Corneal confocal microscopy identifies structural small fibre abnormalities in an adolescent with type 1 diabetes and impaired awareness of hypoglycaemia / Journal of the ASEAN Federation of Endocrine Societies

@#Impaired awareness of hypoglycaemia (IAH) is present in around 25-40% of individuals with type 1 diabetes mellitus (T1DM). Herein, we present a case of an adolescent with T1DM and IAH who had worse corneal nerve parameters compared to a T1DM adolescent without IAH. Small fibre abnormalities detected by corneal confocal microscopy in an objective easy-to-perform non-invasive test might be a surrogate indicator of underlying autonomic dysfunction in T1DM and IAH.

The current approach to the diagnosis of vascular anomalies of the head and neck: A pictorial essay

Throughout the years, various classifications have evolved for the diagnosis of vascular anomalies. However, it remains difficult to classify a number of such lesions. Because all hemangiomas were previously considered to involute, if a lesion with imaging and clinical characteristics of hemangioma does not involute, then there is no subclass in which to classify such a lesion, as reported in one of our cases. The recent classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA, 2014) has solved this problem by including non-involuting and partially involuting hemangioma in the classification. We present here five cases of vascular anomalies and discuss their diagnosis in accordance with the ISSVA (2014) classification. A non-involuting lesion should not always be diagnosed as a vascular malformation. A non-involuting lesion can be either a hemangioma or a vascular malformation depending upon its clinicopathologic and imaging characteristics.

Metastatic adenocarcinoma arising from fibrocalcific pancreatic diabetes / Journal of the ASEAN Federation of Endocrine Societies

@#Fibrocalcific pancreatic diabetes (FCPD) is a rare form of ketosis-resistant diabetes in the young (15 to 40 years old) of unknown etiology. It has been observed in tropical and subtropical countries with highest incidence in south India, and is believed to have some association with tropical chronic pancreatitis, malnutrition, toxin exposure (e.g., cassava) and SPINK1 mutation. It is associated with a hundredfold increased risk of pancreatic cancer compared to the general population.

Pituitary hyperplasia and Van Wyk Grumbach Syndrome: A consequence of chronic untreated congenital Hypothyroidism / Journal of the ASEAN Federation of Endocrine Societies

@#An eight-year, 4-month old Indian girl with low IQ and delayed milestones, presented with headache (4 years), breast development (4 months), and menstrual bleeding for 22 days. Examination revealed short stature [height: 91.5 cm; SD score: -5.59], coarse dry skin, umbilical hernia (arrow), delayed reflexes, Tanner’s stage-3 breasts, absent pubic and axillary hair

Advances in pharmacotherapy of type 2 diabetes [part-3: the gliptins]

Type 2 diabetes is witnessing major advances in pharmacotherapy. After a rather dormant period spanning the period from 1960s to the 1990's following the discovery of the sulphonylurea and biguanide groups of drugs in the 1950's, significant advances have been achieved in discovering new drugs. This has been possible because of the advances in biotechnology. In this part of the series of reviews we will be looking at the second group of the incretin-based therapies. These gliptins which include several agents, namely sitagliptin, vildagliptin and saxagliptin, with others still in development. The other group of the incretin-based agents the incretin mimetics have been discussed in more details in the previous issue of this journal

Metabolic syndrome in type 1 diabetes

The aim of this study was to assess the prevalence and effects of the presence of metabolic syndrome in patients with type 1 diabetes. Retrospective analysis of data from a one year period of patients attending annual review clinic was undertaken. Body weight, height and blood pressure were measured along with assessment of micro-/macro-vascular complications. HbAlc, urea, cholesterol, triglyceride, urinary albumin: creatinine ratios were also measured. Patients were divided into those with and those without metabolic syndrome. Data from 365 type 1 diabetic patients was analysed. Hundred and twelve had metabolic syndrome. There was no difference according to gender or smoking. Type 1 diabetic patients with metabolic syndrome had longer duration of diabetes, were significantly older, heavier, had higher blood pressure, higher triglyceride and lower HDL cholesterol levels. There were significant increases in mean BMI, urea, serum creatinine, urinary albumin: creatinine ratio, cholesterol and triglyceride in the group with metabolic syndrome even after controlling for both age and duration of diabetes. Neuropathy and macro-vascular complications were commoner in patients with metabolic syndrome. Patients with metabolic syndrome were more likely to be on statins, ACE inhibitors and angiotensin receptor blockers and had a significantly higher mean insulin dosage requirement per kg. This study highlights the importance of the presence of the metabolic syndrome in patients with type 1 diabetes. It shows that metabolic syndrome is associated with a higher incidence of diabetes-related complications, a need for higher insulin doses and a more aggressive multifactorial intervention