Hirsutism in Saudi females of reproductive age: a hospital-based study

Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females. 101 Saudi Arab women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism. Polycystic ovary syndrome [PCOS] was the cause of hirsutism in 83 patients [82%] followed by idiopathic hirsutism [IH] in 11 patients [11%]. Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients [4%], microprolactinoma in 2 [2%] and Cushing's syndrome in 1 [1%] patient. Age at presentation of PCOS was 24.5_6.6 years [mean +/- SD] and 51% of the subjects were obese. Furthermore, 74 [89%] of patients with PCOS had an oligo/anovulatory cycle while the remaining 9 patients [11%] maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with IH [P<.05]. The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients

High prevalence of osteoporosis in Saudi men

To determine the prevalence of osteoporosis in healthy Saudi men. We randomly recruited 429 Saudi men from the community. The recruited Saudi men were subjected to an interview to reveal their lifestyle parameters, calcium intake and level of activity. Bone densitometry was assessed at lumbar spine [L1-4] and the femoral neck. The dual x-ray absorptiometry [DXA] scan was carried out in the Nuclear Medicine at King Khalid University Hospital, Riyadh, Saudi Arabia from September 2002 to December 2004. The World Health Organization definition of low bone mineral density was used. Poor oral calcium intake and low level of daily activity were noted. The overall prevalence of osteopenia for the lumbar spine in the whole group was 35.7% while osteoporosis was present in 21.4% of the subjects. In the femoral neck, osteopenia was noted in 38% and osteoporosis in 11.4%. When either lumbar spine or femoral neck osteoporosis is used for diagnosis, the prevalence of osteoporosis rises to 23.5%. Within the whole group, osteopenia and osteoporosis were more common in individuals above the age of 50 than those below 50 years old. Low bone mineral density occurs with high frequency in Saudi men. Lumbar spine appears to be affected to a higher degree. The reason for the high prevalence of osteoporosis in Saudi men is unclear. Possible underlying causes include nutritional, life style and genetic factors

Thyroid autoantibodies: High prevalence among schoolchildren and adolescents in Gizan, Saudi Arabia

To study the prevalence of antithyroid antibodies among schoolchildren and adolescents in Gizan, Saudi Arabia Prospective, field study. Primary, intermediate and secondary schools in Gizan, Saudi Arabia. Schoolchildren and adolescents in Gizan schools. Antithyroid antibodies [antithyroglobulin and antimicrosomal] were tested in Gizan schoolchildren and adolescents using the haemagglutination method. We tested 1136 students [694 males and 442 females]. Positive antithyroglobulin antibodies were obtained in 81 students [7.1%] while 162 students [14.3%] had positive antimicrosomal antibodies. Antithyroglobulin antibodies were positive in 2.7% of male subjects and 14% of female subjects. Antimicrosomal antibodies were detected in 9.6% of males and 21.5% of females. None of the students had biochemical hypothyroidism. Thyroid autoantibodies occur with high frequency among schoolchildren and adolescents in Gizan. Genetic, and environmental factors as well as consanguineous marriages are suggested as possible factors for this high frequency

prevalence of endemic goitre among schoolchildren and adolescents in Gizan, Saudi Arabia

To study the prevalence of endemic goitre in Gizan, Saudi Arabia. Prospective, field study Primary, intermediate and secondary schools in Gizan, Saudi Arabia. Schoolchildren and adolescents in Gizan schools. Clinical assessment, goitre and urinary iodide measurement. We examined 4445 schoolchildren and adolescents; 2632 were males [59.2%] and 1813 [40.8%] were females. The overall prevalence of goitre was 2.2% [97 cases]. In 1324 students [78.8%], the iodide excretion was more than 100/micro g/l. In 310 students, the excretion was 50-I00 micro g/l. In 42 students the excretion was between 25-50 micro g/1. Goitre does not appear to be endemic in the Gizan region. However, some areas may be at risk of iodine deficiency

Pattern of diabetic foot lesions in Saudi Arabia: experience from King Khalid University Hospital, Riyadh

A retrospective study was carried out to estimate the magnitude and pattern of foot lesions seen in diabetics living in Saudi Arabia. A review of the records of 1010 diabetic patients seen at King Khalid University Hospital, Riyadh, revealed an overall prevalence of 10.4% for diabetic foot lesions. Of these, 88 patients were further characterized; 55 [62 .5%] were males and 33 [37.5%] were females. Seventy-five patients [85.2%] were Saudis and 13 [14.8%] were non-Saudis. The average age was 58 years. Eighty-five patients had type 2 diabetes and three had type 1. The spectrum of foot lesions included: 10 cases of cellulitis, 33 cases of ulcers, 29 cases of gangrene, and 16 cases of abscess. Evidence of peripheral vascular disease was present in 48 patients [54.5%] while peripheral neuropathy was found in 43 [48.8%]. Surgical debridement with prolonged dressing was done in 58 patients [66%] while amputation was performed in 30 [34.1%]. The average hospitalization was 6.8 weeks. Diabetic foot lesions constitute a major complication of this disease in Saudi Arabia. The high amputation rate is a source of concern and improved techniques are urgently needed to reduce this serious outcome

Ramadan fasting: medical aspects in health and in disease

Ramadan fasting is one of the Pillars of Islam. Its observance involves abstinence from eating and drinking from dawn until sunset during the entire holy month. The effects of Ramadan fasting on body physiology as well as on the different biochemical, hematological, and metabolic parameters are reviewed. Metabolic changes, when present, are mild and reversible. The effects of fasting on diabetes mellitus, treatment with nonsteroidal antiinflammatory agents, and anticoagulation therapy are discussed

Iodide concentrations in Saudi waters: a cause for concern

Samples of tap water and drinking mineral water from different regions of Saudi Arabia were analyzed for iodide content. Low iodide concentrations were found in all samples. This finding may reflect an overall low iodide content in the soil and consequently also in locally grown food, which could predispose to endemic goiter. In the absence of data on the prevalence of endemic goiter, we recommend the routine use of iodized salt in Saudi Arabia

Hyperthyroxinemia of acute psychiatric illness

The present study was undertaken to determine the frequency of abnormal thyroid function tests in patients admitted with acute psychiatric illness. Elevated thyroxine [T4] levels were noted in ten [11.4%] of 88 psychiatric patients during short-term admissions and these levels retuned to normal by three weeks after admission [P< 0.0001]. None of the patients had schizophrenia. There were no patients with hypertriiodothyroninemia. Hypothyroidism was not observed in any of the patients studied. High normal T4 levels were noted on admission in 32 patients [mean T4, 117.46 +/- 19.18I/L], and decreased to a mean of 93.52 +/- 15.2 mmol/L three weeks later [P< 0.0001]. Fiver of the patients who showed hyperthyoxinemia on the previous admission were readmitted to the psychiatry unit during the study period because of relapse of their psychiatric illness, but none showed hyperthoxinemia on the second admission. Hyperthyroxinemia of acute psychiatric illness is a graded phenomenon. Its incidence is unpredicatable and may not be reproducible

Thyrotoxicosis: experience from the King Khalid University Hospital, Riyadh

Ninety-one patients with thyrotoxicosis, 57 females and 34 males, 52 Saudis and 39 non-Saudis, were seen at King Khalid University Hospital, Riyadh. The mean age was 31.8 years. Seventy-eight patients had Grave's disease. Thyrotoxicosis caused by silent thyroiditis was about observed. Thyrotoxicosis had a low female preponderance with a female-to-male ratio of 1. 7:1 in the Saudi patients and 3.5:1 in non-Saudi. Patients with Graves' disease were characterized by a lower rate of ophthalmopathy [30%] than previously reported and by absence of pretibial myxedema. Medical treatment was the initial mode of management in all patients and in 60 patients was the maintenance treatment. Subtotal thyroidectomy was performed in 23 patients, and radioactive iodine ablation was the treatment for eight patients

spectrum of insulin allergy: two case reports and review of the literature

Two cases of insulin allergy, one with a localized reaction and another with anaphylaxis are reported. Clinical features, immunological mechanisms and treatment are discussed