With advancement in genetic studies, familial phaeochromocytoma (PCC) and paraganglioma (PGL)
are increasingly being recognized. Characteristically, correlations exist between genotypes and clinical
and biochemical phenotypes. We report a phaeochromocytoma in a young patient with intriguing family
histories, raising the possibility of his being a familial case.
Free light chains (FLCs) are tumour markers of monoclonal gammopathies. Detection of urinary FLC or also known as Bence-Jones protein through urinary protein and its immunofixation electrophoreses (UPE and uIFE, respectively) have been considered the gold standard for its biochemical diagnosis. This is mainly due to their superior detection limits compared to their counterpart investigations in serum. However, urinalysis is limited in many ways. The emergence of serum FLC assay with markedly improved detection limit circumvents many of these problems and has gained much importance in biochemical investigations of monoclonal gammopathies. Nevertheless, they are not without limitations. This review discusses the advantages and limitations of serum and urinary FLC assays.
Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti- thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings.
Introduction: Total calcium concentration is widely used to assess body calcium status although limited by many
confounding factors. Thus, this study aimed to derive and internally validate an albumin-adjusted calcium equation
for a selected Malaysian population. Method: This cross-sectional study involved 1011 adults at an emergency
department of a tertiary hospital. Patients who had total calcium, ionised calcium and albumin measurements
taken simultaneously were included. Derivation of the albumin-adjusted calcium equation was based on the
adjustment equation obtained from the Association for Clinical Biochemistry and Laboratory Medicine 2015
position paper. Additionally, the equation was internally validated and compared with ionised calcium
(gold standard) and the conventional Payne’s equation. Results: The newly derived equation =
total calcium + 0.017 (41.35 – albumin). Internal validation exhibited the amount of shrinkage of 0.049.
It tends to overestimate the adjusted calcium by a mean difference of 0.029 mmol/L compared to Payne’s equation.
The comparison between Payne’s equation and the new equation with ionised calcium reclassified
402 and 486 patients, respectively into different calcium status. When both equations were compared,
calcium status classification significantly differed in all and hypoalbuminaemic subjects by 90 and 16 patients,
respectively. Conclusion: Locally derived albumin-adjusted calcium equation differed statistically in calcium
status classification when compared to the Payne’s equation. However, to confirm this significance, the
result must be compared to ionised calcium under strict, controlled preanalytical conditions. In terms of clinical
significance, there was no difference in classification of calcium status between Payne’s and the new equation at
medical decision limits
Introduction: Diabetes Mellitus (DM), characterised by chronic
hyperglycaemia, exposes patients to acute and chronic
complications, such as hypoglycaemia and vascular
complications, respectively. The latter is associated with the
degree of glycaemic control. Glycated haemoglobin (HbA1c)
indicates long-term glycaemic control of the preceding 2-3
months. The practice of self-monitoring blood glucose (SMBG)
is essential for insulin-treated diabetic patients to achieve
optimum glycaemic control and prevent hypoglycaemia. Aim:
The study aimed to determine the SMBG practice and frequency
and its association with HbA1c and factors in insulin-treated
diabetic patients. Methods: This was a cross-sectional study of
insulin-treated diabetic patients attending follow-up at the
diabetic clinic of Hospital Serdang from April 2015 to August
2015. Consented eligible patients completed validated selfadministered
questionnaires. Patients’ HbA1c results were
obtained from the hospital information system. Results: Ninetyone
of 137 (66%) patients practiced SMBG and 46 (34%) did
not. Although 82% had seen diabetic nurses, 54% of patients did
not alter their treatment accordingly. Neither the practice nor the
frequency of SMBG was significantly associated with
differences in HbA1c levels (p=0.334 and p=0.116 respectively).
Ethnicity and household income significantly affected SMBG
practice. The presence and frequency of hypoglycaemia
significantly increased the likelihood of SMBG practice
(p
Introduction: The prevalence of diabetes mellitus (DM) in Malaysia is drastically increasing. Subjects with DM are
more likely to have deranged liver function tests (LFT). This study aimed to determine the prevalence of abnormal liver enzymes [(alanine aminotransferase (ALT) and alkaline phosphatase (ALP)] and its associated factors among type
2 DM (T2DM) subjects visiting a referral diabetic clinic in a tertiary government hospital. Methods: This retrospective, cross-sectional study included electronic data of 300 T2DM subjects ≥18 years old in the outpatient specialist
clinic from January 2011 to December 2014. Statistical analysis was performed using SPSS version 22. Results: The
study population at large included Malays, of age >60 years with comparable gender percentage. Most subjects had
long-standing DM, poor glycaemic control and were on treatment. The prevalence of abnormal ALT and ALP was
27.3% and 13%; with 90.2% and 97.4% having mild ALT and ALP elevations, respectively. Significant associations
noted for age, body mass index (BMI) and duration of T2DM for ALT whereas for ALP, anti-diabetic medication was
significant between groups of normal and abnormal levels. Deranged liver enzymes were associated significantly
with dyslipidaemia. Conclusion: Our study on the crude prevalence of raised liver enzymes may help identify T2DM
patients at increased risk of non-alcoholic fatty liver disease (NAFLD). Modification of metabolic risk factors, such
as weight loss, control of dyslipidaemia rather than just tighter glycaemic control should be emphasised to reduce
morbidity and mortality. Liver enzymes remain a simple and non- invasive marker of liver pathology in daily medical
practice.
Introduction: Prevention of osteoporotic fracture requires identification of individuals at high risk. Bone mineral
density(BMD) is commonly used to estimate fracture probability despite inadequate predictive discrimination ability.
Sphingosine-1-phosphate(S1P), a new marker of bone metabolism and bone turnover markers(BTM) such as procollagen-type-1 amino-terminal propeptide(P1NP) and C-terminal telopeptide of type I collagen(CTX) may complement
current assessment. The study determined P1NP, CTX and S1P levels and their correlation with BMD, 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone(PTH) in selected subjects. Method: A cross-sectional study involving
Malaysian Chinese men and women aged 50-90 years old from Puchong and Kajang, Selangor. Each subject had
BMD determined by dual-energy x-ray absorptiometry and blood samples taken for 25(OH)D, PTH, P1NP, CTX and
S1P. Results: A total of 131 subjects [45(34.4%) males and 86(65.6%) post-menopausal women] with median age
of 65(IQR=17) were recruited. P1NP and CTX were significantly higher in post-menopausal women (P1NP=61.71
ng/ml, CTX=0.489 ng/ml) compared to men (P1NP=46.94 ng/ml, CTX=0.381 ng/ml). P1NP and CTX differed significantly according to BMD categories with values highest in osteoporosis. S1P between men (2.12±0.75 µmol/L) and
post-menopausal women (1.96±0.68 µmol/L) did not differ significantly and did not differ according to BMD categories. S1P did not correlate with BMD, P1NP, CTX and 25(OH)D. P1NP and CTX negatively correlated with BMD
at all measured sites but not 25(OH)D. Conclusion: CTX and P1NP, but not S1P negatively correlated with BMD.
CTX and P1NP were highest in those with osteoporosis. In this group of Malaysian Chinese subjects, CTX and P1NP
rather than S1P reflects bone health.