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Fulltext Endocrine complications in transfusion dependent thalassaemia in Penang Hospital

Ong CK, Lim SL, Tan WC, Ong EE, Goh AS

Med J Malaysia, 2008 Jun;63(2):109-12.
PMID: 18942294 MyJurnal

Frequent blood transfusions can lead to iron overload which may result in several endocrine complications especially in the absence of adequate chelation therapy. The objectives of this study are to determine the prevalence of endocrine complications in transfusion dependent thalassaemia patients and the correlation of endocrine complications with the degree of iron chelation. This retrospective study looked at cases of adult patients with transfusion dependent thalassaemia treated in the Haematology Unit, Penang Hospital. Of the 25 transfusion dependent thalassaemia patients, there were 10 male and 15 female patients respectively with almost equal number of Malay and Chinese patients (13 and 12 patients respectively). Short stature was seen in 36.0% of our patients. In our cohort, 12 patients had delayed puberty (male 70.0% and female 33.3%). Prevalence of osteoporosis was 36.0%. Hypogonadism was noted in 40.0% of males and 46.7% of females. 53.4% of the female population had menstrual abnormalities with prevalence of primary and secondary amenorrhoea at 26.7% each. The prevalence of other endocrinopathies was much lower: 8.0% had diabetes mellitus and only one patient had hypocortisolism. Iron chelation appeared insufficient in our study population. The high frequency of endocrine complications noted in our study supports the rationale for regular follow-up of transfusion dependent thalassaemic patients to ensure early detection and timely treatment of associated complications.

Matched MeSH terms: Endocrine System Diseases/etiology*
Fulltext Pigmented 'black' adenoma: a rare cause of Conn's syndrome

Saladina, J.J., Rohaizak, M., Jasmi, A.Y., Sellymiah, A., Aishah, M.A.S., Das, S., et al.

JUMMEC, 2011;14(1):23-25.
MyJurnal

Presence of a hypofunctioning pigmented adenoma are commonly asymptomatic and is usually only found during an autopsy. In contrast, hyperfunctioning pigmented adenoma is a rare clinical entity and in the majority of cases results in Cushing's syndrome. In this case study, we report a 66-year-old male who presented instead with the clinical and biochemical features of Conn's syndrome. On laparoscopic adrenalectomy, it was found that the tumour had a functioning black adenoma which does not usually present with Conn's syndrome but rather to that of a Cushing's. The intraoperative changes and histopathological findings are discussed.

Matched MeSH terms: Endocrine System Diseases
Fulltext Preliminary study: effects of social instability stress on depressive behaviours in ovariectomised rats

Al-Rahbi B, Zakaria R, Muthuraju S, Othman Z, Hassan A

Malays J Med Sci, 2013 Mar;20(2):35-40.
PMID: 23983575 MyJurnal

Depression is one of the common post-menopausal symptoms. In addition to estrogen deficiency, social instability stress may contribute as an additional underlying factor in the development of depressive behaviour in females. Therefore, this study was aimed at examining the influence of social instability stress on depressive behaviour in ovariectomized rats.

Matched MeSH terms: Endocrine System Diseases
Fulltext Prevalence of growth and endocrine disorders in Malaysian children with transfusion-dependent thalassaemia

Tan KA, Lum SH, Yahya A, Krishnan S, Jalaludin MY, Lee WS

Singapore Med J, 2019 Jun;60(6):303-308.
PMID: 30556093 DOI: 10.11622/smedj.2018155

INTRODUCTION: Endocrine dysfunction due to iron overload secondary to frequent blood transfusions is a common complication in children with transfusion-dependent thalassaemia (TDT). We ascertained the prevalence of endocrine dysfunction in children with TDT seen in a hospital setting in Malaysia.
METHODS: We reviewed all patients with TDT who had ≥ 8 blood transfusions per year. Patients who had a history of stem cell transplantation, concurrent autoimmune diseases or were newly diagnosed to have TDT were excluded. Standard diagnostic criteria were used in the diagnosis of various endocrine dysfunctions.
RESULTS: Of the 82 patients with TDT, 65% had at least one endocrine dysfunction. Short stature was the commonest (40.2%), followed by pubertal disorders (14.6%), hypoparathyroidism (12.3%), vitamin D deficiency (10.1%), hypocortisolism (7.3%), diabetes mellitus (5.2%) and overt hypothyroidism (4.9%). Subclinical hypothyroidism and pre-diabetes mellitus were seen in 13.4% and 8.6% of the patients, respectively. For children aged < 10 years, the prevalence of both thyroid dysfunction and hypoparathyroidism was 9.1%.
CONCLUSION: Two-thirds of children with TDT experienced at least one endocrine dysfunction. Thyroid dysfunction and hypoparathyroidism may be missed if endocrine screening is only performed in children with TDT > 10 years of age. Close monitoring for endocrine dysfunction and hormonal therapy is essential to prevent long-term adverse outcomes.

Matched MeSH terms: Endocrine System Diseases/etiology*; Endocrine System Diseases/epidemiology
Occult primary spontaneous pneumothorax

Tai, Yong-Ting, Tong, Chin-Voon

International e-Journal of Science, Medicine & Education, 2017;11(2):30-33.
MyJurnal

We report a case of occult primary spontaneous
pneumothorax in a 30 years-old woman. She
developed symptoms and signs that were suggestive of
pneumothorax. However, chest radiograph failed to
reveal pneumothorax. Therefore, we proceeded with
computed tomography (CT) thorax which revealed
significantly moderate right pneumothorax. The
diagnostic approach and the management of this case
are discussed.

Matched MeSH terms: Endocrine System Diseases
Bilateral adrenal cysts and ectopic pancreatic tissue in Beckwith-Wiedemann syndrome: is a conservative approach acceptable?

Rahmah R, Yong JF, Sharifa NA, Kuhnle U

J Pediatr Endocrinol Metab, 2004 Jun;17(6):909-12.
PMID: 15270410

Beckwith-Wiedemann syndrome is a common overgrowth syndrome associated with an increased risk of neoplasias which might be explained by the nature and localization of the genetic defect. While malignant tumors are often associated with hemihypertrophy, benign tumors are also found. We report a patient with the typical features of Beckwith-Wiedemann syndrome with two histologically different abdominal tumors, bilateral cystic adrenals and ectopic pancreatic tissue present at birth. In both tumors no malignancy could be detected. Ectopic pancreatic tissue is rarely seen and has been described in Beckwith-Wiedemann syndrome only once. After extirpation of the ectopic pancreatic tissue the cystic adrenals were left in situ since macroscopically no normal adrenal tissue could be identified and separated. Regular ultrasound examinations revealed complete resolution of the cystic adrenals within 24 months. Thus it seems that a conservative approach in selected tumors associated with the Beckwith-Wiedemann syndrome might be acceptable.

Matched MeSH terms: Endocrine System Diseases/complications*
The Functional Significance of Endocrine-immune Interactions in Health and Disease

Muthusami S, Vidya B, Shankar EM, Vadivelu J, Ramachandran I, Stanley JA, et al.

Curr Protein Pept Sci, 2020;21(1):52-65.
PMID: 31702489 DOI: 10.2174/1389203720666191106113435

Hormones are known to influence various body systems that include skeletal, cardiac, digestive, excretory, and immune systems. Emerging investigations suggest the key role played by secretions of endocrine glands in immune cell differentiation, proliferation, activation, and memory attributes of the immune system. The link between steroid hormones such as glucocorticoids and inflammation is widely known. However, the role of peptide hormones and amino acid derivatives such as growth and thyroid hormones, prolactin, dopamine, and thymopoietin in regulating the functioning of the immune system remains unclear. Here, we reviewed the findings pertinent to the functional role of hormone-immune interactions in health and disease and proposed perspective directions for translational research in the field.

Matched MeSH terms: Endocrine System Diseases/genetics; Endocrine System Diseases/immunology; Endocrine System Diseases/metabolism*; Endocrine System Diseases/pathology
Fulltext Endocrinopathies in HIV infected patients

Rosdina Zamrud Ahmad Akbar, Sharifah Faradila Wan Muhammad Hatta, Rosnida Mohd Noh, Fatimah Zaherah Mohd Shah, Thuhairah Abdul Rahman, Rohana Abdul Ghani, et al.

Journal of Clinical and Health Sciences, 2020;5(2):39-45.
MyJurnal

Introduction: Hormonal abnormality is one of many clinical manifestations of HIV infections
that is not well understood. However, the consequences could affect quality of life and are
potentially treatable. Thus, this study aimed to determine the prevalence and associated
factors of thyroid, adrenal and gonadal dysfunctions among HIV-infected patients. Methods:
This is a single centre cross-sectional study involving 150 HIV-infected patients attending the
HIV clinic. Each subject was required to answer specific symptoms questionnaire and their
medical records were reviewed for relevant clinical and biochemical data. Blood for was
collected and thyroid hormones, cortisol, ACTH, FSH, LH, testosterone and estradiol were
analysed using electrochemiluminescent immunoassay. Thyroid, adrenal and gonadal axes
abnormalities were identified. Results: Hypogonadism had the highest prevalence amongst
the endocrine abnormalities, which was detected in 23 patients (15.3%), followed by thyroid
dysfunction in 18 patients (12%) and hypocortisolism in 2 patients (1.3%). There was
significant correlation between CD4 count, BMI and age with the hormone levels. Conclusion:
Prevalence of endocrine abnormalities was low in these well-treated HIV-positive patients,
with hypogonadism being the most common. However, significant correlations between CD4
count, age and BMI with the hormonal levels were detected. Clinical symptoms in relation to
endocrinopathy are not specific as a screening tool thus underscoring the need for
biochemical tests to identify these treatable conditions.

Matched MeSH terms: Endocrine System Diseases
Fulltext Co-Occurrence of Exogenous and Endogenous Cushing's Syndromes-Dilemma in Diagnosis

Tong CV, Rajoo S

Case Rep Endocrinol, 2019;2019:2986312.
PMID: 31737375 DOI: 10.1155/2019/2986312

Approach to patients who manifest with features of Cushing's syndrome often begin with exclusion of exposure to excessive exogenous source of glucocorticoids (GC). Most guidelines advocate no further assessment if excessive exogenous GC use is present. We present a case of a 66-year-old lady who was noted to have typical features of Cushing's syndrome. As she gave a very clear history of ingesting exogenous GC for a year, no further work up was undertaken. Despite cessation of GC for a year, she continued to have thin skin and easy bruising. Upon admission for hypertensive emergency, her clinician took note of her changes and investigated her for endogenous Cushing's syndrome. Her cortisol post overnight dexamethasone suppression test was 707 nmol/l. Post low dose dexamethasone suppression test yielded a cortisol of 1133.2 nmol/l. 24 hours urine cortisol was 432.2 nmol/l. Plasma ACTH was 1.1 pmol/l, indicating an ACTH independent Cushing's syndrome. We proceeded with Computed tomography scan (CT scan) of adrenals which revealed a right adrenal adenoma measuring 4.4 × 3.4 × 4.0 cm. Right retroperiteneoscopic adrenalectomy was done. Histopathology examination was consistent with adrenal cortical adenoma with foci of myelolipoma. Post adrenalectomy she developed hypocortisolism secondary to contralateral adrenal suppression which lasted up to the present date. Her cutaneous and musculoskeletal manifestations improved substantially. Co-occurrence of endogenous and exogenous Cushing's syndromes is uncommon but should be considered in patients whose Cushingnoid features do not resolve after cessation of exogenous GC.

Matched MeSH terms: Endocrine System Diseases