong novel association of circulating miR-330-3p with risk of primary caesarean delivery as a pregnancy outcome linked with poor maternal glycaemic control, strengthening the growing body of evidence for roles of diabetes-associated miRNAs in glucose homeostasis and adaptation to the complex changes related to pregnancy.

Resumen Antecedentes y objetivos Las pacientes con diabetes mellitus gestacional (DMG) presentan un mayor riesgo de desarrollar hipertension arterial inducida por el embarazo (HIE). La monitorizacion ambulatoria de presion arterial (MAPA) ha sido usada para detectar HIE y preeclampsia, pero hasta la fecha no ha sido suficientemente estudiada en DMG. El objetivo del presente trabajo es identificar de forma precoz, en mujeres con DMG, perfiles de presion arterial (PA), detectados mediante MAPA, que pudieran definir una poblacion de mayor riesgo de desarrollar HIE y preeclampsia. Material y metodos Estudio prospectivo en 93 pacientes con PA normal con DMG. Se les implanto entre la semana 28-32 de gestacion la MAPA durante 24 h (Spacelabs 90207) y se analizaron variables clinicas, analiticas y resultados obstetricos y perinatales. Resultados La edad media fue 34,8 ± 4,39 anos. Cinco pacientes (5,4%) desarrollaron HIE. Encontramos niveles mas elevados de HbA1c (p = 0,005) y microalbuminuria (p = 0,001) entre las que desarrollaron HIE. Las pacientes con patron no dipper (50,5%) presentaron cifras de PAS nocturna (106,7 vs 98,4 mmHg) y PAD nocturna (64,8 vs 57,2 mmHg) mas elevadas (p Conclusiones En la DMG existen alteraciones tensionales con un predominio de patron no dipper de PA y con valores mas elevados de PAS y PAD nocturnos, pudiendo ser estas alteraciones predictoras de HIE. Los valores elevados de PAS nocturna aumentan el riesgo de desarrollo de HIE. Se requieren futuros estudios para determinar la relacion entre las alteraciones tensionales y las complicaciones maternas y perinatales.

BACKGROUND AND OBJECTIVE Gestational diabetes mellitus (GDM) is associated to an increased risk of pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to detect PIH and preeclampsia, but few data are currently available on its use in women with GDM. The aim of this study was to achieve early identification in women with GDM of BP profiles (detected by ABPM) that could define a population at greater risk of developing PIH and preeclampsia. MATERIAL AND METHODS A prospective study of 93 normotensive women with GDM in whom 24-h ABPM was performed (using a Spacelabs 90207 monitor) at 28-32 weeks of pregnancy. Clinical and laboratory variable and obstetric and perinatal outcomes were analyzed. RESULTS Mean age was 34.8±4.39years, and 5.4% of patients developed PIH. Higher levels of HbA1c (P=.005) and microalbumin (P=.001) were seen in patients with PIH. Patients with non-dipper patterns (50.5%) had higher values of night-time systolic BP (106.7 vs 98.4mmHg) and night-time diastolic BP (64.8 vs 57.2mmHg) (P

Resumen Introduccion El impacto del hipotiroidismo subclinico (HSC) y la autoinmunidad antitiroidea positiva en los resultados obstetricos y perinatales permanece en controversia y es objeto de gran interes. Objetivo Evaluar el impacto del HSC y la autoinmunidad positiva en las complicaciones obstetricas y perinatales en nuestra poblacion. Material y metodo Estudio de cohortes retrospectivo en 435 mujeres con HSC (TSH entre 3,86 y 10 μUI/ml, y FT4 normal) en el primer trimestre de la gestacion, con seguimiento durante el embarazo. Se analizaron parametros epidemiologicos y clinicos y se relacionaron con complicaciones obstetricas y perinatales en funcion de la presencia de autoinmunidad positiva (anticuerpos antiperoxidasa [aTPO] > 34 UI/ml). Resultados La edad media fue de 31,3 anos (desviacion estandar: 5,2). El 17% de las pacientes presentaban aTPO positivos. La presencia de aTPO se asocio a antecedentes familiares de hipotiroidismo (p = 0,04), y con una mayor probabilidad de aborto (p = 0,009). En el analisis multivariante, los aTPO positivos suponian un aumento de probabilidad de presentar aborto de 10,25 veces. No se encontraron asociaciones estadisticamente significativas con el resto de las complicaciones obstetricas y perinatales. Conclusiones En nuestro medio, las gestantes con HSC y autoinmunidad positiva presentan un mayor riesgo de aborto, pero no de otras complicaciones obstetricas y perinatales.

Background Gestational diabetes mellitus is a significant risk factor for metabolic syndrome and cardiovascular disease. Aims To assess the relationships between components of the metabolic syndrome and cytokine and adhesion molecule levels in women with GDM during pregnancy and after delivery. Patients and methods A prospective case–control study on a sample of 126 pregnant women (63 with and 63 without gestational diabetes mellitus). In an intra-subject analysis, 41 women with history of gestational diabetes mellitus and 21 controls were re-assessed in the postpartum period. Clinical data and levels of cytokines and adhesion molecules were recorded during weeks 24–29 of pregnancy and 12 months after delivery. Results In the postpartum period, there were significantly higher levels of tumor necrosis factor alpha in both cases and controls, and of adiponectin in controls. Cases showed higher leptin levels, with no significant differences during and after pregnancy. No significant differences were seen in adhesion molecules and interleukin-6 between cases and controls during pregnancy and in the postpartum period, but levels of both were higher in cases. During pregnancy and after delivery, adiponectin decreased in cases and increased in controls. Significant positive correlations were seen between adiponectin and fasting blood glucose levels and vascular cell adhesion molecule-1, and also between leptin and tumor necrosis factor alpha levels. Conclusions The results suggest that increased inflammation and transient hyperglycemia during pregnancy would represent a latent form of metabolic syndrome, with an increased risk for type 2 diabetes mellitus and future cardiovascular disease.

To evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus. We enrolled 147 pregnant women with pre-existing type 1 or 2 diabetes mellitus. Clinical and biochemical parameters were analysed in relation to obstetric and fetal outcomes. 14.2% received treatment with Neutral Protamine Hagedorn insulin and short-acting insulin analogues; 19% with premixed human insulin; 40.1% with insulin glargine and lispro, 6.2% with detemir and aspart and 20% with continuous subcutaneous insulin infusion. All 5 types of treatment achieved a reduction of the mean HbA1c during pregnancy (p = 0.01). Pre-pregnancy care was carried out for 48% of patients. We found no statistically significant differences between the different insulin therapies and the obstetric-fetal outcomes. In conclusión, the different insulin therapies used in patients with pregestational diabetes mellitus does not seem to affect obstetric-fetal outcomes.

Gestational diabetes mellitus (GDM) is associated to an increased risk of pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to detect PIH and preeclampsia, but few data are currently available on its use in women with GDM. The aim of this study was to achieve early identification in women with GDM of BP profiles (detected by ABPM) that could define a population at greater risk of developing PIH and preeclampsia.A prospective study of 93 normotensive women with GDM in whom 24-h ABPM was performed (using a Spacelabs 90207 monitor) at 28-32 weeks of pregnancy. Clinical and laboratory variable and obstetric and perinatal outcomes were analyzed.Mean age was 34.8±4.39years, and 5.4% of patients developed PIH. Higher levels of HbA1c (P=.005) and microalbumin (P=.001) were seen in patients with PIH. Patients with non-dipper patterns (50.5%) had higher values of night-time systolic BP (106.7 vs 98.4mmHg) and night-time diastolic BP (64.8 vs 57.2mmHg) (P.001). Lower birth weights (3,084.57 vs 3,323.7) (P=.021) and shorter gestational age at delivery (38.67 vs 39.27 weeks) (P=.04) were found in women with non-dipper pattern. High night-time systolic BP significantly increased the chance of developing PIH (OR: 1.18; 95%CI: 1.00-1.39; P=.043).Patients with GDM have BP changes, with predominance of the non-dipper pattern and higher night-time systolic and diastolic BP, changes that could be useful predictors of PIH. High night-time systolic BP values increase the risk of developing PIH. Further studies are needed to ascertain the relationships between BP changes and obstetric and perinatal complications.

Background The prevalence of adrenal incidentalomas is increasing with the ageing of the population and the use of high resolution imaging techniques. Current protocols propose a comprehensive monitoring of their functional and morphological state, but with no conclusive clinical evidence that endorses it. Method Retrospective study of 96 patients diagnosed with adrenal incidentaloma between 2008 and 2012. We evaluated clinical, functional, and imaging at baseline and during follow-up. Results Initially, 9 cases were surgically removed: 4 due to hyperfunction (2 Cushing syndromes and 2 pheochromocytomas) and 5 due to size larger than 4 cm. During follow-up one case of pheochromocytoma was diagnosed and another grew more than 1 cm, needing surgery. In 98.86% of nonfunctional and benign lesions, there were no functional and/or morphological changes in the final evaluation. Conclusions The results of our study challenge the validity of current diagnostic–therapeutic protocols of incidentalomas, which should be reassessed in prospective studies taking into account efficiency characteristics.

Resumen Antecedentes La prevalencia de los incidentalomas suprarrenales esta aumentando por el envejecimiento de la poblacion y el empleo de tecnicas de imagen de alta resolucion. Los protocolos actuales proponen un seguimiento de su estado funcional y morfologico exhaustivos, sin una evidencia clinica concluyente que lo avale Metodo Estudio retrospectivo de 96 pacientes diagnosticados de incidentaloma adrenal entre 2008 y 2012. Se evaluan caracteristicas clinicas, funcionales y de imagen, basales y durante el seguimiento. Resultados Inicialmente, 4 casos fueron intervenidos por hiperfuncion (2 sindromes de Cushing y 2 feocromocitomas) y 5 por tamano superior a 4 cm. Durante el seguimiento, tan solo se diagnostico un caso de feocromocitoma y otro crecio mas de 1 cm, indicandose cirugia. En el 98,86% de los incidentalomas diagnosticados inicialmente como benignos y no funcionantes, no se objetivaron modificaciones funcionales y/o morfologicas en la evaluacion final. Conclusiones Los resultados de nuestra serie cuestionan la validez de los protocolos de seguimiento de los incidentalomas adrenales vigentes en la actualidad, que deberian ser revaluados atendiendo a caracteristicas de eficiencia mediante estudios prospectivos.

Background The impact of subclinical hypothyroidism (SH) and thyroid autoimmunity on obstetric and perinatal complications continues to be a matter of interest and highly controversial. Aim To assess the impact of SH and autoimmunity in early pregnancy on the obstetric and perinatal complications in our population. Material and method A retrospective cohort study in 435 women with SH (TSH ranging from 3.86 and 10 μIU/mL and normal FT4 values) in the first trimester of pregnancy. Epidemiological and clinical parameters were analyzed and were related to obstetric and perinatal complications based on the presence of autoimmunity (thyroid peroxidase antibodies [TPO] > 34 IU/mL). Results Mean age was 31.3 years (SD 5.2). Seventeen percent of patients had positive TPO antibodies. Presence of positive autoimmunity was associated to a family history of hypothyroidism ( p = 0.04) and a higher chance of miscarriage ( p = 0.009). In the multivariate analysis, positive TPO antibodies were associated to a 10.25-fold higher risk of miscarriage. No statistically significant associations were found with all other obstetric and perinatal complications. Conclusions In our region, pregnant women with SH and thyroid autoimmunity had a higher risk of miscarriage but not of other obstetric and perinatal complications.

Gestational diabetes mellitus (GDM) is associated with increased proinflammatory cytokines and is also associated with adverse cardiovascular disease (CVD) outcomes later in life. We aim to evaluate the relationships between uterine arteries vascularization and endothelial dysfunction markers, proinflammatory cytokines, and glycemic and lipid profile in women with GDM.Fifty pregnant women were recruited at the third trimester of pregnancy for a prospective cohort study. They were classified into 2 groups: control and GDM. Comparisons of maternal plasma concentrations of endothelial dysfunction markers (vascular cell adhesion molecule 1, intercellular adhesion molecule 1, and plasminogen activator inhibitor 1), proinflammatory cytokines and mediators (interleukin 6 [IL-6], tumor necrosis factor α, vascular endothelial growth factor, placental growth factor, leptin, leukocyte count, and C-reactive protein), lipid profile, glucose, and glycosylated hemoglobin levels were performed. Mean uterine arteries Doppler pulsatility index (PI) was calculated and the relationships between the variables and PI were also analyzed.Women with GDM showed higher proinflammatory cytokines, however, endothelial dysfunction markers were similar in both groups. In the diabetic group, significant correlations were found between the mean uterine arteries PI and maternal IL-6 ( r = .56, P = .01), triglycerides ( r = .49; P = .03), total cholesterol/high-density lipoprotein cholesterol (HDL-c) ratio ( r = .61; P = .006), glucose (r = .62, P = .005), and glycosylated hemoglobin ( r = .48; P = .03). A negative significant correlation between mean uterine arteries PI and HDLc ( r = -.58; P = .02) was also found.The proinflammatory status, hyperlipidemia, and metabolic control correlate with uterine blood flow velocity waveforms in women with gestational diabetes.

Dysregulation of NO production is implicated in pregnancy-related diseases, including gestational diabetes mellitus (GDM). The role of NO and its placental targets in GDM pregnancies has yet to be determined. S-Nitrosylation is the NO-derived posttranslational protein modification that can modulate biological functions by forming NO-derived complexes with longer half-life, termed S-nitrosothiol (SNO). Our aim was to examine the presence of endogenous S-nitrosylated proteins in cysteine residues in relation to antioxidant defense, apoptosis, and cellular signal transduction in placental tissue from control (n=8) and GDM (n=8) pregnancies. S-Nitrosylation was measured using the biotin-switch assay, while the expression and protein activity were assessed by immunoblotting and colorimetric methods, respectively. Results indicated that catalase and peroxiredoxin nitrosylation levels were greater in GDM placentas, and that was accompanied by reduced catalase activity. S-Nitrosylation of ERK1/2 and AKT was increased in GDM placentas, and their activities were inhibited. Activities of caspase-3 and caspase-9 were increased, with the latter also showing diminished nitrosylation levels. These findings suggest that S-nitrosylation is a little-known, but critical, mechanism by which NO directly modulates key placental proteins in women with GDM and, as a consequence, maternal and fetal anomalies during pregnancy can occur.

Relationships between adhesion molecules (AM), oxidative stress, gestational diabetes mellitus (GDM) and future development of type 2 diabetes mellitus are unclear. We investigated AM and oxidant/antioxidant markers in women with previous history of GDM. Postpartum women with GDM (cases; n = 41) and healthy women (controls; n = 21) had clinical and laboratory variables measured, including indicators of vascular damage (ICAM-1, VCAM-1 and E-selectin), oxidative stress (LPO, GSH and GST) and antioxidant markers (catalase, SOD, GPX and TAC). Previous GDM versus control women presented higher body mass index: 27.4 ± 5.6 versus 23.9 ± 3.6 (p = 0.013); waist circumference: 85.2 ± 12.9 versus 77.5 ± 9.0 (p = 0.017); MetS (WHO definition): 14.6 versus 0 % (p = 0.012); MetS (NCEP-ATPIII definition): 22 versus 0 % (p = 0.002); low HDL: 36.6 versus 9.5 % (p = 0.024); fasting glucose (mmol/L): 5.4 ± 0.6 versus 4.9 ± 0.2 (p

Background Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for metabolic syndrome and CVD. The aim of the study was to evaluate the relationships between levels of cytokines, components of metabolic syndrome and cardiovascular risk markers in women with previous gestational diabetes. Methods Women (n = 41) with gestational diabetes background (cases) and 21 healthy women (controls) in the postpartum period were enrolled. Demographic and clinical data, lipid and carbohydrate metabolism and uric acid and adipokine levels (TNF-α, IL-6, leptin and adiponectin) were compared and their relationships analysed. Metabolic syndrome prevalence was calculated by WHO and NCEP-ATPIII definitions. Results There were significant differences between cases and controls: body mass index (kg/m2) 27.4 ± 5.6 vs 23.9 ± 3.6 (p = 0.013), waist circumference (cm) 85.2 ± 12.9 vs 77.5 ± 9.0 (p = 0.017), metabolic syndrome (WHO definition) 14.6% vs 0% (p = 0.012), metabolic syndrome (NCEP-ATPIII definition) 22% vs 0% (p = 0.002), low HDL 36.6% vs 9.5% (p = 0.024), fasting glucose (mmol/L) 5.4 ± 0.6 vs 4.9 ± 0.2 (p

Goiter is defined as any increase in either diffuse or nodular thyroid gland, whatever their cause. Goiter assessment should include complete history and examination, assessment of thyroid function and laboratory tests required to guide the benignity or malignancy of the lesion and potential effects on adjacent structures. As for treatment must be identified considering numerous variations implicated as age and patient history, size and associated symptoms.

The patient's history with thyroid disease should be directed to symptoms of thyroid dysfunction and / or malignancy, the exam include mainly thyroid.inspection and palpation Thyroid function is determined by analysis of serum thyrotropin (TSH), free thyroxine (T4) and triiodotiroinine (T3) to avoid interference of situations that alter their binding to proteins. Although initially, is recommended to measure TSH and, depending of results, FT4 and FT3, the measure of these, should be performed if pituitary disease, hyper-or hypothyroidism is suspected. The presence of autoantibodies reflects the presence of autoimmune disease, serum thyroglobulin is the best marker of differentiated thyroid carcinoma and calcitonin of medullary carcinoma. Thyroid ultrasonography is a useful technique for the morphological assessment of the gland, and scintigraphy allows morpho-functional assessment. The fine-needle aspiration biopsies are essential for diagnosis and therapeutic orientation of the thyroid nodule.

The relationship between late-onset gestational diabetes mellitus [GDM] and oxidative stress is not well known, and the importance of the oxidant/antioxidant equilibrium in the clinical evolution and its complications require elucidation. The aim of the study was to evaluate the relationships between maternal levels of markers of oxidative stress in women with late-onset GDM that, potentially, may have considerable clinical implications in the pathogenesis and/or the evolution of GDM. Pregnant women (n = 78; 53 with GDM, 25 controls), between the 24th and 29th week of gestation, were enrolled. Both groups were analysed for demographic data, perinatal and obstetrics outcomes together with the levels of the marker's oxidative stress and antioxidant status. Control versus patient results in the univariate analysis were the following: pre-gestational body mass index [BMI] 23.31 ± 4.2 vs. 27.13 ± 4.6 kg/m(2) (P = 0.001); weeks at delivery 39.2 ± 3.05 vs. 38.9 ± 1.8 (P = 0.09); Caesarean delivery 12.5 vs. 43% (P = 0.004); macrosomia 4 vs. 9.4% (P = 0.6); lipoperoxides [LPO] 2.06 ± 1.00 vs. 3.14 ± 1.55 μmol/mg (P = 0.001); catalase 3.23 ± 1.41 vs. 2.52 ± 1.3 nmol/min/ml (P = 0.03); superoxide dismutase [SOD] 0.11 ± 0.04 vs. 0.08 ± 0.01 U/ml (P = 0.0003); glutathione peroxidase [GPX] 0.03 ± 0.006 vs. 0.025 ± 0.006 nmol/min/ml (P = 0.01); glutathione reductase [GSH] 0.004 ± 0.002 vs. 0.004 ± 0.004 nmol/min/ml (P = 0.9)]; and glutathione transferase [GST] 0.0025 ± 0.0012 vs. 0.0027 ± 0.00017 nmol/min/ml (P = 0.7). Multivariate analysis showed catalase might have a protective effect against GDM development and LPO seems to be a risk factor for the disease. These data suggest an increase in oxidative stress and a decrease in antioxidative defence in women with late-onset GDM and, as such, may have considerable clinical implications in the pathogenesis and/or the course of the pregnancy in these patients.

Objective: To describe a case of agranulocytosis and severe hepatotoxicity associated with Carbimazole treatment. Case Summary: A 37-year-old woman was diagnosed with severe hyperthyroidism resulting from Graves' disease. Treatment with Carbimazole 30 mg/day was initiated. Within 15 days following the start of therapy, both minor (eg, pruritus, rash, urticaria, fever, arthralgias) and potentially life-threatening (eg, agranulocytosis, severe mixed hepatotoxicity with severe cholestatic jaundice) adverse effects developed. The patient's symptoms and laboratory abnormalities resolved following withdrawal of Carbimazole. Treatment with other antithyroid drugs was not attempted, and 131I ablation of the thyroid was successfully performed. Thyroid function was maintained with standard follow-up care. Agranulocytosis, identified following bone marrow biopsy, was treated with granulocyte colony-stimulating factor. Discussion: Agranulocytosis and hepatotoxicity are rare adverse effects associated with Carbimazole treatment and are usually dose- and age-related. The likelihood that Carbimazole induced these undesirable events in our patient is rated as probable based on the Naranjo probability scale. We believe this case to be the first to describe minor and major adverse effects related to Carbimazole therapy in a patient with Graves' disease. Conclusions: Major adverse effects associated with Carbimazole are infrequent. However, clinicians need to be aware that the effects described here, including severe liver failure and bone marrow toxicity, may occur in patients receiving this drug.

Actualmente existen numerosas pruebas de laboratorio para el diagnostico y el seguimiento de los pacientes con diabetes mellitus:determinacion de glucemia en ayunas y posprandial, autoanalisis de glucemia capilar, presencia de cuerpos cetonicos, hemoglobina glucosilada y fructosamina, microalbuminuria y determinacion de marcadores geneticos y de autoinmunidad. La evidencia cientifica que respalda cada una de ellas varia sustancialmente y las guias de practica clinica proporcionan las recomendaciones con mayor soporte cientifico junto con otras basadas tan solo en consensos de expertos. En este trabajo se revisan las determinaciones de laboratorio mas importantes en diabetes mellitus y se evalua su grado de evidencia cientifica.

The prevalence of adrenal incidentalomas is increasing with the aging of the population and the use of high resolution imaging technics. Current protocols propose a comprehensive monitoring of their functional and morphological state, but with no conclusive clinical evidence that endorses it.Retrospective study of 96 patients diagnosed with adrenal incidentaloma between 2008 and 2012. We evaluated clinical, functional and imaging at baseline and during follow-up.Initially, 9 cases were surgically removed: 4 due to hyperfunction (2 Cushing syndromes and 2 pheochromocytomas) and 5 due to size larger than 4cm. During follow-up one case of pheochromocytoma was diagnosed and another grew more than 1cm, needing surgery. In 98.86% of nonfunctional and benign lesions, there was no functional and/or morphological changes in the final evaluation.The results of our study challenge the validity of current diagnostic-therapeutic protocols of incidentalomas, which should be reassessed in prospective studies taking into account efficiency characteristics.

Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for metabolic syndrome and CVD. The aim of the study was to evaluate the relationships between levels of cytokines, components of metabolic syndrome and cardiovascular risk markers in women with previous gestational diabetes.Women (n = 41) with gestational diabetes background (cases) and 21 healthy women (controls) in the postpartum period were enrolled. Demographic and clinical data, lipid and carbohydrate metabolism and uric acid and adipokine levels (TNF-α, IL-6, leptin and adiponectin) were compared and their relationships analysed. Metabolic syndrome prevalence was calculated by WHO and NCEP-ATPIII definitions.There were significant differences between cases and controls: body mass index (kg/m(2) ) 27.4 ± 5.6 vs 23.9 ± 3.6 (p = 0.013), waist circumference (cm) 85.2 ± 12.9 vs 77.5 ± 9.0 (p = 0.017), metabolic syndrome (WHO definition) 14.6% vs 0% (p = 0.012), metabolic syndrome (NCEP-ATPIII definition) 22% vs 0% (p = 0.002), low HDL 36.6% vs 9.5% (p = 0.024), fasting glucose (mmol/L) 5.4 ± 0.6 vs 4.9 ± 0.2 (p 0.001), glucose 120' oral glucose tolerance test (mmol/L) 5.8 ± 1.7vs 4.7 ± 0.8 (p = 0.007), fasting insulin (μU/mL) 13.4 ± 8.1 vs 8.4 ± 4.3 (p = 0.004), HOMA index 3.3 ± 2.3 vs 1.8 ± 1.0 (p = 0.002), HbA(1c) (%) 5.4 ± 0.2 vs 5.2 ± 0.2 (p = 0.021), uric acid (mg/dL) 4.1 ± 1 vs 3.5 ± 0.6 (p = 0.009), leptin (ng/mL) 32 025.5 ± 19 917.3 vs 20 258.9 ± 16 359.9 (p = 0.023), respectively.Women with previous gestational diabetes have central adiposity, atherogenic lipid profile, carbohydrate intolerance and adverse adipokine profile, all of which are risk factors for the future development of metabolic disease and CVD.

Diabetes and its microand macro-vascular complications constitute one of the principal social-health problems world-wide. It has high impact on the quality of life and prognosis of the individuals affected, as well as high direct and indirect economic costs to the Public Health Service. Following the publication of benchmark studies in the 1990s which indicated that the maintenance of glycaemia levels as close as possible to normality is associated with a lower incidence, progression and severity of the complications, the optimisation of metabolic control has been converted to a core therapeutic objective (DCCT, 1993; Herman, 1999; UKPDS, 1998). The tools for the management of diabetes have advanced spectacularly in these past few years, not only for the control of glycaemia but also for its measurement. As such, currently, there is a wide variety of drugs available with different mechanisms of action which, alone or in combination, enable a reasonable metabolic control in the majority of cases. Although insulin has been used for >80 years, the biggest advances in the mode of use have been over the last two decades. This change has been due, in great part, to: 1) development of new sources of insulin (analogues of insulin) together with the development and fine-tuning of different forms of its administration (continuous subcutaneous insulin infusion; CSII) in search of profiles of activity closer to the normal physiologic state; 2) change in philosophy in the therapeutic planning of diabetes, such that the strategies of coresponsibility and flexibility of life-style have become fundamental aspects; 3) introduction of self-control using capillary glycaemia (SCCG) in daily practice (De Witt & Hirsch, 2003); 4) recent incorporation in clinical practice of the use of glucose sensors, continuous glucose monitoring systems (CGMS) that generate the maximum information on modifications of glucose levels in plasma along the course of the whole day. This review centres on the importance, in clinical practice, of the metabolic control targets for patients with DM type 1. Difficulties in achieving glycaemia goals using multiple insulin injection with new insulin analogues, and modern technologies such as CGMS and CSII are extensively analysed.

Inflammation is an important component of the metabolic syndrome (MetS) which could be the link between the metabolic and the cardiovascular consequences of this condition. Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for MetS and an inflammation component has been described in this disease. The aim of the study was to evaluate the relationships between cytokine concentrations, components of MetS and cardiovascular risk markers in women with late-onset GDM. Women (n=63) with late-onset GDM and 63 controls were enrolled. Clinical variables, and obstetrics and perinatal outcomes were recorded. Relationships between cytokines (TNF-α, leptin, IL6, adiponectin) and endothelial injury markers (VCAM, ICAM and selectine) were analyzed. Control vs. patient data indicated: pre-gestational body mass index (BMI) 23.46±3.73 vs. 26.97±5.07kg/m(2) (p=0.001); TNF-α 2.2±0.8 vs. 3.1±1.5pg/mL (p=0.002); leptin 18714.78±8859.08 vs. 27365.79±16209.67pg/mL (p=0.001); adiponectin 162.42±34.19 vs. 141.54±41.33ng/mL (p=0.04). Multivariate analyses showed that adiponectin had a protective effect (OR=0.9; p=0.02) and BMI carried a significant risk (OR=8.4; p=0.01) for GDM. No differences were found in endothelial injury markers. In conclusion, the cytokine profile in women with late-onset GDM is characterized by high concentrations of TNF-α and leptin and low adiponectin. This profile is related, in large extent, to an increased pregravid BMI which, potentially, may be linked to the future development of both metabolic and cardiovascular disease.