Outcome of Patients with Common Endocrine Diseases Who Had COVID-19 in two Centers in Lagos, Nigeria: A Cross-Sectional Study.

BACKGROUND: Endocrine diseases are ubiquitous. In our environment, diabetes mellitus (DM), obesity and thyroid disorders represent the most common examples. Diabetes mellitus is a global health problem with a myriad of complications. We sought to evaluate outcome in terms of fatality in those with common endocrine diseases who were infected with COVID-19. AIMS AND OBJECTIVES: To determine outcome in terms of mortality in patients with common endocrine diseases who contracted COVID-19. MATERIALS AND METHODS: We conducted an observational, descriptive, cross-sectional study with 120 participants drawn from the endocrinology/DM clinic at the Lagos University Teaching Hospital and Serenity Hospital, Surulere (a private medical clinic). Data collected included age, gender, type of endocrine disease, comorbid diseases, and COVID-19 status. Through charts from the medical records department, outcome of participants in terms of mortality was determined. RESULTS: Data of 120 subjects were analyzed. There were 61males and 59 females, yielding a male:female ratio of 1:1. Mean age was 58 years and the mode was 46 years. Over half (88) of the patients had diabetes mellitus, 22 had obesity, and 17 had thyroid disorders. The case fatality rate of patients with endocrine diseases who had COVID-19 was 11%, with about 85% of these deaths occurring in the elderly (those aged above 60 years). Ninety-two percent of the patients who died had type 2 DM. Approximately 80% of patients who were infected with COVID-19 had at least one co-morbid disease. CONCLUSION: Older age, type 2 diabetes mellitus, and the presence of at least one comorbidity were associated with increased mortality in patients with endocrine diseases who were infected with COVID-19 in our study.

CONTEXTE: Les maladies endocriniennes sont omniprésentes. Dans notre environnement, le diabète sucré, l'obésité et les troubles thyroïdiens en sont les exemples les plus courants. Le diabète est un problème de santé mondial qui s'accompagne d'une myriade de complications. Nous avons cherché à évaluer l'issue en termes de mortalité chez les personnes atteintes de maladies endocriniennes courantes qui ont été infectées par COVID-19. BUTS ET OBJECTIFS: Déterminer l'issue en termes de mortalité chez les patients atteints de maladies endocriniennes courantes qui ont contracté COVID 19. MATÉRIEL ET MÉTHODOLOGIES: Nous avons mené une étude observationnelle, descriptive et transversale auprès de 120 participants provenant de la clinique d'endocrinologie/DM de l'hôpital universitaire de Lagos et de l'hôpital Serenity, Surulere (clinique médicale privée). Les données recueillies comprenaient l'âge, le sexe, le type de maladie endocrinienne, les maladies concomitantes et le statut COVID-19. Les résultats des participants en termes de mortalité ont été déterminés à partir des dossiers médicaux. RÉSULTATS: Les données de 120 sujets ont été analysées. Il y avait 61 hommes et 59 femmes, avec un ratio homme/femme de 1:1. L'âge moyen était de 58 ans, le mode de 46 ans. Plus de la moitié [88] des patients souffraient de diabète sucré. 22 patients souffraient d'obésité et 17 de troubles thyroïdiens. Le taux de létalité des patients souffrant de maladiesendocriniennes et atteints de COVID-19 était de 11 %, 85 % de ces décès survenant chez des personnes âgées, c'est-à-dire de plus de 60 ans. 92 % des patients décédés souffraient de diabète de type 2. Environ 80 % des patients infectés par COVID-19 présentaient au moins une maladie concomitante. CONCLUSION: L'âge avancé, le diabète de type 2, la présence d'au moins une comorbidité sont associés à une mortalité accrue chez les patients atteints de maladies endocriniennes et infectés par COVID-19 dans notre étude. Mots-clés: Maladies endocriniennes, COVID-19, comorbidités, syndrome métabolique.

Body mass index and its effect on serum cortisol level.

INTRODUCTION: Cortisol measurement is indicated in suspected over or under production of cortisol by the adrenal cortex. The finding of low cortisol can create concern and initiate further investigations for the exclusion of adrenal insufficiency. Cushing's syndrome is frequently included in the differential diagnosis of obesity. Some literature describes reduced serum cortisol levels in obesity, however, this is not a well-recognized phenomenon. AIM: The aim of this study was to determine the relationship between body mass index (BMI) and serum cortisol levels. SUBJECTS, MATERIALS AND METHODS: Seventy healthy participants agreed to take part in the study. The anthropometric measurements (weight, height, and waist and hip circumferences) were done. Exclusion criteria include those with a history of adrenal/pituitary disease or medications altering cortisol level. The basal cortisol (BC) sample was taken at 8 a.m. immediately before administration of an intravenous bolus injection of 250 µg adrenocorticotropic hormone (ACTH). BMI categories were defined as normal and high if BMI was 18.5-24.99 kg/m² and ≥ 25 kg/m², respectively. RESULTS: Forty (57.1%) participants had normal BMI while 30 (42.9%) participants had BMI ≥ 25 kg/m² (P0 = 0.053). The mean BC level was lower in participants with BMI ≥ 25 kg/m² but not significant. There was a negative correlation between BMI and BC level ( r = -0.205, P = 0.88) while a positive correlation existed between stimulated cortisol level and BMI (r = 0.009, P = 0.944). CONCLUSION: Persons with BMI above 25 kg/m² had lower BC level though not statistically significant, the trend was noticed. Subjecting people whose BMI is above 25 kg/m² to further stimulation with ACTH because of low BC is not advised because their response to ACTH stimulation was similar to those who have normal BMI.

Lipoatrophy among patients on antiretroviral therapy in Lagos, Nigeria: Prevalence, pattern and association with cardiovascular risk factors.

CONTEXT: Antiretroviral therapy (ART) is linked with morphologic abnormalities such as lipoatrophy (LA), which may accompany metabolic alterations (dysglycemias, dyslipidemia and insulin resistance) that increase cardiovascular disease risk. LA and its association with metabolic alterations have been infrequently studied amongst Nigerians on ART. AIMS: To determine the prevalence, pattern and association of LA with metabolic abnormalities and hypertension among patients on ART attending an ambulatory human immunodeficiency virus clinic in Lagos, Nigeria. SUBJECTS AND METHODS: A cross-sectional study was carried out among patients on ART using a structured interviewer administered questionnaire. Data obtained included patients and physician's assessment of body fat changes, drug history, blood pressure, body composition assessment using bioelectrical impedance analysis and biochemical evaluation (glucose, lipids). LA was defined clinically. Data were analyzed using IBM SPSS statistical software version 21. RESULTS: A total of 48 (33.1%) of the 145 patients had LA. The face was the most frequently affected body region. Patients with LA with lower body circumferences, skin-fold thickness and body fat (P < 0.05). The frequencies of lipid abnormalities were: Reduced high density lipoprotein-cholesterol (47.1%), elevated total cholesterol (35.6%), reduced low density lipoprotein-cholesterol (19.2%), elevated triglycerides (14.4%). Fasting plasma glucose (FPG)≥6.1 mmol/l and hypertension were present among 9.6% and 40.7% respectively. LA was not significantly associated with the presence of glucose intolerance, dyslipidemia or hypertension (P > 0.05). CONCLUSIONS: Lipoatrophy, though commonly encountered in patients on ART in Nigeria was not associated with the presence of dyslipidemia, abnormal FPG or hypertension. Regular monitoring by the physician and increased patients awareness are necessary to reduce its prevalence and impact.

Rural-urban difference in plasma lipid levels and prevalence of dyslipidemia in Hausa-Fulani of north-western Nigeria.

OBJECTIVES: To compare the serum lipids levels, prevalence of dyslipidaemia, and adiposity of rural versus urban dwellers in Sokoto, Nigeria. METHODS: A cross-sectional study was conducted in both rural and urban areas of Sokoto, Nigeria. One hundred participants were recruited using a multi-stage sampling method. Demographic data and anthropometric measurements were obtained. Fasting blood was drawn for assessment of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) cholesterol. The classification of dyslipidemia was based on the National Cholesterol Education Program-Adult Treatment Panel guidelines. RESULTS: The (mean [SD]) waist circumference of the urban participants (83.8 [9.5] cm) was significantly higher than the rural participants (79.2 [11.2] cm) (P = .030). The mean BMI of the urban participants (23.9 [3.9] kg/m2) was higher than the rural participants (22.2 [3.7] kg/m2) (P = .09). The mean TC was significantly higher in urban (175.9 [49.6] mg/dL) than rural participants (148.3 [24.3] mg/dL) P < .001. Mean serum LDL-C, and TG concentrations were higher in the urban than rural participants but the difference was not statistically significant. Mean serum HDL-C was also insignificantly higher in the rural (51.1 [7.9] mg/dL) than in urban participants (50.2 [11.7] mg/dL) (P = .64). The most frequent dyslipidemia was abnormally low HDL-C (13%) and this was more common in the urban participants (16%) than in rural participants (10%). CONCLUSION: This study demonstrated that compared to the rural dwellers, the urban dweller were more likely to be obese and had higher frequency of adverse plasma lipid profile. This may have implications for rural-urban patterns of lipid related cardiovascular disease.

Relationship between liver function tests and thyroid hormones in thyroid disorders.

AIMS AND OBJECTIVES: To evaluated the effect of thyroid dysfunction on liver function tests and if there is any correlation between them. MATERIALS AND METHODS: A total of 68 subjects (40 hyperthyroid and 28 hypothyroid) between the ages of 20-60 years old and 40 healthy euthyroid volunteers of the same age groups were studied. Plasma albumin, bilirubin (total and conjugated), thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH); activities of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) were estimated in the plasma of the participants. RESULTS: Plasma concentration of Total .bilirubin and liver enzyme activities increased significantly in both hyperthyroid and hypothyroid subjects. The positive correlations between thyroid hormones and liver enzymes in hyperthyroid subjects were negative in hypothyroid subjects and vice-visa. CONCLUSION: It can be concluded that both hyperthyroidism and hypothyroidism altered liver function tests. It is thus recommended that liver function tests interpretation in thyroid dysfunction should be with caution.

Urinary free cortisol in the diagnosis of Cushing's syndrome: how useful?

Cushing's syndrome results from chronic exposure to excessive circulating levels of glucocorticoids. To confirm the clinical suspicion, biochemical tests are needed. These biochemical tests include the measurement of excess total endogenous cortisol secretion assessed by 24-hour urinary free cortisol (UFC), loss of the normal feedback of the hypothalamo-pituitary-adrenal axis assessed by suppressibility after dexamethasone testing, and disturbance of the normal circadian rhythm of cortisol secretion assessed by midnight serum or salivary cortisol. We searched the Medline, Pubmed, journal articles, WHO publications and reputable textbooks relating to Cushing's syndrome using publications from 1995 to 2011. UFC has been the classic screening test used to confirm hypercortisolemia as the first step in diagnostic work-up of Cushing's syndrome. Its long-term use in clinical practice has led to emergence of significant evidence regarding the utility of UFC in the diagnosis of Cushing's syndrome. UFC would have been a simple diagnostic tool to use but for the drawbacks in the sample collection, different laboratory methods of assay, not easily determined normal range. UFC use as a screening test is not strongly favoured because cortisol is not uniformly secreted during the day, and the increased prevalence of mild, preclinical or cyclic Cushing's syndrome. A very high level of UFC negates the need for other test procedures in patients with obvious symptoms and signs of Cushing's syndrome. We therefore suggest that UFC should be used with other screening tests for Cushing's syndrome to increase diagnostic yield.

Adrenocortical function in Nigerian patients with pulmonary tuberculosis (PTB).

Addison's disease was frequently consequent upon affectation of the glands by tuberculosis. Pulmonary Tuberculosis (PTB) is still very common in Nigeria but no report on the functional status of the adrenal cortex in patients with PTB in Nigeria exists. It is very important to note that subclinical adrenocortical failure in tuberculosis is an entity that should be considered as cortisol deficiency could be responsible for unexpected sudden death in this category of patients. This study sets out to determine the prevalence of subclinical adrenocortical failure in persons with PTB by determining the response to low-dose (1 ìg) ACTH stimulation. Forty four persons with newly diagnosed sputum-positive PTB and treatment naive, (23 males and 21 females, mean age 34.4 +/- 11.3 years, and mean body mass index (BMI) of 18.9 +/- 2.9 kg/m2) completed the study. Of the one hundred healthy volunteers recruited as control subjects, 70 persons (35 males and 35 females, mean age 38.1 +/- 12.5 years, BMI 24.1 +/- 3.7 kg/m2) completed the exercise. There was no statistically significant difference in the basal cortisol of healthy subjects and persons with PTB (239.9 vs. 229.1 nmol/L, p = 0.661). The thirty minute response to ACTH stimulation test and increment were significantly lower in persons with PTB than in healthy subjects. Adrenocortical insufficiency, mostly at the subclinical level, is common in persons with PTB infection, occurring in about 23% of patients. We therefore recommend that basal cortisol levels should not be used to detect adrenocortical insufficiency; rather stimulation tests should be used to exclude or confirm suspected adrenocortical insufficiency in patients with PTB.

Comparison of low dose and standard dose adrenocorticotropin stimulation tests in healthy Nigerians.

Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is a potentially life-threatening condition. It is of paramount importance that safe, reliable diagnostic tests be available to identify patients at risk for adrenal insufficiency. The 250 microg Adrenocorticotropic hormone (ACTH) stimulation test is commonly used to assess adrenocortical function. The 250 microg dose is supraphysiological, therefore several investigators, over the years, have used 1 microg ACTH stimulation test to assess adrenocortical function. The aim of the study was to compare the response of healthy adult Nigerian subjects to the 250 microg and 1 microg ACTH tests. Ten healthy subjects, five males and five females, aged between 20-60 years, (mean, 38.7 years) participated in this study. They all had normal medical histories and physical examinations, were nonsmokers, and had never received any type of glucocorticoid therapy. Serum chemistries, full blood counts, erythrocyte sedimentation rate, were all within normal limits. Both low dose ACTH test and standard dose ACTH test were performed on the 10 subjects in a randomized order on different days.There was no statistically significant difference in mean serum cortisol levels between the two test doses at 30 minutes (928.4 vs 929.8 nmol/L). There was a strong correlation between 30-minute cortisol responses to 1 microg and 250 microg ACTH stimulation tests, r = 0.999; p < 0.001. In agreement with other published data, our study confirms that 1 microg ACTH stimulates adrenocortical secretion in normal subjects in the period 30 minutes post injection comparable to 250 microg ACTH testing.

Steroid responsive hypertension secondary to 11-beta hydroxylase deficiency--a case report.

BACKGROUND: Congenital adrenal hyperplasia (CAH), due to deficiency in 11â hydroxylase enzyme is rare a cause of virilization associated with glucocorticoid responsive hypertension. OBJECTIVE: To present a rare cause of CAH and secondary hypertension responsive to glucocorticoid therapy. METHODS: Clinical and laboratory evaluation of a young woman with a "phallus" and hypertension. Investigations carried out included serum biochemistry, bone age determination, sex chromatin evaluation and serum levels of androgens and 17-OH progesterone, as well as pelvic ultrasonography. RESULTS: There was a history of cliteromegaly, first noticed at age 14 years, but menstrual periods were said to be regular. Physical findings included male type hairline and musculature with a blood pressure of 160/110mmHg. Breast development was Tanner Grade 3 while the public hair was male in pattern. The clitoris was 5cm long. Serum electrolytes were normal but levels of testosterone, dehydroepiandosterone sulphate and 17-OH progesterone were elevated. Features were compatible with a diagnosis of congenital adrenal hyperplasia (CAH) due to Il-beta-hydroxylase defficiency. Hypertension responded to glucocorticoid therapy, recurred on default and was corrected again on re-starting hydrocortisone. CONCLUSION: Congenital adrenal hyperplasia due to 11â-hydroxylase deficiency though rare, should be considered in the differential diagnosis of hypertension with virilization in young females.

Diabetic ketoacidosis: diagnosis and management.

The objective of this manuscript is to review the clinical manifestations, diagnosis and management of diabetic ketoacidosis, one of the most common acute complications of diabetes mellitus. We performed a medline search of the English-language literature using a combination of words (diabetic ketoacidosis, hyperglycemic crises) to identify original studies, consensus statements and reviews on diabetic ketoacidosis published in the past 15 years. Emphasis was placed on clinical manifestations of diabetic ketoacidosis, its diagnosis and treatment.Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus that can be life-threatening if not treated properly. Once thought to occur only in patients with type 1 diabetes, diabetic ketoacidosis has also been observed in patients with type 2 diabetes under certain conditions. The basic underlying mechanism for diabetic ketoacidosis is insulin deficiency coupled with elevated levels of counterregulatory hormones, such as glucagon, cortisol, catecholamines, and growth hormone. Diabetic ketoacidosis can be the initial presentation of diabetes mellitus or precipitated in known patients with diabetes mellitus by many factors, most commonly infection. The management of diabetic ketoacidosis involves careful clinical evaluation, correction of metabolic abnormalities, identification and treatment of precipitating and co-morbid conditions, appropriate long-term treatment of diabetes, and plans to prevent recurrence. Many cases of DKA can be prevented by better access to medical care, proper education, and effective communication with a health care provider during intercurrent illness. Provision of guidelines will also reduce mortality. Resources need to be redirected towards prevention by funding better access to care and educational programs.

Pattern of dyslipidaemia among Nigerians with type 2 diabetes mellitus.

OBJECTIVE: To characterize the pattern of lipid profile abnormalities among Nigerians with type 2 diabetes mellitus attending the Diabetes clinic of a tertiary referral centre in Nigeria. METHOD: A cross sectional analysis of 192 diabetic patients consecutively recruited from patients attending the Diabetes clinic and 52 volunteering non-diabetic and non-hypertensive controls was undertaken. The main outcome measures were lipid profile and anthropometric indices. Data analysis was done with SPSS version 10. Results were expressed as mean +/- SD. Differences between groups were regarded as significant atp < 0.05. Comparisons of means, test of association were done using independent t-test, chi-square test and bivariate (Pearson's) correlation analysis. RESULTS: Eighty-nine percent of the patients had at least one abnormal lipid profile while 64.5% had combined dyslipidaemia. Reduced HDL-C and raised TG constituted the most (88.0%) and least (25.0%) prevalent abnormalities respectively. Significant difference in the mean values of HDL-C and LDL-C was observed between the patients and controls. CONCLUSION: Dyslipidaemia is common among patients with type 2 diabetes mellitus in Nigeria with majority of the patients having a combined dyslipidaemia. There is therefore the need to pay great attention to the lipid parameters in Nigerians with type 2 diabetes mellitus.

Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report.

OBJECTIVES: Hypercholesterolaemia is a risk factor for cardiovascular diseases. Tocotrienols reportedly possess hypocholesterolaemic activity. This study examined the effect of tocotrienols (T3) in TOCOVIDTM Suprabio TM on serum lipids. Patients and Methods :A randomised (2:1), open-label study of patients with mild hypercholesterolaemia (= 5.18mmol/L to <7.77mmol/L) and one additional cardiovascular risk factor was carried out. Subjects received either tocotrienols (as TOCOVIDTM Suprabio TM ) (n=28) or vitamin E (a-tocopherol) 500mg daily (n=16). Fasting lipids were compared at baseline and after 4 weeks therapy. RESULTS: Following 4 weeks therapy, mean +/- SD total cholesterol declined significantly in the tocotrienol group (from 6.10+/-0.66 to 5.47+/-1.16; P=0.02) compared to the a-tocopherol group (from 5.92+/-0.52 to 5.47+/-0.76; P>0.05). Mean LDL-C levels (mmol/L) were also significantly reduced in the tocotrienol group (3.82+/-0.85 to 3.24+/-1.26; P=0.04), but not in those on a-tocopherol (3.84+/-0.75 to 3.28+/-0.94; P>0.05). There were no significant changes in HDL-C and triglycerides in both groups. The tocotrienol group experienced a net decline in TG (7.1+/-31.4 %; P>0.05) while the a-tocopherol group had a net increase at week 4 (38.6+/-61.7%; P>0.05). CONCLUSION: The study adds to existing evidence of the favourable effect of tocotrienols on total cholesterol and LDL-C. However, the results need further evaluation.

Magnitude and gender distribution of obesity and abdominal adiposity in Nigerians with type 2 diabetes mellitus.

BACKGROUND: Obesity and abdominal adiposity are associated with increased cardiovascular morbidity in diabetes. This study evaluated their magnitude and gender distribution in Nigerians with Type 2 DM attending a tertiary care clinic. PATIENTS AND METHODS: 258 consecutive patients with type 2 DM were evaluated. Base line characteristics (gender, age, duration of DM), weight, height, waist circumference (WC), and hip circumference were recorded. Body mass index (BMI), waist-hip ratios (WHR), and waist-to-height ratios (WHtR) were calculated for each patient. RESULTS: Despite similar demographics (mean age and duration of DM), the prevalence of of DM was significantly higher in females (35/135 i.e.25.9% compared to 13/123 i.e. 10.6% in males) (2; P=0.007). Median BMI (27.1 v. 25.6), WHtR (0.58 v. 0.54), and frequency of elevated WC (71.9% v. 21.1%) and elevated WHR (94.1% v. 49.6%) were all significantly higher in females compared to males (P<0.05). Amongst obese persons, the magnitude of obesity and abdominal adiposity was also significantly higher in females as exemplified by median BMI (females: 34.3 v. males 31.6; P=0.014) and median WHtR (0.70 v. 0.64; P=0.0016). CONCLUSIONS: The evident gender disparity of obesity and abdominal adiposity in females with type 2 DM represented by this cohort buttresses the need to focus on obesity management in African women with DM as a special at-risk group in order to minimize the potential for adverse cardiovascular outcome.

Prevalence of dysglycemia in Calabar: a cross-sectional observational study among residents of Calabar, Nigeria.

OBJECTIVE: Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. DESIGN: This was a cross-sectional observational study. METHODS: 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110-125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. RESULTS: Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. CONCLUSIONS: The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. TRIAL REGISTRATION NUMBER: CRS/MH/CR-HREC/020/Vol.8/43.

Adrenocortical function in Nigerians with human immunodeficiency virus infection.

OBJECTIVE: This study sets out to determine the prevalence of adrenocortical insufficiency in persons with HIV infection by determining the response to low-dose (1 µg) ACTH stimulation. DESIGN: An experimental study involving people with HIV infection and healthy people. SETTING: The study group and the controls were recruited from the Lagos University Teaching Hospital (LUTH). PARTICIPANTS: forty-three newly diagnosed and treatment naïve persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. INTERVENTION: One µg Synacthen was given intravenously to stimulate the adrenal glands. MAIN OUTCOME MEASURES: Blood was collected for basal cortisol levels and 30 minutes after the injection of ACTH. Cortisol was assayed using ELISA. RESULTS: The mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (p<0.001); while the 30-minute post ACTH test cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (p<0.001) and the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (p<0.001) in HIV and healthy subject group respectively. Using the diagnostic criteria derived for the diagnosis of adrenocortical insufficiency in this study (30 minute cortisol level <380.2 nmol/L and increment from basal to stimulated cortisol level <158.5 nmol/L); fifteen (34.8%) persons with HIV had adrenal insufficiency. CONCLUSION: Adrenocortical insufficiency is common in persons with HIV infection, occurring in about 34.8% of patients studied. Clinically evident adrenocortical insufficiency is uncommon in persons with HIV.

Endocrine-related diseases in the emergency unit of a Tertiary Health Care Center in Lagos: A study of the admission and mortality patterns.

INTRODUCTION: Non-communicable diseases are emerging as an important component of the burden of diseases in developing countries. Knowledge on admission and mortality patterns of endocrine-related diseases will give insight into the magnitude of these conditions and provide effective tools for planning, delivery, and evaluation of health-care needs relating to endocrinology. MATERIALS AND METHODS: We retrieved medical records of patients that visited the emergency unit of the Lagos University Teaching hospital, over a period of 1 year (March 2011 to February 2012) from the hospital admissions and death registers. Information obtained included: Age, gender, diagnosis at admission and death, co-morbidities. Diagnoses were classified as endocrine-related and non-endocrine related diseases. Records with incomplete data were excluded from the study. RESULTS: A total of 1703 adult medical cases were seen; of these, 174 were endocrine-related, accounting for 10.2% of the total emergency room admission in the hospital. The most common cause of endocrine-related admission was hyperglycaemic crises, 75 (43.1%) of cases; followed by diabetes mellitus foot syndrome, 33 (19.0%); hypoglycaemia 23 (13.2%) and diabetes mellitus related co-morbidities 33 (19.0%). There were 39 endocrine-related deaths recorded. The result revealed that 46.1% of the total mortality was related to hyperglycaemic emergencies. Most of the mortalities were sepsis-related (35.8%), with hyperglycaemic crises worst affected (71.42%). However, the case fatalities were highest in subjects with thyrotoxic crisis and hypoglycaemic coma. CONCLUSION: Diabetic complications were the leading causes of endocrine-related admissions and mortality in this health facility. The co-morbidity of sepsis and hyperglycaemia may worsen mortality in patients who present with hyperglycaemic crises. Hence, evidence of infection should be sought early in such patients and appropriate therapy instituted.

Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria.

To determine the prevalence and relationship between prehypertension and hypertension, we studied 782 ethnic Hausa and Fulanis (men, 409; women, 373) aged 38.9±13.9 years recruited by multistage cluster sampling. Demographic, anthropometry, metabolic and JNC VII-based blood pressure categories were obtained and analysed using univariate and multivariate models. The prevalence rates of prehypertension and hypertension were 58.7% (men 59.2%, women 58.2%) and 24.8% (men 25.9%, women 23.6%), respectively. Only 16.5% of the population had JNC VII defined optimum blood pressure. Compared to hypertension, prehypertension had earlier onset (second versus third decade) and peak (fourth versus fifth decade) of life. The peak and trough prevalence of hypertension and prehypertension, respectively were observed in the 5th decade of life. Obesity, abnormalities of glucose metabolism and insulin resistance were the major factors associated with prehypertension and hypertension. Multivariate analysis identified obesity and impaired glucose tolerance as independent predictors of hypertension. Of those with hypertension, 13.9% were aware of their high blood pressure status of which 85.7% were commenced on treatment and 12.5% achieved blood pressure control. Overall, 1.5% of the study population had blood pressure <140/90 mm Hg. It is concluded that less than 20% of people of Hausa and Fulani ethnicities had optimum blood pressure. These are predominantly in their second decade of life suggesting that rise in blood pressure begins early in this population. The fifth decade of life may represent a period of transition from prehypertension to hypertension.

Lipid peroxidation and erythrocyte fragility in poorly controlled type 2 diabetes mellitus.

BACKGROUND: Type 2 Diabetes mellitus has been recently found to have evidence of raised inflammatory markers. The chronic inflammation correlates strongly with cardiovascular morbidity markers such as coronary artery disease, stroke and peripheral arterial disease. The chronic inflammation has been linked to the generation of free radicals. The evidence is however inconclusive. Thus there is increased interest in determining the oxidative status of persons with diabetes. OBJECTIVES: This study was carried out to determine if the plasma oxidative stress status is high in diabetics (especially those that are poorly controlled) and to determine the effect on erythrocyte stability. METHODS: Plasma levels of thiobarbituric acid reacting substances (TBARS), an index of lipid peroxidation, and erythrocyte osmotic stability were determined. These were compared between poorly controlled type 2 diabetics and nondiabetic individuals. RESULTS: The plasma level of TBARS were significantly higher in the plasma of the diabetics: 0.90 +/- 0.09 micromol malondialdehyde (MDA) equivalent L(-1) vs 0.57 +/- 0.02 micromol MDA equivalent L(-1) for control subjects (p=0.002). The diabetic erythrocytes also showed significantly higher fragility: 3.99 +/- 0.37% haemolysis vs 2.11 +/- 0.27% haemolysis for controls (p=0.0004). CONCLUSION: Our data shows the occurrence of significantly higher oxidative stress level and osmotic fragility of erythrocytes in the cohort of persons with poorly controlled diabetes mellitus.