RESUMO
La hiperglucemia, defi nida estrictamente como una glucemia plasmática basal >=126 mg/dL, se presenta en la gran mayoría de los pacientes críticos. La elevación de estas cifras de glucemia durante la hospitalización se ha asociado de forma consistente con un deterioro del pronóstico del paciente, incluso en ausencia de antecedentes previos de diabetes y con elevaciones mínimas sobre los niveles considerados normales. Sin embargo, conocer cuál debería ser la actitud terapéutica en función del perfil del paciente y qué objetivos se deberían plantear, así como el beneficio, si lo hubiere, de nuestra actuación médica y, sobre todo, la forma de lograr dichos objetivos, es todavía un tema controvertido y muy poco implantado en la práctica clínica habitual, incluso para aquellos endocrinólogos dedicados preferentemente a la atención de la diabetes en el área hospitalaria. Aun así, probablemente sea en el ámbito de las unidades de cuidados intensivos (UCI) y en pacientes críticos en general donde se han realizado los mejores estudios. Por ello, el desarrollo y la implantación de protocolos específicos de uso de insulina intravenosa en las UCI y de otras estrategias terapéuticas con la finalidad de normalizar las cifras de glucemia se consideran un criterio de calidad de estas unidades. Por esta razón, el control adecuado de la hiperglucemia en el hospital, y en las UCI en particular, es en la actualidad una medida médicamente efectiva: disminuye la mortalidad, reduce la morbilidad de los procesos y es coste-efectiva para los sistemas públicos de salud
Hyperglycemia, strictly defined as blood glucose >=126 mg/dL, occurs in the majority of critically ill patients. Elevated glucose values during hospitalization have been consistently linked to a poorer prognosis, even in the absence of preexisting diabetes and with nearly normal blood glucose levels. Nevertheless, the most appropriate strategies according to the patient profile, what benefits should be expected, if any, depending on medical care and how these objectives can be achieved, remain controversial, even for endocrinologists working in a hospital setting. Even so, the major randomized clinical studies dealing with the management of in hospital hyperglycemia have been carried out in critical care patients. Thus, the development and introduction of specific protocols for the intravenous administration of insulin to critically ill patients and other strategies to restore normal blood glucose values are quality criteria in any intensive care unit (ICU). For this reason, at the present time, proper hyperglycemia management in the hospital and, in particular, in the ICUs reduces mortality and morbidity and is cost-effective as well
Assuntos
Humanos , Unidades de Terapia Intensiva , Hiperglicemia/terapia , Insulina/administração & dosagem , Protocolos Clínicos , Hospitalização , Diabetes Mellitus/terapiaRESUMO
BACKGROUND: We report here two families illustrating the intrafamilial phenotypic variety of the non-classical 21-hydroxylase deficiency and other discrepancies between clinical and hormonal data. PATIENTS, METHODS AND RESULTS: The index case in the first family had a mild hirsutism which appeared peripuberally and basal 17-hydroxyprogesterone over the measurement limit. One of her sister, without hair excess, had the same biochemical abnormality. The index case in the second family was detected at five years because of early appearance of public hair and basal 17-hydroxyprogesterone over the measurement limit. One of her siblings, a 16-year old girl, was also diagnosed of mild hirsutism and increased levels of basal and post-stimulation 17-hydroxyprogesterone. CONCLUSIONS: The association of marked biochemical abnormalities with scarce or no clinical expression in the first family and the different presentation form of both cases in the second family suggest that there is something else than the mutation in the CYP 21B gene in the non-classic deficiency of 21-hydroxylase.
