Endocrine System Diseases Commons^™

Enhancing Diabetes Care In Lmics: Insights From A Multinational Consensus, Jose Carlos Miranda, S Abbas Raza, Babatope Kolawole, Jahanzeb Kamal Khan, Atiba Alvi, Fariha Sadiq Ali, Ejim Emmanuel Chukwudi, Nanik Ram, Amira Oluwatoyin

Section of Diabetes, Endocrinology and Metabolism

The International Cardio-Metabolic Forum held a plenary session to establish a multinational consensus on the challenges faced in diabetes management within lower-middle-income countries (LMICs) and their potential solutions. Stakeholders, including patients, family/caretakers, healthcare professionals, and healthcare policymakers & organizations, participated in discussions. The audience of 280 doctors from 15 different countries (Pakistan, Qatar, Sri Lanka, Kenya, Myanmar, Georgia, Nigeria, Philippines, Uzbekistan, Iraq, Tanzania, Cambodia, Kazakhstan, South Sudan and Libya) was divided into 4 groups led by Group Leaders to represent each stakeholder group. Questionnaires addressing key challenges and solutions specific to each group were used to facilitate consensus development. Participants …

A Retrospective Analysis Of Endocrine Disease In Sphingosine-1-Phosphate Lyase Insufficiency: Case Series And Literature Review, Avinaash Maharaj, Ruth Kwong, Jack Williams, Christopher Smith, Helen Storr, Ruth Krone, Debora Braslavsky, Maria Clemente, Nanik Ram, Indraneel Banerjee

Section of Diabetes, Endocrinology and Metabolism

Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional …

Neonatal Outcomes And Congenital Anomalies In Pregnancies Affected By Hypothyroidism, Zareen Kiran,, Aisha Sheikh, Khadija N Humayun, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Maternal hypothyroidism has been reported to have concerns over neonatal outcomes, not only in the context of neurocognitive development but also in the short term as birth weight and neonatal jaundice.
Patients and methods: We conducted a cross-sectional retrospective study on 638 cases who delivered live births in the Aga Khan University Hospital after ethical approval. Data were collected on hypothyroid pregnant females who were diagnosed before conception or during their antenatal visits during the year 2008-2016. Neonatal outcomes were noted for birth weight, maturity, and neonatal jaundice, neonatal hypothyroidism, neonatal respiratory distress syndrome, sepsis, hypocalcaemia, congenital anomalies, need …

Relationship Between Estimated Average Glucose (Eag) And Fasting Plasma Glucose In A Cohort Of Pakistani Diabetic Subjects, Nanik Ram, Sibtain Ahmed, Saadia Sattar, Saira Furqan, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Introduction: Scientific literature is scarce on the utility of estimated average glucose (eAG) from Pakistan. Hence, there is a dire need to evaluate the relationship between eAG and fasting plasma glucose (FPG), in order to enhance our understanding of eAG and its usefulness. This study aims to investigate the relationship between FPG and eAG in diabetic patients calculated using HbA1C.
Materials and methods: A retrospective study was conducted at the Aga Khan University, Karachi, Pakistan. The medical records of both genders in the age range of 18-60 years, presenting as outpatients at the endocrine clinic, labeled as DM, were reviewed …

Clinical Outcomes Of Sodium-Glucose Cotransporter-2 Inhibitors In Patients With Type 2 Diabetes Mellitus: An Observational Study From Pakistan, Bhagwan Das, Aisha Sheikh, Bilal Ahmed, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To determine the efficacy and safety of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in the Pakistani population.
Methods: Retrospective review of initial 100 patients who were prescribed with any agent of the SGLT2i group from July 1, 2018, to January 2019 at Aga Khan University Hospital, Karachi. SGLT2i was offered to patients of above 18 years of age with inadequate glycemic control on existing antidiabetic agents. Changes in HbA1c, the Body Mass Index (BMI), serum creatinine, any decrease in the requirement of insulin and sulphonylurea dose along with any side effects reported by the patients on follow-up visits.
Results: Most …

Follicular Thyroid Carcinoma In A Developing Country: A 10-Year Retrospective Study, Abdul Aziz, Qamar Masood, Saadia Sattar, Saira Fatima, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: The most common endocrine tumor is thyroid cancer. Follicular thyroid carcinoma (FTC) accounts for 5-10% of all thyroid cancers. Patients with FTC frequently present with more advanced diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery while radioactive iodine (RAI) therapy is the main adjuvant therapy according to the American Thyroid Association guidelines.
Methodology: This was a retrospective observational study of FTC patients aged 18 and above conducted at a tertiary care hospital in Karachi from January 01, 2010 to December 31, 2019.
Results: A total of …

Malignant And Non-Malignant Causes Of Hypercalcemia: A Retrospective Study At A Tertiary Care Hospital In Pakistan, Sabiha Banu, Sumera Batool, Saadia Sattar, Muhammad Qamar Masood

Section of Diabetes, Endocrinology and Metabolism

Background: Hypercalcemia is a common electrolyte abnormality presenting with a variety of symptoms. The common causes are primary hyperparathyroidism and malignancy associated with hypercalcemia. However, iatrogenic hypercalcemia with the overzealous use of vitamin D has now emerged as another important cause of hypercalcemia over the past decade.
Objective: This study aims to evaluate the causes of hypercalcemia, management strategies, and outcomes in patients admitted with hypercalcemia in a tertiary care hospital. Method: It is a retrospective study done at Aga Khan University Hospital (AKUH), Karachi after taking approval from the ethical review committee (ERC). Data were gathered about all patients …

Sglt2i Use In Non-Diabetics, Sarah Nadeem, Masooma Rana, Kaleem Ahmed, Sanjay Kalra

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Patterns Of Abnormal Glucose Metabolism In Acromegaly And Impact Of Treatment Modalities On Glucose Metabolism, Sajjad A. Khan, Nanik Ram, Qamar Masood

Section of Diabetes, Endocrinology and Metabolism

Background: Chronic exposure to high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) leads to metabolic complications, most importantly dysglycemia in the form of diabetes mellitus and pre-diabetes. Dysglycemia if diagnosed early in the course of the disease can decrease complications. Treatment modalities in the form of surgery and medical therapy have varied impacts on glucose metabolism.
Objective: To determine the frequency of diabetes mellitus, impaired glucose tolerance, and impaired fasting glucose in Pakistani patients with acromegaly and to establish the impact of the intervention (surgery/medical) on glucose metabolism.
Methods: This study was a retrospective review of …

Compliance Of Checking Hba1c In A Tertiary Care Hospital Of Pakistan, Abdul Aziz, Syed Ahsan Ali

Section of Diabetes, Endocrinology and Metabolism

Background and objectives: The prevalence of diabetes mellitus worldwide was 171 million one and half decade ago, while the prediction is 366 million patients by 2030 and more than 640 million people by 2040. HbA1c value represents average blood glucose over the past 2-3 months and accounts for both pre-prandial and post-prandial blood glucose levels. A link between HbA1c and diabetic complications has been confirmed. In general, patients with controlled diabetes mellitus should have at least biannual testing, while patients with uncontrolled diabetes mellitus or unmet glycemic targets should be tested every three months. The objective was to see compliance …

Response To Comments On Aisha Sheikh Et Al (J Pak Med Assoc. 70: 1477, 2020) Changing Prevalence Of Gestational Diabetes Mellitus During Pregnancy Over More Than A Decade, Aisha Sheikh, Lumaan Sheikh

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Frequency Of Silent Carotid Artery Stenosis In Diabetics And Its Associated Factors: An Analysis In Tertiary Care Hospital, Faiza Sadaqat Ali, Nimrah Bader, Bader Faiyaz Zuberi, Sabiha Banu

Section of Diabetes, Endocrinology and Metabolism

Objective: To estimate frequency of silent carotid artery stenosis and its associated factors in diabetic patients attending a tertiary care hospital.
Methods: This cross-sectional study was conducted in tertiary care Civil Hospital, Karachi from March 2019 to September 2019,. A total of 166 patients with Diabetes Mellitus were included in this study. Brief history was taken for the duration of DM, treatment, and smoking habits. Carotid artery stenosis (CAS) wafrs measured by Doppler ultrasound of right and left common, internal, and external carotid arteries.
Results: Frequency of silent carotid artery stenosis (CAS) in diabetic patients was observed in 28.92% (48/166) …

Localizing An Occult Insulinoma By Selective Calcium Arterial Stimulation Test: First Ever Experience And A New Dimension To Diagnosis In Pakistan, Muhammad Owais Rashid, Sumerah Jabeen, Zareen Kiran,, Khurram Minhas, Muhammad Azeemuddin, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Insulinomas are rare, usually benign, solitary tumours accounting for 60% of islet cell tumours. These tumours can be difficult to localize preoperatively due to their small size. We present a challenging case of a 40 year old male with frequent hypoglycaemic spells and endogenous hypoglycaemia who presented as a diagnostic dilemma. Patient had an occult insulinoma with inconclusive CT Abdomen, MRI Abdomen and Octreotide scan. The final localization of the tumour was made by selective arterial calcium stimulation testing (SCAT), done for the first time in Pakistan at Aga Khan University Hospital. This was followed by successful distal pancreatectomy as …

The Utility Of Ultrasound In The Preoperative Localization Of Primary Hyperparathyroidism: Insights From Pakistan, Tehseen Fatima, Bhagwan Das, Saadia Sattar, Sumerah Jabeen, Abid Abbas Khan, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: We aimed to evaluate and compare the diagnostic performance of ultrasound (US) and 99m-Tc sestamibi scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT).
Methods: This retrospective study was conducted at the Aga Khan University Hospital in Karachi, Pakistan, and comprised the data of patients with PHPT who underwent parathyroidectomy from 2008 to 2017. Preoperative US and 99m-Tc sestamibi scintigraphy findings were recorded and compared to surgical and histological findings, which were taken as a reference standard.
Results: The sensitivity of US in the preoperative localization of PHPT was 88.3%, positive predictive value (PPV) was 94.6%, and accuracy …

Changing Prevalence Of Gestational Diabetes Mellitus During Pregnancy Over More Than A Decade, Aisha Sheikh, Lumaan Sheikh

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Levosulpiride-Induced Hyperprolactinemia, Sarah Nadeem, Bhagwan Das

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Endocrine Complications In Patients Of Beta Thalassemia Major In A Tertiary Care Hospital In Pakistan, Amina Adil, Zain A. Sobani, Abdul Jabbar, Salman N Adil, Safia Awan

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the major endocrine complications present in patients of Thalassemia major presenting to a tertiary care center in Karachi, Pakistan.

METHODS: Records of all thallasemia major patients at a Haematology Department in a tertiary care hospital of Karachi were retrospectively reviewed from May to August 2009 with specific focus on endocrine data and investigations. The patients' data was recorded in a questionnaire and analyzed using SPSS v.17, frequencies and percentages along with corresponding 95% confidence interval were computed.

RESULTS: Our data revealed that a significantly small percentage of those under care received regular endocrine follow-up. Male hypo-gonadal abnormalities …

Frequency Of Silent Myocardial Ischaemia In Diabetics: A Single Centre Study, Adil Sheikh, Syed Shah Faisal, Abdul Jabbar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To find the frequency of silent myocardial ischaemia in diabetics as compared to non-diabetics.

METHODS: This was a cross sectional study conducted between November 2008 and March 2010. Two hundred subjects were recruited by convenience sampling after informed consent. All were subjected to an exercise stress test. Electrocardiographic changes were noted for silent Ischaemia Descriptive Statistics were applied for significance.

RESULT: Of the 200 subjects included in the study, 31 had diabetes and 1 69 were non-diabetics. The mean age was 46 +/- 10 years. Twenty eight subjects tested positive for silent ischaemia, of whom six were diabetics (19%) …

Diabetic Ketoacidosis Associated With Tacrolimus In Solid Organ Transplant Recipients, Muhammad Qamar Masood, Madiha Rabbani, Wasim Jafri, Manal Habib, Taimur Saleem

Section of Diabetes, Endocrinology and Metabolism

Diabetic ketoacidosis in patients receiving tacrolimus in the post-transplant setting is rare. We describe two such cases in solid-organ transplant recipients. The first patient, a 17-year-old male, presented with severe diabetic ketoacidosis and was managed with intravenous fluids and insulin infusion. He was a known case of Laurence-Moon-Bardet-Biedl syndrome and had received a renal transplant 2 years ago and was receiving tacrolimus since then. Although diabetic ketoacidosis resolved in 24 hours, large doses of subcutaneous insulin (upto 130 units per day) were needed to keep serum glucose within the normal range. Substitution of tacrolimus with cyclosporine obviated the need for …

Spurious Hyperkalaemia: An Insight, Khawaja Salman Zaki, Uzma Majid, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Hyperkalaemia is a common electrolyte disorder with potentially lethal consequences and can lead to life-threatening cardiac dysrhythmias. Spurious hyperkalaemia, also known as pseudohyperkalaemia or factitious hyperkalaemiais, is also quite common in clinical practice and it's a source of avoidable emergency department visits or hospital admissions. We report a case in which alarming hyperkalaemia was found in a patient having Chronic Monomyelocytic Leukaemia on two different occasions, later diagnosed to be spurious.

Self-Glucose Monitoring And Glycaemic Control At A Tertiary Care University Hospital, Karachi, Pakistan, Khurshid Khowaja, Humaira Waheed

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG.

METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups.

RESULTS: We identified that HbA1c value was maintained at good …

Etiology, Functional Status And Short Term Outcome Of Patients With Pituitary Lesions. An Experience From A Developing Country, Osama Ishtiaq, Mansoor Ul Haq, Azra Rizwan, Mohammad Qamar Masood, Saeed Mehar, Abdul Jabbar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To describe the etiology, functional status and short term outcome of patients with pituitary lesions (PL).

METHODS: Brain or pituitary MRI reports of 3753 patients were analyzed for PL over the period of 2000 to 2007, done at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. MRIs with reported PL and all those ordered by Endocrinologists with or without pituitary abnormalities, were included in the analysis. This made a total of 338 (9%) MRI reports. PL were defined as pituitary tumors, cysts, haemorrhage, hypoplasia; and empty sella. Patients with these PL, were analyzed for symptoms, hormonal profile and short …

Vitamin D Deficiency In Ambulatory Patients, Lubna M Zuberi, Aysha Habib, Naeemul Haque, Abdul Jabbar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the frequency of subclinical vitamin D deficiency in an ambulatory care setting.

METHODS: This was an observational study which measured 25 vitamin D levels in medical clinic patients. Patients with chronic renal failure, known osteomalacia and rickets were excluded. A total of 119 patients were evaluated. They were divided in three diagnostic categories based on their serum 25 vitamin D levels. Those with levels below 8 ng/ml were categorized to have severe deficiency, levels between 8 - 20 ng/ml as moderate deficiency and levels of 21-35 mg/ml as mild deficiency.

RESULTS: Of 119 patients, 92% had vitamin …

Hyponatraemia: Etiology, Management And Outcome, Aasima Yawar, Abdul Jabbar, Naeem Ul Haque, Lubna M Zuberi, Najmul Islam, Jaweed Akhtar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting.

STUDY DESIGN: Case series.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, between January and June 2004.

METHODOLOGY: Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients (3) 15 years with a sodium level on admission of (2) 130 mmol/litre were included. The records of those patients were reviewed for relevant demographic, clinical and laboratory data, in addition to the diagnosis, treatment and outcome of hospitalization. The …

Vitamin B12 Deficiency Common In Primary Hypothyroidism, Abdul Jabbar, Aasma Yawar, Sabiha Waseem, Najmul Islam, Naeem Ul Haque, Lubna Zuberi, Ataullah Khan, J. Akhter

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To assess the prevalence and clinical features of B12 deficiency in hypothyroid patients and to evaluate clinical response in symptoms to B12 replacement therapy.

METHODS: One hundred and sixteen hypothyroid patients from our endocrine clinic were evaluated for signs and symptoms of vitamin B12 deficiency. Laboratory parameters including Haemoglobin (Hb), MCV, Vitamin B12 levels and presence of anti thyroid antibodies were analyzed. Patients with low B12 levels were treated with parenteral intramuscular vitamin B12 monthly, and monitored for improvement of symptoms.

RESULTS: A total of 116 patients (95 females and 21 males) were evaluated. Forty six (39.6%) hypothyroid patients …