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- Volume 18, Issue 3, 2013
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 18, Issue 3, 2013
Volume 18, Issue 3, 2013
Author Willie MollentzeSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 132 –133 (2013)More Less
In this last edition of JEMDSA for 2013, in an article entitled, Clinical challenges in the co-management of diabetes mellitus and tuberculosis in southern Africa, Reid, McFadden and Tsima place the challenges regarding the management of tuberculosis and diabetes in South Africa under the microscope in an important review on the topic.
Clinical challenges in the co-management of diabetes mellitus and tuberculosis in southern Africa : review articleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 135 –140 (2013)More Less
Over the past 20 years, tuberculosis incidence in southern Africa has increased at an alarming rate, fuelled primarily by the human immunodeficiency virus epidemic. The emerging prevalence of diabetes mellitus in the region represents a new threat to tuberculosis control. The intersecting double burden is a cause for concern since diabetes mellitus increases the risk of tuberculosis and results in poor treatment outcomes. This review article discusses the evidence of a causal association between these two conditions, and examines the numerous clinical challenges that relate to tuberculosis and diabetes mellitus co-management. Diabetes is associated with a more advanced age and body weight in patients with tuberculosis, although not with a specific clinical presentation of tuberculosis. Rifampicin adversely alters glycaemic control by lowering the concentrations of most oral antidiabetic drugs. Poor glycaemic control, possibly exacerbated by tuberculosis and anti-tuberculous therapy, is an important contributing factor to tuberculosis case fatality and relapse. Clinicians need to be aware of these clinical and pharmacological challenges when co-managing these complex diseases.
Normal reference values for thyroid uptake of technetium-99m pertechnetate for the Namibian population : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 142 –147 (2013)More Less
Objective : Historically, changes in normal thyroid uptake values for iodine have been reported in different geographical areas. These changes have been linked to geographical and chronological fluctuations in dietary iodine intake in different populations. Namibia is a country with mixed ethnicity, with access to dietary iodine in table salt. Despite historical reports on deviating normal thyroid uptake values (emphasising the importance of establishing local normal reference values), the relevant Namibian authorities have never revised these reference values, nor have local reference values been established. The aim of this study was to establish the normal reference values for thyroid uptake of technetium-99m pertechnetate in the Namibian population.
Design : Participants who were considered to be euthyroid completed a questionnaire designed to exclude individuals with thyroid pathologies, as well as those with renal or heart disease.
Settings and subjects : The study cohort consisted of 76 participants (58 women and 18 men), ranging in age from 39-81 years. The participants were of mixed ethnicity, consisting of Hereros, Ovambos, Damaras, Namas, Coloureds, Caucasians and other (non-Namibian immigrants), and were from Windhoek, Namibia. Studies were performed at the Windhoek Central Hospital.
Outcome measures : Blood was drawn for thyroid hormone assessment. Participants were then given 100 MBq of technetium-99m pertechnetate intravenously, and their percentage thyroid uptake recorded after 20 minutes.
Results : In this study, thyroid-stimulating hormone, triiodothyronine, and thyroxine levels were found to be 1.7 µIU/ml, 4.9 pmol/ml and 10.3 pmol/ml, respectively. Analysis of the empirical data showed that the normal reference uptake value for technetium-99m pertechnetate in the studied population ranged between 0.04% and 2.40%. The fifth and 95th percentiles for pertechnetate uptake were 0.15% and 1.69%, respectively.
Conclusion : These results provide new evidence which supports the importance of periodical evaluation of normal thyroid uptake reference values for technetium-99m pertechnetate.
Lack of association of glycated haemoglobin with blood pressure and subclinical atherosclerosis in black South Africans : a five-year prospective study : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 148 –153 (2013)More Less
Objectives : Hypertension and diabetes are common in rapidly urbanising sub-Saharan African communities. However, lack of longitudinal data in these regions prevents adequate analysis of the link between measures of glycaemia and cardiovascular disease. Therefore, we examined the relationships of fasting glucose and glycated haemoglobin (HbA1c) with brachial and central blood pressure (BP), and measures of vascular structure and function after five years in black South Africans.
Setting and subjects : Nine hundred and twenty-eight participants were included as part of the Prospective Urban Rural Epidemiological (PURE) study in the North West Province.
Outcome measures : Fasting glucose, HbA1c and brachial BP at two time points were determined. Central BP, augmentation index (AI) and carotid intima-media thickness (CIMT) were taken at follow-up.
Results : Fasting glucose [4.78 (3.50, 6.30) vs. 5 mmol/l (3.96, 6.42)]; HbA1c [5.6 (4.9, 6.3) vs. 5.9% (5.2, 6.9) and (37 vs. 41 mmol/mol)]; and BP (134/88.1 vs. 138/89.5 mmHg) increased significantly over five years (p-value < 0.05). However, an association was absent between BP, AI or CIMT and either baseline or the five-year change in glucose or HbA1c. Multivariate analyses confirmed that neither glucose or HbA1c predicted changes in BP, CIMT or AI, but factors that did associate significantly were age, male gender, rural location, abdominal obesity, alcohol intake, total cholesterol to high-density lipoprotein ratio, C-reactive protein and antihypertensive medication (R2, ranging from 0.24-0.36).
Conclusion : Although both BP and measures of glycaemia increased significantly over five years in black South Africans, glucose was not independently associated with BP or measures of large artery structure or function. We suggest that fasting glucose and HbA1c below the threshold of diagnosing diabetes should not be used in isolation to predict cardiovascular risk in African individuals.
The implementation of guidelines in a South African population with type 2 diabetes : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 154 –158 (2013)More Less
Objective : The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus, using national treatment guidelines.
Design : Cross-sectional study.
Setting and subjects : The study consisted of 666 patients with type 2 diabetes mellitus, attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.
Outcome measures : Using a public sector database, retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis, and if they were receiving oral hypoglycaemic and/or insulin therapy. Age, gender, race, blood pressure, haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients' previous coronary artery disease, strokes, nephropathy, neuropathy and retinopathy was recorded.
Results : The mean age of the patients was 63 years [standard deviation (SD) 11.9], 55% of whom were females. The HbA1c was 8.8% (SD 2.5). 26.2% of patients attained HbA1c levels of < 7%. Of the total patients, 45.8% met a < 130/80 mmHg blood pressure target, and 53.8% a low-density lipoprotein (LDL) cholesterol of < 2.5 mmol/l. Only 7.5% obtained the combined target for HbA1c , blood pressure and LDL cholesterol.
Conclusion : Traditionally, type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet, as many as 80% of people with type 2 diabetes mellitus die from some form of cardiovascular disease (CVD). Many trials have demonstrated the benefits of targeting CVD risk factors (HbA1c, blood pressure and lipids) in patients with type 2 diabetes mellitus. Despite the wealth of evidence, our data suggest that significant undertreatment of risk factors in patients with type 2 diabetes mellitus remains.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 159 –163 (2013)More Less
A 27-year old woman presented with primary amenorrhoea and infertility. On examination, she was found to have palpable inguinal gonads, normal female external genitalia, a blind-ending vagina with no cervix, almost complete absence of axillary and pubic hair, and good breast development. Further investigations confirmed the absence of internal female genitalia, the presence of a 46,XY karyotype and testosterone levels in the high normal male reference range. A diagnosis of complete androgen insensitivity syndrome was made, based on this clinical picture and laboratory findings. Two of her younger siblings were subsequently also diagnosed with this condition. She underwent an orchidectomy and is currently on female hormone replacement therapy. At the time of writing up this case study, her two younger sisters were still awaiting surgery.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 164 –166 (2013)More Less
The adrenal gland consists of two endocrine tissues of different embryological origin, namely the primarily steroid-producing adrenocortical tissue, and the catecholamine-producing chromaffin cells. Adrenal catecholamines and steroids are important regulators of the stress response, immune function, blood pressure and energy homeostasis. Chromaffin cells regulate steroid hormone release by the adrenal cortex. Steroids induce catecholamine production in the medulla. Consequently, disorders of the adrenal cortex have been shown to affect chromaffin cell function and vice versa.
We report on a patient with an unusual combination of Addison's disease and phaeochromocytoma, whose initial presentation was adrenocortical failure. After replacement therapy for adrenocortical failure, a clinical presentation of phaeochromocytoma emerged.
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 168 –170 (2013)More Less
Cassim et al are to be commended on their detailed and clear recommendations for the acute and long-term medical management of osteoporotic hip fractures, published in a recent issue of JEMDSA. This publication, a position paper of the National Osteoporosis Foundation of South Africa (NOFSA) and the South African Geriatrics Society, comes at a most opportune time, as it coincides with the launch of the Capture the Fracture campaign of the International Osteoporosis Foundation (IOF) and the 2 Million 2 Many initiative of the American Society for Bone and Mineral Research (ASBMR). Both of these programmes aim to emphasise the fact that a mere one in every 10 patients with hip fractures is afforded proper prophylactic therapy to prevent subsequent fractures. This is particularly unfortunate, given the fact that hip fractures carry high mortality (20-36%) and morbidity (less than 50% of patients with hip fractures are capable of leading an independent existence following a hip fracture), yet are very amenable to preventive therapy (a 30-50% reduction in fracture risk).