Alberto Fernández

Is Pregnancy Outcome Worse in Type 2 Than in Type 1 Diabetic Women

Most research on pregestational diabetes has focused on type 1 diabetes, and surprisingly little knowledge exists concerning outcomes of pregnancies of women with type 2 diabetes. A dearth of published data suggest outcomes similar to those of type 1 diabetic women (1,2), although recent studies report poorer outcomes in women with type 2 diabetes (3–7). We retrospectively compared maternal and perinatal outcomes of 93 consecutive singleton pregnancies in women with type 2 diabetes and 532 consecutive singleton pregnancies in women with type 1 diabetes referred to the Diabetes and Pregnancy Unit at University Hospital La Paz from 1984 to 2004. Women with type 2 diabetes were significantly older ([means ± SD] 31.8 ± 5.5 …

Successful treatment of intrauterine cytomegalovirus infection with an intraventricular cyst in a dichorionic diamniotic twin gestation using cytomegalovirus immunoglobulin

Abstract Congenital cytomegalovirus (CMV) infection is the leading cause of severe congenital abnormalities. CMV immunoglobulin (CMVIG) may lower risk for symptomatic disease in congenital CMV infection. In a twin pregnancy, only one fetus shows CMV infection, raising a dilemma about intervention since the uninfected fetus would be exposed to treatment unnecessarily. CMVIG (2 × 200 U/kg) was given due to high viral load and development of an intraventricular cyst. The cyst growth plateaued, no other brain damage developed, and at 8 months, the infant was symptom-free. CMVIG appears appropriate to treat intrauterine CMV infection in this setting.

Unusual Response to Bromocriptine of a Giant Pituitary Adenoma and Fertility Restoration: a Record of a Pregnancy

A 23-year-old woman presented to clinic with a large pituitary adenoma and coexisting hyperprolactinaemia. Diagnoses, initially considered, included two possibilities: prolactinoma or nonfunctioning tumour with a pituitary stalk disconnection. Diagnosis of prolactinoma was considered as the first possibility. Therefore, a trial with the dopamine agonist Bromocriptine was decided. Serum prolactin levels decreased and significant tumour shrinkage was obtained. Bromocriptine was discontinued when the patient became pregnant. Surprisingly, tumour enlargement did not occur. The residual adenoma remained stable for six years after delivery. Surgical intervention was neither needed during pregnancy nor after a long follow-up period. This clinical presentation was consistent with a final diagnosis of nonfunctioning pituitary macroadenoma with an extraordinary response to Bromocriptine treatment.

Ganglioneuroma adrenal: dilema clínico-quirúrgico acerca de un hallazgo fortuito

Ganglioneuroma is a benign neoplasm derived from the neural crest consisting of mature ganglionic cells and Schwann cells. The posterior mediastinum is its most common location, followed by the retroperitoneum. Only a small proportion of ganglioneuromas arise from the adrenal medulla (15--30%). The routine use of imaging tests has increased the frequency of diagnosis of adrenal incidentalomas. Most of these lesions are nonfunctional benign adenomas. Other less common lesions include cortisol-secretin adenoma, metastases, adrenal carcinoma, and myelolipoma. Lesions such as cysts, inflammatory or infectious lesions, bilateral adrenal bleeding or, as in the case reported here, ganglioneuroma are less frequently found. Our clinical case was a 61-year-old with a history of pemphigus vulgaris in 1998 who required high-dose corticosteroid therapy. She reported no known allergic reactions to drugs, and had no history of high blood pressure, diabetes mellitus, or dyslipidemia. A computed tomography (CT) scan of the chest performed for chronic cough revealed a left adrenal mass 61 mm × 47 mm × 37 mm in size with lobulated contours and attenuation values of 20--30 Hounsfield units (HUs) in basal slices (Fig. 1; oral and intravenous contrast was not used because the radiologist suspected pheochromocytoma based on basal images). The patient was referred to the endocrinology department to work-up a left adrenal incidentaloma. The patient reported pain at rest in the left lumbar region. Upon specific questioning, she reported no constitutional symptoms or evidence of hypercortisolism (central obesity, striae, muscle weakness, bruising, mood changes, hirsutism, acne), hyperandrogenism, or hyperaldosteronism (HBP, muscle weakness, nocturia, urinary