1.Reappraisal of bovril as a source of arginine in the arginine stimulation test for growth hormone deficiency
Huai Heng, Loh ; Norlela Sukor ; Nor Azmi Kamaruddin
The Medical Journal of Malaysia 2015;70(3):208-209
The purpose of this case study is to report the use of oral
Bovril (a food supplement which contains arginine) as an
alternative test for growth hormone stimulation test. We
performed oral Bovril test in 3 patients -- one with suspected
growth hormone deficiency in whom insulin tolerance test
could not be performed (subject A), one sex-matched
control (subject B), and one with confirmed growth hormone
deficiency (subject C). 14g/m2 of oral Bovril was mixed with
150ml of warm water and was given to all three subjects.
Blood for growth hormone was taken at baseline, and every
30 minutes till 150 minutes after ingestion of oral Bovril. The
ingestion of oral Bovril showed a positive response in
subjects A and B, with highest growth hormone levels of
28.4mIU/L and 42.0mIU/L respectively at 150 minutes.
Subject C had suppressed growth hormone throughout the
test. Oral Bovril is readily available and is a safe alternative
for standard growth hormone stimulation test.
Growth Hormone
2.Pheochromocytoma and Pregnancy: A Difficult and Dangerous Ordeal
Mohamed Ismail Nor Azlin ; Abd Rahman Rahana ; Abd Wahab Norasyikin ; Muhammad Rohaizak ; Nor Azmi Kamaruddin
Malaysian Journal of Medical Sciences 2012;19(1):65-68
Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient’s medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.
3.Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan.
Huai Heng LOH ; Nor Azmi KAMARUDDIN
Annals of the Academy of Medicine, Singapore 2020;49(7):468-476
During Ramadan, Muslims fast from sunrise (Sahur) to sunset (Iftar) and are required to abstain from food and fluids, including oral and injectable medications. Patients with diabetes who fast during Ramadan are at risk of developing hyperglycemia with increased risk of ketoacidosis, hypoglycemia, dehydration and thrombosis. Pre-Ramadan education and preparation of a fasting patient are essential to reduce severe complications. This review paper summarizes studies to date on oral and injectable medications available for patients with type 2 diabetes during Ramadan fasting, as well as recommendations on management of these patients during Ramadan. Although there is limited data on the use of Metformin, Acarbose and Thiazolidinedione in Ramadan, they appear to be safe. Sulphonylurea, especially Glibenclamide, is associated with higher risk of hypoglycemia during Ramadan fasting, hence may need adjustment in dosing and timing. The incretin group and SGLT2 inhibitor use during Ramadan fasting is associated with low risk of hypoglycemia with no increased adverse events. Insulin regimes need to be individualized for patients who fast during Ramadan.
4.Medical Nutrition Therapy Administered by a Dietitian Yields Favourable Diabetes Outcomes in Individual with Type 2 Diabetes Mellitus
M Y Barakatun Nisak ; A T Ruzita ; A K Norimah ; Kamaruddin Nor Azmi
The Medical Journal of Malaysia 2013;68(1):18-23
Aim: This prospective, single-group, pre-post design trial
was conducted to evaluate the effect of individualised
Medical Nutrition Therapy intervention administered by a
dietitian in individuals with type 2 diabetes mellitus on
glycaemic control, metabolic parameters and dietary intake.
Methods: Subjects (n=104; age=56.4 +9.9 years; 37% male;
years of diagnosis = 6.3 +4.9 years) treated with diet and on a stabile dose of oral anti-diabetic agents were given dietary advice by a dietitian for a 12 week period. Individualised dietary advice was based on Malaysian Medical Nutrition Therapy for adults with type 2 diabetes mellitus. The primary outcome measure was glycaemic control (fructosamine and HbA1c level) and the secondary outcome included measures of anthropometry, blood pressure, lipid profile, insulin levels
dietary intake and knowledge on nutrition.
Results: At week 12, 100 subjects completed the study with
a dropout rate of 3.8%. The post-Medical Nutrition Therapy
results showed a significant reduction of fructosamine
(311.5 +50 to 297 +44 umol/L; p< 0.001) and HbA1c (7.6 +1.2
to 7.2 +1.1 %, p<0.001) with pronounced reduction for
subjects who had very high HbA1c levels of >9.3% at
baseline. Waist circumference (90.7 +10.2 to 89.1 +9.8 cm,
p<0.05), HDL-cholesterol (1.1 +0.3 to 1.2 +0.3 mmol/L,
p<0.05), dietary intake and nutrition knowledge score (42
+19 vs. 75 +17%; p< 0.001) were significantly improved from
the baseline.
Conclusions: Individualised Medical Nutrition Therapy
administered by a dietitian resulted in favourable diabetes
outcomes, which were more apparent for individuals with
higher than optimal HbA1c levels at the start of the study.
5.A case of appendiceal goblet cell carcinoid tumor: Getting it right under the microscope.
Waye Hann KANG ; Norasyikin Abdul WAHAB ; Nor Azmi KAMARUDDIN
Journal of the ASEAN Federation of Endocrine Societies 2020;35(1):102-104
Goblet cell carcinoid (GCC) is a rare neoplasm of the vermiform appendix and can be mistaken as a typical neuroendocrine tumour (TNET). The natural history of this disease is more aggressive compared to TNETs and requires a more aggressive approach. We report a case of a 37-year-old male who was initially diagnosed with TNET, but subsequently revised as Tang's A GCC. He underwent appendectomy and right hemicolectomy. Aside from a persistently elevated carcinoembyrogenic antigen (CEA) result, his 18F-fluorodeoxyglucose (FDG) PET/CT and a 68-Gallium DOTATATE PET/CT scan showed no FDG or DOTATATE avid lesions.
Human ; Carcinoid Tumor-pathology
6.Successful primary medical therapy with somatostatin receptor ligand in acromegaly with thyroid cancer
Shalini Sree Dharan ; Nor Azmi Kamaruddin
Journal of the ASEAN Federation of Endocrine Societies 2017;32(2):169-172
Acromegaly is a rare disease with an annual incidence of 3 to 4 cases in a million.[1] Diagnosis is often delayed due to the slow progression of the disease. Persistent elevation of growth hormone (GH) in acromegaly causes a reduction in life expectancy by 10 years. Aside from multiple cardiovascular, respiratory and metabolic co-morbidities, it has also been proven to cause an increased incidence of cancer. The main treatment of acromegaly is surgical excision of the functioning pituitary adenoma. Multiple comorbidities, including obstructive sleep apnea (OSA), left ventricular hypertrophy (LVH) and soft tissue swelling, make surgery complicated, if not impossible. Medical therapy to reduce co-morbidities may be indicated in certain situations. Somatostatin receptor ligands (SRL) are able to reduce, and possibly normalize, IGF-1 levels.[2] Reduction of insulin-like growth factor-1 (IGF-1), the main mediator of GH, is able to resolve headache, sweating, fatigue and soft tissue swelling, and also reduce ventricular hypertrophy. This case report illustrates the successful use of the SRL octreotide LAR in treating acromegaly. It also confirms the observation from several case series that thyroid cancer is the most common malignancy in acromegaly.
Acromegaly
;
Thyroid Cancer, Papillary
7.A case of retroperitoneal liposarcoma mimicking an adrenocortical carcinoma.
Waye KANG ; Carolina SINGARAYAR ; Nurasyikin Abdul WAHAB ; Norlela SUKOR ; Nor Azmi KAMARUDDIN
Journal of the ASEAN Federation of Endocrine Societies 2019;34(1):95-98
An adrenal mass can be a diagnostic challenge as it is not easy to differentiate the adrenal glands from other adrenal pseudotumours with only radio-imaging. We report a 28-year-old patient who was diagnosed radiologically as an adrenal cortical carcinoma after he presented with abdominal pain and fullness. Biochemically, he demonstrated secondary hyperaldosteronism. Intra-operatively there was a huge mass, inferior to a normal right adrenal, which was histopathologically proven to be a dedifferentiated liposarcoma.
8.Metastatic Bone Disease Secondary to Bronchial Adenocarcinoma in a patient with Paget’s Disease of the Bone
Kim Piow Lim ; Wei Hao Kok ; Nor Azmi Kamaruddin
Journal of the ASEAN Federation of Endocrine Societies 2018;33(1):63-68
A 69-year-old female complained of intermittent left hip pain for the past 3 years. Biochemical tests revealed normal serum calcium and phosphorus with markedly raised alkaline phosphatase. MRI of the hip revealed extensive marrow signal abnormalities at the left pelvic bone, while CT of the thorax revealed a spiculated lung nodule at the left lower lung lobe. In order to diagnose either primary, metastatic bone tumour or Paget’s disease of the bone (PDB), an open biopsy of the left iliac bone was performed. The histopathology of bone biopsy of the left iliac bone was consistent with PDB. A CT guided biopsy of the lung mass done later revealed adenocarcinoma of the lung. She had 18F-FDG PET-CECT Scan for staging evaluation and result was suggestive of new bony metastases. Patient was started on IV Zoledronic acid for treatment of the PDB. In view of the stage 4 lung adenocarcinoma with bony metastases, patient was scheduled for palliative chemotherapy.
9.History of severe hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A comparative case control study
Mohd Asyiq Raffali ; Syawal Faizal Muhammad ; Hamzaini Abdul Hamid ; Azmawati Mohammed Nawi ; Nor Azmi Kamaruddin
Journal of the ASEAN Federation of Endocrine Societies 2021;36(1):37-44
Objectives:
A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH.
Methodology:
We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD.
Results:
A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029).
Conclusion
In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.
Hypoglycemia
;
Coronary Artery Disease
;
Diabetes Mellitus, Type 2
;
C-Reactive Protein
10.Glycemic patterns and factors associated with Post-Hemodialysis Hyperglycemia among end-stage Renal Disease patients undergoing, maintenance Hemodialysis
Abdul Hanif Khan Yusof Khan ; Nor Fadhlina Zakaria ; Muhammad Adil Zainal Abidin ; Christopher Tiam Seong Lim ; Nor Azmi Kamaruddin
Journal of the ASEAN Federation of Endocrine Societies 2020;35(1):68-76
Introduction:
Chronic and post-prandial hyperglycemia are independent risk factors for diabetic complications. Glycemic patterns among hemodialysis end-stage-renal-disease (ESRD) differ as glucose metabolism changes with declining kidney function with more pronounced glycemic fluctuations. The objectives of this study are to determine glycemic patterns on hemodialysis days, the magnitude of post-hemodialysis rebound hyperglycemia (PHH) and their associated factors.
Methodology:
148 patients on hemodialysis were analysed, 91 patients had end-stage-diabetic-renal disease (DM-ESRD), and 57 patients had end-stage-non-diabetic renal disease (NDM-ESRD). Glycemic patterns and PHH data were obtained from 11-point and 7-point self-monitoring blood glucose (SMBG) profiles on hemodialysis and non-hemodialysis days. PHH and its associated factors were analysed with logistic regression.
Results:
Mean blood glucose on hemodialysis days was 9.33 [SD 2.7] mmol/L in DM-ESRD patients compared to 6.07 [SD 0.85] mmol/L in those with NDM-ESRD (p<0.001). PHH occurred in 70% of patients and was more pronounced in DM-ESRD compared to NDM-ESRD patients (72.5% vs 27.5%; OR 4.5). Asymptomatic hypoglycemia was observed in 18% of patients. DM-ESRD, older age, previous IHD, obesity, high HbA1c, elevated highly-sensitive CRP and low albumin were associated with PHH.
Conclusion
DM-ESRD patients experienced significant PHH in our cohort. Other associated factors include older age, previous IHD, obesity, high HbA1c, elevated hs-CRP and low albumin.
Renal Dialysis
;
Diabetes Complications
;
Hyperglycemia
;
Risk Factors
;
Asian