1.Factors Influencing Disconnection Hyperprolactinemia and Reversal of Serum Prolactin after Pituitary Surgery in a Non-Functioning Pituitary Macroadenoma
Thinesh Kumran ; Saffari Haspani ; Jafri Malin Abdullah ; Azmi Alias ; Fan Rui Ven
Malaysian Journal of Medical Sciences 2016;23(1):72-76
Background: To investigate factors influencing disconnection hyperprolactinemia, including tumour volume, degree of pituitary stalk displacement and extent of tumour growth based on a modified Wilson-Hardy classification in a non-functioning pituitary macroadenoma and to confirm reductions in serum prolactin levels after endoscopic transphenoidal surgery. Methods: This prospective, descriptive study was conducted in the Department of Neurosurgery, General Hospital Kuala Lumpur from Jan 1, 2011 to Jan 1, 2013. Forty patients fulfilling the inclusion criteria were enrolled. All patients underwent endoscopic transphenoidal resection of non-functioning pituitary macroadenoma. Pituitary stalk angle, tumour volume and extent of tumour growth were measured from Magnetic Resonance Imaging (MRI) pre- and post-operatively. These variables were compared to serum prolactin levels measured pre and post operatively. SPSS 21 was used to perform statistical analyses. Results: In 40 patients, the mean tumour volumes were 10.58 cm3 (SD 7.81) pre-operatively and 3.1 cm3 (SD 3.45) post-operatively. There was a 70% reduction in tumour volume post-operatively (P < 0.01). The mean serum prolactin was 457 mIU/L (SD 66.93) pre-operatively and 297 mIU/L (SD 6.73) post-operatively. There was a 65% reduction in prolactin serum levels after surgery (P < 0.01). The mean pituitary stalk angles were 93.45 ± 3.89 degrees pre-operatively and 51.45 ± 1.46 degrees post-operatively (P = 0.01). The mean pituitary stalk angle in the control group was 50.4 ± 8.80 degrees. Hence, there was a 98% reduction in pituitary stalk angle after surgery (P < 0.01). This study showed a linear correlation between the pre-operative and post-operative tumour volumes and serum prolactin levels (P = 0.01 pre-and post-operative) and between serum prolactin levels and pituitary stalk angle (P = 0.20 pre-operative; P = 0.01 post-operative). Conclusion: Tumour volume and pituitary stalk angle displacement have positive predictive values for disconnection hyperprolactinemia in non-functioning pituitary macroadenoma. However, a larger sample size and further objective studies are needed to confirm these findings.
Hyperprolactinemia
2.Endocrinological Outcome of Endoscopic Transsphenoidal Surgery for Functioning and Non-Functioning Pituitary Adenoma
Lee Shwu Yi ; Azmi Alias ; Abdul Rahman Izaini Ghani ; Mohammad Badrulnizam Long Bidin
Malaysian Journal of Medical Sciences 2019;26(3):64-71
Introduction: The present study analysed the (i) remission and preservation of hormones,
(ii) endocrinological and anatomical complications and (iii) visual improvement after endoscopic
transsphenoidal surgery (ETS).
Methods: The retrospective observational study of all consecutive cases of pituitary
adenoma treated with ETS in Hospital Kuala Lumpur (HKL) between 2006 and 2015. Age, sex, preand
post-operative hormone level, tumour size, and complications were noted.
Results: A total of 67 patients were diagnosed with non-functioning pituitary adenoma
throughout this period. Of these, 11 patients had both visual and hormonal improvement postoperation.
Of the 27 patients with tumour invaded into the cavernous sinus, 13 showed an
improved vision. In the adenoma patients who had impaired hormonal function before the
surgery, the hormone level normalised post-surgery in 42 patients.
Moreover, 39 patients were diagnosed with functioning pituitary adenoma. Ten patients
recovered from acromegaly and four patients recovered from Cushing disease within seven days
post-operative. Also, five patients with functioning adenoma suffered complications.
Conclusion: Outcome for the preservation and hormone recovery in non-functioning
pituitary adenoma group was satisfactory, with only one patient’s hormonal level worsening.
No visual deterioration and mortality were detected throughout this study. A dedicated team
specialised in endoscopic transsphenoidal pituitary surgery further improved the outcome of this
surgical method.
3.Deep Vein Thrombosis and the Neurosurgical Patient
Rakesh Rethinasamy ; Azmi Alias ; Regunath Kandasamy ; Azman Raffiq ; Mun Choon Looi ; Tassha Hillda
Malaysian Journal of Medical Sciences 2019;26(5):139-147
Background: Neurosurgical patients are varied, encompassing cranial and spinal
diseases and trauma, and are admitted under both elective and emergency settings. In all settings,
neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have
long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT).
We conducted a study to identify the factors associated with DVT among neurosurgical patients,
and the overall rate of occurrence at our centre. We aimed to also compare our results to the
incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis
was undertaken. We also included the Well’s score to validate its usefulness in screening for DVT
in our local setting.
Methods: All patients admitted into our centre were screened for eligibility and those
who underwent surgery from September 2016 to September 2017 had a D-dimer screening after
surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant
therapy was not influenced by this study, and observation of the use was in keeping with usual
practices in our centre was done.
Results: A total number of 331 patients were recruited in this study, however, after the
inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for
analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of
the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate
analysis, the Well’s score and the number of days in bed remained statistically significant,
after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT
prophylaxis with an adjusted odd’s ratio, and a confidence interval of 95%, and P < 0.05 for each.
Conclusion: Well’s scoring and number of days in bed were independent factors affecting
the rate of DVT in patients undergoing neurosurgical procedures in our centre.
4.Updates on Knowledge, Attitude and Preventive Practices on Tuberculosis among Healthcare Workers
Farhanah Abd Wahab ; Sarimah Abdullah ; Jafri Malin Abdullah ; Hasnan Jaafar ; Siti Suraiya Md Noor ; Wan Mohd Zahiruddin Wan Mohammad ; Abdul Aziz Mohamed Yusoff ; John Tharakan ; Shalini Bhaskar ; Muthuraju Sangu ; Mohd Shah Mahmood ; Fauziah Kassim ; Md. Hanip Rafia ; Mohammed Safari Mohammed Haspani ; Azmi Alias ; Rogelio Hernández Pando
Malaysian Journal of Medical Sciences 2016;23(6):25-34
Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted
with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths
reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare
workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early
1990s, the concern about the transmission to both patients and healthcare workers has been
raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the
general population. Several studies on knowledge, attitude and practices on tuberculosis among
healthcare workers worldwide have revealed that majority of the participated healthcare workers
had good knowledge on tuberculosis. Most of the healthcare workers from South India and South
Africa also reported to have positive attitude whereas a study in Thailand reported that most of
the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless,
majority of the healthcare workers have low level of practice on tuberculosis prevention. An
improved communication between healthcare workers and the patients as well as their families
is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice
towards tuberculosis.
5.Malaysian consensus statement for the diagnosis and management of acromegaly.
Zanariah Hussein ; Mohamed Long Bidin ; Azmi Alias ; Muthukkumaran Thiagarajan ; Kartikasalwah Abdul Latif ; Jeyakantha Ratnasingam ; Wan Juani Wan Seman ; Azraai Nasruddin
Journal of the ASEAN Federation of Endocrine Societies 2019;34(1):8-14
In Malaysia, acromegaly is under-recognised with only 10-15% of the expected number of cases from prevalence estimates, having been diagnosed and managed in established endocrine centres with access to multidisciplinary care. This is mainly due to lack of awareness and standardised approach in diagnosing this disease resulting in delay in diagnosis and management with suboptimal treatment outcomes. This first Malaysian consensus statement on the diagnosis and management of acromegaly addresses these issues and is based on current best practices and latest available evidence so as to reduce the disease burden on acromegaly patients managed in the Malaysian healthcare system.
Human ; Acromegaly ; Consensus ; Malaysia