Journal of the ASEAN Federation of Endocrine Societies最新文献

Objective: This study determined the incidence of perioperative complications associated with routine preoperative glucocorticoid use in patients undergoing pituitary surgery with normal preoperative hypothalamo-pituitary-adrenal axis (HPA axis).

Methodology: From 2011-2021 retrospective chart review, 243 patients undergoing pituitary surgery with normal preoperative HPA axis were analyzed into 2 groups: 1) with preoperative steroids; and 2) without preoperative steroids. Development of postoperative complications was subsequently evaluated.

Results: Incidence of primary composite postoperative complications of in-hospital mortality, postoperative infection and postoperative diabetes insipidus (DI) was significantly increased among those who had preoperative steroids compared to those without (58.33% versus 33.33%, p-value 0.004) with an adjusted odds ratio of 2.90 (CI 1.29 to 6.53, p-value 0.010). Among the components of the composite outcome, post-operative DI was statistically higher among those who were given preoperative steroids (52.45% versus 28.21%, p-value 0.006) with an adjusted OR of 3.31 (CI 1.43 to 7.67, p-value 0.005). The incidence of postoperative adrenal insufficiency was similar between the 2 groups (20.15% with steroids versus 8.70% without steroids, p-value 0.258).

Conclusion: Among patients undergoing pituitary surgery with normal preoperative HPA axis, routine preoperative steroids use was associated with an increased risk of composite postoperative complications.

Graves' disease (GD) presenting as fluctuations between hyperthyroidism and hypothyroidism is a rare phenomenon and poses a diagnostic challenge. A 14-year-old female with GD, initially thought to have Hashimoto's thyroiditis presented with a goiter and oscillating thyroid function over the course of 4 years. This case depicts a case of GD with oscillating thyroid function and stresses the importance of TSH receptor antibodies (TRAb) in the evaluation of patients with hyperthyroidism without Graves' ophthalmopathy.

Due to its rarity, pheochromocytoma or paraganglioma (PPGL) in pregnancy is often not timely diagnosed, thus resulting in high materno-fetal complications. We report a 28-year-old female who presented with paroxysmal symptoms and severe hypertension during early pregnancy. Biochemical confirmatory tests and localization imaging were delayed due to multiple factors. She suffered from two pregnancy losses before she had resection of the paraganglioma.

Objective: The ACTION Asia Pacific (ACTION-APAC) study was designed to identify the perceptions, attitudes, behaviours and potential barriers to effective obesity management in people with obesity (PwO) and healthcare professionals (HCPs) in nine countries of Southeast Asia. This study represents the findings in Vietnam.

Methodology: This cross-sectional, non-interventional study gathered information from Vietnamese PwO (n = 1000) and HCPs (n = 200) via an anonymous online survey between April and May 2022.

Results: The majority of PwO (67%) and HCPs (80%) believed that obesity is a chronic disease that profoundly impacts a person's overall health (76% PwO, 81% HCPs). About 58% of PwO agreed that managing weight loss was solely their responsibility. Meanwhile, 76% of HCPs believed they should actively contribute to their patients' weight loss efforts. Most of the PwO (82.7%) had attempted weight loss with an average of four times. PwO and HCPs cited lack of exercise (63% vs. 86%) and lack of motivation (60% vs. 80%) as the principal barriers to weight loss. HCPs cited PwOs' lack of interest (52%) and motivation to lose weight (45%) as top reasons for not discussing weight.

Conclusion: The study emphasised raising awareness for obesity management among PwO and HCPs and suggested early weight management conversations with HCPs.

Objective: We aimed to study the prevalence of hypophosphatemia and its associated risk factors in Diabetic Ketoacidosis (DKA) patients in the pediatric population.

Methodology: We included 65 subjects aged 7 months to 18 years old who were admitted to Hospital Universiti Sains Malaysia (HUSM) for DKA. Patients' socio-demographic and clinical characteristics, and biochemical examinations from their first admission for DKA were analyzed. The diagnosis of DKA was based on the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria. Multiple logistic regression models examined associations between different variables and hypophosphatemia.

Result: The prevalence of hypophosphatemia in DKA was highest on day 1, at 70.8%, with a mean age of 11 on presentation. Multiple logistic regression analysis showed plasma bicarbonate at day 3 [adjusted odds ratio (OR) 1.2, with a p-value of 0.027] and baseline hemoglobin [adjusted OR 0.62, with p-value 0.009] were significantly associated with hypophosphatemia during DKA.

Conclusion: The prevalence of hypophosphatemia in DKA pediatric patients admitted to our center was highest on day 1 of admission. There were many factors associated with hypophosphatemia from simple logistic regression analysis. However, our final model revealed that plasma bicarbonate on day 3 and baseline Hb were the only significant risk factors for hypophosphatemia in DKA patients in the pediatric population.

Background: The development of interactive multimedia-based applications has become increasingly important in providing effective health education to Type 2 Diabetes Mellitus (T2DM) patients. Understanding the educational content required for such applications from local patients' perspectives is crucial for designing a user-friendly and impactful tool for T2DM management.

Objective: This study aims to investigate patients' views and preferences on the educational content and features of an interactive multimedia-based application for T2DM patients.

Methodology: Semi-structured qualitative interviews were carried out with a sample of T2DM outpatients (n = 16) at a tertiary referral university hospital in Kuala Lumpur between October 2022 and January 2023. The interviews were recorded, transcribed and subjected to thematic analysis.

Result: The majority of participants had been diagnosed with T2DM for less than ten years. The thematic analysis identified several key aspects related to the educational content required for development of a multimedia-based application. These include preference for educational materials, essential contents and interactive features. The participants also proposed a discussion area within such applications that would allow them to communicate and receive immediate advice from healthcare professionals, thus eliminating the need for frequent hospital visits.

Conclusion: The findings of this study highlight the significance of interactive multimedia-based applications in providing health education for T2DM patients. The identified essential content areas from the patients' perspectives can inform the development of effective tailored educational materials for patient's benefit.

Lymphocytic hypophysitis (LHy) is a rare autoimmune inflammatory process that selectively affects the neurohypophysis and infundibulum, typically presenting with arginine vasopressin deficiency (AVP-D). On magnetic resonance imaging (MRI) with contrast, there is a thickening of the pituitary stalk, enlargement of the neurohypophysis or both with homogeneous enhancement. LHy can be self-limiting and regression can be seen radiologically during follow-up. A 22-year-old male presented with clinical findings consistent with AVP-D in 2016. MRI brain demonstrated enlargement of the pituitary stalk and absence of a posterior pituitary bright spot. He was given a trial of glucocorticoid treatment. His serial MRI brain showed a reduction of the pituitary stalk, but the AVP-D persisted. He was diagnosed with LHy. LHy is characterized by lymphocytic infiltration, leading to eventual destruction of the pituitary tissue accompanied by varying degrees of pituitary dysfunction. Definite diagnosis can only be established via pituitary stalk biopsy. Due to the wide range of possible aetiologies, close monitoring is strongly recommended for the treatment of presumed cases lacking histopathologic confirmation. The response rate to glucocorticoids has been variable. Periodic monitoring of anterior pituitary function and pituitary MRI are essential in the management of this condition.

Pheochromocytomas and paragangliomas syndrome are grouped into three specific disease clusters based on their underlying genetic alterations. Pathogenic variants affecting the myelocytomatosis-associated factor X (MAX) gene predispose pheochromocytomas and paragangliomas syndrome to occur at younger ages, with more than half having bilateral pheochromocytomas. We report a case of bilateral pheochromocytomas with a novel pathogenic variant identified in the MAX gene (c.234_235dup). This young male was found to have a huge left suprarenal mass after he presented with severe hypertension and myocardial infarction. His endocrine workup confirmed a diagnosis of pheochromocytoma as evidenced by elevated levels of normetanephrine, metanephrine, and 3-methoxytyramine in the urine. CT of the adrenal glands revealed bilateral adrenal masses; the widest diameter for the left adrenal mass was almost 8 cm whereas for the right one was 2 cm. ⁶⁸Gallium-DOTATATE functional imaging showed significant uptake in the left adrenal mass, but indeterminate on the right, and no significant uptake was seen elsewhere to suggest metastatic lesions. He did not have syndromic features associated with multiple endocrine neoplasia, neurofibromatosis or von Hippel Lindau disease. The collective findings raised the clinical dilemma of whether unilateral or bilateral adrenalectomy should be pursued. The detection of pathogenic MAX gene was therefore crucial in guiding personalized treatment strategy. Following the bilateral adrenalectomy, his hypertension was cured. Annual biochemical screening and 2-yearly MRI imaging to look for recurrence of pheochromocytomas were planned according to international consensus.

Objectives: To report the incidence and clinical characteristics of paediatric patients presenting with diabetic ketoacidosis to the Emergency Department (ED) with new and pre-existing type 1 diabetes mellitus (T1DM).

Methodology: A ten-year retrospective data analysis was performed on children under 16 years presenting to the ED with T1DM from January 2010. Demographic and laboratory data were extracted to determine the rates of DKA. Comparative statistics were performed between age groups and pre-existing and newly diagnosed T1DM patients.

Results: A total of 196 children with T1DM were included. The mean age of the cohort was 9.3 ± 4.0 years, with female predominance (54%, p = 0.38). Most (60%) were newly diagnosed with T1DM, of which 38% presented in DKA. Amongst the total cohort, 43% presented in DKA.The older children accounted for 50% of the DKA presentations in the newly diagnosed cohort. Amongst the younger age group, 42% presented with severe DKA. There were higher rates of T1DM in areas of relative socioeconomic advantage.

Conclusion: Children with T1DM presented with unacceptably high rates of DKA and posed a significant medical, psychosocial and financial burden on families and medical services. These findings suggest that a prospective public health campaign to reduce rates of DKA is warranted.

Objectives: We determined the clinical characteristics and prevalence of metabolic syndrome among adult Filipinos with overt hypothyroidism.

Methodology: This is a cross-sectional study of 151 adults. Patients were recruited by sequential enrollment. Anthropometric and blood pressure measurements were performed followed by blood extraction for metabolic parameters and thyroid function tests. Clinical and laboratory characteristics were compared between patients with and without metabolic syndrome.

Results: The prevalence of metabolic syndrome is 40.4% (95%CI: 32.5%, 48.7%). Patients with metabolic syndrome have a waist circumference of 88.4 ± 7.7 cm in females and 93.3 ± 9.0 cm in males. The median fasting blood glucose was 111.4 (52.2) mg/dL, median systolic blood pressure of 120 (30) mm Hg and diastolic blood pressure of 80 (20) mmHg, median serum triglycerides of 174.3 (114.2) mg/dL, median HDL-C of 42.3 (19.2) mg/dL and a proportion of patients with diabetes (23.0%) and hypertension (44.3%), respectively. The presence of increased waist circumference is the most prevalent component seen among hypothyroid patients. There were no differences in terms of age, sex, etiology of hypothyroidism and anti-TPO levels in those with and without metabolic syndrome.

Conclusion: The prevalence of metabolic syndrome in adult Filipinos with hypothyroidism is high. Emphasis must be placed on early screening using waist circumference and metabolic parameters among hypothyroid patients who are at high risk of developing metabolic syndrome.