This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as
Introduction: During a pandemic, use of remote monitors may reduce close patient contact and decrease risk of occupational exposure. This study evaluated the impact of continuous glucose monitor (CGM) use on the number of close encounters required for diabetes management in pregnant individuals. Methods: This study included 24 pregnant people with pregestational diabetes or medication-controlled gestational diabetes admitted for antepartum care. Participants received a Dexcom G6 CGM and were randomized to clinical use of CGM (intervention) or to standard care with fingerstick point-of-care (POC) glucose checks and a CGM device in blinded mode (control). The primary outcome was the number of POC glucose measurements per nursing shift. Secondary outcomes included glycemic control, neonatal outcomes, and patient and nursing satisfaction measured with surveys. Results: Patients in the intervention group required fewer POC measurements per shift than the control group, but this difference did not reach statistical significance (1.56 ± 0.88 vs 2.28 ± 1.17, p=0.08). Time in the pregnancy-recommended glycemic range (63-140 mg/dL) was similar in both the intervention and the control groups (77.65% ± 22.95 vs. 73.30% ± 27.23, p = 0.89). Time above range (21.64% ± 23.49 vs. 24.84% ± 27.82, p = 0.95) and below range (0.70% ± 1.58 vs. 1.86% ± 4.93, p = 0.64) were also comparable in the intervention and control patients. Neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, hyperbilirubinemia and supplemental oxygen were less likely in the intervention group, however this difference was not significant when adjusted for gestational age at delivery. Patient and nursing satisfaction was high in both groups and not significantly different. Conclusion: Although use of CGM's for antepartum admissions did not significantly decrease close patient contact, equivalent glycemic control was achieved as with standard care. Neonatal outcomes were also similar in both groups. Disclosure J. Grasch: Research Support; Dexcom, Inc., TrueRelief, LLC. N. Nandam: None. E. Buschur: Consultant; Beta Bionics, Inc., Research Support; Dexcom, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust. Funding Dexcom, Inc. (IIS-2020-052)
Background Pituitary apoplexy is caused by hemorrhage or infarction of the pituitary gland. This diagnosis is rare in pregnancy, with little data to guide management in this population. Case A 30-year-old previously healthy pregnant female G4P3002 at 31 weeks gestation, presented with three days of severe headaches, dizziness, polyuria, polydipsia, and photophobia without vision loss. Her last pregnancy two years prior was uncomplicated. Pituitary MRI showed a 1.5 cm lesion with internal blood products, possibly indicating recent hemorrhage within an adenoma or cyst. The pituitary gland extended into the suprasellar cistern without compressing the optic chiasm. She was empirically started on stress dose steroids. Labs showed an ACTH of 32.9 pg/mL [9. 0-50. 0], cortisol 27.13 mcg/dL [3. 09-22.40], TSH 1.404 uIU/mL [0.550-4.780], with free T4 0.94 ng/dL [0.93-1.76] and total T4 of 11. 0 mcg/dL [4.5-10.9]. Glucocorticoids were continued given the inability to verify adrenal insufficiency after steroid initiation. Central hypothyroidism was diagnosed based on total T4 being less than 1.5 times the upper limit of the pre-pregnancy normal range, and she was started on levothyroxine. Prolactin was 93. 0 ng/mL [9.7-208.5] without hook effect on dilutional testing; this value was considered lower than expected for the third trimester. IGF-1 was normal at 296 ng/mL [117-329]. FSH was <0.3 mIU/mL [<0.3], LH <0.7 mIU/mL [<0.1-1.5], and estradiol >4000 pg/mL [reference range unavailable], all normal values for pregnancy. She had a normal serum sodium, however had polyuria at 266 mL/hour during a six hour water restriction test, with persistently dilute urine studies. Urine output and concentration improved after giving desmopressin. She was diagnosed with partial central diabetes insipidus and started on maintenance desmopressin. Per her obstetric team's recommendation, she underwent an uncomplicated Caesarean section at 38 weeks and was able to breastfeed shortly after delivery . Due to refractory headaches, 8 weeks after delivery she underwent transsphenoidal resection of an intrasellar cystic lesion with old blood products. No adenoma was identified. She was able to taper off hydrocortisone, desmopressin, and levothyroxine over one year after surgery. Follow up FSH, LH, estradiol, and prolactin levels normalized, and she resumed regular menses. Annual MRI's over five years have shown no evidence of lesion recurrence. Conclusion Studies have shown successful treatment of pituitary apoplexy with both surgical and non-surgical management, with surgery favored in patients with severe and/or progressive neuro-ophthalmologic deficits (1). However, there is a lack of data to guide treatment in pregnant patients. We present a case of pituitary apoplexy in pregnancy in which symptoms and hormonal function fully recovered after surgery, and imaging has been stable. Further research is needed to compare surgical and non-surgical treatment in this population, as well as the risk of tumor recurrence. (1) Marx et al. Endocrine, 2021. Presentation: No date and time listed
Introduction: Capable of generating excess catecholamines, untreated extra-adrenal paragangliomas (PGL) result in severe cardiovascular morbidity and mortality. Increasingly, a hereditary basis can be identified to underlie PGLs, though such data is largely absent in non-Caucasian populations. Case 1: A 43 yr. old Kinyarwanda-speaking woman from DR Congo presented with left lower extremity edema and hypertension, with blood pressure of 154/86 while on spironolactone, HCTZ and furosemide. Ultrasound was negative for a DVT; abdominal CT revealed a 3 cm necrotic mass, inferior to the duodenum and abutting the IVC and aorta, as well as 2 bladder wall lesions. EUS-guided FNA revealed a keratin-negative neuroendocrine tumor. Urinary 24hr norepinephrine (NE) was high at 185 mcg [15–80]. Urinary 24hr normetanephrine (NM) was high at 1404 mcg [119-451; hypertensive <900]. MIBG scan confirmed avidity in the aortocaval mass. Despite lack of bladder uptake on MIBG, pathology similarly pointed to PGL. Surgery included excision of bladder, pelvic nodes, uterus, and aortocaval tumor. Post-op, urinary 24hr NE was 18 mcg and NM was 297 mcg, both normal. One year later, MIBG/SPECT and CT of the abdomen were negative for recurrence. A GeneDx panel of 12 PGL/PCC mutations was negative. Case 2: An unrelated 41 yr. old Kinyarwanda-speaking woman from Rwanda, with prior history of preeclampsia and multiple miscarriages, presented with palpitations, headaches and hypertension. Echo showed a 4 cm mass posterior to the left atrium; the mass was18F-FDG PET-avid. Video-assisted thoracoscopy was performed yet the tumor’s vascularity precluded a biopsy. Biopsy of mediastinal mass after performing thoracotomy was consistent with PGL. Plasma NM was high at 7.1 nmol/l (<0.90), consistent with PGL and she underwent complete removal of the tumor. Testing for SDHB mutation was negative. Symptoms resolved and antihypertensives were discontinued. Follow-up plasma NM was 0.55 nmol/l 1-year post op and remained normal for six years of follow-up. Discussion: Less than 10% of PGLs are known to involve the mediastinum or bladder (1). In familial PGL, the most commonly identified non-syndromic mutations involve SDHD, SDHAF2, SDHB, SDHD, SDHC, VHL, and MAX. Tumorigenesis in a sizable fraction of PGLs is not well understood. Conclusion: We present two cases of extra-adrenal PGL, both exhibiting similar age, sex and geographic ancestry. Our cases raise questions that require active investigation regarding additional environmental and/ or genetic factors which might predispose to PGLs in uncommon anatomic sites. References: (1) Erickson D et al. J Clin Endocrinol Metab, 2001 (2) Martins et al. Int J of Endocrinol, 2014
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.