Poorer perinatal outcome in male newborns of women with pregestational diabetes mellitus.

AIMS: To assess perinatal outcome in women with pregestational diabetes mellitus according to the sex of the fetus. METHODS: A retrospective review of all singleton pregnancies of women with pregestational diabetes progressing to a gestational age of 22 weeks or more who attended the diabetes and pregnancy clinic from 1981 to 2006 (n=455). We compared maternal characteristics and perinatal outcomes (perinatal mortality, major congenital malformations, small and large for gestational age newborns, preterm birth and a composite of the former) according to the sex of the fetus. A logistic regression analysis was performed using the composite perinatal outcome as the dependent variable and all maternal variables and sex of fetus as potential predictors. RESULTS: Maternal characteristics did not differ in mothers of male and female newborns. In the whole cohort, the composite perinatal outcome was significantly higher in male fetuses; adjusted OR 1.61 (95% CI 1.04-2.50). CONCLUSIONS: In women with pregestational diabetes, perinatal outcome was poorer in male newborns despite similar maternal characteristics.

Thyrotoxic periodic paralysis: a case report and literature review.

We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.

Particularidades del tratamiento de la gestante con diabetes mellitus tipo 2 / Special considerations in the treatment of pregnant women with type 2 diabetes mellitus

La prevalencia de diabetes mellitus tipo 2 (DM2) en la gestación está en aumento y puede superar la de la diabetes mellitus tipo 1 (DM1).En general, el tratamiento es similar, con algunas particularidades. Las pacientes con DM2 son de mayor edad, son más obesas, tienen hipertensión crónica con mayor frecuencia, reciben asistencia pregestacional específica con menor frecuencia, consultan más tarde durante la gestación y están más expuestas a fármacos potencialmente teratógenos. En contrapartida, el tiempo de evolución de la enfermedad y la frecuencia de complicaciones son inferiores y el control metabólico es mejor. Aunque hay controversia, la evolución perinatal es similar, a excepción de la prematuridad, que es inferior en DM2.El fármaco recomendado para el tratamiento de la hiperglucemia es la insulina. Antes del embarazo, el énfasis debe ponerse en aumentar la asistencia pregestacional, mejorar el control glucémico, reforzándola educación diabetológica, y evitar la exposición a fármacos potencialmente teratógenos. Durante la gestación, los últimos objetivos continúan vigentes. Después del parto, se debe replantear el programa terapéutico teniendo en cuenta el paso de los fármacos a la leche materna (AU)

The prevalence of type 2 diabetes mellitus(DM2) in pregnancy is increasing and can exceed that of type 1 DM (DM1). In general, treatment is similar with some special considerations. Patients with DM2 are older and heavier, more likely to have chronic hypertension, less likely to receive specific prepregnancy care, consult later inpregnancy, and are more frequently exposed to potentially teratogenic drugs. In contrast, diabetes duration and the complications rate are lower and metabolic control is better. Although there is some controversy on the topic, perinatal outcomes are similar, except for the prematurity rate, which is lower in DM2. The recommended drug for the treatment of hyperglycemia is insulin. Before pregnancy, emphasis shouldbe placed on increasing attendance at prepregnancy care, improving glycemiccontrol, reinforcing diabetes instruction and avoiding exposure to potentially teratogenicdrugs. During pregnancy, the latter aims remain applicable. After delivery, the treatment regimen should be reconsidered, taking into account transfer of different drugs through breast milk (AU)

Determinants of neurosurgical outcome in pituitary tumors.

OBJECTIVE: Neurosurgery is one of the main therapies for pituitary tumors; optimising outcome is highly desirable for the patient and the health system. We have analysed predictors of outcome in surgically treated pituitary adenomas operated in this centre. DESIGN AND PATIENTS: A total of 289 patients underwent neurosurgery for a pituitary tumor, by the same two neurosurgeons, between 1982 and 2001. Their records were examined to find predictors of post-surgical outcome. Thirty-eight percent were males, with a median age of 40.8 (8-82.7) yr; 51.9% had been operated since 1992, 92.2% by the transsphenoidal route. Most tumors (70.2%) were macroadenomas; 28.4% were non-functioning, 27.3% secreted PRL, 26.3% GH of which 14 (4.8%) also secreted PRL, 17.3% ACTH, 0.3% FSH and 0.3% TSH. RESULTS: A stepwise, forward logistic regression analysis revealed tumor size as the only significant predictor of radiological cure [odds ratio (OR) for macroadenoma 0.16 vs microadenoma, p=0.0005]. Hormonally, PRL-secretion by the tumor was a predictor of poor prognosis (OR 3.29 for cure of non-PRL-secreting tumors, p=0.005), as was tumor size (OR 0.45 for cure of macroadenomas, p=0.005). Considering simultaneous radiological and hormonal remission, tumor size (OR 0.35 for macroadenoma, p=0.0002), and operation date (OR 0.40 for up to 1991, p=0.0002) were the only significant predictors. CONCLUSIONS: PRL secretion, tumor size and operation date are the main predictors of neurosurgical outcome in pituitary tumors, the latter suggesting that neurosurgical experience plays an important role.