PubMed Health⌕ Search

Biomedical subjects

R Simó

Publications and source records attributed to R Simó.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Relationship between iron stores and diabetes mellitus in patients infected by hepatitis C virus: a case-control study].

BACKGROUND: To investigate whether the high prevalence of diabetes observed in patients infected by the hepatitis C virus (HCV) is associated to iron stores. PATIENTS AND METHODS: Serum ferritin levels were determined in 123 patients infected by HCV (55 diabetic and 68 non-diabetic). RESULTS: Serum ferritin concentrations were higher in diabetic than in non-diabetic patients (205 ng/ml [14-861] vs. 58 ng/ml [15-494]; p < 0.0001). CONCLUSIONS: Serum ferritin levels are related with the presence of diabetes in patients infected by HCV.

Biopsy↗
PubMed2000

Encephalopathy associated to autoimmune thyroid disease: a more appropriate term for an underestimated condition?

Hashimoto's encephalopathy is a severe and rather infrequent clinical condition initially described in patients suffering from chronic lymphocytic thyroiditis. Its origin is still controversial but it can be agreed to have an autoimmune etiology. In fact, its most characteristic finding is the high titre of antithyroid antibodies, especially antimicrosomal. We describe three cases of Hashimoto's encephalopathy and establish a relationship between the clinical status, the antithyroid antibody levels and its response to corticosteroid treatment. There was an excellent response to corticosteroid treatment in all three cases. Interestingly, one case was associated with Graves' disease. Given this, and after the review of the literature, we believe that the term 'encephalopathy associated to autoimmune thyroid disease' could be more appropriate to define this entity. Finally, we suggest that autoimmune thyroid encephalopathy must be suspected in the face of unaccounted acute or subacute encephalopathy with high levels of antithyroid antibodies.

Adolescent↗
PubMed2000

[Diagnostic performance of serum thyroglobin and iodide-131 Na scan according to the type of recurrence in differentiated thyroid carcinoma].

BACKGROUND: There is no consensus about the best follow-up protocol in differentiated thyroid carcinoma (DTC). The aim of this study is to evaluate the usefulness and prognostic value of serum thyroglobulin (Tg) and the iodide-131 whole body scan (WBS) in DTC recurrences as a whole and according to the type of recurrence (local recurrence or distant metastases). PATIENTS AND METHODS: Thirty-four patients with recurrent DTC recruited in our institution over 15 years, with a minimum 5 years of follow-up and without either distant metastases at time of diagnosis nor detectable anti-Tg antibodies were included in the study. All patients were submitted to total or near-total thyroidectomy and 131INa ablation of postsurgical thyroid remnants. The follow-up included Tg measurement and WBS performed in hypothyroid state. RESULTS: Serum Tg was increased in the 67.4% of the patients and the WBS was positive in the 82.3%. In the isolated local recurrences the sensitivity of WBS was higher than Tg measurement (93.7 vs 43.7%; p < 0.05), but patients with positive Tg had a worse prognostic. By contrast, in patients with distant metastases the sensitivity of Tg was higher than WBS (83.3 vs 58.3%; p = NS). In 14 patients (41.2%) the results of WBS and Tg were in disagreement. In these cases a worse prognosis was observed when Tg was positive and WBS negative. CONCLUSIONS: The sensitivity of Tg and WBS is different depending on the type of recurrence. Therefore, both tests complement each other and it is not recommended to omit one of them in the follow-up of DTC.

Adult↗
PubMed2000

Serum laminin as a marker of diabetic retinopathy development: a 4-year follow-up study.

PURPOSE: The usefulness of laminin as a serum marker of diabetic retinopathy is a topic that generates conflicting views. The aim of the present study was to investigate the effect of diabetic retinopathy on serum laminin-P1, the larger pepsin resistant fragment of laminin, and to elucidate whether serum laminin-P1 could be an indicator of the risk for development of diabetic retinopathy. METHODS: In a prospective study, 97 consecutive diabetic patients (35 type 1 and 62 type 2) without diabetic retinopathy and a urinary albumin excretion rate lower than 20 microg per minute were enrolled in a 4-year follow-up study. Patients who developed microalbuminuria during the study were excluded in order to avoid the influence of diabetic nephropathy on serum laminin-P1. At the end of follow-up, data from ophthalmologic studies and serum laminin-P1 were evaluated in the 66 normoalbuminuric diabetic patients who completed the study. RESULTS: No statistical differences were observed in baseline laminin-P1 serum concentrations between patients who developed diabetic retinopathy (n = 15) and patients who remained without it during follow-up (n = 51). However, serum laminin-P1 levels obtained at the end of the study were significantly higher in patients who developed diabetic retinopathy (1.75 +/- 0.33 U/ml versus 1.47 +/- 0. 27 U/ml; P =.002). Furthermore, statistical difference was observed when initial and final values of serum laminin-P1 were compared in patients who developed diabetic retinopathy (1.56 +/- 0.27 U/ml versus 1.75 +/- 0.33 U/ml; P =.001). Remarkably, an increase in serum laminin-P1 concentration was detected in all but two of the patients who developed diabetic retinopathy. The relative risk of development of diabetic retinopathy in patients who showed an increase in serum laminin-P1 during follow-up was 5.4 (95% confidence interval, 1.32 to 22.13). CONCLUSIONS: Serum laminin-P1 is a marker and a risk indicator of diabetic retinopathy but is not an early predictor of its development.

Biomarkers↗
PubMed2000

Short-term hypothyroidism has no effect on serum leptin concentrations.

The aim of the study is to determine the effect of short-term hypothyroidism on serum leptin levels. For this purpose 30 patients with past medical history of thyroidectomy for differentiated thyroid carcinoma were included. Serum leptin concentrations were similar when patients were on thyrotrophin-suppressive thyroxine therapy than when were admitted 4 weeks after stopping thyroxine treatment to perform a routine 131I scan in hypothyroid status (17.0 +/- s.e.m. 2.14 vs. 17.6 +/- s.e.m. 2.41 ng/ml; p = n.s.). Moreover, no differences were obtained when the analysis was performed separately in men and in women. We conclude that short-term hypothyroidism does not alter serum leptin concentrations. Furthermore, our results suggest that thyroid hormones do not operate through changes in serum leptin levels to regulate energy expenditure.

Female↗
PubMed2000

Influence of surgical stress and parenteral nutrition on serum leptin concentration.

UNLABELLED: Experimental studies suggest that leptin may be an important metabolic signal for energy regulation. AIM: To assess whether surgical stress produces changes in serum leptin concentration and to investigate and compare the effect of total parenteral nutrition and hypocaloric parenteral nutrition on serum leptin levels. PATIENTS AND METHODS: Twenty-two surgical patients (11 male and 11 female) in need of parenteral nutrition were recruited. Parenteral nutrition was always initiated 24 h after surgical procedure. Group I (n=15) received total parenteral nutrition, while Group II (n=7) were treated with hypocaloric parenteral nutrition. Serum leptin concentration was determined before surgical procedure (day -1), after surgery and before parenteral nutrition was started (day +1), and after 5 days of treatment with parenteral nutrition (day +6). RESULTS: A tendency to increase serum leptin levels was observed after surgical procedure (6.0+/-1.9 vs 9.9+/-2.7 ng/ml;P= 0.07). After starting parenteral nutrition no significant changes on serum leptin concentrations were found in both groups, but a trend to raise serum leptin was observed in Group I (6.2+/-1.7 vs 8.3+/-2.7 ng/ml) whereas a trend to decrease serum leptin was detected in Group II (4.6+/-2.5 vs 1.6+/-0.5 ng/ml). On day +6 an increase of serum leptin and insulin levels was observed in Group I in comparison with Group II (8.3+/-2.7 vs 1.6+/-0.5 ng/ml;P<< 0.05 and 58+/-41 vs 12+/-15 microU/l;P<< 0.05 respectively). Finally, a positive correlation at day +6 between insulin and serum leptin levels was observed (r= 0.66;P<< 0.01). CONCLUSIONS: a) Surgical stress is associated to an increase of serum leptin concentrations; b) Total and hypocaloric parenteral nutrition produces quite different effects on serum leptin levels that could be related to distinct insulin response.

Energy Intake↗
PubMed2000

Bacterial community structure associated with a dimethylsulfoniopropionate-producing North Atlantic algal bloom.

The bacteria associated with oceanic algal blooms are acknowledged to play important roles in carbon, nitrogen, and sulfur cycling, yet little information is available on their identities or phylogenetic affiliations. Three culture-independent methods were used to characterize bacteria from a dimethylsulfoniopropionate (DMSP)-producing algal bloom in the North Atlantic. Group-specific 16S rRNA-targeted oligonucleotides, 16S ribosomal DNA (rDNA) clone libraries, and terminal restriction fragment length polymorphism analysis all indicated that the marine Roseobacter lineage was numerically important in the heterotrophic bacterial community, averaging >20% of the 16S rDNA sampled. Two other groups of heterotrophic bacteria, the SAR86 and SAR11 clades, were also shown by the three 16S rRNA-based methods to be abundant in the bloom community. In surface waters, the Roseobacter, SAR86, and SAR11 lineages together accounted for over 50% of the bacterial rDNA and showed little spatial variability in abundance despite variations in the dominant algal species. Depth profiles indicated that Roseobacter phylotype abundance decreased with depth and was positively correlated with chlorophyll a, DMSP, and total organic sulfur (dimethyl sulfide plus DMSP plus dimethyl sulfoxide) concentrations. Based on these data and previous physiological studies of cultured Roseobacter strains, we hypothesize that this lineage plays a role in cycling organic sulfur compounds produced within the bloom. Three other abundant bacterial phylotypes (representing a cyanobacterium and two members of the alpha Proteobacteria) were primarily associated with chlorophyll-rich surface waters of the bloom (0 to 50 m), while two others (representing Cytophagales and delta Proteobacteria) were primarily found in deeper waters (200 to 500 m).

Alphaproteobacteria↗
PubMed2000

Hepatocyte growth factor in vitreous and serum from patients with proliferative diabetic retinopathy.

BACKGROUND: Hepatocyte growth factor (HGF) is an endothelium specific growth factor that has been implicated in angiogenesis, a crucial event for the development of proliferative diabetic retinopathy (PDR). The aim of the study is to determine the intravitreous concentrations of HGF in diabetic patients with PDR, and to investigate whether its serum levels could contribute to its intravitreous concentration. METHODS: 17 diabetic patients and seven non-diabetic patients in whom a vitrectomy was performed were studied. Both groups were matched by serum levels of HGF. Venous blood and vitreous samples were collected simultaneously at the time of vitreoretinal surgery. Vitreous and serum HGF were determined by ELISA. RESULTS: Intravitreous concentrations of HGF (median and range) were higher in diabetic patients (17.04 ng/ml (9.98-80)) in comparison with non-diabetic patients (5.88 ng/ml (2.57-14.20); p=0. 003). Intravitreous HGF concentrations were strikingly higher than serum HGF concentrations both in diabetic patients (17.04 ng/ml (9. 98-80) v 0.66 ng/ml (0.26-1.26); p<0.001) and in the control group (5.88 ng/ml (2.57-14.20) v 0.68 ng/ml (0.49-0.96); p=0.003). No correlation was found between serum and vitreous levels of HGF in both groups (diabetic patients, r= -0.31; p=0.5 and control subjects r= -0.15; p=0.5). CONCLUSION: The high vitreous levels of HGF observed in diabetic patients with PDR cannot be attributed to serum diffusion across the blood-retinal barrier. Therefore, intraocular synthesis appears to be the main contributing factor for the high vitreous HGF concentrations in diabetic patients, a cytokine that seems to be directly involved in the pathogenesis of PDR.

Aged↗
PubMed2000

Relationship of lipoprotein(a) and its phenotypes with the albumin excretion rate in diabetic patients: a multivariate analysis.

BACKGROUND/AIM: The possible association between lipoprotein(a) [Lp(a)] and albumin excretion rate (AER) is a topic that has generated conflicting views. The aim of this study was to determine the relationship between serum Lp(a) concentrations and AER in diabetic patients, taking into account Lp(a) phenotypes in a multivariate analysis. METHODS: For this purpose 191 consecutive diabetic patients (69 type 1 and 122 type 2) were included in the study. Lp(a) was determined by ELISA and its phenotypes by SDS-PAGE followed by immunoblotting. Lp(a) phenotypes were grouped by size in small (F, B, S1, S2), big (S3, S4) and null. RESULTS: Diabetic patients with an AER >20 microg/min presented higher Lp(a) concentrations than patients with an AER <20 microg/min: median 19 mg/dl versus 5 mg/dl (p < 0.0001). The differences remained at a significant level when the type of diabetes was considered. A linear correlation was observed between Lp(a) concentration and AER (type 1: r = 0.32, p = 0.01; type 2: r = 0.25, p < 0.05). The AER was independently correlated with Lp(a) concentrations in a multiple regression analysis (p < 0.01), and Lp(a) was independently associated with the presence of diabetic nephropathy in the logistic regression analysis. The overall frequency distribution of Lp(a) phenotypes differed significantly between patients with or without microalbuminuria (p < 0.05). In addition, the AER (microg/min) was different among the Lp(a) phenotypes: small 55 +/- 122 (median 4.9), big 58 +/- 123 (median 5.7) and null 3 +/- 2 (median 2.3); p = 0.01. The significant difference mainly resulted from low AER (<10 microg/min) detected in all patients with the null phenotype. CONCLUSIONS: In diabetic patients the serum Lp(a) concentration is associated with AER. Thus, the elevated cardiovascular risk observed in diabetic patients with a high AER could be related to the Lp(a) concentration. Finally, patients with the null Lp(a) phenotype can be considered as a group at low risk of the development of diabetic nephropathy.

Adult↗
PubMed2000

Vitreous levels of IGF-I, IGF binding protein 1, and IGF binding protein 3 in proliferative diabetic retinopathy: a case-control study.

OBJECTIVE: To evaluate vitreous levels of IGF-I and its binding proteins IGFBP-1 and IGFBP-3 in patients with proliferative diabetic retinopathy (PDR). Because intravitreal proteins are elevated in patients with PDR due to the disruption of the blood-retinal barrier, we have corrected vitreal IGF-I and IGFBPs by total vitreal proteins to avoid this confounding factor. RESEARCH DESIGN AND METHODS: We compared 21 diabetic patients with proliferative retinopathy (group A) and 13 nondiabetic patients (group B) in whom a vitrectomy was performed. Both groups were matched by age, serum IGF-I, IGFBP-1, and IGFBP-3 levels. Serum and vitreous levels of IGF-I, IGFBP-1, and IGFBP-3 were measured by immunological methods. Vitreal proteins were assessed by turbidimetric method. RESULTS: Vitreal levels of IGF-I were elevated in group A (median 1.35 ng/ml [range 0.3-8.7]) in comparison with group B (median 0.25 ng/ml [range 0-1.38]), P<0.001. After adjusting by vitreal proteins [ratio IGF-I (ng/ml)/protein (mg/ml)], the differences remain significant (P<0.005). Vitreal levels of IGFBP-1 and IGFBP-3 were also elevated in diabetic patients (IGFBP-1: group A, median 1.6 ng/ml [range 0.6-20.7]; group B, median 0.4 ng/ml [range 0.3-1.9], P<0.001. IGFBP-3: group A, median 102.6 ng/ml [range 53.9-350.8]; group B, median 29.0 ng/ml [range 3.2-87.8], P<0.001). However, when the ratio IGFBP/protein was considered, the differences were not significant. CONCLUSIONS: Intraocular synthesis contributes to elevated vitreous concentrations of IGF-I found in PDR. By contrast, unspecific increase of intravitreal proteins is the main factor explaining the elevated vitreous levels of IGFBP-1 and IGFBP-3 found in diabetic patients.

Case-Control Studies↗
PubMed1999

[Lipoprotein (a) and the evaluation of low density cholesterol by the Friedewald formula: a new problem for an old equation].

BACKGROUND: To evaluate the influence of lipoprotein(a) [Lp(a)] concentration on the LDL-cholesterol calculated by the Friedewald formula. MATERIAL AND METHODS: Lp(a) was determined to a worker population of 947 subject in order to perform a correction of LDL-cholesterol obtained by the Friedewald formula. RESULTS: In subjects in whom Lp(a) was > 30 mg/dl (12.9%) LDL-cholesterol levels were overestimated 10 mg/dl at least. CONCLUSION: Lp(a) should be considered in order to reduce Friedewald's formula error on the estimation of LDL-cholesterol.

Cholesterol, HDL↗
PubMed1999

[Fibronectin and diabetes mellitus: the factors that influence its plasma concentrations and its usefulness as a marker of late complications].

BACKGROUND: The usefulness of plasma fibronectin (FNp) as a marker of late diabetic complications is controversial. The aim of the study was to assess the influence of several variables on FNp in diabetic patients and to determine its usefulness as a marker of late diabetic complications. PATIENTS AND METHODS: 79 diabetic patients randomly selected were included in the study. The clinical variables considered were: age, gender, body mass index (BMI), tobacco and alcohol consumption, type, duration and treatment of diabetes, hypertension, and diabetic late complications (macroangiopathy, retinopathy, nephropathy and neuropathy). The laboratory variables analyzed were: blood glucose, glycated hemoglobin, total cholesterol, HDL-cholesterol, LDL-cholesterol, tryglicerides, apolipoprotein AI, apolipoprotein B, microalbuminuria, creatinin and FNp. Statistical study included a multiple regression analysis taking FNp as the dependent variable. RESULTS: A direct correlation between FNp and BMI and also with tryglicerides was observed (r = 0.362; p = 0.002, and r = 0.234; p = 0.038, respectively). Higher levels of FNp were found in type 2 diabetic patients in comparison with type 1 (464 [SD, 127] versus 395 [SD, 96] mg/dl; p = 0.014). This difference was due to the higher BMI and tryglicerides concentrations observed in type 2 diabetic patients in comparison with type 1 (28.61 [SD, 4.67] versus 22.56 [SD, 2,.19] kg/m2; p < 0.001, and 4.24 [SD, 2.36] versus 2.52 [SD, 1.40] mmol/l, respectively). Multiple regression analysis showed that only BMI significantly influenced on FNp concentrations (r = 0.330; p = 0.004). No relation among FNp and late diabetic complications and other variables considered in the study was observed. CONCLUSIONS: FNp is not a useful marker of diabetic late complications and its concentrations are direct and independently influenced by BMI.

Adult↗
PubMed1999

Effect of panretinal photocoagulation on serum levels of laminin in patients with diabetes: a prospective study.

BACKGROUND/AIM: Laminin, a major specific non-collagenous glycoprotein of basement membrane, has been proposed as an index of diabetic retinopathy and high serum concentrations have been reported in patients with proliferative diabetic retinopathy. On the other hand, panretinal photocoagulation (PRP) prevents the progression of severe diabetic retinopathy and reverses preretinal neovascularisation. The aim of the study was to investigate the effect of PRP on serum levels of laminin in patients with diabetes. METHODS: 20 patients with diabetes undergoing PRP and 15 patients with mild or moderate non-proliferative diabetic retinopathy in whom a PRP was not performed were included in the study. Serum laminin-P1 (Lam-P1), the largest pepsin resistant fragment of laminin, was determined by radioimmunoassay in each patient before starting PRP and 3 months after it was accomplished. Similarly, a baseline and a 4 month sample were analysed in the non-photocoagulated controls. RESULTS: Serum Lam-P1 concentrations obtained 3 months after PRP were significantly lower when compared with the initial values (1.62 (SD 0.36) U/ml v 1.91 (0.37) U/ml; p <0.001). A decrease of serum levels of Lam-P1 could be seen in all patients. By contrast, in those patients with mild or moderate non-proliferative diabetic retinopathy in whom a PRP was not performed, no significant changes were detected in serum Lam-P1 concentrations (1.72 (0.20) U/ml v 1. 74 (0.17); p=0.250). CONCLUSION: PRP decreases serum Lam-P1 levels in patients with severe diabetic retinopathy. Thus, the studies addressed to evaluate the usefulness of Lam-P1 as a marker of diabetic retinopathy should consider previous PRP as an influencing factor. Finally, our results suggest that retinal source of Lam-P1 strongly contributes to serum Lam-P1 in patients with severe diabetic retinopathy.

Aged↗
PubMed1998

Trace chromatographic analysis of dimethyl sulfoxide and related methylated sulfur compounds in natural waters.

Dimethyl sulfoxide (DMSO) occurs in the environment as a result of a number of biogenic and anthropogenic production and emission processes. It is an environmentally significant compound because of its use as a substrate by bacteria and its potential role in the biogeochemical cycle of dimethyl sulfide (DMS), a climatically active trace gas. In this paper, current methods for DMSO determination at nanomolar levels in natural waters, all involving gas chromatography, are reviewed. Direct injection and separation of aqueous DMSO offers a simple and fast application, but exhibits limited sensitivity due to limitation on injection volumes. So far, most authors have preferred DMSO reduction and subsequent analysis of the evolved DMS by purge-and-trap preconcentration and flame photometric detection. Several reducing agents have been used, though some require cumbersome procedures or are very sensitive to operational conditions. The common algal component dimethylsulfoniopropionate (DMSP) acts as an interference in some reduction methods and, therefore, either DMSP elimination prior to DMSO analysis or correction a posteriori is required. DMSO can be analyzed along with DMS, methanethiol, dimethyl disulfide and DMSP in the same water sample, either sequentially or separately, so that comprehensive speciation of methylated sulfur is obtained. Owing to the biological activity of DMSO, appropriate water sampling and handling procedures must be applied. Acidification and freezing appear to be suitable for aqueous DMSO storage, although immediate analysis in the field is always preferable. Future directions of DMSO determination in aquatic environments are suggested.

Chromatography↗
PubMed1998

[Prevalence of nephropathy in type I diabetes].

BACKGROUND: Diabetic nephropathy is a serious complication of diabetes, of which there are few epidemiological data in Spain. The aim of this study is to determine diabetic nephropathy prevalence in a group of patients with type I diabetes mellitus, representative of the population of Barcelona, Spain, evaluating several risk factors related with its development. PATIENTS AND METHODS: 639 patients (296 males and 343 women), from 6 hospitals, selected according with the diabetes duration (194 between 5 and 9 years [group I], 227 between 10 and 19 years [group II] and 218 with 20 years or more [group III]) were studied. In all patients urinary albumin excretion and plasma levels of creatinine, HbA1c, cholesterol and triglycerides were determined. The presence of retinopathy, neuropathy, vasculopathy and tobacco consumption were also evaluated. RESULTS: The prevalence of diabetic nephropathy increased with longer diabetes duration (8.1% [CI: 4.3-11.9] in group I, 24.7% [CI: 19.1-30.3] in group II and 44.7% [CI: 38.1-51.3] in group III), as well as that of hypertension, diabetes complications, cholesterol and triglycerides plasma levels. Related to people with normal renal function, after logistic regression, microalbuminuria was associated with hypertension and longer diabetes duration. Clinical nephropathy (macroalbuminuria + renal failure) to hypertension, longer duration, hypertriglyceridemia, male sex and tobacco consumption. CONCLUSIONS: The prevalence of diabetic nephropathy in Barcelona area is high and similar to that observed in other european regions. Its existence is associated with other diabetic complications. In addition to the classic risk factors, tobacco consumption must also be considered as a factor for diabetic nephropathy.

Adult↗
PubMed1998

Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours. Study Group of Incidental Adrenal Adenoma.

OBJECTIVE: Clinically silent cortisol hypersecretion has been frequently observed in recent series of adrenal 'incidentalomas'. A significant body of data indicates that a spectrum of cortisol excess exists. Up to 90% of patients with cortisol hypersecretion are glucose intolerant. The aim of this study was (1) to assess glucose tolerance in consecutive patients with 'nonfunctioning' adrenal adenomas, and (2) to study the influence of the status of the hypothalamo-pituitary-adrenal axis (HPAA) on carbohydrate tolerance. PATIENTS AND METHODS: Sixty-four consecutive patients with nonfunctioning adrenal adenomas (non-hypersecretory) diagnosed between September 1995 and July 1996 in five hospitals were included in the study. The prevalence of glucose intolerance or diabetes mellitus was determined with an oral glucose tolerance test (oGTT) according to the recommendations of the National Diabetes Data Group. Twenty-three consecutive unselected patients diagnosed with 'nonfunctioning' adrenal adenoma were enrolled in a study to determine the influence of HPAA status on carbohydrate tolerance. In these patients, in addition to basal and post-dexamethasone serum and urinary free cortisol concentrations, assessment of peripheral sensitivity to insulin (estimated during the oGTT according to a previously validated method) and adrenal sensitivity to ACTH (calculated from the CRH test) were performed. RESULTS: Twenty-five patients were considered to have normal glucose tolerance (95% confidence interval (95% CI) for the mean of 2 h glucose, 5.5-6.5 mmol/l); 17 showed glucose intolerance (95% CI 8.5-9.3 mmol/l); and 22 were classified as having diabetes mellitus (95% CI 12.1-14.6 mmol/l), including six patients with previously known diabetes mellitus. These three groups were comparable in age, sex, body mass index, waist-hip ratio and concomitant diseases. Thus, the prevalence of disturbed glucose tolerance was 39/64 (61%), well above the prevalence of NIDDM described in a population of similar age in our area. Among the 23 patients included in the study of HPAA status, the size of the tumour correlated with serum cortisol after dexamethasone (DXM) (r = 0.52, P < 0.01) and 24-h urinary free cortisol (UFC) after DXM (r = 0.55, P < 0.01), and negatively with DHEAs (r = -0.42, P = 0.04). The area under the curve for ACTH after hCRH (AUCacth) correlated negatively with both UFC (r = -0.40, P = 0.04) and serum cortisol after dexamethasone (r = -0.47, P = 0.02). The degree of peripheral sensitivity to insulin (SI) positively correlated with adrenal sensitivity (r = 0.56, P = 0.005). CONCLUSIONS: A high prevalence (61%) of disturbed glucose tolerance was found among consecutive patients harbouring incidental 'nonfunctional' adrenal adenomas. Therefore, patients with incidental adrenal tumours should be tested for glucose tolerance. The positive correlation between insulin sensitivity and adrenal sensitivity to ACTH suggests that, in these patients, insulin resistance hampers ACTH action at the level of the adrenal.

Adenoma↗