Alteraciones en el metabolismo glucémico antes y después del tratamiento en pacientes con acromegalia / Glucose metabolism before and after treatment in patients with acromegaly

Introducción: El objetivo de este estudio es conocer la prevalencia de alteraciones hidrocarbonadas en pacientes diagnosticados de acromegalia y evaluar qué ocurre a los 2 años del tratamiento. También se pretende valorar qué factores se asocian a la aparición de estas alteraciones. Material y métodos: Se incluyeron 66 pacientes diagnosticados de acromegalia en nuestro centro. Se clasificó a los pacientes en función del metabolismo glucémico: normal, prediabetes y diabetes. A los 2 años del tratamiento de la acromegalia se analizó de nuevo la prevalencia de alteraciones hidrocarbonadas, en función del estado del paciente (curado, controlado con tratamiento médico o no controlado). Resultados: Al diagnóstico de acromegalia, el 27,3% de los pacientes tenían diabetes (n=18), el 39,4% prediabetes (n=26) y el 33,3% no presentaba alteraciones (n=22). Se encontraron diferencias significativas en los niveles de IGF-1 y z-score de IGF-1 (mediana de 18,1 en diabéticos y 10,6 en no diabéticos, p=0,005) entre los 3 grupos. A los 2 años del tratamiento, se observa una importante reducción de la prevalencia de diabetes y prediabetes en los pacientes curados (del 29,2 al 8,3% y del 45,8 al 16,7% respectivamente, p=0,003) pero no en los pacientes controlados con tratamiento médico o no controlados. Conclusión: En nuestro centro, el 66,6% de los pacientes con acromegalia presentan alteraciones en el metabolismo hidrocarbonado al diagnóstico, con una prevalencia de diabetes del 27,3%. A los 2 años del tratamiento de la acromegalia, se objetiva un descenso de la prevalencia de diabetes y prediabetes en el grupo de pacientes curados (AU)

Introduction: The aim of this study was to ascertain the prevalence of carbohydrate changes in patients diagnosed with acromegaly, and to evaluate what happens two years after treatment. It was also intended to assess which factors are associated to the occurrence of such changes. Material and methods: Sixty-six patients diagnosed with acromegaly at our center were enrolled and divided into groups with normal glucose metabolism, prediabetes, and diabetes. After 2 years of treatment of acromegaly, prevalence carbohydrate changes was assessed again depending on the patient condition (cured, controlled with medical treatment, or uncontrolled). Results: At the time of diagnosis of acromegaly, 27.3% of the patients had diabetes (n=18), 39.4% had prediabetes (n=26), and 33.3% had no changes (n=22). Significant differences were found in IGF-1 and z-score of IGF-1 (median of 18.1 in diabetics and 10.6 in non-diabetics, P=.005). Two years after treatment, there was a significant decrease in the prevalence of diabetes and prediabetes in cured patients (from 29.2% to 8.3% and from 45.8% to 16.7%, respectively, P=.003), but not in patients controlled with medical treatment or not controlled. Conclusion: At our center, 66.6% of patients with acromegaly had changes in carbohydrate metabolism at diagnosis, with a prevalence of diabetes of 27.3%. Two years after treatment of acromegaly, prevalence of diabetes and prediabetes decreased in cured patients (AU)

Glucose metabolism before and after treatment in patients with acromegaly. / Alteraciones en el metabolismo glucémico antes y después del tratamiento en pacientes con acromegalia.

INTRODUCTION: The aim of this study was to ascertain the prevalence of carbohydrate changes in patients diagnosed with acromegaly, and to evaluate what happens two years after treatment. It was also intended to assess which factors are associated to the occurrence of such changes. MATERIAL AND METHODS: Sixty-six patients diagnosed with acromegaly at our center were enrolled and divided into groups with normal glucose metabolism, prediabetes, and diabetes. After 2 years of treatment of acromegaly, prevalence carbohydrate changes was assessed again depending on the patient condition (cured, controlled with medical treatment, or uncontrolled). RESULTS: At the time of diagnosis of acromegaly, 27.3% of the patients had diabetes (n=18), 39.4% had prediabetes (n=26), and 33.3% had no changes (n=22). Significant differences were found in IGF-1 and z-score of IGF-1 (median of 18.1 in diabetics and 10.6 in non-diabetics, P=.005). Two years after treatment, there was a significant decrease in the prevalence of diabetes and prediabetes in cured patients (from 29.2% to 8.3% and from 45.8% to 16.7%, respectively, P=.003), but not in patients controlled with medical treatment or not controlled. CONCLUSION: At our center, 66.6% of patients with acromegaly had changes in carbohydrate metabolism at diagnosis, with a prevalence of diabetes of 27.3%. Two years after treatment of acromegaly, prevalence of diabetes and prediabetes decreased in cured patients.

Prognostic value of thyroglobulin serum levels and 131I whole-body scan after initial treatment of low-risk differentiated thyroid cancer.

Diagnostic iodine-131 whole-body scan ((131)I-WBS) and serum thyroglobulin values (Tg) performed 6 to 12 months after thyroid ablation for differentiated thyroid carcinoma were evaluated in 194 consecutive patients at the Hospital de Navarra, (Pamplona, Spain). All patients underwent near-total thyroidectomy and (131)I ablation with 3.7 GBq. Patients with positive anti-Tg antibodies or with (131)I uptake outside the neck were previously excluded. Uptake of (131)I in the thyroid bed was detected in 27 patients (13.9%). Serum Tg levels were below 0.5 ng/mL in 133 patients, ranged from 0.5-10 ng/mL in 39 patients, and was above 10 ng/mL in 22 patients. After a follow-up of 7.7 +/- 3.3 years, persistence of the illness has been observed in 2 patients with undetectable Tg (1.5%), but metastases were not detected in any case. In those with Tg higher than 0.5 ng/mL, 29 of 61 patients had persistence of the disease (47.5%) with evidence of metastases in 15 (24.5%), irrespective of the initial total body scan (131)I uptake. In conclusion, serum Tg levels obtained after thyroid ablation has a good prognostic value and permits the selection of patients for further diagnostic studies, while diagnostic (131)I-WBS performed at that time did not correlate with results of Tg and scarcely provides additional information.