BACKGROUND

Gestational diabetes mellitus (GDM) may increase fetal abdominal fat mass, but its correlation with fetal abdominal circumference (AC) is inconsistent. This study compares third trimester fetal AC between adult pregnant patients with and without GDM, and between those managed with diet modification alone versus insulin therapy.

METHODS

This retrospective cohort study involved 354 Filipino adult pregnant patients at The Medical City admitted for delivery from January 2016 to May 2022. This included 180 patients with GDM, and 174 patients without GDM. One hundred sixteen (116) of the GDM patients were diet-managed, and 64 were insulin-requiring. Participants underwent third trimester fetal AC ultrasound and 75-gram oral glucose tolerance test (OGTT) between 24 to 28 weeks of gestation. The third trimester fetal AC, fetal outcomes and maternal outcomes between patient groups were analyzed using Stata 15.0.

RESULTS

The GDM group had higher rates of cesarean section delivery (70% vs 46.55%, p < .001), maternal complications (35.56% vs 2.3%, p < .001); and neonates with lower age of gestation at birth (38 vs 39 weeks, p < .001), longer birth length (49 vs 48cm, p = .001), and higher number of NICU admissions (13.33 vs 4.02%, p = .002). The study exhibited correlation between GDM status and third trimester fetal AC (coefficient (ββ) 0.60, 95% confidence interval 0.18, 1.03). Adjusting for gestational age at ultrasound, fetal AC in the GDM group was 0.60 cm larger than in the non-GDM group (p = .006). At 37 weeks, median fetal AC was 33.2 cm in the GDM group (versus 32.4, p = 0.001). There was no significant association between GDM management type and fetal AC.

CONCLUSION

Third trimester fetal AC is significantly larger in women with GDM compared to non-GDM women, regardless of management method. Monitoring fetal AC during the third trimester is important for prenatal care in GDM pregnancies.

Human ; Female ; Diabetes, Gestational

Background: A rare case of Mayer-Rokitansky-Kuster-Hauser syndrome is reported here. A 26 year old Filipina with primary amenorrhea consults for inability to consummate sexual intercourse with a male partner. She is phenotypically female - has female secondary sexual characteristics, and has normal female external genitalia. There is a shallow vaginal dimple. Absence of the upper vagina and uterus has been demonstrated by transrectal ultrasound. Ultrasound and intravenous pyelography have documented the absence of the left kidney. Chromosomal analysis reveals a normal female karyotype (46, XX). Endocrine evaluation shows normal levels of estradiol, follicle-stimulating hormone and luteinizing hormone. Radiographs did not reveal any associated skeletal abnormalities. Aside from this being a rare case of a disorder of sexual development, this is worth reporting because it illustrates the diagnostic work-up of a patient presenting with primary amenorrhea.

The presence of cortisol - secret ing adenoma concomitantly with rheumatic heart disease, schizophrenia and myoma uteri is rare. This is a case of a 40 year old female with Schizophrenia who gradually developed Cushing's syndrome from an adrenal adenoma. She suffered a cardio-embolic stroke from Rheumatic heart disease which delayed hysterectomy for a bleeding intrauterine myoma. As ide f rom the phys ical f indings of Cushing's syndrome laboratory work up revealed an elevated 24 hour urine free cortisol with loss of normal diurnal cortisol secretion, suppressed 8AM ACTH level and negative suppression after a high dose dexamethasone. The patient underwent laparoscopic adrenalectomy for a 3.8 x 2.4 x 3 cm left adrenocortical adenoma. She required steroid supplementation. Menstrual flow immediately normalized, functional capacity improved and metabolic parameters such as weight, blood pressure and blood sugar were controlled six months after the surgery. Relapse of psychotic symptoms occurred eight months postoperatively because of non-compliance to antipsychotic medications. Cushing's syndrome if untreated can cause significant morbidities such as metabolic, hemodynamic, cardiovascular, bleeding disorder and psychiatric illness. These complications however can also be caused by primary medical illnesses like schizophrenia, rheumatic heart disease and myoma uteri. Treatment of the Cushing's syndrome may resolve some but not all the metabolic and hemodynamic problems and theoretically should also decrease the risk of complications of other primary illnesses concomitantly present. The presence of concomitant primary disease that can cause psychosis, cerebrovascular disease and metrorrhagia should also be investigated in a patient who has Cushing's syndrome. Prompt management of Cushing's syndrome would lessen the risk of complication attributed to schizophrenia, rheumatic heart disease and myoma uteri.

Human ; Female ; Adult ; Adrenocortical Adenoma ; Cerebrovascular Disorders ; Cushing Syndrome ; Dexamethasone ; Psychotic Disorders ; Rheumatic Heart Disease ; Schizophrenia ; Stroke ; Myoma

Turner Syndrome ; Amenorrhea

Diabetes Mellitus ; Complications ; Neuropathy

CLINICAL PRESENTATION: A 38 year old Filipina had a 3 days of colicky epigastric pain, vomiting and high grade fever. She had salphingooophorectomy for a left ovarian cystic teratoma in 1995, and is on propylthiouracil (PTU) and propranolol for Grave's disease since December 2004. However, thyrotoxicosis persisted. On admission, the abdomen was rigid and tenderness. Pelvic examinatin showed posterior cul de sac tenderness. TSH was 0.007 mIU/L (NV 0.3 - 3.8 mIU/L) while FT4 was 30.5 pmol/L (NV 11 - 24 pmol/L). Transvaginal ultrasound revealed an abdominopelvic mass. Burch-Wartofsky score was 35. Prior to surgery, PTU as retention enema, IV iodinated contrast, dexamethasone, and paracetamol were given. Exploratory laparotomy revealed a ruptured right cystic ovary. Histopathologic diagnosis was struma ovarii. FT4 remained elevated (38.1 to 46 pmol/L) postoperatively. Scintigraphy showed an enlarged thyroid with elevated 2 and 24 hour uptake. RAI was given after a year.Significance: Cystic variant of struma ovarii is rare, but coexistence of Graves disease and struma ovarii is even more uncommon, with only 12 other cases reported. This case is complicated by ovarian cysy rupture, resulting in an acute abdomen in a patient with impending thyroid storm.CONCLUSIONS: A high index of suspicion is necessary for the diagnosis of struma ovarii, especially with coexistent Graves' disease. Diagnosis should be considered in patients who remain thyrotoxic despite adequate treatment and in those with pelvic masses and concomitant thyrotoxicosis. Surgery for the struma ovarii should be emphasized as part of adequate treatment.
Human ; Female ; Adult ; Grave's Disease ; Struma Ovarii

BACKGROUND: Awareness regarding obstructive sleep apnea (OSA) in diabetic patients remains low. No inquiry into the quality of life of diabetics with OSA has been reported.

OBJECTIVES: Our primary objective was to determine the prevalence and associations of high OSA risk in adult diabetic Filipinos consulting at Philippine General Hospital. Secondary objectives included determining prevalence of excessive daytime sleepiness and the quality of life.

METHODOLOGY: This was a cross-sectional study. Saint Luke's Medical Center - Obstructive Sleep Apnea Clinical Score (SLMC-OSACS), Epworth Sleepiness Scale (ESS), and Audit of Diabetes Dependent Quality of Life questionnaire (ADDQoL) were used.

RESULTS: 317 subjects were recruited. Majority had type 2 diabetes. 21 percent had high OSA risk. True OSA prevalence is estimated at 14.1 percent. High OSA risk is associated with hypertension (68.1 percent vs. 49 percent, p=0.004), type II obesity (19.4 percent vs. 7.8 percent, p=0.004), increased waist circumference (mean 89.06+10.87 cm vs. 85.37+10.07 cm, p = 0.008), increased hip circumference (mean 99.73 + 9.36 cm vs. 96.62+7.68 cm, p=0.004), increased neck circumference (mean 36.09+3.66 cm vs. 34.85+4.19 cm, p=0.025) elevated serum triglyceride (mean 163.78 + 73.77 mg/dL vs. 138.73 + 67.28 mg/dL, p=0.007), metabolic syndrome (68.1 percent vs. 51 percent, p=0.011), and higher ESS score (mean 10.86 + 4.97 vs. 9.13 + 4.85, p=0.008). No significant difference in mean ADDQoL score was noted, although low risk subjects were more likely to report a good general quality of life (34.7 percent, p = 0.024).

CONCLUSIONS: The 14.1 percent estimated OSA prevalence is significant in light of its associations with cardiovascular risk factors. SLMC-OSACS and ESS are inexpensive bedside tools for OSA screening.

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