Cefalea e hipertensión como forma de presentación de un feocromocitoma y simulando un síndrome post-COVID-19 / Headache and hypertension as a form of presentation of pheochromocytoma and simulating a post-COVID-19 syndrome

El síndrome post-COVID-19 es un conjunto de síntomas y signos que persisten durante más de 12 semanas después de una infección por COVID-19 y actualmente carece de una definición clínica estandarizada. Únicamente se ha informado un caso en el que un feocromocitoma se confundió con un síndrome post-COVID-19. La sintomatología de este síndrome es variable y abarca desde la cefalea y la fatiga hasta la disnea persistente y las alteraciones neurocognitivas. Además, el SARS-CoV-2 puede afectar al sistema nervioso autónomo, contribuyendo a síntomas que se asemejan a los del feocromocitoma. Se recalca la importancia y la necesidad de discernir entre síntomas relacionados con la COVID-19 y otras afecciones, ya que la especificidad de las manifestaciones clínicas del síndrome post-COVID-19 es muy baja y puede ser confundido con otras enfermedades vitales. Se presenta un caso en el que un feocromocitoma fue confundido con un síndrome post-COVID-19 en una paciente sin antecedentes médicos.(AU)

Post-COVID-19 syndrome is a set of symptoms and signs that persist for more than 12 weeks after COVID-19 infection and currently lacks a standardised clinical definition. Only one case has been reported in which a pheochromocytoma was mistaken for post-COVID-19 syndrome. The symptomatology of this syndrome is variable and ranges from headache and fatigue to persistent dyspnoea and neurocognitive disturbances. In addition, SARS-CoV-2 can affect the autonomic nervous system, contributing to symptoms resembling those of pheochromocytoma. The importance and need to discern between COVID-19-related symptoms and other conditions is emphasised, as the specificity of the clinical manifestations of post-COVID-19 syndrome is very low and can be confused with other vital pathologies. A case is presented in which a pheochromocytoma was mistaken for post-COVID-19 syndrome in a patient with no medical history.(AU)

[Headache and hypertension as a form of presentation of pheochromocytoma and simulating a post-COVID-19 syndrome]. / Cefalea e hipertensión como forma de presentación de un feocromocitoma y simulando un síndrome post-COVID-19.

Post-COVID-19 syndrome is a set of symptoms and signs that persist for more than 12 weeks after COVID-19 infection and currently lacks a standardised clinical definition. Only one case has been reported in which a pheochromocytoma was mistaken for post-COVID-19 syndrome. The symptomatology of this syndrome is variable and ranges from headache and fatigue to persistent dyspnoea and neurocognitive disturbances. In addition, SARS-CoV-2 can affect the autonomic nervous system, contributing to symptoms resembling those of pheochromocytoma. The importance and need to discern between COVID-19-related symptoms and other conditions is emphasised, as the specificity of the clinical manifestations of post-COVID-19 syndrome is very low and can be confused with other vital pathologies. A case is presented in which a pheochromocytoma was mistaken for post-COVID-19 syndrome in a patient with no medical history.

Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study.

We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1ß, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination.

Patterns of prescription of hypoglycaemic drugs in Gran Canaria (Canary islands, Spain) and estimation of the prevalence of diabetes mellitus.

OBJECTIVE: To study the patterns of hypoglycaemic treatment in our community and to estimate the prevalence of known and drug-treated diabetes mellitus. METHODS: From all the diabetic patients who attended the Healthcare Centers of the National Health Service in Gran Canaria in 1999, a random sample of 2924 diabetic patients > 20 years old was selected. Data on age, gender, clinical onset of diabetes, and hypoglycaemic treatment were obtained. Data on drug consumption were supplied by the National Health Service. RESULTS: Of the DM-2 patients 4.4% (3.65-5.14) 84.2% (82.7785.42), 9.4% (8.34-10.45) and 2.1% (1.58-2.61) received diet only, oral drugs, insulin or combination. The duration of DM-2 was associated with more oral drugs and more insulin treatment, but the duration of DM-1 was not associated with intensive insulin therapy;<50% of the type 1 patients had >or=3 daily injections. The prescriptions of biguanides were scarce; over 1/3 of them were of buformin. DM-1 and DM-2 patients were treated with similar doses of insulin, but DM-1 patients had more insulin injections (2.56 vs 2.07, P<0.001), and more fast-acting insulins (65.2% vs 38.0%, P<0.001). The estimated prevalences of known and drug-treated diabetes in the Gran Canaria island were 5.95% (95% CI: 5.096.80%) and 5.73% (4.88-6.57%). CONCLUSIONS: Our prevalences of known and drug-treated diabetes is among the highest reported in European populations. The prescriptions of metformin and of combined therapy in DM-2, and of intensive insulin therapy in DM-1 are less frequent than expected, but nonetheless insulin therapy in DM-1 is more intensive and uses more fast-acting insulin than in DM-2.

Prevalence of obesity in a Canarian community. Association with type 2 diabetes mellitus: the Guía Study.

OBJECTIVE: We sought to estimate the prevalence of obesity and central obesity, and their association with type 2 diabetes mellitus in the Canarian community of Guía. DESIGN AND SETTING: Population-based study. SUBJECTS: A random sample of 691 subjects over 30 y old (stratified by age and sex) was studied. DATA AND MEASURES: Age, sex, family history of diabetes and medication use were obtained, height, weight and waist circumference were measured and standard oral glucose tolerance tests were performed RESULTS: The prevalences of obesity/central obesity were 36.5%/66.5% (women) and 23.6%/32.0% (men). The prevalence of diabetes was 21.0% (women) and 18.4% (men). These rank among the highest in Europe. Bivariate analyses show a strong association of both obesity and central obesity with diabetes mellitus (P<0.001), but in a multivariate model, waist circumference (P<0.001) but not body mass index (P=0.212) was retained as an independent predictor of diabetes. CONCLUSION: The prevalences of obesity, central obesity and diabetes in our community are extremely high, and central obesity is a better predictor of diabetes than obesity.

Prevalence and determinants of diabetes mellitus and glucose intolerance in a Canarian Caucasian population - comparison of the 1997 ADA and the 1985 WHO criteria. The Guía Study.

AIMS: To estimate the prevalence of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance in a Canarian population according to the 1997 ADA and the 1985 WHO criteria; and to study the cardiovascular risk factors associated with these categories. METHODS: A total of 691 subjects over 30 years old were chosen in a random sampling of the population (stratified by age and sex). An oral glucose tolerance test was performed (excluding known diabetic patients) and lipids were determined in the fasting state. Anthropometric and blood pressure measurements were performed, and history of smoking habits and medications was recorded. RESULTS: The prevalence of diabetes was 15.9% (1997 ADA) and 18.7% (1985 WHO); the prevalence of impaired fasting glucose and impaired glucose tolerance was 8.8 and 17.1%, respectively. The age-adjusted prevalence of diabetes (Segi's standard world population) for the population aged 30-64 years was 12.4% (1985 WHO). The risk factors significantly associated with diabetes (1997 ADA and 1985 WHO) were age, body mass index; waist-to-hip ratio, systolic and mean blood pressure, triglycerides, total cholesterol and low HDL-cholesterol. Age, body mass index and systolic blood pressure were associated with impaired fasting glucose and impaired glucose tolerance; triglycerides were also associated with impaired fasting glucose. CONCLUSIONS: The prevalence of diabetes mellitus and glucose intolerance in Guía is one of the highest among studied Caucasian populations. The new 1997 ADA criteria estimate a lower prevalence of diabetes. Impaired fasting glucose also had a lower prevalence than impaired glucose intolerance and the overlap of these categories was modest.

[Diabetes insipidus and adipsic hypernatremia in a patient with a craniopharyngioma]. / Diabetes insípida e hipernatremia adípsica en un paciente con craneofaringioma.

A fourteen-year male patient presented a retrochiasmatic craniopharyngioma. Aer transcranial surgical resection, the patient had diabetes insipidus, which presented an interphase with manifestations of inadequate secretion of ADH. The patient was adequately treated with intranasal desmopresin, but aer i.v. fluid replacement was withdrawn, severe dehydration occurred. This was attributed to loss of the thirst reflex, due to surgical lesion of the lamina terminalis, where the osmoreceptor neurons are located. This case underscores the complications with body fluids and osmolality which may occur after surgery of hypothalamic lesions; i.e. diabetes insipidus (which may have a triphasic course), and adipsia, an infrequent complication due to absence of thirst.

Prevalence of hypertension in IDDM patients in the northern Grand Canary Island, according to the WHO/ISH and JNC-V/ADA criteria.

UNLABELLED: In order to establish the prevalence of hypertension (according to both the JNC-V/ADA and the WHO/ISH criteria) in patients with insulin-dependent diabetes mellitus (IDDM), a group of 142 unselected young adults with IDDM from Northern Gran Canaria Island was cross-sectionally studied. The relationship of hypertension to diabetic nephropathy and lipid profile was also studied. Blood pressure, urinary albumin excretion and plasma lipids (total cholesterol with VLDL, LDL and HDL fractions, triglycerides and Lp(a)) were measured. The prevalence of hypertension was 11.9% (95% CI 6.5-17.3) with the WHO criteria (> 160/95 mmHg) versus 58.7% (50.5-66.9) with the JNC-V criteria (> 130/85 mmHg). The respective prevalences were 3.8 (0.0-8.1) versus 49.4% (38.0-60.7) in patients with normoalbuminuria (< or = 20 micrograms/min), 17.9 (2.7-33.0) versus 71.4% (53.6-89.3) in patients with microalbuminuria (21-200 micrograms/min), and 44.4 (9.0-69.9) versus 83.3% (64.3-100) in patients with macroalbuminuria (> 200 micrograms/min). The presence of hypertension and of micro or macroalbuminuria was associated with a worse lipid profile. IN CONCLUSION: the new JNC-V criteria drastically increase the figures of prevalence of hypertension in young insulin-dependent diabetic adults. Early and aggressive antihypertensive treatment benefits at least those patients with incipient nephropathy.