Glinidas. Revisión de su uso terapéutico en la diabetes mellitus tipo 2 / Glinides. A review of their therapeutic use in type 2 diabetes mellitus

Las glinidas representan una nueva familia de secretadores de insulina, químicamente heterogénea, caracterizados por un inicio de acción rápido y de corta duración. La repaglinida posee un efecto hipoglucemiantes uperponible al de las sulfonilureas convencionales. Algunos estudio sindican un descenso en el riesgo de hipoglucemias, sobre todo nocturnas, y en el caso de omisión de una comida principal. Este fármaco parece especialmente útil en estadios iniciales de la diabetes tipo 2 y en combinación con metformina. Puede emplearse en pacientes con insuficiencia renal moderada y está contraindicada en caso de insuficiencia hepática grave. La nateglinida presenta una menor duración de acción y un peor control de la hemoglobina glucosilada que la repaglinida. Algunos estudios experimentales sugieren que las glinidas pueden preservar mejor que las sulfonilureas la función de la célula betapancreática y que el mejor control de las excursiones glucémicas posprandiales podría tener un efecto beneficioso en la reducción del riesgo cardiovascular de estos pacientes (AU)

Glinides are a new, chemically heterogeneous class of insulin-secreting agents characterized by rapid onset and short duration of action. Repaglinide has an equivalent hypoglycemic effect to conventional sulfonylureas. Several studies have reported a decreased risk of hypoglycemias, particularly nocturnal hypoglycemic episodes or those occurring after a main meal has been missed. This drug seems to be particularly useful in the early stages of type 2 diabetes or in combination with met formin. Repaglinide can be used in patients with moderate renal insufficiency, but is contraindicated in severe hepatic dysfunction. Nateglinide has a shorter duration of action and is less effective in HbA1c control than repaglinide. Several experimental studies have suggested that glinides could be more effective in preserving beta-cell function than sulfonylureas, and that improvement of postprandial glucose levels could exert a protective cardiovascular effect (AU)

Bocio endémico en la Comunidad Valenciana. Réplica / Endemic goiter in the autonomous community of Valencia (Spain). Reply

No disponible

[Iodine nutritional status in the school-aged population in Alicante (Spain)]. / Situación nutricional de yodo en la población escolar de Alicante.

BACKGROUND: According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. MATERIAL AND METHODS: We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. RESULTS: No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. CONCLUSIONS: Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population.

Situación nutricional de yodo en la población escolar de Alicante / Iodine nutritional status in the school-aged population in Alicante (Spain)

Antecedentes Según la Organización Mundial de la salud (OMS), España se consideró un país afectado de endemia bociosa. El déficit de yodo es el responsable de dicha endemia además de ser la principal causa de retraso mental y parálisis cerebral evitable en el mundo. Material y métodos Estudio observacional para determinar la prevalencia de bocio endémico y el estado nutricional de yodo en la provincia de Alicante. Para ello se midió la yoduria en una muestra aislada y el volumen tiroideo mediante ecografía. Se consideró bocio todo volumen tiroideo superior al percentil 97 por edad publicado por la OMS. Resultados No se ha encontrado ningún caso de bocio. Así mismo las cifras de yoduria obtenidas también pueden ser consideradas dentro de la normalidad bajo los criterios de la OMS. Conclusiones Se puede decir que la provincia de Alicante no padece endemia bociosa y que además las cifras de yoduria demuestran una adecuada ingesta de yodo. Se evidencia la necesidad de realizar más estudios ecográficos de tiroides en otras zonas para establecer volúmenes tiroideos de referencia para nuestra población

Background According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. Material and methods We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. Results No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. Conclusions Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population

Comparison of two low-calorie diets: a prospective study of effectiveness and safety.

OBJECTIVE: To evaluate the cost-effectiveness and safety of two distinct low calorie diets (LCD). DESIGN: Prospective controlled study. METHODS: 67 obese patients [body mass index (BMI) 40 kg/m2] were included in two study groups. Group A: 26 patients followed a 458 kcal diet given in three meals for 1 month. Group B: 41 patients followed a 800 kcal diet for 3 months and with outpatient control. MEASUREMENTS: Anthropometric, cardiovascular risk and nutritional profile changes were evaluated, as well as total direct and indirect costs, and the incidence of complications. RESULTS: No significant initial differences were observed between the two study groups. Eighty-six point two per cent of the patients completed the therapy correctly. After treatment a significant decrease was observed in the following variables for both groups, but no differences were detected between Groups A and B: mean weight loss (A= 9.28 kg, B= 8.7 kg), ponderal loss percentage (A/B= 7.2/6.8%), glycemia (A/B= 18.6/12.1 mg/dl), systolic blood pressure (SBP) (A/B= 11.8/6.5 mmHg), diastolic blood pressure (DBP) (A/B 5.9/6.8 mmHg), and final insulin-resistance (IR) index (A= 4.4, B= 4.3). Group A had the highest drop in total cholesterol (37.7 vs 8.1 mg/dl) and triglycerides (54.4 vs 2.5 mg/dl). No changes were observed in ureic acid, renal function and serum albumin. Thirty-six patients (55.3%) suffered trivial complications associated to the VLCD (16.9% gastrointestinal, 20% anxiety), with no differences between groups. Group A patients were on sick leave due to asthenia, and two patients in this group had serious complications (transient ischemic attack and atrial fibrillation). The total cost of Group A treatment was 3018.9 against 582.6 euros for Group B. CONCLUSIONS: The 3-month 800 kcal/day VLCD was more cost-effective and safer than the 1-month 458 kcal/day diet.

Clínica de la acromegalia: presentación, cuadro clínico y comorbilidades / Clinical features of acromegaly: presentation, clinical picture and comorbidities

La acromegalia es un síndrome clínico producido por la secreción excesiva de hormona del crecimiento que afecta a prácticamente todo los órganos y tejidos. Se caracteriza por la desfiguración progresiva de los rasgos somáticos debido a las complicaciones metabólicas, endocrinas, cardiovasculares, respiratorias y articulares, así como por un aumento de la prevalencia de cáncer, sobre todo gastrointestinal. Conlleva una gran morbilidad y un aumento significativo de la mortalidad (AU)

Acromegaly is a clinical syndrome produced by excess growth hormone secretion affecting practically all organs and tissues. It is characterized by progressive enlargement of parts of the body due to metabolic, endocrine, respiratory and joint complications, as well as by an increase in the prevalence of cancer, especially gastrointestinal forms. This disorder produces high morbidity and a significant increase in mortality (AU)

One-year follow-up of patients with acromegaly treated with fixed or titrated doses of lanreotide Autogel.

OBJECTIVE: Somatostatin analogue treatment is first-line medical therapy for acromegaly. This study compared the efficacy and tolerability of titrated doses of the long-acting somatostatin analogue preparation lanreotide Autogel with fixed doses and with lanreotide prolonged release (PR) 30 mg microparticles. PATIENTS: Patients entering the initial study had received a diagnosis of active acromegaly within the previous 5 years. DESIGN: This open, comparative, multicentre study was a 1-year extension of a previous trial during which patients with acromegaly had switched from lanreotide PR 30 mg microparticles injected intramuscularly every 7, 10 or 14 days, for at least 3 months, to one of three fixed doses of lanreotide Autogel (120, 90, or 60 mg every 28 days, respectively). In this extension study, patients continued to receive 60, 90, or 120 mg of lanreotide Autogel by deep subcutaneous injection every 28 days for 1 year. Doses could be titrated at entry or after four or eight injections, according to the GH/IGF-I response (dose increased if GH > 2.5 micro g/l, or decreased if GH < 1 micro g/l with normal IGF-I). MEASUREMENTS: Mean +/- SEM GH and IGF-I concentrations were analysed and gallbladder echography performed at weeks 0, 16, 32, and 48. Acromegaly symptoms were recorded monthly and tolerance and side-effects were monitored throughout the study. RESULTS: In total, 130 patients entered this extension phase. After 1 year of treatment with titrated doses of lanreotide Autogel, mean GH (2.4 +/- 0.2 micro g/l) and IGF-I (287 +/- 12 micro g/l) concentrations were significantly lower than with lanreotide microparticles (GH, 2.8 +/- 0.2 micro g/l, P < 0.001; IGF-I, 332 +/- 15 micro g/l, P < 0.01) or with fixed-dose lanreotide Autogel (GH, 3.0 +/- 0.2 micro g/l, P < 0.001; IGF-I, 310 +/- 14 micro g/l, P = 0.02). GH hypersecretion was reduced to

[Utility of verapamil in the treatment of diastolic dysfunction in patients with acromegaly]. / Utilidad del verapamil en el tratamiento de la disfunción diastólica de pacientes acromegálicos.

INTRODUCTION: Diastolic dysfunction is a common complication in patients with acromegaly. By using the metabolic treatment for acromegaly, an improvement in diastolic function is not always achieved and a group of these patients could obtain some benefit from a specific treatment for such a condition. The objective of the present study was to evaluate the utility of verapamil therapy in acromegalic patients with diastolic dysfunction. METHODS: Fourteen patients (7 males and 7 females) with the diagnosis of acromegaly and diastolic dysfunction confirmed by echocardiogram were studied. After six months of treatment with verapamil (240 mg/day) the echo-cardiographic parameters and the functional class (NYHA) of patients were reevaluated. RESULTS: All patients showed an increased basal measurement of the cardiac mass (mean [percentiles 25-75]: 149 g/m2 [128-264]) and no improvement was observed after treatment (182 g/m2 [123-328]). Also, no improvement was found regarding the studied diastolic function parameters: E/A relationship of left ventricle (0.70 [0.54-0.83] versus 0.61 [0.54-0.86]) and isovolumetric relaxation time (146 [119-193] versus 120 [97-169]). A trend towards improvement was indeed found in the functional class, although no statistical differences were observed. CONCLUSION: Our results did not demonstrate a benefit derived from the treatment with verapamil upon the diastolic function in patients with acromegaly.

[The Influence of the growth hormone in the profile of blood pressure. Results in adult patients with deficiency in this hormone]. / Influencia de la hormona de crecimiento en el perfil de la presión arterial. Resultados en pacientes adultos con déficit de dicha hormona.

INTRODUCTION AND OBJECTIVES: There is an increasing interest in the relationship between the growth hormone (GH) and the heart since the GH has an important inotropic effect and its use has been tested in patients with severe systolic dysfunction. However, cardiovascular diseases are the main cause of increased morbimortality observed in patients with acromegaly. Growth hormone deficiency has been related to different clinical findings depending on the age of onset. Recent studies have demonstrated that GH deficiency in adults is associated with alterations in blood pressure. The aim of our study was to assess the influence of GH in blood pressure. PATIENTS AND METHODS: We studied 14 adult patients with GH deficiency and 15 healthy subjects, matched for sex and age. The diagnosis of GH deficiency was based on GH response to intravenous insulin tolerance test < 5 ng/ml and IGF-1 levels lower than the normal limit for each age group. In all the patients 24-hour Holter blood pressure monitorization was performed in addition to a treadmill test and echographic evaluation. RESULTS: All patients showed normal systolic and diastolic function in the echocardiographic study. Only one patient had an increased left ventricular mass. Blood pressure was lower in the patients than in the control subjects (p < 0.05). Moreover, the difference remained significant when analysis was based on the time of day. However, the patients showed normal blood pressure response to the effort test with a mean increase of 60%. The length of the exercise on the treadmill test was shorter in the subgroup of GH deficient patients. CONCLUSIONS: Lower systolic blood pressure was observed in GH deficiency patients. The patients studied did not show structural heart alterations. Blood pressure and chronotrophic response to the effort test were similar in both groups.

[Biventricular impairment of diastolic function in acromegaly]. / Alteración de la función diastólica de ambos ventrículos en la acromegalia.

AIM: Left ventricle impairment is very common in acromegaly. Concentric hypertrophy and diastolic dysfunction are observed at an early stage. Late left ventricle dilatation with systolic dysfunction may appear. Few reports have studied right ventricle diastolic function. METHODS: Twenty-seven acromegalic patients were included. Biventricular diastolic function was assessed using Doppler-echocardiography. Possible associations with hormonal activity, evolution time of illness, hypertension, left ventricular hypertrophy and systolic impairment on echocardiography were studied. RESULTS: Fifteen patients showed left ventricular diastolic dysfunction, whereas thirteen patients showed right ventricular diastolic dysfunction. A good correlation was observed between E/A relation of both ventricles (r = 0.70; p < 0.01) and isovolumetric relaxation time (r = -0.60; p < 0.01). The right ventricular E/A relation correlated with left ventricular mass index and significance was almost achieved with the presence of hypertension. There was no statistical correlations between the right ventricular E/A relation and hormone values or evolution time of illness. The left ventricular E/A relation showed a significant association with left ventricular mass index, isovolumetric time index and evolution time of illness. There were no statistical association with hormone values. CONCLUSIONS: The high prevalence of right ventricular diastolic dysfunction observed in acromegaly suggests the presence of acromegalic myocardiopathy.

[Trans-septo-sphenoidal transnasal approach for microsurgery of hypophyseal tumors]. / Abordaje trans-septo-esfenoidal transnasal para el tratamiento microquirúrgico de tumores de hipófisis.

The surgical treatment of hypophyseal tumors has improved from external approach (transcranial-subtemporal) to the trans-septo-transphenoidal approach. Since the last thirty years this way to access has been increasingly used, because it provides an excellent exposure, little bleeding, is rapidly and easily performed with less morbi-morality and has smoother postoperative period. A retrospective study of 16 patients whose hypophyseal tumors were treated surgically using the trans-septo-sphenoidal transnasal (maxillary-premaxillary) approach is presented. All these patients were seen in the E.N.T. Department of Alicante's General University Hospital, between January 1990 and June 1993. The trans-septo-sphenoidal transnasal via avoids some of the problems of the sublabial trans-sphenoidal procedure; namely longer operating time, oral contamination of the surgical field, subsequence difficulties due to the lack of sensibility and discomfort of the upper jax area and postoperative alterations in the projection of the septal-columelar tip.

45,X/46,XY gonadal dysgenesis in an infertile adult male.

A 33-year-old male was referred for infertility. Examination revealed bilateral scrotal gonads of soft consistency and small size. Semen analysis showed azoospermia. Elevated serum follicle-stimulating hormone levels and normal testosterone values were found. Surgical exploration and histopathology diagnosed dysgenetic testes with complete epididymis, and remnants of Fallopian tubes attached to the albuginea, with normal vas deferens and seminal vesicles showed on deferentovesiculography. Karyotype was 45,X/46,XY del(Y)(q11) with only 15% of 46XY cells in gonadal tissue. The clinical spectrum of 45,X/46,XY mosaicism and significance of this chromosomic anomaly is discussed.