Reliability of adrenal computed tomography in predicting the functionality of adrenal incidentaloma.

BACKGROUND: Adrenal incidentaloma (AI) is an adrenal mass discovered accidentally during abdominal or chest imaging techniques not aimed to adrenal gland assessment. Guidelines suggested confirming the benignity of AI radiologically and excluding hormonal dysfunctions. This study evaluated the reliability of computed tomography (CT) scan radiological parameters in predicting the functionality of AI. PATIENTS AND METHODS: A cross-sectional study performed in Faiha Specialized Diabetes, Endocrine and Metabolism Centre from July 2017 to July 2018, involving 38 patients (23 females [60.5%]) harbouring 43 AI referred for evaluation. For all patients, we assessed history, physical examination, radiological parameters of AI by CT scan (native Hounsfield unit [HU]), maximum diameter and absolute percentage washout [APW] and blood investigations (glycated haemoglobin, adrenocorticotropic hormone, aldosterone, renin, aldosterone/renin ratio, normetanephrine, metanephrine, dehydroepiandrosterone sulphate, cortisol and 1 mg overnight dexamethasone suppression test). RESULTS: Native CT adrenal HU ≥18.5 was statistically significant seen in most functional AI (FAI) (P = 0.006), especially in patients with mild autonomous cortisol excess (MACE) and pheochromocytoma (PCC) with P = 0.02 in both. Maximum diameter was significantly high (≥40 mm) in PCC and congenital adrenal hyperplasia (CAH) (P = 0.018 and 0.008, respectively). APW was significantly < 60% only in PCC (P = 0.02). CONCLUSIONS: Native HU was the most significant radiological parameter in predicting the functionality of FAI, MACE and PCC, but not in CAH and aldosterone-producing adenoma. The maximum diameter was significant in predicting the PCC and CAH, whereas the APW was significant in predicting PCC only.

How Biotin Induces Misleading Results in Thyroid Bioassays: Case Series.

Biotin is widely available over the counter in different doses and is used medically in the management of hair and nail problems. Recent literature suggested the use of high doses of biotin for the treatment of progressive multiple sclerosis. We present four cases that show a misleading increase in thyroid function tests toward a false diagnosis of Grave's disease after the administration of 20-30 mg biotin for different periods. All the four cases are free of the signs and symptoms of hyperthyroidism, and all of their results returned to baseline values within 24-48 hours after biotin withdrawal. The assemblage of these cases, thyroid assay results, and biotin doses had occurred by chance, with no selection bias, and they represented all cases of biotin interference with thyroid assays in our center during this year. The first case is a 23-year-old female who was diagnosed with Grave's disease during a routine checkup after she ingested a prescribed 20 mg biotin per day for three months for excessive hair fall. The second case is a 19-year-old female with hair and nail problems associated with iron deficiency anemia. She administered a self-prescribed biotin dose of 20 mg a day for a month. She asked an endocrinologist's opinion about a recent increase in her thyroid function tests, with no signs of hyperthyroidism. The third case is a 45-year-old man with near-total thyroidectomy for retrosternal multinodular goiter with compressive symptoms. His usual levothyroxine dose had been decreased from 100 to 50 microgram per day, after which he felt unwell and gained four kilograms, with signs and symptoms of hypothyroidism. His investigations were consistent with hyperthyroidism while his signs were of hypothyroidism, which was illogical. He was administered 30 mg medically prescribed biotin for nail changes due to recently diagnosed psoriasis. The fourth case is that of one of the authors who volunteered to take 30 mg of biotin daily for one week. His initial investigations were in the normal range but changed within this period to be Grave's disease-like, with no signs or symptoms. In conclusion, the ingestion of 20 mg or more of biotin may lead to a clinically relevant thyroid assay interference. The clinicians must take this point in consideration before assessing the results of any thyroid function tests.

A feasibility study of mobile phone text messaging to support education and management of type 2 diabetes in Iraq.

BACKGROUND: We undertook a feasibility study to evaluate feasibility and utility of short message services (SMSs) to support Iraqi adults with newly diagnosed type 2 diabetes. SUBJECTS AND METHODS: Fifty patients from a teaching hospital clinic in Basrah in the first year after diagnosis were recruited to receive weekly SMSs relating to diabetes self-management over 29 weeks. Numbers of messages received, acceptability, cost, effect on glycated hemoglobin (HbA1c), and diabetes knowledge were documented. RESULTS: Forty-two patients completed the study, receiving an average 22 of 28 messages. Mean knowledge score rose from 8.6 (SD 1.5) at baseline to 9.9 (SD 1.4) 6 months after receipt of SMSs (P=0.002). Baseline and 6-month knowledge scores correlated (r=0.297, P=0.049). Mean baseline HbA1c was 79 mmol/mol (SD 14 mmol/mol) (9.3% [SD 1.3%]) and decreased to 70 mmol/mol (SD 13 mmol/mol) (8.6% [SD 1.2%]) (P=0.001) 6 months after the SMS intervention. Baseline and 6-month values were correlated (r=0.898, P=0.001). Age, gender, and educational level showed no association with changes in HbA1c or knowledge score. Changes in knowledge score were correlated with postintervention HbA1c (r=-0.341, P=0.027). All patients were satisfied with text messages and wished the service to be continued after the study. The cost of SMSs was €0.065 per message. CONCLUSIONS: This study demonstrates SMSs are acceptable, cost-effective, and feasible in supporting diabetes care in the challenging, resource-poor environment of modern-day Iraq. This study is the first in Iraq to demonstrate similar benefits of this technology on diabetes education and management to those seen from its use in better-resourced parts of the world. A randomized controlled trial is needed to assess precise benefits on self-care and knowledge.