Short stature in Saudi Arabia: etiologic profile in adult endocrine clinic.

BACKGROUND: To determine causes of short stature (SS) in adult endocrine service at a Saudi Arabian tertiary center. METHODS: A retrospective analysis was made of data from 104 subjects who were primarily evaluated for causes of SS in the endocrinology unit of King Khalid University Hospital Riyadh from January 1 997 to December 2006. RESULTS: Growth hormone deficiency (GHD) and normal variant short stature (NVSS) were the leading causes of SS contributing 90 subjects (86%; 43% for each), followed by celiac disease in 4 subjects (4%). Other etiologies of short stature included primary hypothyroidism, diabetes mellitus, and Turner's syndrome (2% each). CONCLUSION: We conclude that GHD and NVSS are the commonest causes of SS in Saudi Arabia. In view of the need to differentiate the two major etiologies, it is suggested that growth hormone stimulatory tests be conducted on all patients with SS associated with delayed bone age. Further prospective study in a larger population is needed to characterize this finding.

Graves' disease in Saudi Arabia: a ten-year hospital study.

OBJECTIVE: To determine clinical manifestation and mode of treatment of Graves' disease at King Khalid University Hospital Riyadh, Saudi Arabia. METHODS: A retrospective study of all cases of Graves' disease diagnosed at the hospital in the period between January 1995 and December 2004, who received a minimum of two years treatment were included in the study. RESULTS: A total of 194 patients were seen with female: male ratio of 2.9:1 and mean age of 32 +/- 0.9 years. Sixty nine percent of the patients had positive thyroid antibodies. Palpitations, tremors, weight loss and nervousness were the most common presenting manifestations. Forty nine percent of patients were treated with radioiodine, 38% with antithyroid drugs, and 13% underwent subtotal thyroidectomy. CONCLUSION: Clinical manifestations of Graves' disease in our patients distinctly differed from those reported in the West and Pacific Islanders with notable rarity of pretibial myxoedema and hyperpigmentation respectively. We also noted higher male to female ratio and an increasing utility of radioactive iodine therapy while use of antithyroid drugs and surgery are declining.

Growth hormone deficiency short stature in a third world adult endocrine clinic: usefulness of clonidine test in its diagnosis.

BACKGROUND: Short stature (SS) can be treatable; yet the diagnostic value of a simple test in correctly identifying the two common etiologies in developing countries, viz., growth hormone deficiency (GHD) and normal variant short stature (NVSS), has not been reported in a typical third world population. OBJECTIVES: The aim of the study was to evaluate the reliability of clonidine test in differentiating short stature caused by GHD from NVSS. SETTINGS AND DESIGN: Data of subjects evaluated for growth hormone deficiency SS at a Saudi Arabian university hospital were retrospectively reviewed. MATERIALS AND METHODS: Clonidine and insulin tolerance tests (ITT) were conducted on 60 subjects aged 12 years and above with SS, while peak stimulated growth hormone cut off value of < 10 microg/l was used to diagnose GHD. STATISTICAL ANALYSIS: Sensitivity and specificity for clonidine test and ITT were computed, while receiver operator characteristic (ROC) curves were constructed from the results in order to assess the diagnostic usefulness of the two tests. Mann-Whitney test was used to determine level of significance. RESULTS: Clonidine test showed superior sensitivity and specificity, viz., 81% and 82%, as against 65% and 59% for ITT respectively. Overall, the efficiency of clonidine test in correctly differentiating short stature caused by GHD from NVSS was higher, viz., 90%, compared to ITT's 77%. CONCLUSIONS: Clonidine test proved to be an excellent test for initial assessment of GHD and may be used as a screening test for short stature in third world countries.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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 Cushingâs 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). CONCLUSIONS: 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.

OBJECTIVE: To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. METHODS: 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. RESULTS: 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). CONCLUSION: 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.