BACKGROUND: Hyperglycemia occurs in 60% of acute stroke patients, 12-52% of which maybe previously undiagnosed with diabetes. A retrospective study by Gacutan showed 21% admission hyperglycemia at the Philippine General Hospital. Screening for glucose disorders among hyperglycemic stroke patients provides a venue for secondary prevention. There are no current guidelines on screening for post-stroke hyperglycemia by the Stroke Society of the Philippines.

OBJECTIVE: To determine the prevalence and outcomes of unrecognized diabetes and prediabetes among acute stroke patients. Secondarily, we aim to determine the clinical and biochemical predictors of unrecognized/newly diagnosed diabetes mellitus among the acute stroke patients.

METHODOLOGY: Cross-sectional prospective study. Acute stroke patients admitted from January to December, 2008 with admission hyperglycemia were included. Random blood sugar, glycosylated hemoglobin & the National Institute of Health Stroke Scale (NIHSS) were done on admission. All were followed up six weeks post-discharge for an FBS and 75-grams OGTT except those discharged with anti-diabetes medications who were considered newly-diagnosed diabetes.

OUTCOMES: Glucose disorders were classified at six weeks post-discharge. Mortality was measured at six weeks and 12 weeks. Functional outcomes using the Modified Rankin Score & the Barthel's Index were measured at the OPD 6-weeks postdischarge.

RESULTS: There were 504 stroke patients of which 178(35%) had admission hyperglycemia. Majority were newly diagnosed diabetes 32.7%, stress hyperglycemia 29.56%, impaired glucose tolerance, (IGT) 13.8%, impaired fasting blood sugar, (IFG) 8.8%, combined IGT and IFG 3.7%, previous diabetes 11.32%. Age, body mass index, alcohol abuse, smoking, hypertension, nosocomial infections, acute coronary syndrome were associated with diabetes. No association was noted with diabetes and atrial fibrillation. By Kruskal-Wallis test, admission RBS and HbA1c were higher among diabetics compared to prediabetics and stress hyperglycemics. Triglycerides was higher and HDL was lower among diabetic versus the stress hyperglycemia. No trends were noted for total cholesterol and LDL cholesterol across groups. On multiple logistic regression, age (OR: 1.06, p0.07), smoking (OR: 9.81, p0.05) and Hba1c (OR:11.39, p
Human ; Human ; Male ; Female ; Adult ; Young Adult ; Middle Aged ; Aged ; Diabetes Mellitus ; Prediabetic State ; Hyperglycemia ; Prevalence ; Stroke

PlummerÊs disease is an unusual cause of thyrotoxicosis in young adults. Remissions donot occur using antithyroid drugs. Radioactive iodine therapy is also not indicated . Surgery is the best optionfor these patients. Prior to thyroidectomy, patients should be rendered euthyroid using antithyroid drugsto minimize risk of exacerbation of thyrotoxicosis. In a patient who developed a major adverse drug reactionto an antithyroid (i.e. cholestatic jaundice) , achieving euthyroidism prior to thyroidectomy is a dilemmato the physicians handling the patient. We therefore present a case of a patient with PlummerÊs disease whodeveloped cholestatic jaundice due to propylthiouracil (PTU) but successfully underwent thyroidectomy byusing propranolol and dexamethasone preoperatively to control thyrotoxicosis.
PlummerÊs Disease ; Multinodular Toxic ; Goiter ; Ptu-induced Cholestatic Jaundice ; Preoperative ; Preparation For Thyroidectomy

Thyroidectomy ; Jaundice, Obstructive