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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La diabetes mellitus neonatal transitoria es un raro tras-torno del metabolismo de los hidratos de carbono que se manifiesta entre el segundo d&#237;a y las 6semanas de vida de forma sintom&#225;tica&#44; y que por lo general se resuelve en los primeros 6 meses de vida&#46; Se presenta un caso de diabetes mellitus neonatal transitoria de presentaci&#243;n asintom&#225;tica y de larga evoluci&#243;n que fue tratada con insulina r&#225;pida y de acci&#243;n intermedia &#40;NPH&#41; demostrando el estudio gen&#233;-tico una alteraci&#243;n asociada a la enfermedad&#46; Se describe el caso de un reci&#233;n nacido de bajo peso&#44; fruto de una primera gestaci&#243;n de 37semanas que curs&#243; con dia-betes gestacional controlada con dieta&#46; No existen antece-dentes familiares de diabetes mellitus&#46; En la exploraci&#243;n f&#237;si-ca s&#243;lo destacaba sindactilia del segundo y tercer dedos de ambos pies&#46; Desde el segundo d&#237;a de vida se detect&#243; hiperglu-cemia mayor de 200mg&#47;dl&#44; sin repercusi&#243;n cl&#237;nica&#46; Al cuarto d&#237;a de vida se inici&#243; tratamiento con insulina regular subcu-t&#225;nea con respuesta err&#225;tica&#46; Al 41d&#237;a se introduce insulin NPH&#44; consiguiendo una mejor regulaci&#243;n y una disminuci&#243;n de la dosis de insulina r&#225;pida&#44; que se suprimi&#243; a los 15d&#237;as del tratamiento con NPH&#46; Alos 9meses de vida se retir&#243; la in-sulinoterapia&#46; Los valores de insulina&#44; cortisol&#44; p&#233;ptido C&#44; an-ticuerpos antiinsulina&#44; antiperoxidasa tiroidea &#40;anti-TPO&#41;&#44; antitiroglobulina&#44; antideshidrogenasa del &#225;cido glut&#225;mico&#44; antitirosinfosfatasa y hemoglobina glucosilada fueron nor-males&#46; Ecograf&#237;a abdominal normal&#46; Cariotipo&#58; 46XX&#44; der&#40;6&#41; dup&#40;q22-q23&#41; &#40;duplicaci&#243;n brazos largos del cromosoma 6&#41;&#46; En conclusi&#243;n&#44; el tratamiento con insulina NPH puede ser una alternativa al tratamiento de los reci&#233;n nacidos con diabetes mellitus neonatal transitoria hasta ahora tra-tados con insulina r&#225;pida&#46; La asociaci&#243;n con alteraciones gen&#233;ticas puede tener implicaciones pron&#243;sticas&#46;</p>"
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        "resumen" => "<p id="spar00010" class="elsevierStyleSimplePara elsevierViewall">Transitory neonatal diabetes mellitus is a rare carbohydra-te metabolism disorder that usually occurs between the ages of 2days and 6months&#46; We report the case of an asymptoma-tic newborn treated with NPH insulin&#44; in whom genetic study revealed an alteration associated with neonatal diabetes&#46; The patient was a low birth weight infant born after 37 weeks&#39; gestation to a previously childless mother with gestational diabetes controlled by diet&#46; There were familial antecedents of diabetes&#46; Physical examination revealed only syndactylia of the second and third toes&#46; Asympto-matic hyperglycemia higher than 200 mg&#47;dl was detected on the second day of life&#46; Treatment with regular subcuta-neous insulin was started on the fourth day of life with irregular response&#46; On the forty-first day of life treatment with NPH insulin was started with better response&#44; per-mitting the reduction of regular insulin until its suppres-sion 15days later&#46; Treatment with NPH insulin was stop-ped when the patient was 9 months old&#46; During this time concentrations of insulin&#44; cortisone&#44; peptide C&#44; insulin an-tibodies&#44; anti-TPO&#44; anti-TG&#44; anti-GAD&#44; anti-tyrosine-phosp-hatase and glycosylate hemoglobin were normal&#46; Abdo-minal echography showed no abnormalities&#46; Karyotype&#58; 46XX&#44; der&#40;6&#41;dup&#40;q22-q23&#41; &#40;long arm duplication of chro-mosome number 6&#41;&#46; In conclusion&#44; NPH insulin could provide an alternative to regular insulin in the treatment of transitory neonatal diabetes mellitus&#46; Its association with genetic alterations could alter prognosis&#46;</p>"
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Vol. 54. Núm. 4.
Páginas 394-396 (abril 2001)
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Vol. 54. Núm. 4.
Páginas 394-396 (abril 2001)
Acceso a texto completo
Diabetes neonatal transitoria
Transitory neonatal diabetes
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7683
J. Carretero Bellón
Autor para correspondencia
jcarr@tinet.fut.es

Correspondencia: Servicio de Pediatría. Hospital Universitario Juan XXIII. Dr. Mallafré Guasch, 4. 43007 Tarragona
, J. Moralejo Benítez, R. Olivé Vilella, R. Collell Hernández, A. Cardona Barberán, R. Closa Monasterolo
Unidad de Neonatología. Servicio de Pediatría. Hospital Universitario Juan XXIII. Tarragona.
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La diabetes mellitus neonatal transitoria es un raro tras-torno del metabolismo de los hidratos de carbono que se manifiesta entre el segundo día y las 6semanas de vida de forma sintomática, y que por lo general se resuelve en los primeros 6 meses de vida. Se presenta un caso de diabetes mellitus neonatal transitoria de presentación asintomática y de larga evolución que fue tratada con insulina rápida y de acción intermedia (NPH) demostrando el estudio gené-tico una alteración asociada a la enfermedad. Se describe el caso de un recién nacido de bajo peso, fruto de una primera gestación de 37semanas que cursó con dia-betes gestacional controlada con dieta. No existen antece-dentes familiares de diabetes mellitus. En la exploración físi-ca sólo destacaba sindactilia del segundo y tercer dedos de ambos pies. Desde el segundo día de vida se detectó hiperglu-cemia mayor de 200mg/dl, sin repercusión clínica. Al cuarto día de vida se inició tratamiento con insulina regular subcu-tánea con respuesta errática. Al 41día se introduce insulin NPH, consiguiendo una mejor regulación y una disminución de la dosis de insulina rápida, que se suprimió a los 15días del tratamiento con NPH. Alos 9meses de vida se retiró la in-sulinoterapia. Los valores de insulina, cortisol, péptido C, an-ticuerpos antiinsulina, antiperoxidasa tiroidea (anti-TPO), antitiroglobulina, antideshidrogenasa del ácido glutámico, antitirosinfosfatasa y hemoglobina glucosilada fueron nor-males. Ecografía abdominal normal. Cariotipo: 46XX, der(6) dup(q22-q23) (duplicación brazos largos del cromosoma 6). En conclusión, el tratamiento con insulina NPH puede ser una alternativa al tratamiento de los recién nacidos con diabetes mellitus neonatal transitoria hasta ahora tra-tados con insulina rápida. La asociación con alteraciones genéticas puede tener implicaciones pronósticas.

Palabras clave:
Diabetes mellitus
Neonato
Diabetes transitoria

Transitory neonatal diabetes mellitus is a rare carbohydra-te metabolism disorder that usually occurs between the ages of 2days and 6months. We report the case of an asymptoma-tic newborn treated with NPH insulin, in whom genetic study revealed an alteration associated with neonatal diabetes. The patient was a low birth weight infant born after 37 weeks' gestation to a previously childless mother with gestational diabetes controlled by diet. There were familial antecedents of diabetes. Physical examination revealed only syndactylia of the second and third toes. Asympto-matic hyperglycemia higher than 200 mg/dl was detected on the second day of life. Treatment with regular subcuta-neous insulin was started on the fourth day of life with irregular response. On the forty-first day of life treatment with NPH insulin was started with better response, per-mitting the reduction of regular insulin until its suppres-sion 15days later. Treatment with NPH insulin was stop-ped when the patient was 9 months old. During this time concentrations of insulin, cortisone, peptide C, insulin an-tibodies, anti-TPO, anti-TG, anti-GAD, anti-tyrosine-phosp-hatase and glycosylate hemoglobin were normal. Abdo-minal echography showed no abnormalities. Karyotype: 46XX, der(6)dup(q22-q23) (long arm duplication of chro-mosome number 6). In conclusion, NPH insulin could provide an alternative to regular insulin in the treatment of transitory neonatal diabetes mellitus. Its association with genetic alterations could alter prognosis.

Key words:
Diabetes mellitus
Newborn
Transitory diabetes
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Bibliografía
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Copyright © 2001. Asociación Española de Pediatría
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