Journal of the ASEAN Federation of Endocrine Societies最新文献

Background: Hirata syndrome, or Insulin Autoimmune Syndrome (IAS), is a rare condition characterized by hyperinsulinemic hypoglycemia due to autoantibodies targeting endogenous insulin. Its rarity and unique presentation make diagnosis and management challenging.

Objective: To analyze the clinical presentation, diagnostic methods, and management of IAS based on a single-center experience.

Methodology: This was a case series, conducted at a tertiary care center in northeast India, involving six cases diagnosed between January 2022 and April 2024. Clinical histories, including drug use and comorbidities, were reviewed. Laboratory analyses during hypoglycemic episodes assessed insulin, C-peptide, β-hydroxybutyrate, and cortisol levels. Extended OGTT and 72-hour fasting tests were used when spontaneous hypoglycemia was absent. Insulin autoantibodies (IAA) confirmed the diagnosis.

Results: Six IAS cases were identified, with most linked to α-lipoic acid in multivitamins and one to methimazole. Patients experienced recurrent postprandial hypoglycemia. Elevated insulin, C-peptide, and IAA levels confirmed the diagnosis. Management included discontinuation of causative drugs, dietary changes with frequent complex carbohydrate meals, and pharmacotherapy (acarbose or prednisolone). Follow-up showed resolution of hypoglycemia and normalization of IAA levels in all patients.

Conclusion: IAS should be considered in patients with hypoglycemia and a history of sulfhydryl-containing medications. Early diagnosis using IAA measurement and appropriate management, including drug discontinuation, dietary adjustments, and pharmacotherapy, is essential. Further research is needed to refine treatment strategies and understand the pathogenesis of this rare syndrome.

Objective: To clarify whether reducing the energy ratio of carbohydrates and increasing the ratio of fats contribute to suppressing blood glucose elevation not only under normal conditions, but also under the effects of glucocorticoids.

Methodology: Three test enteral nutrition solutions, differing in energy ratios and used in actual clinical settings, were given to rats: HINEX E-Gel (ST) with 20% fat and 64% carbohydrate content; HINEX E-Gel LC (LC) with 34% fat and 50% carbohydrate content; and HINEX Renute (RN) with 50% fat and 26% carbohydrate content. The time course data of plasma glucose, triglyceride, and insulin levels after a single oral administration of the test EN solution were obtained in normal rats (Experiment 1) and hyperglycemia model rats treated with dexamethasone (Experiment 2).

Result: In both normal and dexamethasone-induced hyperglycemic rats, plasma glucose levels were lower in the groups given RN than in the groups given ST. The differences in EN solutions did not significantly affect plasma triglyceride and insulin levels in both rat models.

Conclusion: This study suggested that the EN solution that is high in fat and low in carbohydrate suppressed the post-administration increase of blood glucose levels even in a state of steroid-induced hyperglycemia with insulin resistance.

Background: Congruent with the increasing prevalence of diabetes, a growing armamentarium of anti-diabetes medications has been introduced. Among these are sodium glucose co-transporter-2 inhibitors (SGLT2i).

Objectives: SGLT2i use has been linked to an increased incidence of urogenital infections. The study aims to compare resistance patterns of urinary tract isolates among patients with diabetes who are on SGLT2i and not on SGLT2i.

Methodology: Single-center retrospective cohort study. A total of 464 patients (75 on SGLT2i, 389 not on SGLT2i) with DM type 2 and urinary tract infection were included. Urine culture results were compared.

Results: A similar pattern of urinary tract isolates was found between groups except for C. albicans being more common in the SGLT2i group. There was no significant association between the presence of resistant urinary tract pathogens and the use of SGLT2i. There was no statistically significant difference in resistance rates between groups, except for imipenem (p = 0.015).

Conclusion: SGLT2i use per se does not play a pivotal role in mediating bacterial resistance in urinary tract pathogens among patients with DM type 2. We do not recommend for or against the use of specific antimicrobials based on SGLT2 inhibitor alone. Patient's clinical profile along with urine culture test results remain key factors in patient management.

Objective: Turner syndrome (TS) is a genetic disorder characterized by X chromosome abnormalities in females. It presents with various clinical features, including short stature and cardiovascular anomalies. Limited awareness and diagnostic facilities contribute to the underdiagnosis of TS in India. The current study aims to explore genotype-phenotype associations with clinical characteristics and cardiovascular abnormalities in TS patients in India.

Methodology: A cross-sectional study involving 40 TS patients underwent clinical assessments and karyotyping. Data on demographics, anthropometry, Turner stigmata, cardiovascular evaluation, neurocognitive assessment and biochemical parameters were collected. The statistical analysis was conducted utilizing Statistical Package for Social Sciences (SPSS) version 27.0.

Results: Monosomy 45, X (55%) was the most prevalent genotype, with notable differences in age at diagnosis and height standard deviation score among genotypes. Thirty-five percent (35%) of participants had cardiovascular abnormalities, with a higher prevalence in the monosomy group. Lower IQ scores and increased thyroid autoimmunity were associated with specific genotypes. Additionally, a greater occurrence of skeletal and cutaneous stigmata, including cubitus valgus and multiple nevi, was observed in the monosomy group.

Conclusion: The study underscores the significance of genotype-phenotype associations in TS, emphasizing personalized management strategies. Early detection using sophisticated technologies like MRI, comprehensive assessments and assisted personalized management strategies to individual genetic profiles may improve cardiovascular and overall health outcomes in Turner syndrome patients.

Introduction: Adrenal venous sampling (AVS) is the gold standard procedure to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and is only performed in a limited number of centers in Sri Lanka. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism.

Methodology: Thirty-two patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Continuous and categorical variables were summarized with mean ± SD and proportions, respectively. Mean and standard deviation of contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model.

Results: The adrenal veins were successfully cannulated in 12 (37.5%). Lateralization was established in 11 (91.7%), and one was diagnosed as having bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), out of which lateralization was demonstrated in 9 (50%), while the rest were considered inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, while the other remained inconclusive. Among patients classified as having unilateral disease, the estimated mean of the CSI was 0.33 (89% credible interval: 0.11-0.86).

Conclusion: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. CSI remains a useful tool when cannulation is unsuccessful, especially on the right side.

Reninoma is a rare cause of renin-induced hypertension commonly seen in young adults and adolescents. Here, we describe a case of reninoma presenting with hypertension in the young. Further investigation revealed elevated renin and aldosterone levels. Computed tomography of the kidneys showed a right-sided renal mass. A diagnosis of reninoma was made, and the patient underwent nephron-sparing surgery, which rendered her normotensive post-operatively.

Pheochromocytoma is often not the first diagnosis considered for many neurological complaints, especially obstructive hydrocephalus. We report a case of Von Hippel-Lindau disease in an adolescent presenting with obstructive hydrocephalus due to adrenergic storm requiring emergency ventriculoperitoneal shunt. This vignette emphasizes the importance of an integral approach, particularly accurate diagnosis that would lead to targeted pharmacological therapy focusing on alphaa-drenergic receptor blockade, which was followed by total curative excision of pheochromocytoma in a timely fashion.

Background: Overweight and obesity, as well as the coexistence of multimorbidity, have been recognized as global health challenges. However, less is known about the prevalence of obesity and multimorbidity among older people in the Philippines. This study sought to determine the prevalence of obesity and multimorbidity among community-living older people.

Methodology: A cross-sectional analysis of older persons ≥60 years from the Focused Intervention for Frail Older Adults Research and Development Program (FITforFrail). Height and weight were measured by body mass index as underweight, <18.5 kg/m²; normal, 18.5-22.9 kg/m²; overweight, 23-27.5 kg/m²; and obese, ≥27.5 kg/m². Multimorbidity was defined as the presence of two or more chronic diseases, assessed as a self-reported physician's diagnosis.

Results: The prevalence of obesity was 15.4%, which was significantly more common among women (p <0.013) and nonsmokers (p <0.006). Multimorbidity, including overweight/obesity, was reported by 77.9% of older persons, and among older persons with overweight and obesity, multimorbidity was present in 76.5%. A higher number of chronic diseases were reported by older persons who were overweight and obese (p <0.006). Significantly more overweight and obese older women reported having multimorbidity (p <0.049) compared to older men. Hypertension, hyperlipidemia, musculoskeletal disorders and hyperuricemia were the most commonly reported chronic diseases among older persons with overweight and obesity.

Conclusion: The results of this study highlight the importance of overweight/obesity as a determinant of multimorbidity. Future research should look into gender differences in risk factors and multimorbidity patterns.

Background: Diabetes is a complex multifactorial disease. Therapy focused only on managing glycaemia does not yield optimal health outcomes. Health-related Quality of Life (HRQOL) is a broad, subjective, and multidimensional concept gaining significance in diabetes care. The complex interplay of HRQOL and other factors must be addressed to achieve optimal health outcomes.

Objective: We aim to describe the factors associated with HRQOL in type 2 diabetes.

Methodology: A single-center cross-sectional short messaging service (SMS) survey invited adults with type 2 diabetes (T2D) with ≥1 clinic attendance in the past year. Participants completed the Problem Areas in Diabetes-5 (PAID-5), Diabetes Distress Scale-17 (DDS17), and European Quality of Life Score (EQ-5D-5L). Demographic and diabetes-related data were retrieved from electronic medical records. Multiple regression models were created with EQ-5D-5L Index score (HRQOL) as the dependent variable.

Result: A total of 1406 people with T2D participated, 46.4% women, mean (SD) age 61.1 (13.4) years, BMI 27.1 (5.4) kg/ m², and HbA1c 8.0 (1.4)%. Of these, 60.9% had ≥1 microvascular and 23.8% had ≥1 macrovascular complication. Mean (SD) of EQ-5D-5L Index score was 0.81 (0.27), EQ5D Visual Analog Score (VAS) was 77.4 (23.8), total mean DDS17 score was 1.87 (0.93) and PAID-5 score was 5.04 (4.5). 26.9% and 11.3% had significant diabetes distress (DD) based on PAID-5 ≥8 and DDS17 ≥3. Multiple regression models revealed diabetes distress, a lower class of housing type, presence of macrovascular complication, higher BMI, older age, and female sex to be associated with a poorer EQ-5D-5L Index Score.

Conclusion: Multiple non-glycemic factors like sociodemographic, socioeconomic, diabetes distress, impact health-related QoL in people with type 2 diabetes.