Endocrinology
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- ItemClinical practice recommendations for the detection and management of hyperglycemia in pregnancy from South Asia, Africa and Mexico during COVID‑19 pandemic(Wolters Kluwer, 2021-12) Priya, Gagan; Bajaj, Sarita; Kalra, Bharti; Coetzee, Ankia; Kalra, Sanjay; Dutta, Deep; Lim, Vivien; Diwakar, Hema; Deshmukh, Vaishali; Mehta, Roopa; Sahay, Rakesh; Gupta, Yashdeep; Sharma, J. B.; Dasgupta, Arundhati; Patnala, S.; Afsana, Faria; Giri, Mimi; Sheikh, Aisha; Baruah, Manash P.; Asirvatham, A. R.; Sheikh, Shehla; Cooray, Samanthi; Acharya, Kirtida; Langi, Y. A.; Jacob, Jubbin J.; Malhotra, Jaideep; George, Belinda; Grewal, Emmy; Chandrasekharan, Sruti; Nadeem, Sarah; Lamptey, Roberta; Khandelwal, DeepakThe human coronavirus disease 2019 (COVID‑19) pandemic has affected overall healthcare delivery, including prenatal, antenatal and postnatal care. Hyperglycemia in pregnancy (HIP) is the most common medical condition encountered during pregnancy. There is little guidance for primary care physicians for providing delivery of optimal perinatal care while minimizing the risk of COVID‑19 infection in pregnant women. This review aims to describe pragmatic modifications in the screening, detection and management of HIP during the COVID‑ 19 pandemic. In this review, articles published up to June 2021 were searched on multiple databases, including PubMed, Medline, EMBASE and ScienceDirect. Direct online searches were conducted to identify national and international guidelines. Search criteria included terms to extract articles describing HIP with and/or without COVID‑19 between 1st March 2020 and 15th June 2021. Fasting plasma glucose, glycosylated hemoglobin (HbA1c) and random plasma glucose could be alternative screening strategies for gestational diabetes mellitus screening (at 24–28 weeks of gestation), instead of the traditional 2 h oral glucose tolerance test. The use of telemedicine for the management of HIP is recommended. Hospital visits should be scheduled to coincide with obstetric and ultrasound visits. COVID‑19 infected pregnant women with HIP need enhanced maternal and fetal vigilance, optimal diabetes care and psychological support in addition to supportive measures. This article presents pragmatic options and approaches for primary care physicians, diabetes care providers and obstetricians for GDM screening, diagnosis and management during the pandemic, to be used in conjunction with routine antenatal care.
- ItemDiabetes mellitus and COVID-19 : a review and management guidance for South Africa(Health & Medical Publishing Group, 2020-08) Coetzee, A.; Taljaard, J. J.; Hugo, S. S.; Conradie, M.; Conradie-Smit, M.; Dave, J. A.ENGLISH ABSTRACT: This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on the convergence of infectious diseases such as coronavirus infections and non-communicable diseases including DM. The mechanisms for the interaction between COVID-19 and DM are explored, and suggestions for the management of DM in patients with COVID-19 in South Africa are offered.
- ItemEvidence to support the classification of hyperglycemia first detected in pregnancy to predict diabetes 6–12 weeks postpartum : a single center cohort study(Elsevier, 2020-09) Coetzee, Ankia; Sadhai, Nishendra; Mason, Deidre; Hall, David R.; Conradie, MagdaAims: Diagnostic criteria for type 2 diabetes mellitus (T2DM) applied to women with gestational diabetes mellitus (GDM) may predict postpartum T2DM but requires validation. Methods: Women with GDM aged ≥ 18-years were prospectively evaluated 6–12 weeks after delivery at Tygerberg Hospital, Cape Town, South-Africa (November 2015- December 2018). Glucose status at GDM diagnosis was categorized into i) International Association for Diabetes in Pregnancy Study Group (IADPSG) T2DM (fasting glucose ≥ 7 mmol/L and/or 2hr-glucose ≥ 11.1 mmol/L) or ii) modified National Institute for Care Excellence (NICE) GDM (fasting glucose ≥ 5.6 mmol/L-6.9 mmol/L and/or 2hr-glucose ≥ 7.8 mmol/L-11 mmol/L) and compared with postpartum OGTT. Results: IADPSG T2DM and NICE GDM was present in 35% (n = 64) and 65% (n = 117) of the 181 women who completed the 8 ± 2 weeks postpartum evaluation respectively. Postpartum, the prevalence of T2DM and prediabetes was 26% (n = 47/181) and 15% (n = 28). Antenatal IADPSG T2DM categorization identified 31/47 women with postpartum T2DM (sensitivity 75%; specificity 48%). All of the modified NICE GDM category women who developed T2DM (n = 16/117) had elevations of both fasting and 2hr-glucose values antenatally. Conclusion: The utility of the IADPSG T2DM criteria to predict T2DM postpartum is confirmed. Women with both fasting and 2hr-glucose values above GDM cut-offs emerged as another high-risk category.
- ItemInfluence of disodium etidronate on Paget's disease of bone(Health & Medical Publishing Group, 1987) Muir, H. G.; Schabort, I.; Hough, F. S.The use of agents that decrease bone resorption, notably the calcitonins, diphosphonates and mithramycin, has been shown to result in symptomatic and/or biochemical improvement in patients with Paget's disease of bone (osteitis deformans). The effects of short-term (6 months), low-dose (5 mg/kg body mass/d) etidronate disodium, a diphosphonate compound at present subject to registration in this country, on the clinical and laboratory manifestations of this disorder were examined. Marked symptomatic improvement was noted in 70% of patients, while biochemical parameters of bone turnover, namely serum alkaline phosphatase level (44%) and urine hydroxyproline excretion (56%), decreased significantly (P less than 0.001). A technetium-99m bone scan revealed an impressive reduction in uptake of isotope in 50% of patients. The drug was well tolerated and no adverse reactions (clinical, biochemical or haematological) were evident. It is concluded that short-term low-dose etidronate disodium affords a convenient and effective therapeutic alternative in patients with symptomatic Paget's disease.
- ItemAn interesting D-lemma : what is all the excitement about vitamin D?(Medpharm Publications, 2012) Conradie, Marli; Ascott-Evans, BrynneThere has been a dramatic interest in the importance of vitamin D, “the sunshine vitamin”, in the past few years with regard to its impact on various aspects of health and disease. Research into well-known skeletal effects, as well as extra-skeletal effects, has been overwhelming. At times it has been difficult to make informed clinical decisions regarding replacement, if needed at all. This article aims to provide the family practitioner with a summary of the most important clinical effects of vitamin D, as well as give guidelines on testing for possible deficiency and consideration of replacement thereof.
- ItemLeiomyoma : a rare cause of adrenal incidentaloma(Medpharm Publications, 2013) Alteer, Mohamed; Ascott-Evans, Brynn; Conradie, MagdaA 40-year-old, treatment-naïve, human immunodeficiency virus- (HIV) positive male was found to have a large right adrenal incidentaloma on ultrasound of the abdomen, which was confirmed on adrenal computed tomography imaging. The laboratory workup excluded functionality of the mass lesion. As the radiological examination of the mass raised the suspicion of a non-benign lesion, the patient underwent a right adrenalectomy. Histology, supported by a panel of immunohistochemical stains, confirmed the diagnosis of an adrenal leiomyoma. Most of the reported cases of adrenal leiomyomas in the literature are of patients with HIV and/or latent Epstein-Barr virus infections. This case illustrates that benign tumours, such as leiomyomas, can mimic the imaging phenotype of adrenal cortical carcinomas, and should be included in the differential diagnosis of adrenal incidentalomas, especially in the HIV-positive population.
- ItemNew anabolic agents in the treatment of osteoporosis(Health & Medical Publishing Group, 2003) Hough, Stephen[No abstract available]
- ItemPancreatic islet regeneration : therapeutic potential, unknowns and controversy(Academy of Science of South Africa, 2015-07-27) Cockburn, Ingrid L.; Ferris, William F.ENGLISH ABSTRACT: Glucose homeostasis in mammals is primarily maintained by the insulin-secreting β-cells contained within pancreas-resident islets of Langerhans. Gross disruption of this glucose regulation as a result of pancreatic dysfunction frequently results in diabetes, which is currently a major health concern in South Africa, as well as globally. For many years, researchers have realised that the pancreas, and specifically the islets of Langerhans, have a regenerative capacity, as islet mass has frequently been shown to increase following induced pancreatic injury. Given that gross β-cell loss contributes significantly to the pathogenesis of both type 1 and type 2 diabetes, endogenous pancreatic islet regeneration has been investigated extensively as a potential β-cell replacement therapy for diabetes. From the extensive research conducted on pancreatic regeneration, opposing findings and opinions have arisen as to how, and more recently even if, pancreatic regeneration occurs following induced injury. In this review, we outline and discuss the three primary mechanisms by which pancreatic regeneration is proposed to occur: neogenesis, β-cell replication and transdifferentiation. We further explain some of the advanced techniques used in pancreatic regeneration research, and conclude that despite the technologically advanced research tools available to researchers today, the mechanisms governing pancreatic regeneration may remain elusive until more powerful techniques are developed to allow for real-time, live-cell assessment of morphology and gene expression within the pancreas.
- ItemPrevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa(AJOL, 2021-08-31) Van der Made, T; Van der Vyver, M; Conradie-Smit, M; Conradie, MagdaBackground: The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. Aims: The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) were studied. Methods: Women admitted for HG, who underwent thyroid function evaluation between 1 August 2016 and 30 April 2019, were studied. Laboratory data included baseline human chorionic gonadotropin (hCG) and baseline (t1), discharge (t2) and follow-up (t3) thyroid function tests (thyroid stimulating hormone [TSH] and free thyroxin [fT4]). Available TSH receptor antibody status was assessed. Results: Eighty-two patients were included. The incidence of thyrotoxicosis was 49% based on local laboratory TSH range and 48% if trimester-specific ranges used. In the majority of normal pregnancies, thyrotoxicosis was hCG-mediated (72.5%), 15% were confirmed to have Graves’ disease and 12% had a molar pregnancy. Very high fT4 levels (> 40 pmol/l) at baseline [t1] were documented in 24% of women with hCG-mediated thyrotoxicosis. Clinical features were absent in a third of women with Graves’ disease and the diagnosis was reliant on positive antibody status. Free T4 values declined from (t1) to later in gestation (t3) (p < 0.001). Conclusion: The incidence of thyrotoxicosis in women with HG is high. Free-T4 values decrease with clinical stabilisation of HG, suggesting a contribution of dehydration to the large variation in baseline fT4 measurements. Testing for TSH-receptor antibodies should be considered in women with TSH < 0.01 pmol/l and persistent fT4 elevation on follow-up. Final review of thyroid function should be performed after 15 weeks’ gestation.
- ItemThe role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosis(Health and Medical Publishing Group, 2015) Coetzee, Ankia; Hoffmann, Mariza; Ascott-Evans, BrynneBackground. Urine dipstick testing for ketones is widely used when diabetic ketoacidosis (DKA) is suspected in patients with hyperglycaemia. If urinary ketones are positive, patients are referred for further management – often inappropriately, as the test is a poor surrogate for plasma ketones. Plasma beta-hydroxybutyrate (β-OHB) levels >3 mmol/L are diagnostic of DKA, while levels <1 mmol/L are insignificant. Objectives. To evaluate a hand-held electrochemical (point-of-care testing; POCT) ketone monitor and compare it with the gold-standard manual enzymatic method (MEM) for detection of plasma ketones. Methods. In a prospective and comparative study, we evaluated the measurement of β-OHB by means of POCT and the MEM in 61 consecutive samples from patients with suspected DKA at Tygerberg and Karl Bremer hospitals, Cape Town, South Africa. Capillary (for POCT) and plasma samples (for the MEM) were obtained simultaneously and compared for accuracy. Precision was assessed with control samples. Results. The POCT method was precise (coefficient of variation <4.5%), and there was a good correlation between the two methods (r=0.95). Regression analysis showed a proportional bias, with POCT reading higher than the MEM. However, when assessed at the relevant medical decision limits (β-OHB >3 mmol/L and <1 mmol/L), the total allowable error (bias + imprecision) was not exceeded. Patients will therefore still be classified correctly. The POCT method had a sensitivity of 100% and specificity of 89% for DKA (β-OHB >3 mmol/L), while at levels <1 mmol/L sensitivity was 100% and specificity 87.5%. Conclusion. The POCT device provides an accurate and precise result and can be used as an alternative to the MEM in the diagnosis of DKA.
- ItemSteroid-induced osteoporosis(Health & Medical Publishing Group, 1994) Hough, F. S.To the Editor: Kalla et al. ' recently published their work on the effect of glucocorticoid (GC) therapy on the bone mass of 'patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). They made the interesting observation that cortical bone mass was significantly lower in patients with RA than in those with SLE, although the latter required larger cumulative doses of GC for longer periods.
- ItemThyrotoxicosis secondary to thyroiditis following SARS-CoV-2 infection(AJOL, 2022-10) Coetzee, A; Bhikoo, R; Berndorfler, B; Conradie, W; Taljaard, JJ; Conradie-Smit, MSubacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding viral infection. Patients typically present with complaints of anterior neck pain associated with a tender enlarged thyroid gland. The coronaviruses have never before been implicated in the aetiology of subacute thyroiditis. It is postulated that the pathogenesis related to thyroid disease in Coronavirus disease 2019 (COVID-19) is multifactorial. Contributory factors include effects of the virus-related cytokine storm and direct action of the virus on SARS-CoV-2 receptors in the thyroid. This article further reviews the association between thyroiditis and COVID-19. The clinical characteristics, diagnostic workup and management of a patient who presented with subacute thyroiditis following COVID-19 are discussed. Furthermore, complications are entertained and suggestions for the management of thyroiditis following COVID-19 are provided.
- ItemVanadate impedes adipogenesis in mesenchymal stem cells derived from different depots within bone(Frontiers Media, 2016-08-03) Jacobs, Frans Alexander; Sadie-Van Gijsen, Hanel; Van de Vyver, Mari; Ferris, William FrankENGLISH ABSTRACT: Glucocorticoid-induced osteoporosis (GIO) is associated with an increase in bone marrow adiposity, which skews the differentiation of mesenchymal stem cell (MSC) progenitors away from osteoblastogenesis and toward adipogenesis. We have previously found that vanadate, a non-specific protein tyrosine phosphatase inhibitor, prevents GIO in rats, but it was unclear whether vanadate directly influenced adipogenesis in bone-derived MSCs. For the present study, we investigated the effect of vanadate on adipogenesis in primary rat MSCs derived from bone marrow (bmMSCs) and from the proximal end of the femur (pfMSCs). By passage 3 after isolation, both cell populations expressed the MSC cell surface markers CD90 and CD106, but not the hematopoietic marker CD45. However, although variable, expression of the fibroblast marker CD26 was higher in pfMSCs than in bmMSCs. Differentiation studies using osteogenic and adipogenic induction media (OM and AM, respectively) demonstrated that pfMSCs rapidly accumulated lipid droplets within 1 week of exposure to AM, while bmMSCs isolated from the same femur only formed lipid droplets after 3 weeks of AM treatment. Conversely, pfMSCs exposed to OM produced mineralized extracellular matrix (ECM) after 3 weeks, compared to 1 week for OM-treated bmMSCs. Vanadate (10 μM) added to AM resulted in a significant reduction in AM-induced intracellular lipid accumulation and expression of adipogenic gene markers (PPARγ2, aP2, adipsin) in both pfMSCs and bmMSCs. Pharmacological concentrations of glucocorticoids (1 μM) alone did not induce lipid accumulation in either bmMSCs or pfMSCs, but resulted in significant cell death in pfMSCs. Our findings demonstrate the existence of at least two fundamentally different MSC depots within the femur and highlights the presence of MSCs capable of rapid adipogenesis within the proximal femur, an area prone to osteoporotic fractures. In addition, our results suggest that the increased bone marrow adiposity observed in GIO may not be solely due to direct effect of glucocorticoids on bone-derived MSCs, and that an increase in femur lipid content may also arise from increased adipogenesis in MSCs residing outside of the bone marrow niche.