Pituitary Adenoma Prevalence and Characteristics of Omani Patients: A Single Center Experience.

Objectives: To estimate the incidence of pituitary adenomas (PA) in adult Omani patients and describe its epidemiological, clinical, and radiological characteristics. Methods: In this longitudinal, descriptive study, we reviewed the records of all PA patients from January 2015 to January 2020 who presented at the endocrinology facilities at Sultan Qaboos University Hospital, Muscat. Results: The participants comprised of 112 Omani patients with PA. The incidence of PA among all adult patients at Sultan Qaboos University Hospital (inpatient and outpatient) over five years (2015-2020) was 0.23%. The cohort had a mean age of 41.0±15.0 years. Of the 112 patients included in this study, 79 (70.5%) were women. Nearly half (51; 45.5%) of adenomas were prolactinomas while 46 (41.1%) were non-functioning adenomas, and seven (6.3%) were growth hormone-secreting adenomas while six (5.4%) were adrenocorticotropic hormone secreting adenomas. Headache was present in 67 (59.8%) patients, followed by visual field defects (40; 35.7%), galactorrhea (26; 23.2%), and fatigue (19; 17.0%). The majority of women (45/79; 57.0%) presented with menstrual cycle abnormalities. Radiological appearances were nearly equally distributed between micro- and macroadenomas. Most cases (58/112; 52.0%) of PA were treated medically by cabergoline, octreotide, and replacement therapies such as hydrocortisone and thyroxin, 38 (33.9%) were treated surgically (mainly by trans-sphenoidal pituitary resection), and the remaining 10 (8.9%) cases were subjected to radiotherapy. Medical treatment combined with surgery was employed for 15 (13.4%) patients. Conclusions: In our investigation, PA was primarily prevalent among Omani female patients, and the most common subtype of pituitary tumors was prolactinomas. The most common presentation symptom was headaches; most female patients had menstrual irregularities. Medical treatment was the primary approach for the applicable types of PAs, while surgery and radiotherapy were found to be secondary and tertiary treatment options, respectively.

Acute Pericarditis as an Uncommon Presentation of Graves' Disease.

Cardiovascular manifestations are well recognized features of hyperthyroidism, particularly Graves' disease. Common cardiac complications include atrial fibrillation, hypertension, and high or normal output congestive heart failure. In rare cases, acute pericarditis can be a manifestation of Graves' disease. We present a 28-year-old male who presented with acute pericarditis and was later diagnosed with Graves' disease.

Mutation in the PCSK9 Gene in Omani Arab Subjects with Autosomal Dominant Hypercholesterolemia and its Effect on PCSK9 Protein Structure.

Proprotein convertase subtilisin/kexin type (PCSK9) is a crucial protein in LDL cholesterol (LDL-C) metabolism by virtue of its pivotal role in the degradation of the LDL receptor. Mutations in the PCSK9 gene have previously been found to segregate with autosomal dominant familial hypercholesterolemia (ADFH). In this study, DNA sequencing of the 12 exons of the PCSK9 gene has been performed for two patients with a clinical diagnosis of familial hypercholesterolemia where mutation in the LDL-receptor gene hasn't been excluded. One missense mutation was detected in the exon 9 PCSK9 gene in the two ADFH patients. The patients were found to be heterozygote for Ile474Val (SNP rs562556). Using an array of in silico tools, we have investigated the effect of the above mutation on different structural levels of the PCSK9 protein. Although, the mutation has already been reported in the literature for other populations, to the best of our knowledge this is the first report of a mutation in the PCSK9 gene from the Arab population, including the Omani population.

Accuracy of ultrasound-guided fine-needle aspiration cytology for diagnosis of carcinoma in patients with multinodular goiter.

BACKGROUND: Fine-needle aspiration (FNA) is a useful method for evaluating multinodular goiter; however, its role is still controversial. The aim of this study was to assess the utility of ultrasound-guided thyroid FNA in detecting malignancy in patients with multinodular goiter in Oman. MATERIALS AND METHODS: This was a retrospective study where all patients with multinodular goiter seen at the Sultan Qaboos University Hospital endocrinology clinic in Oman in 2005 were evaluated. The thyroid FNA results were grouped into either malignancy (positive result) or others (negative result). They were compared to those of final histopathological examination in order to calculate the value of the test in diagnosing malignancy. Analyses were evaluated using descriptive statistics. RESULTS: A total of 272 patients were included in the study. The mean age was 39΁13 years with an age range from 5 to 85 years. The majority of the patients were females (n=236; 87%). The results of thyroid FNA revealed that 6% (n=15) of the patients had malignancies while histopathological results showed that the proportion of subjects with malignancies was 18% (n=49). Out of the 15 cases identified to have malignances by thyroid FNA, only 53% (n=8) of the subjects were confirmed to have malignancy by biopsy. Overall, the results of the tests were poor, revealing a sensitivity of 16%, specificity of 97% and a diagnostic accuracy of 82%, with a positive predictive value of 53% and a negative predictive value of 84%. CONCLUSION: Thyroid FNA is not a useful test in differentiating multinodular goiter from malignancy, as more than 80% of the malignancies go unnoticed.

High-sensitivity C-reactive protein is a marker of obesity and not of polycystic ovary syndrome per se.

High-sensitivity C-reactive protein is more a marker of obesity than polycystic ovary syndrome itself, in particular in women >30 years of age.

Chronic adreno-cortical insufficency associated with a unilateral adrenal mass.

Adreno-cortical insufficiency in the context of an adrenal mass can be a challenging clinical problem. The two main possibilities are either a benign mass or a malignant pathology. We describe here a patient who was investigated for chronic adreno-cortical insufficiency and was found to have a left adrenal mass that was later confirmed histopathologically to be tuberculous in nature.

Clinical and Epidemiological Characteristics of Pituitary Tumours using a Web-based Pituitary Tumour Registry in Oman.

OBJECTIVE: From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance (MRI) and the different treatment modalities. METHODS: All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 1998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry. RESULTS: A total of 160 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 ±12 years (age range 8-73 years). The majority of registrations were female (n=114; 71%). There were 81 patients with non-functioning adenomas (50.6%), 59 with prolactinoma (36.9%) eight with acromegaly (5%), seven with craniopharyngioma (4.4%), four with Cushing's disease (2.5%) and one with sarcoidosis (0.6%). Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours (non-functioning adenomas, prolactinomas, and acromegaly). The most prevalent symptoms are amenorrhea-galactorrhea (n=55; 37%), headache (n=31; 21%) and fatigue (n=23; 16%). The most common treatment modality was medical (n=58; 39%), followed by observation (n=56; 38%), surgery (n=31; 21%) and surgery plus medical (n=3; 2%). None of the patients in this registry are recorded to have died. CONCLUSION: To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman.

Subcutaneous administration of testosterone. A pilot study report.

OBJECTIVE: To investigate the effect of low doses of subcutaneous testosterone in hypogonadal men since the intramuscular route, which is the most widely used form of testosterone replacement therapy, is inconvenient to many patients. METHODS: All men with primary and secondary hypogonadism attending the reproductive endocrine clinic at Royal Victoria Hospital, Monteral, Quebec, Canada, were invited to participate in the study. Subjects were enrolled from January 2002 till December 2002. Patients were asked to self-administer weekly low doses of testosterone enanthate using 0.5 ml insulin syringe. RESULTS: A total of 22 patients were enrolled in the study. The mean trough was 14.48 +/- 3.14 nmol/L and peak total testosterone was 21.65 +/- 7.32 nmol/L. For the free testosterone the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. All of the patients delivered testosterone with ease and no local reactions were reported. CONCLUSION: Therapy with weekly subcutaneous testosterone produced serum levels that were within the normal range in 100% of patients for both peak and trough levels. This is the first report, which demonstrated the efficacy of delivering weekly testosterone using this cheap, safe, and less painful subcutaneous route.

Prevalence and predictors of microalbuminuria in patients with type 2 diabetes mellitus: a cross-sectional observational study in Oman.

AIM: To evaluate the prevalence and predictors of microalbuminuria in type 2 diabetics in Oman. METHODS: All patients attending an outpatient diabetic clinic at the Sultan Qaboos University Hospital between 2002 and 2003 were enrolled in the study. RESULTS: A total of 261 patients were included in this study. The mean overall age of the cohort was 50+/-13 years, and 57% were male. The proportion of subjects who had microalbuminuria was 27% (n=70; N=261). The logistic regression model indicated that significant predictors for the development of microalbuminuria include HbA(1c), log creatinine, and the presence of hypertension. A one unit increase in HbA(1c) was associated with a 23% increase in the odds of developing microalbuminuria (OR 1.23; 95% CI: 1.10-1.37; p<0.001). Additionally, patients that had a one unit increase in log creatinine were 5.72 times more likely to develop microalbuminuria (OR 5.72; 95% CI: 1.86-17.59; p=0.002). Furthermore, patients who were hypertensive were 2.37 times more likely to have microalbuminuria (OR 2.37; 95% CI: 1.11-5.09; p=0.026). CONCLUSIONS: The prevalence of microalbuminuria in patients with type 2 diabetes in this study was 27%. Significant predictors of microalbuminuria included HbA(1c), creatinine, and the presence of hypertension.

Insulin responses to the oral glucose tolerance test in women of different ethnicity with polycystic ovary syndrome.

OBJECTIVE: To evaluate insulin responses to the oral glucose tolerance test (OGTT) in women of different ethnic origins diagnosed with polycystic ovary syndrome (PCOS). METHODS: We evaluated 92 women diagnosed with PCOS. Their ethnic origins were Western European (n = 41), Middle Eastern (n = 18), African American (n = 15), East Indian (n = 9), and South American (n = 9). The clinical diagnosis of PCOS included at least 3 of the following symptoms: menstrual disturbances (amenorrhea or oligomenorrhea); ovulatory infertility, hirsutism, and elevated serum testosterone (> or = 2.0 nmol/L); or a luteinizing hormone/ follicle-stimulating hormone ratio of > or = 3. The diagnosis was also supported by ultrasonographic changes revealing the presence of multiple small antral follicles distributed peripherally. All investigations were performed after an overnight fast on days 2 through 5 of a spontaneous menstrual cycle or progesteroneinduced withdrawal bleeding. The women underwent an OGTT with a glucose loading of 75 g. The responses of glucose and insulin to the OGTT were analyzed as the area under the curve (AUC) and were calculated with the trapezoidal method. RESULTS: There were no significant differences in age or body mass index (BMI) among the different ethnic groups. All groups showed endocrine changes consistent with PCOS, but there were no differences in the hormonal levels among them. Middle Eastern women had higher AUC, glucose (P < 0.02; 95% confidence interval [CI], 0.5-3.5), and insulin (P < 0.04; 95% CI, 13.3-593.4) levels than did women with Western European origin. CONCLUSIONS: Middle Eastern women with PCOS expressed different insulin responses to OGTT than did Western European women, suggesting that Middle Eastern women with PCOS had poor carbohydrate metabolism.