Tecnología en Endocrinología: tiempos, conceptos e implementación

Propósito. La ciencia aplicada, una de las aristas definitorias de la tecnología, ha tenido un acercamiento a la medicina desde su aurora; dicho aspecto llega a lo más profundo de la Endocrinología. El presente texto tiene por objetivo denotar conceptos de aproximación, para así describir la implementación práctica del tándem entre tecnología y Endocrinología en los diferentes tiempos que lo han acompañado. Contenidos. Se empieza con algunos elementos históricos puntuales de encuentro entre la tecnología y la Endocrinología. Posteriormente, se introduce un concepto de vibrante vigencia: el tiempo en rango como métrica del control glucémico en la actualidad. Se reconoce el rol protagónico del monitoreo continuo de glucosa en la diabetes, al igual que se exploran sus potenciales usos. En el cuarto capítulo se hace un alto en el camino para comprender la inmediación entre la matemática y la Endocrinología. En los dos últimos capítulos se hace una inmersión al mundo de los ecosistemas digitales, a través del camino de la inteligencia artificial y recursos funcionales como la apps. Conclusiones. El apasionante mundo de la tecnología nos seduce cada vez más en los diferentes ámbitos; su relación con la Endocrinología es y será en el tiempo de una contundencia irrebatible. De esta manera, se ofrece una invitación abierta a vivir los procesos venideros de dicha fusión conceptual

Switching to a Minimed 780G closed-loop hybrid system: Real-life experience in a center of Latin America

Introduction: Insulin pumps serve as alternative insulin delivery methods with physiological similarity to the normal pancreas. The MiniMed 780G device is an advanced closed-loop hybrid system. Recent real-life studies have allowed reaching a higher percentage of time in range (TIR) (70 to 180 mg/dL). Being an emerging technology, it is of the utmost value to report on the early experience of use of this device. Methods: This was an observational, descriptive, cross-sectional study that included patients older than 18 years with types 1 diabetes mellitus and other types switched to a Medtronic 780G insulin pump. Baseline clinical and glycemic control variables and those after 4 weeks of using the SmartGuard mode were evaluated. Results: Thirty-nine patients (mean age, 33 years) were analyzed, 95 % of whom had type 1 diabetes with an average disease duration of 17 years. The values for time below range (TBR) 180 mg/dL, and TAR >250 mg/dL were 0 %, 3 %, 72 %, 21 %, and 3 %, respectively, at baseline and 1 %, 2 %, 79 %, 14 %, and 2 %, respectively, after the intervention. The changes in TIR varied based on prior therapy: multiple daily injections of insulin, 13 % improvement; MiniMed Paradigm Veo/MiniMed 640G, 6 % improvement; and MiniMed 670G, −4 % improvement. Conclusion: In conclusion, the application of a hybrid closed-loop system allowed for better glycemic control based on international standards. The average percentage improvement in TIR was lower than that in other studies and was dependent on the previous method of insulin administration, achieving lower performance with the migration from recent technologies such as the Minimed 670G

Stroke due to extrinsic compression of the internal carotide secondary to invasive hypophyseal macroadenoma with pituitary Apoplejia: A case report and literature review

Background: Pituitary apoplexy is a medical emergency with a low population incidence that is more frequent in patients with pituitary tumors and whose management is mainly surgical. We present a description of a patient with ischemic cerebrovascular disease (CVD) secondary to extrinsic compression of the internal carotid artery by a pituitary macroadenoma presenting pituitary apoplexy.Case presentation: We present the case of a 43-year-old female patient with type diabetes mellitus and with invasive pituitary macroadenoma with extrinsic compression of the internal carotid artery, she consulted the emergency room for generalized tonic-clonic seizures, drowsiness, left hemiplegia and neurological deterioration for which she needed management in the ICU, with brain MRI showing sellar and suprasellar lesion invading the cavernous sinus and right Meckel's cavum, a mass surrounds the right internal carotid artery in its cavernous and supraclinoid segments, and decrease in the caliber of the proximal segments of the ipsilateral middle cerebral and anterior cerebral arteries, longitudinal axis 37 mm, with hemoglobin degradation residues suggestive of pituitary apoplexy. In addition, central hypothyroidism without other alterations. She was not a candidate for surgical management due to an infectious process (sinusitis), initiating management with cabergoline with clinical improvement, greater interaction with the environment. MRI at one month showed significant reduction of the lesion (25x23x26mm). Conclusion: Ischemic CVD due to extrinsic compression of the middle cerebral artery by hypophyseal apoplexy is infrequent, only 33 similar cases have been reported worldwide that have been taken to surgery; this is a successful case of treatment with medical management due to the impossibility of surgical management