Sri Lanka Journal of Diabetes Endocrinology and Metabolism最新文献

{"title":"Challenges in post-operative management of Cushing disease","authors":"P. G. Buddhika, K. W. S. T. Wijeyawardena, P. Punchihewa, D. Muthukuda","doi":"10.4038/sjdem.v14i2.7511","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7511","url":null,"abstract":"Patients with Cushing disease (CD) undergo transsphenoidal resection of the pituitary tumor as the primary management option. Post operative period is considered as one of the most challenging aspects in the CD management due to the related high morbidity and mortality. Assessing remission following surgery is done commonly by assessing nadir serum cortisol level, a level < 2 to 5 µ,g/ dL (55-138 nmol/L) during 24 to 7 4 hours postoperatively is accepted as remission. Values more than 5-10 µ,g/dL (138-276 nmol/L) considered as non-remission. If remission is achieved, it is important to treat the adrenal insufficiency (AI) with steroids until the Hypothalamic-Pituitary-Adrenal axis (HPA axis) recovery happens. Other anterior pituitary hormone dysfunctions should be assessed and treated appropriately. If the remission is not achieved by the surgery, secondary management options such as repeat surgery, radiotherapy and medical therapy can be used. Prevention and management of hypercortisolemia associated complications such as infections, thromboembolic events, cardiovascular and metabolic diseases are also important aspect in the post operative management of CD. It is also challenging to manage surgery related complications such as Syndrome of Inappropriate ADH Secretion (SIADH) and Diabetes Insipidus (DI). Prevention or successful treatment of cortisol withdrawal syndrome is another challenging aspect that a physician needs to focus on.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42783776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of glycaemic control on neutralizing antibody response to COVID-19 among patients with Type 2 diabetes mellitus in the Kurunegala District of Sri Lanka; A prospective cohort study","authors":"D. Kottahachchi, N. Badanasinghe, P. Samarathunga, P. Sandeepani, S. Cooray, T. Warnakulasuriya","doi":"10.4038/sjdem.v14i2.7510","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7510","url":null,"abstract":"Background: The antibody response following COVID-19 vaccination among patients with diabetes mellitus (DM) is of particular concern given the increased risk of severe disease in this population. The correlation between glycaemic control among persons with DM and the antibody response was not published in Asian populations. Hence, this study aimed to determine whether glycaemic control has an association with the development of an adequate antibody response for SARS-CoV-2 among patients with DM following the administration of two doses of the COVID-19 vaccine.Methods: A prospective cohort study was carried out at three vaccination centers in the Kurunegala district from November 2021 to January 2022. Seventy-one patients with type 2 diabetes were recruited for this study and followed up on vaccination with the Sinopharm COVID-19 vaccine. HbA1 c levels at the first dose and after 6-8 weeks from the second dose of vaccine were analyzed. The neutralizing antibodies (NAbs) were analyzed using C Pass™ neutralizing antibody detection ELISA Kit following 6-8 weeks of the 2nd dose.Results: The median (IQR) age of the total population (63.4% females) was 53 years (44.0-58.0) and they were diagnosed with diabetes for 6 years (3-11 years). The median first and second HbAlc values were 9.3% (7.2-10.7%) and 8.2% (7.1-10.2%) respectively. From the total population, only 66.2% developed protective levels of NAbs after 6-8 weeks of the second dose of the vaccine. The second HbAlc value was significantly lower compared to the first (z=-2.63, p=0.008). There was no significant difference in terms of sex, age, duration of diabetes, pre-vaccination HbAlc level, or HbAlc level 6-8 weeks after the vaccination among those who developed protective levels of antibodies and those who did not (p>0.05). There was no difference in sero-conversion depending on the abnormal HbAlc value (.28%) (1st HbAlc p=0.957, 2nd HbAlc p=0.360).Conclusion: We did not detect an association between glycaemic control and sero-conversion. However, 1/3rd of patients with diabetes did not have a protective level of NAbs following 2 doses of Sinopharm COVID-19 vaccination. Furthermore, glycaemic control did not deteriorate with COVID-19 vaccination.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44429693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future of endocrinology – The role of the female physician","authors":"D. Muthukuda, U. Wijenayake, F. Afsana, D. Kottahachchi, P. Punchihewa, B. A. M. Premadasa, S. Ali, A. Moazzam, S. Shaikh, D. Shreshtha, D. Karuppiah, S. Bajaj","doi":"10.4038/sjdem.v14i2.7509","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7509","url":null,"abstract":"No abstract available","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45370679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary adrenal insufficiency among Sri Lankan adults: A cross-sectional study in National Hospital Colombo, Sri Lanka","authors":"H. Dissanayake, P. Katulanda, N. Somasundaram, M. Sumanatilleke, S. L. Senevirathne","doi":"10.4038/sjdem.v14i2.7498","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7498","url":null,"abstract":"Background: Clinical, biochemical & radiological characteristics and aetiologies of primary adrenal insufficiency (PAI) among Sri Lankan adults are not known.Aims: To describe the clinical features, aetiology, diagnostic and treatment outcomes of patients with PAI in Sri Lanka.Methods: A cross-sectional study was conducted in Endocrine clinics of National Hospital of Sri Lanka. We screened prescription records to identify patients with PAI. Data was collected using a structured interviewer administered questionnaire and by reviewing clinic records, during their scheduled clinic visit.Results: Forty patients were recruited (median age 38 (IQR 27-52), men 35%, 361 patient-years follow up). Adrenal tuberculosis was the aetiology in 10 / 40. Cause was unknown in 29 / 40, among whom 16 had an associated other organ autoimmune dysfunction. Delay in presentation, diagnosis and presentations with Addisonian crisis were less in patients who presented after 2010 compared to those before (9 vs 18 months, 6 vs 12 months and 5/12 vs 3/28 respectively). Hyperpigmentation (39 / 40), weight loss (32/ 40) and postural lightheadedness (27 / 40) were the common manifestations. Adrenal atrophy and adrenal calcification were seen in 20/30 and 6/30 respectively. All patients were on hydro cortisone, 31 / 40 were on fludrocortisone and none were on androgen replacement. Incidence of Addisonian crisis was 7.5 per 100 patient-years: commonest cause was lapses in medication adherence (14 of 24 events).Conclusion: Tuberculosis was the cause of PAI in 25% of adult patients. Aetiology in others is presently unknown. Delay in presentation and diagnosis has shortened over time. Addisonian crisis after diagnosis is commonly due to non-adherence.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42433336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report on a rare combination of Gitelman syndrome and marfanoid body habitus in a young female","authors":"G. M. Gajaweera, D. Jegavanthan, K. A. N. Ravindu, C. Antonypillai","doi":"10.4038/sjdem.v14i2.7508","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7508","url":null,"abstract":"No abstract available","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46973266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When growth exceeds boundaries: Tall stature, enlarged hands & feet – Is it what you think?","authors":"G. M. Gajaweera, D. Jegavanthan, K. A. N. Ravindu, C. Antonypillai, N. Atapattu","doi":"10.4038/sjdem.v14i2.7502","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7502","url":null,"abstract":"No abstract available","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45154758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of bilateral Vanishing Testicle Syndrome","authors":"K. Jayawickreme, R. Hashim, C. Antonypillai","doi":"10.4038/sjdem.v14i2.7495","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7495","url":null,"abstract":"Vanishing testicle syndrome (VTS) is due to regression of already formed testes. This could occur at any stage during or after testicular descent due any insult resulting in testicular atrophy. VTS is estimated to affect 1:1250 males. We present a rare case of a 12-year-old boy presenting with absent secondary sexual characteristics and short stature found to have bilateral vanishing testicle syndrome. His testes were impalpable at neonatal examination. At the age of 1.5 years an ultrasound scan detected the right testis in the inguinal ring, measuring 1.5 x 1 cm with features suggestive of ischaemia with likely acute or subacute torsion. The left testes was seen in the inguinal canal already atrophied by that time. Subsequently, on surgical exploration the right testis was found atrophied in the inguinal canal, and was replaced in the right sub-dartose pouch, but left testis could not be identified. Surprisingly, 4 months later laparoscopic exploration failed to identify either of the testes except for bilateral atrophied gubernaculum, indicating testicular regression. At the age of 7 years, magnetic resonance imaging confirmed the absence of either of the testes, with no remnants. On examination his height was 146.5cm, which was between the 25th and 50th percentile for that age, and below his mid-parental height range. He had no androgenic hair growth, testes were impalpable and had a prepubertal penis accounting to tanner stage of 1. He had hypergonadotrophic hypogonadism. Pubertal induction was done with testosterone injections which resulted in height gain and development of secondary sexual characteristics.Introduction: The entity Vanishing testicle syndrome (VTS) was coined by Abryaratne et al. in 1969, and is also referred to as \"Testicular regression syndrome\" [1][2]. The two essential diagnostic criteria are; visualizing the blind-ending spermatic vessels within the retro-peritoneum or spermatic vessels and vas deferens exiting a closed internal inguinal ring, and Testis not palpated during examination under anaesthesia[2][3]. A small fibrotic nodule or nubbin with dystrophic calcification and haemosiderin deposition is usually found at the end of the spermatic cord, with or without identifiable testicular or para-testicular structures [2][3]. Cryptorchidism is reported in 1 -4.6% full term and 1.1 -45.3% pre-mature male infants [4]. This prevalence of cryptorchidism decreases to 1 % by the age of 1 year [5]. Testes are non-palpable in 10 -20% cases of cryptorchidism, and of these VTS accounts for 35 - 60% [6] VTS occurs in < 5% cases of cryptorchidism [7]. VTS is estimated to affect 1:1250 males [8]. We present a rare case of bilateral VTS in a 12 year old boy who presented with short stature and absent secondary sexual characteristics with unpalpable testes.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48398682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Hypoparathyroidism associated with chronic plaque psoriasis; A case report & review of literature","authors":"K. A. N. Ravindu, C. Antonypillai, D. Jegavanthan, G. M. Gajaweera","doi":"10.4038/sjdem.v14i2.7500","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7500","url":null,"abstract":"No abstract available","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42253026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatoid adenocarcinoma masquerading as adrenocortical carcinoma in an elderly male","authors":"N. Somasundaram, N. D. de Silva, L. D. Ranasinghe, A. Grossman, L. M. Wang, B. Rathnasena, G. Ranaweera, A. Samarasekera","doi":"10.4038/sjdem.v14i2.7499","DOIUrl":"https://doi.org/10.4038/sjdem.v14i2.7499","url":null,"abstract":"Background: Hepatoid adenocarcinoma is a malignant lesion arising from an anatomic site other than the liver with histological features similar to hepatocellular carcinoma. Hepatoid adenocarcinoma has been reported from various anatomical sites, but adrenal hepatoid adenocarcinomas are extremely rare.Case Description: A 70-year-old male with well-controlled hypertension presented with chronic abdominal pain and was found to have a large left-sided supra renal mass. The lesion showed radiological features suggestive of malignancy with local invasion. There was biochemical evidence of primary aldosteronism and a non-suppressed overnight dexamethasone suppression test. He underwent open left-sided adrenalectomy: histologically the tumour demonstrated features typical of a hepatoid carcinoma with bile production and immunohistochemical staining for Hep Par-1 and CD10 demonstrating a hepatic canalicular pattern. Adrenocortical-specific immunohistochemical markers (Inhibin and melan A) and neuroendocrine markers (synaptophysin and chromogranin) were negative. He did not have clinical or biochemical evidence of cirrhosis, Hepatitis B or C infection. Triple-phase CT scanning of the abdomen before resection of the adrenal lesion and five months following surgery did not show any significant lesion in the liver suggestive of primary hepatocellular carcinoma, except an 8 mm non enhancing benign-appearing cystic lesion.Conclusion: Most hepatoid adenocarcinomas originate from the gastro-intestinal tract. We present a patient with hepatoid adenocarcinoma masquerading as adrenocortical carcinoma due to misleading imaging and biochemical evidence. Very little is known about their pathogenesis, especially those with an atypical site of origin such as the adrenal gland.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44578309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report on Phaeochromocytoma in a young girl; A great masquerader hidden among many clinical clues","authors":"P. Dissanayake, N. Pathirana, I. U. Jayawardana, S. Pathmanathan, M. Sumanatilleke","doi":"10.4038/sjdem.v14i1.7494","DOIUrl":"https://doi.org/10.4038/sjdem.v14i1.7494","url":null,"abstract":"Introduction: Phaeochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that can be lethal if left undiagnosed. But the variability in the clinical presentation can make the diagnosis challenging even to the most experienced clinician.\u0000Case Description: We describe a case of a phaeochromocytoma in an 18-year-old girl who had had a multitude of non-specific symptoms over 3 years without apparent hypertension but with persistent tachycardia. Despite having had classic symptoms of PPGLs at times (episodic flushing, palpitations, and headaches), a phaeochromocytoma was not suspected as she was labeled with panic attacks due to her social circumstances at the time of presentation. A large adrenal mass was detected incidentally and further evaluation revealed elevated metanephrine levels. She underwent curative surgery successfully and remains symptoms free to date. She will be under lifelong surveillance for a recurrence as the possibility of an underlying genetic defect is high considering her young age.\u0000Conclusion: PPGLs can have a very diverse presentation, evading early detection. A high degree of suspicion is needed to diagnose during the early course of illnes.","PeriodicalId":52577,"journal":{"name":"Sri Lanka Journal of Diabetes Endocrinology and Metabolism","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42110921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}