Context and objective: The interaction between pregnancy and acromegaly has been studied only retrospectively. We used prospective data to assess those interactions. Design: Prospective, interventional, multicentric study. Patients: Ten pregnancies in eight acromegalic patients were included according to the following criteria: previous diagnosis of acromegaly; and active acromegaly before pregnancy. Sellar magnetic resonance image (MRI), GH, and IGF1 measurements were carried out before pregnancy. The exclusion criterion was radiotherapy. Intervention: Withdrawal of pharmacological treatment (octreotide and/or cabergoline and/or pegvisomant) following pregnancy diagnosis. Main outcome measures: Clinical/biochemical evaluations throughout pregnancy/puerperium and sellar MRI after delivery; and GH and IGF1 measurements before pregnancy. GH was measured by an interference-free IFMA assay during pregnancy and IGF1 by measured by Immulite 2000 assay in patients and 64 control pregnancies. Results: No tumor growth was observed. Nine deliveries were at term and one at 35 weeks (preeclampsia). All newborns were healthy. Mean IGF1 levels before and during pregnancy were similar, but increased significantly during puerperium. As IGF1 in controls increased after midgestation, the prevalence of controlled IGF1 rose significantly from 2/10 (!20 weeks) to 9/10 (O30 weeks). Diabetes mellitus and hypertension/preeclampsia developed in one patient in each group; both complications were nonsignificantly (PZ0.06) associated with IGF1 O1.3 ULN before pregnancy. Conclusions: Acromegaly control usually improved and tumor growth was not stimulated during pregnancy in spite of withdrawal of drug treatment. Drug treatment can be discontinued in most patients. Uncontrolled disease before pregnancy may pose a higher risk for diabetes and hypertension.

Type 2 diabetes mellitus (T2DM) is one of the most important epidemic diseases in the world this century, and accounts for 90% of cases of diabetes globally. Brazil is one of the most important examples of the alarming picture of T2DM in emergent societies, being the country with the fourth largest number of people with diabetes. The aim of this paper is to review the literature on diabetes in Brazil, specifically looking at the epidemiology and management of T2DM. A literature search was conducted using PubMed and LILACS to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government, World Health Organization, and International Diabetes Federation were also reviewed.

Although fertility is frequently impaired in women with acromegaly, pregnancy is apparently becoming more common due to improvement in acromegaly treatment as well as in fertility therapy. As a result, several studies on pregnancy in patients with acromegaly have been published in recent years adding new and relevant information to the preexisting literature. Also, new GH assays with selective specificities and the knowledge of the expression of the various GH genes have allowed a better understanding of somatotrophic axis function during pregnancy. In this review, we show that pregnancy in women with acromegaly is generally safe, usually with tumoral and hormonal stability. Although the paucity of data limits evidence-based recommendations for preconception counseling and pregnancy surveillance, controlling tumor size and hormonal activity before pregnancy is highly recommended to ensure better outcomes, and surgical control should be attempted when feasible. Treatment interruption at pregnancy confirmation has also proven to be safe, as drugs are not formally allowed to be used during pregnancy. Drug exposure (somatostatin analogs) during early or whole pregnancy might increase the chance of a lower birth weight. Aggressive disease is uncommon and may urge individual decisions such as surgery or drug treatment during pregnancy or lactation.Correspondence should be addressed to J Abucham

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Em pacientes com diabetes, o controle glicêmico deve ser individualizado de acordo com a situação clínica. Os parâmetros de avaliação indicados são a hemoglobina glicada A1c (HbA1c) e as glicemias capilares (ou plasmáticas) determinadas em jejum, nos períodos préprandiais, 2h após as refeições e ao deitar.1 , 2 Mais recentemente, com o advento da monitorização contínua de glicose (CGM), foram incorporados novos parâmetros, como o tempo no alvo (TIR -Time in Range), o tempo em hipoglicemia, o coeficiente de variação e a glicemia média estimada.3No sangue, a glicose liga-se de maneira irreversível à hemoglobina em um processo denominado glicação não-enzimática. A taxa de glicação da fração A1c da hemoglobina A (HbA1c) é expressa em porcentagem e se relaciona à média das glicemias diárias, bem como às complicações crônicas do diabetes. A vida média da hemácia dura de 3 a 4 meses. Aproximadamente 50% da taxa de HbA1c corresponde à glicação ocorrida no mês que precedeu o exame, sendo 25% no mês anterior e os 25% restantes, relativos ao terceiro e quarto meses anteriores. Níveis de HbA1c próximos à 7% correspondem a glicemias médias diárias de aproximadamente 154 mg/dL, variando de 122 a 184 mg/dl,1 e tem sido considerados como referência para a meta mais usada no controle do diabetes. A glicemia média diária estimada também pode ser obtida através da média dos dados dos glicosímetros com softwares próprios, sendo estas, mais fidedignas, tanto quanto mais frequentes forem as aferições diárias. Para comparabilidade adequada entre dosagens de HbA1c recomendadas, os laboratórios devem utilizar métodos certificados pelo National Glycohemoglobin Standardization Program (NGSP), que definem a faixa de normalidade da HbA1c, valores < 5,7%.2