Hypocalcemia in Pregnancy: A Clinical Review Update.

Though hypocalcemia in pregnancy is not often reported in the literature, it occurs in cases of hypoparathyroidism and in mothers with severe dietary inadequacy. Hypocalcemia during pregnancy can pose numerous problems to the mother and fetus. It is associated with hypertensive disorders and can increase the risk of numerous problems such as preeclampsia and fetal growth disorders. In this review, we summarize the challenges physicians face diagnosing and managing hypocalcemia during pregnancy. A multidisciplinary team including endocrinologists and obstetricians is warranted to ensure appropriate treatment and optimal outcomes.

Management of acromegaly: an exploratory survey of physicians from the Middle East and North Africa.

BACKGROUND: Worldwide variations exist in the diagnosis and management of patients with acromegaly. For such a rare condition, the knowledge and perception of physicians would most likely direct the care of patients. However, the adherence of physicians in non-Western regions to guidelines for the diagnosis and management of acromegaly has not been previously ascertained. METHODS: An online survey was conducted to assess the perceptions and practice of physicians regarding acromegaly diagnosis and management as per international guidelines. An electronic questionnaire containing key questions was mailed, initially to physicians in Saudi Arabia (KSA) and later to other countries in the Middle East and North Africa (MENA) region. Additional questions were included to ensure the relevance of the respondents' replies. The responses were captured and summarized anonymously. Descriptive comparisons were made with two similar international and national surveys from other regions. RESULTS: Two hundred forty-seven doctors responded to the survey. Of these, 155 (64.5%) fulfilled the inclusion criteria and, in particular, confirmed having treated acromegaly patients in the previous 12 months, and they constituted the basis of this study. The three most common referring specialties for patients were internists (44; 28.4%), neurosurgeons (46; 29.6%), and family medicine physicians (42; 27.1%), respectively. The combination of growth hormone (GH) nadir during the oral glucose tolerance test (OGTT) and elevated insulin-like growth factor-1 (IGF-1) levels was used by 99 physicians (63.9%) to diagnose acromegaly. The main determinant for treatment choice was tumor mass characteristics confirmed by 117 respondents (75.5%) with neurosurgery as first treatment choice confirmed by 124 respondents (80%). Combined measurement of IGF-1 and GH levels after OGTT at 3 months after surgery was the most widely used criterion for assessment of surgical outcomes, confirmed by 82 physicians (52.9%). The biggest barriers to optimal management of acromegaly as perceived by 38.1% and 35.5% of the respondents were high cost of medications and lack of physicians' awareness, respectively. CONCLUSIONS: The majority of the surveyed physicians reported variable adherence to the international acromegaly guidelines. Clearly, higher awareness is needed among physicians for early diagnosis and timely referral for specialist management.

Association of Glycosylated Hemoglobin Levels With Vitamin D Status.

BACKGROUND: The discovery of vitamin D is one of medicine's great achievements. Despite all the positive evidence emerging about the beneficial effect of vitamin D, we still find many are vitamin D deficient. The purposes of this study were to examine the association between serum 25-hydroxyvitamin D (25(OH)D) and glycosylated hemoglobin (HbA1c) levels, to test the hypothesis that lower 25(OH)D levels are associated with poorer glucose control in diabetes mellitus (DM) patients and to investigate the effect of vitamin D supplementation on HbA1c levels. METHODS: This was a prospective observational cohort study of all patients with type 1 and type 2 diabetes (above 12 years) who attended the outpatient clinics of a tertiary center in Riyadh. HbA1c and vitamin D levels were recorded prior to supplementation and after 9 months of supplementation with vitamin D. All patients were divided into four groups according to their vitamin D level and an association between 25(OH)D and HbA1c was tested. RESULTS: Results showed that 73.1% of the patients had 25(OH)D levels < 50 nmol/L. We observed lowering of HbA1c after vitamin D supplementation (from mean HbA1c of 10.55 to 7.70). We found HbA1c to be inversely related to serum vitamin D levels (r = -0.14 (P < 0.0000002) before supplementation and -0.16 (P < 0.000001) after supplementation with vitamin D). CONCLUSIONS: Advising patients with higher HbA1c to test their vitamin D level and correct any deficiency will result in better blood glucose control and benefit the patient's overall health.

Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study.

CONTEXT: Diabetes in pregnancy (DIP) is either pregestational or gestational. AIMS: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. SETTINGS AND DESIGN: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. SUBJECTS AND METHODS: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. STATISTICAL ANALYSIS USED: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. RESULTS: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. CONCLUSIONS: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception.

Clinical and Biochemical Characteristics of Diabetes Ketoacidosis in a Tertiary Hospital in Riyadh.

Diabetes is the fifth leading cause of death worldwide. Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes. The aim of this study is to investigate the clinical and biochemical characteristics of DKA among 400 patients admitted to hospital, most of whom had type 1 diabetes (n = 372; 93%). Vomiting (n = 319; 79.8%), nausea (n = 282; 70.5%), and abdominal pain (n = 303; 75.8%) were the presenting symptoms most commonly experienced by the patients. Tachycardia was the most common clinical sign noted in the patients on admission (n = 243; 61.8%). The predominant precipitating cause of DKA was noncompliance to an insulin regimen (n = 215; 54.2%). Recurrent DKA admissions in type 1 diabetes patients was higher than those with type 2 diabetes (n = 232 versus n = 9, respectively; P = 0.002). Recurrent DKA admissions in female patients were higher than in male patients (n = 167 versus n = 74, respectively; P = 0.002). Continued diabetic education (given to n = 384; 94%) and counseling on the importance of adhering to the recommended medical regime, addressing the social and cultural barriers that precipitate DKA, as well as the provision of timely medical attention may greatly reduce DKA episodes and their associated complications.

Differences and associations of metabolic and vitamin D status among patients with and without sub-clinical hypothyroid dysfunction.

BACKGROUND: Sub-clinical hypothyroid dysfunction, a relatively understudied disorder in the Kingdom of Saudi Arabia (KSA), has significant clinical implications if not properly monitored. Also from KSA, more than 50% of the population suffer from hypovitaminosis D (<50 nmol/l). In this cross-sectional case-control study, we described the differences and associations in the metabolic patterns of adult Saudis with and without hypothyroid dysfunction in relation to their vitamin D status, PTH, calcium and lipid profile. METHODS: A total of 94 consenting adult Saudis [52 controls (without subclinical hypothyroidism), 42 cases (previously diagnosed subjects)] were included in this cross-sectional study. Anthropometrics were obtained and fasting blood samples were taken for ascertaining lipid and thyroid profile, as well as measuring PTH, 25(OH) vitamin D and calcium. RESULTS: Cases had a significantly higher body mass index than the controls (p < 0.001). Circulating triglycerides was also significantly higher in cases than the controls (p = 0.001). A significant positive association between HDL-cholesterol and PTH (R = 0.56; p = 0.001), as well as a negative and modestly significant negative association between LDL-cholesterol and PTH (R = - 20.0; p = 0.04) were observed. FT3 was inversely associated with circulating 25 (OH) vitamin D (R = -0.25; p = 0.01). CONCLUSIONS: Patients with hypothyroid dysfunction possess several cardiometabolic risk factors that include obesity and dyslipidemia. The association between PTH and cholesterol levels as well as the inverse association between vitamin D status and FT3 needs to be reassessed prospectively on a larger scale to confirm these findings.