Predictors of poor glycemic control and increased glucose variability among admitted moderate to critical COVID-19 patients with type 2 diabetes mellitus: A single center cross-sectional study / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#COVID-19 exacerbates the long-standing, low-grade chronic inflammation observed in diabetes leading to heightened insulin resistance and hyperglycemia. Mortality increases with hyperglycemia and poor glycemic variability, hence, this study aims to identify the predictors associated with poor glycemic control and increased glucose variability among patients with COVID-19 and Type 2 Diabetes Mellitus (T2DM).@*Methodology@#A retrospective chart review of 109 patients with moderate to severe COVID-19 and T2DM admitted from March 2020 to June 2021 was done. Logistic regression was done to determine predictors for hyperglycemia and poor variability.@*Results@#Of the 109 patients, 78% had hyperglycemia and poor variability and 22% had no poor outcomes. Chronic kidney disease (eOR 2.83, CI [1.07-7.46], p=0.035) was associated with increased glycemic variability. In contrast, increasing eGFR level (eOR 0.97, CI [0.96-0.99], p=0.004) was associated with less likelihood of increased variability. Hs-CRP (eOR 1.01, CI [1.00-1.01], p=0.011), HbA1c (eOR 1.86, CI [1.23-2.82], p=0.003), severe COVID-19 (eOR 8.91, CI [1.77-44.94], p=0.008) and critical COVID-19 (eOR 4.42, CI [1.65-11.75], p=0.003) were associated with hyperglycemia. Steroid use (eOR 71.17, CI [8.53-593.54], p<0.001) showed the strongest association with hyperglycemia.@*Conclusion@#Potential clinical, laboratory and inflammatory profiles were identified as predictors for poor glycemic control and variability outcomes. HbA1c, hs-CRP, and COVID-19 severity are predictors of hyperglycemia. Likewise, chronic kidney disease is a predictor of increased glycemic variability.

Systemic hormonal unloading in unilateral adrenalectomy in a patient with bilateral adrenal hyperplasia: A case report

Background @#Unilateral adrenalectomy has not been recommended in the guidelines as a treatment for primary hyperaldosteronism secondary to bilateral adrenal hyperplasia (BAH). Interestingly, recent studies have shown that increased circulation of aldosterone increased oxidative stress, cardiovascular (CV) complications such as atrial fi brillation, myocardial infarction and heart failure; and that unilateral adrenalectomy led to improved CV function. Therefore, recognizing the role of unilateral adrenalectomy in BAH, specifi cally for improved quality of life is important.@*Clinical case@# A 47‐year-old hypertensive (highest blood pressure [BP] 150/90 mmHg) woman had a severe headache, muscle weakness, polyuria, and polydipsia. Her serum potassium (K) was low at 3.1 mmol/L (3.5–5 mmol/L). Initial tests showed elevated plasma aldosterone, suppressed plasma renin activity and elevated aldosterone-renin ratio (6.61 ng/ dL, <0.1 ng/mL and 66, respectively). Plasma aldosterone after saline suppression test (12.70 ng/dL) confi rmed the diagnosis of primary aldosteronism (PA). MRI showed a well-defi ned, oval-shaped solid nodule in the medial limb of the left adrenal gland (1.8 x 1.2 cm). Bilateral adrenal vein sampling with adrenocorticotropic hormone (ACTH) stimulation test was compatible with BAH (cortisol-corrected aldosterone ratio pre-ACTH stimulation 1.29 and postACTH 1.66), with dominant aldosterone secreting left adrenal gland (7200 vs 3760 ng/dL). She was started on spironolactone 200 mg/day and amlodipine 10 mg/day and eventually shifted to eplerenone. Despite the optimal dose of eplerenone and amlodipine, she still experienced severe headaches, palpitations and breakthrough elevations of BP that led to her recurrent admissions. Eplerenone was shifted back to spironolactone (150-200 mg/day) with amlodipine dose (10 mg/day) normalizing her blood pressure and potassium level, yet with persistent headache and muscle weakness. Repeat imaging using CT scan with contrast showed consistent results. Postoperatively, with all medications discontinued the patient was asymptomatic, normotensive (110/70 mmHg) and normokalemic (4.0 mmol/L). One month later, her BP started to increase again at 140/80 mmHg and her K decreased to 3.4 mmol/L. Normalization of said parameters (BP:120/70 mmHg K: 4.1 mmol/L), with stabilization following lower doses of amlodipine (5mg/day) and spironolactone (25 mg/day). Also, all the symptomatology of the patient resolved completely.@*Conclusion@#This present case exemplifi es a unilateral adrenalectomy approach in BAH, which led to improvement in BP and K levels, despite low medication doses. Furthermore, symptom relief and improved quality of life, as desired outcomes, were achieved.