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Biomedical subjects

G Forsbach

Publications and source records attributed to G Forsbach.

At least 19 recordsLinked to original sources
PubMed2000

Virilizing adrenal adenoma and primary amenorrhea in a girl with adrenal hyperplasia.

We report a 14-year-old girl with primary amenorrhea and virilization. The chromosomal analysis showed a normal 46,XX female karyotype and the hormonal assays disclosed high serum levels of testosterone (T): 450 ng/dL (normal 5-90), dehidroepiandrosterone-sulfate (DHEA-S): 690 microg/dL (normal 30-450) and 17-hydroxiprogesterone (17-OHP) >20 ng/mL (normal <2). A pelvic ultrasound disclosed a small uterus and bilateral enlargement of the ovaries, a computed axial tomographic scan of the abdomen identified a large right mass in the adrenal gland and a norcholesterol-I 131 adrenal gammagraphy revealed a functional adrenal tumor. The histological analysis of the surgical removed tumor revealed and adrenal adenoma. After surgery, a steep decline to normal serum levels of T and DHEA-S was observed, remaining an elevated level of 17-OHP: 5.4 ng/mL. During the first three months of follow up, the hirsutism declined sharply and spontaneous mammary development occurred, remaining elevated the 17-OHP serum level: 4.8 ng/mL. Prednisone 5 mg/day, was initiated decreasing the 17-OHP to normal level: 1.4 ng/mL, appearing the menarche followed by cyclical menses. One year after surgery, prednisone was withdrawn during one week, and an ACTH test and HLA typing were done, disclosing a 17-OHP response of an heterozygote for adrenal hyperplasia, and identifying B65 a subtype of B14, and DR1, that are frequently associated to adrenal hyperplasia. Previous reports have informed silent adrenal tumors associated to adrenal hyperplasia, but this is the first report of a functional adrenal tumor associated to adrenal hyperplasia.

Adenoma↗
PubMed1999

[Maternal and fetal morbidity in a group of women with gestational diabetes].

Normal pregnant women in the second and third trimester were screened to detect gestational diabetes. Using the protocol proposed by the World Health Organization, we identified 33 women whose two hr glucose levels was > 200 mg/dl. Only sixteen women had less than 34 weeks of pregnancy when were seen for the first time at the diabetes clinic, the other seventeen women had more than 34 weeks when they presented to the diabetes clinic. The first group, was called the treated group and the second group was the non-treated group. The main clinical characteristics of these patients, treated vs non-treated, were (X +/- SD): age (years) 33.2 +/- 5.2 (20-40) vs 30.2 +/- 6.5 (20-39), p < 0.05; weeks of pregnancy at diagnosis: 27.9 +/- 4.1 (19-33) vs 36.1 +/- 2.3 (34-40), p < 0.05; weight (Kg): 79.9 +/- 13.1 (61.8-108) vs 87.4 +/- 16.8 (60.8-118), p = NS; length of pregnancy (weeks) 38 +/- 1.3 (36-40) vs 38.4 +/- 1.4 (35-40), p = NS; newborns weight (g): 3,654 +/- 650 (2,475-5,100) vs 3,221 +/- 529 (2,650-4,650), p = NS. There was an intrauterine death of a macrosomic fetus in the non-treated group. There were three macrosomic newborns in the treated group and one in the non-treated group, p = NS. Also, there was a premature newborn of 1,975 g, whose pregnancy was interrupted for acute fetal distress. Delivery by cesarean section occurred in 29 women (87.8%), and it was mainly related to the diabetes diagnosis. The prevalence of macrosomia in the treated group supports the idea that treatment has to be established at least at 24 weeks of pregnancy, to reduce this rate. It is concluded that gestational diabetes is associated to an increase in maternal and fetal morbidity, requiring strict supervision to detect and treat fetal distress and a tight glucose control to decrease the macrosomia rate.

Adult↗
PubMed1999

[Sublingual thyroid gland associated with polycystic ovaries].

OBJECTIVE: To describe a young woman with polycystic ovary syndrome and a lingual thyroid gland. CLINICAL HISTORY: A 19-year old woman with secondary amenorrhea whose previous history had been uneventful. She had a normal spontaneous puberty with menarche at 13 years, followed by cyclical menstruations until six months before, when a period of four months of amenorrhea occurred. Physical exploration disclosed a normal young adult woman, without goiter, galactorrhea, acne, nor hirsutism. A pelvic ultrasound showed bilateral enlargement of the ovaries. Hormonal studies showed FSH 4 mUl/mL (nl = 2-12), LH 6 mUl/mL (nl = 2-14) and PRL 12 ng/mL (nl = < 25); TSH 8 microU/mL (nl < 5) and a free thyroxine level of 8.4 ng/dl (nl = 0.75-1.8). A thyroid gammagram with radioiodine disclosed a 6% caption (nl = 8.15%) and a small nodular gland at the base of the tongue. TREATMENT: Levothyroxine 100 micrograms/day was initiated and a month later the TSH level was normal but cyclical menstruations were not established after six months of follow up. COMMENT: The polycystic ovary syndrome is the main endocrine cause of secondary amenorrhea in young women.

Adolescent↗
PubMed1998

[True hermaphroditism with bilateral ovotestis].

A nineteen years old woman with ambiguous external genitalia was studied. This condition had been previously identified as a newborn, but her parents refused medical attention and it was reared as a girl. At 12-years, she began spontaneous mammary development, appearing pubic and axillary hair, and clitoral enlargement. The menarche occurred at 15-years and it was followed by irregular periods. Physical examination, showed absence of hirsutism and acne, normal mammary development equivalent to grade V of Tanner. The external genitalia showed fused labio-scrotal folds with an small introitus. The urethral meatus was absent and was later located inside the introitus. There was a big phallus similar to an adult penis with a normal glans, flexed by a chordee. Hormonal determinations discarded congenital adrenal hyperplasia. The karyotype was 46,XX and testosterone levels were in adult male range. Pelvic ultrasonography disclosed a normal uterus and both gonads in confirmed by laparoscopy identifying bilateral ovotestis. Testicular tissue was removed and plastic reconstruction of female genitals was done.

Adult↗
PubMed1998

[Disappearance of the radiographic image of a macroprolactinoma after treatment with bromocriptine].

A young woman with amenorrhea-galactorrhea induced by a prolactin (PRL) secreting pituitary macroadenoma, was treated with bromocriptine 5 mg/day per os. Serum PRL levels were normal at 6 weeks and menstruation appeared at 8 weeks of treatment. When twenty months of treatment were completed, a tomographic study of the pituitary was unable to show any enlargement. Controversies related to macroprolactinomas treatment are discussed and it is suggested that treatment with dopamine agonists must be the elective treatment for patients with macroprolactinoma.

Adult↗
PubMed1997

Gestational diabetes mellitus and glucose intolerance in a Mexican population.

OBJECTIVE: To determine the prevalence of gestational diabetes mellitus (GDM), glucose intolerance (GI) and macrosomia in a Latin Mexican population, using the one-step procedure proposed by the World Health Organization. METHOD: Consecutive pregnant women (n = 667) who attended the antenatal clinic and delivered at the hospital were recruited after 24 weeks of gestation, mean 34.2 weeks, range 24-40 weeks. After a minimum of 3 days with a 150-g carbohydrate diet, a glucose load of 75 g was administered and 2 h after, a blood sample for glucose was taken, plasma was separated and immediately processed for glucose, using a glucose-oxidase method. RESULTS: Twenty women were diagnosed with GDM (3%), 87 had GI (13%) and 560 had a normal glucose response (84%). Macrosomia occurred in two (10%) of GDM, in nine (10.3%) of GI, and in 29 (5.4%) gravidas with a normal response, respectively. Only one of the macrosomic infants whose mother had GI, had neonatal hypoglycemia and hyperbilirubinemia. CONCLUSION: The overall prevalence of glucose abnormalities during pregnancy was 16%. GI in this group was associated to macrosomia at the same rate as GDM.

Adult↗
PubMed1995

[Medical evaluation of the climacteric patient].

A pilot program with primary care physicians was established in Clinica Cuauhtémoc y Famosa, focused to evaluate women older than 35 years with climateric symptoms. This program included a survey, a complete gynecological examination with Pap smears, ultrasound pelvic examination and mamography. Also, blood samples were collected for cholesterol, tryglycerides, calcium, phosphorus and alkaline phosphatase. An ECG, bone densitometry of the radius and X-rays of the vertebral column were obtained. This group was formed by 69 women with an age media of 50 years (SD 7.6 years, median 49 years). The survey disclosed that 34/65 women had been hysterectomized, and only 34/64 had received antitetanic immunization in the last 10 years. A preexistent chronic disease occurred in 36/59 women, these were diabetes mellitus, arterial hypertension or degenerative osteoarthritis. Alcohol consumption was recorded in 5/66 women and tabac consumption in 9/66 women, and 32/68 women accepted to be sedentary. Laboratory examinations disclosed hypercholesterolemia in 19/66 women and hypertryglyceridemia in 8/64 women. Osteopenia was detected in 33/60 women. This findings support a systematic plan to provide medical assistance for women in this age, specially if previous epidemiologycal studies have disclosed that coronary disease is the main cause of death for women older than 50 years in this region, that also belongs to the area of highest incidence of diabetes.

Alcohol Drinking↗
PubMed1995

[Factors possibly associated with the age at the onset of menopause. Multicenter study].

A transversal study was performed in 1987 to examine 9,844 postmenopausal women aging from 39 to 59 years, residents from the cities of Durango, Monterrey, Guadalajara and Leon. They had their last menstruation at least 12 months before the interview and they were not pregnant. The objective was to know if the menarche, number of deliveries, use of contraceptive methods and smoking could affect the age of menopause. A case control analysis was performed. Based on frequency distribution of the age on which the menopause appeared, cases were classified as early and late menopause when a median value minus 2 SD and plus 2 SD were found, respectively. For control subjects a median + 1 SD was selected. Two and three controls were randomly assigned for early and late menopause, respectively. In total 1,610 subjects were studied. As a measure of association it was used the odds ratio with a confidence level of 95%. It was performed an analysis of confusion and interaction of variables in this study. The most relevant results were; a significant association between smoking 15 packages of cigarettes a year with an OR of 2.31 (1.05-5.17), to have more than five pregnancies with an OR of Mantel and Haenzel of 0.51 (0.33-0.76) for the early menopause. No association with late menopause was observed. It was found that the mean age of menopause was 45.5 years + 4.5 SD (n = 9,844).

Adult↗
PubMed1995

[Macrosomia and death. Relationship with maternal diabetes].

The incidence of macrosomic newborns and fetal death and its possible relation to maternal diabetes mellitus (DM) was registered during six months at the Hospital de Ginecoobstetricia "Dr. I. Morones", IMSS. Both criteria for macrosomia 4,000 g and 4,500 g, were taken for data collection. We had a total of 15,217 newborns, of these, 872 (5.73%), weighed > 4,000 g, and there were 42 mothers with DM, 4.2% of the group. Taking 4,500 g as criteria for macrosomia, there were 105 newborns (0.69%) of the total and there were 8 mothers with DM, 7.6%. 501 of the pregnancies finished by cesarean section and 337 by delivery. There were 151 fetal deaths, 9.9 for 1,000 newborns, eight fetuses had a weight over 4,000 g, and two mothers had DM. It is concluded that maternal diabetes mellitus occurred in less than 5% of the mothers with macrosomic newborns (> 4,000 g). The incidence of macrosomia is lower than in European populations. Fetal deaths were higher than expected because this hospital concentrates patients with obstetrical complications.

Female↗
PubMed1994

[Bone density and osteoporosis. An opinion].

Osteoporosis is a serious health problem for women over 45 years of age. It is divided in type I, affecting mainly cancellous bone and type II, affecting cancellous and cortical bone. Type I osteoporosis is related mainly with menopause, meanwhile, type II osteoporosis is related with ageing in both sexes. Osteoporosis has a major impact in the quality of life and the independence of the individuals, being the best treatment its prevention. All women at the beginning of the menopause should receive hormonal replacement treatment and calcium, in order to avoid type I osteoporosis, since treatment for women with established osteoporosis is aimed to halt the process of bone loss. Bone density may be measured in a reliable way by different techniques, allowing to the practitioner an accurate and reproducible measurement in different segments of the body. The main indications for bone densitometry suggested by the NOF are commented, as well as, the variability that may occur in different populations and the concept of normal values of bone density.

Adult↗
PubMed1991

Noninsulin dependent diabetes mellitus and pregnancy in Mexico.

We analyzed 215 consecutive patients with diabetes mellitus and pregnancy, 118 (54.83%) with noninsulin dependent diabetes mellitus (NIDDM), 90 (41.86%) with gestational diabetes mellitus (GDM) and 7 (3.26%) with insulin dependent diabetes mellitus (IDDM). NIDDM and GDM patients had no significant difference in age and body mass index. There were no maternal deaths, nor episodes of ketoacidosis. Maternal and neonatal complications occurred with a similar frequency in NIDDM and GDM. We concluded that in our population, diabetes associated with insulin-resistance occurred in over 96% of our pregnant diabetic patients and was associated with an increased prevalence of maternal and neonatal complications. Earlier perinatal care has to be established in NIDDM patients, and obese young women should be screened to detect GDM from early gestation and advised to reduce weight before pregnancy ensues.

Adult↗
PubMed1991

The stimulatory effect of estradiol 17-beta on prolactin mRNA is inhibited by anti-calmodulin drugs.

The stimulatory action of estrogens on prolactin (PRL) secretion and synthesis is well known; on the other hand, anti-calmodulin drugs have recently been shown to inhibit prolactin in vitro release induced by estrogens. Based on these data, we decided to evaluate the in vivo effect of anti-calmodulin drugs (trifluoperazine and W7) on basal and estradiol-17 beta stimulated levels of PRL mRNA in anterior pituitary lobes obtained from adult male rats. Total RNA was isolated from pooled pituitaries recovered from animals under the same treatment and, from it, hybridizable PRL mRNA was detected. Estradiol-17 beta consistently stimulated PRL mRNA levels by 3-4 fold. The utilization of either trifluoperazine or W7, invariably inhibited estradiol-17 beta stimulated PRL mRNA. Metoclopramide, a drug with antidopaminergic activity, potentiated the stimulatory effect of estradiol-17 beta on PRL mRNA levels. These results suggest that anti-calmodulin drugs have an in vivo antiestrogenic effect on PRL mRNA levels confirming previous in vitro studies. Although, it is difficult to be conclusive about the mechanism through which these drugs act, one possibility is that the calcium-calmodulin system may be involved.

Animals↗
PubMed1988

Prevalence of gestational diabetes and macrosomic newborns in a Mexican population.

Prevalence of gestational diabetes was investigated in 693 pregnant patients between the 24th and 28th wk of gestation. A glucose screening test (GST) was performed with a 50-g glucose load, followed by a blood sample 1 h later. Patients with glucose levels greater than 140 mg/dl 1 h after the GST were scheduled for a full oral glucose tolerance test (OGTT). One hundred seven patients had an abnormal GST, and 30 patients (4.3%) were diagnosed as having gestational diabetes mellitus (GDM). The percentage of GDM increased significantly when glucose levels were greater than 180 mg/dl to a maximum of 84.61% when glucose levels were greater than 200 mg/dl. Also, patient age was directly related to GDM, which increased in incidence to 20% when patients greater than 26 yr had an abnormal GST. After delivery, newborn weights were compared between those born to mothers with GDM (n = 30) and those born to mothers with an abnormal GST (n = 77). Patients with an abnormal GST and normal OGTT had 12 (15.58%) macrosomic and 2 premature newborns. However, patients with GDM had 5 (16.66%) macrosomic and no premature newborns. Patients with a normal GST had 7.33% of the macrosomic newborns. There was no perinatal mortality in newborns of GDM mothers; only 1 of the 5 macrosomic newborns presented transient hypoglycemia. Evaluation of 26 GDM patients was possible after delivery, disclosing 3 (11.53%) with non-insulin-dependent diabetes mellitus and 5 (19.23%) with impaired glucose tolerance. These results showed 4.3% undetected GDM in our population and no differences in the proportion of macrosomic newborns between those born to mothers with GDM and those born to mothers with an abnormal GST.

Adolescent↗
PubMed1987

Pituitary function in human pseudocyesis.

Two young women with clinically established pseudocyesis were studied by endometrial biopsy, basal hormonal serum levels and dynamic pituitary testing. Basal serum levels of PRL and TSH were in the normal range; estradiol - 17 beta, progesterone and FSH were in the follicular phase range, but LH was in the follicular phase range in one patient and in the climateric range in the other one. The histologic assessment of the endometrial biopsies disclosed a proliferative endometrium in both patients. A group of six patients with hypothalamic amenorrhea were subjected to dynamic pituitary testing to compare results with those obtained in the two patients with pseudocyesis. The dynamic pituitary response to GnRH, TRH and metoclopramide was normal in the two patients with pseudocyesis and in the group with hypothalamic amenorrhea; moreover, challenge with estradiol benzoate (EB) in the two patients with pseudocyesis disclosed a normal positive feedback of LH. These observations and the analysis of data already published suggest that the amenorrhea of pseudocyesis is associated neither with a persistent corpus luteum nor chronic hyperprolactinemia. We suggest that an abnormality in neurotransmitter pathways results in alterations of pituitary hormone secretion. However, additional patients must be studied to prove or disprove this hypothesis.

Adolescent↗
PubMed1987

Neuroendocrine regulation of anterior pituitary function in patients during and after molar pregnancy.

Only partial studies evaluating the endocrine profile in molar pregnancy have been performed. In order to characterize the neuro-endocrine pattern during and after molar pregnancy, we studied the basal hormonal levels of hCG, human placental lactogen (hPL), FSH, GH, TSH, free thyroxine index (FTI), oestradiol-17 beta (E2), and progesterone (PG), as well as the anterior pituitary response to TRH, GnRH, and hypoglycaemia induced by insulin in 7 patients during molar pregnancy and one week after molar abortion. hCG showed significantly higher serum levels during rather than after molar pregnancy and hPL was detectable in only 4 patients during, but in none after molar pregnancy. FSH values were in the follicular phase range before and after molar abortion (12.7 +/- 0.8 and 12.7 +/- 3.5 IU/l). PRL had elevated basal levels before and after molar abortion; 103.0 +/- 16.5 and 43 +/- 10.6 micrograms/l, respectively (P less than 0.05). GH levels were distinctly elevated in 3 patients during molar pregnancy; after molar abortion, the basal GH values were normal in all patients less than 10 micrograms/l. Basal cortisol and TSH levels were in the normal range before and after molar abortion. The FTI was above the normal range in 3 patients during molar pregnancy, whereas after molar abortion the values were normalized. E2 levels were elevated before and after molar abortion, 1881 +/- 477 and 96.5 +/- 39.2 ng/l, respectively (P less than 0.01). PG levels before and after molar abortion were 30.9 +/- 5.4 and 10 +/- 6.7 micrograms/l, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗