Prevalence of thyroid dysfunction among asymptomatic elderly Filipinos at the Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

The elderly are a peculiar group in terms of health management, as they often present with non-specific complaints which are challenging to interpret and may not present with the usual clinical picture of a disease. Objective. The study aims to determine the prevalence of thyroid dysfunction among asymptomatic, elderly Filipinos seen at the Philippine General Hospital (PGH). Methodology. Subjects aged 60 years and older seeking out-patient medical consult for non-thyroidal illness at the PGH were recruited. Patients with known thyroid or pituitary disease, previous thyroid or pituitary surgery, intake of medications known to affect thyroid hormone levels and critical illness were excluded. Fasting blood sugar (FBS), lipid profile, free thyroxine (FT4), thyroid-stimulating hormone (TSH), and anti-thyroperoxidase (anti-TPO) levels were taken. Based on FT4 and TSH levels, subjects were classified as overt hypothyroid, subclinical hypothyroid, euthyroid, subclinical hyperthyroid, or overt hyperthyroid. Results. One hundred eighty subjects were recruited, of whom 152 (84%) were female. Hypertension was the most common comorbidity (58.33%), followed by diabetes (36.67%). One hundred sixty-two (90%) were euthyroid, 12 (6.7%) subclinical hypothyroid, 4 (2.22%) subclinical hyperthyroid, and two (1.11%) overtly hyperthyroid. No one was overtly hypothyroid. There was a trend toward increasing prevalence of diabetes, hypertension, low HDL, obesity and overall cardiovascular risk among those with subclinical hypothyroidism. Conclusion. Subclinical hypothyroidism was the most prevalent thyroid dysfunction among asymptomatic elderly included in the study.

Screening for diabetes mellitus among asymptomatic overseas Filipino workers

BACKGROUND: Diabetes mellitus is becoming prevalent in developing countries like the Philippines. Mass screening is not recommended and is not cost effective. Targeted screening is a more practical way to detect people with disease.Overseas employment is one of the most common occupations in the country. Primary medical examination is done in pre-employment clinics with routine panel of diagnostics, urinalysis included. Fasting blood sugar(FBS) and oral glucose tolerance test (OGTT) are not part of the panel of pre-employment medical examination for overseas Filipino workers (OFW). They are mostly done when they are referred to endocrinology or diabetes clinics when suspicion arises or glucosuria is noted on urinalysis. However, there are patients who consulted endocrinology clinics but deny any symptoms of diabetes.                                                                                                                                                                 OBJECTIVE: The objective of this study is to determine the prevalence of diabetes among OFW by employing FBS and OGTT among those who had urinalysis and referred to endocrinology clinic.RESULTS: Among the 192 OFWs with glucosuria, doing FBS detected 21 percent, 51 percent and 28 percent with diabetes mellitus (DM), impaired fasting glucose (IFG) and normal fasting glucose respectively. By doing OGTT among the OFW with normal FBS, 46 percent were reclassified as diabetic or have impaired glucose tolerance (IGT). OGTT among those with IFG also detected 71 percent with diabetes or IGT. Overall the patients with glucosuria have a DM prevalence that is more than ten times that of the general population done by the National Nutrition and Health Survey in 2003.Among the 149 OFWs without glucosuria, FBS detected 36 percent, 54 percent, and 10 percent with DM, IFG and normal fasting sugar respectively. OGTT among those with normal FBS detected 67 percent of them to have diabetes or prediabetes. Doing the same among those with IFG reclassified 60 percent to have DM or IGT. Similarly the prevalence of DM is about ten times of the national survey.CONCLUSION: Among OFW with or without glucosuria referred for suspicion of diabetes FBS confirmed many to have diabetes and pre-diabetes. This prevalence is doubled by employing OGTT as part of the screening test.

Cortisol secreting adrenal adenoma in a patient with schizophrenia, rheumatic heart disease and myoma uteri: Difficult to find but easy to diagnose

The presence of cortisol - secret ing adenoma concomitantly with rheumatic heart disease, schizophrenia and myoma uteri is rare. This is a case of a 40 year old female with Schizophrenia who gradually developed Cushing's syndrome from an adrenal adenoma. She suffered a cardio-embolic stroke from Rheumatic heart disease which delayed hysterectomy for a bleeding intrauterine myoma. As ide f rom the phys ical f indings of Cushing's syndrome laboratory work up revealed an elevated 24 hour urine free cortisol with loss of normal diurnal cortisol secretion, suppressed 8AM ACTH level and negative suppression after a high dose dexamethasone. The patient underwent laparoscopic adrenalectomy for a 3.8 x 2.4 x 3 cm left adrenocortical adenoma. She required steroid supplementation. Menstrual flow immediately normalized, functional capacity improved and metabolic parameters such as weight, blood pressure and blood sugar were controlled six months after the surgery. Relapse of psychotic symptoms occurred eight months postoperatively because of non-compliance to antipsychotic medications. Cushing's syndrome if untreated can cause significant morbidities such as metabolic, hemodynamic, cardiovascular, bleeding disorder and psychiatric illness. These complications however can also be caused by primary medical illnesses like schizophrenia, rheumatic heart disease and myoma uteri. Treatment of the Cushing's syndrome may resolve some but not all the metabolic and hemodynamic problems and theoretically should also decrease the risk of complications of other primary illnesses concomitantly present. The presence of concomitant primary disease that can cause psychosis, cerebrovascular disease and metrorrhagia should also be investigated in a patient who has Cushing's syndrome. Prompt management of Cushing's syndrome would lessen the risk of complication attributed to schizophrenia, rheumatic heart disease and myoma uteri.