Efectos de los traumatismos craneoencefálicos y la hemorragia subaracnoidea en la función hipofisaria anterior / Effects of traumatic brain injury and subarachnoid hemorrhage on anterior pituitary function

RESUMEN

Los traumatismos craneoencefálicos (TCE) y las hemorragias subaracnoideas (HSA) son enfermedades frecuentes en nuestro medio. Ambos son causa reconocida de hipopituitarismo anterior y su prevalencia varía entre el 20 y el 80% según las últimas series publicadas. No existe consenso sobre la forma de evaluar los diferentes ejes hormonales, aunque sí está claro que se necesitan revisiones periódicas, puesto que el hipopituitarismo puede aparecer hasta transcurrido 1 año del TCE o la HSA. El tratamiento de las posibles deficiencias hormonales facilita el proceso de rehabilitación y disminuye la morbimortalidad Objective: To assess the safety and efficacy of biphasic insulin aspart 30/70 in patients with type 2 diabetes mellitus (DM2). Material and methods: We performed an observational, multicenter, prospective study in 3,054 DM2 patients from primary care and specialized settings, treated with biphasic insulin aspart 30/70 (started within 15 days prior to inclusion). In all patients, the following information was available before starting insulin treatment: HbA1c levels, fasting plasma glucose (FPG), 4-point glucose profile (before and 90 minutes after breakfast and dinner) and number of hypoglycemic episodes/week. A total of 2,887 patients completed the study (26 ± 1 week). The variables evaluated were rate of adverse events (AE), number of hypoglycemic episodes/week, HbA1c, FPG and 4-point glucose profile. Results: At least one AE occurred in 10.7% of the patients (2.3% related to the study drug and 1.4% severe). There was a significant decrease (end of study vs baseline; p < 0.0001 for all the comparisons) in HbA1c (7.3% and 8.9%, respectively), the mean number of minor (0.3/0.5) and major (0.02/0.07) hypoglycemic episodes/week, FPG (145/207 mg/dl) and postprandial glycemia (162/225 mg/dl). The improvement in metabolic control was achieved both in patients previously treated with oral antidiabetic drugs and in those treated with insulin. The number of hypoglycemic episodes decreased in patients previously treated with insulin. Conclusions: Treatment with biphasic insulin aspart 30/70 in patients with DM2 improves glycemic control, irrespective of previous treatment, with a low rate of AE and fewer hypoglycemic episodes in patients previously treated with insulin (AU)

ABSTRACT

Traumatic brain injuries and subarachnoid hemorrhage are frequent events in Spain. Both are well recognized causes of anterior hypopituitarism, the prevalence ranging from 20 to 80% according to recent series. Consensus is lacking on how to assess pituitary function after the injury, although periodic assessment is clearly needed because hypopituitarism may appear at any time in the first year after the event. Hormone replacement when necessary helps recovery and reduces morbidity and mortality (AU)