Medicine- Conference papers

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    Open Access
    Cushing's syndrome in a female with short stature: a case report
    (Association of Clinical Endocrinologists of Nigeria, 2023-04-29) Obijinmi, Boluwatife; Olopade, O.B; Odeniyi, I.A; Fasanmade, O.A
    Cushing’s syndrome is a rare endocrine disorder that occurs when the body produces too much cortisol, a hormone that is produced by the adrenal glands. It results from chronic exposure to high levels of glucocorticoids. It can be caused by external sources such as glucocorticoid medication or internal factors such as an adrenal or pituitary gland tumour. When seen in children or adolescents, it tends to affect growth and development with a myriad of complications. AIM: A rare case of Cushing’s syndrome in a female Nigerian adolescent manifesting A 20-year-old female Nigerian diagnosed with Cushing’s syndrome 5 years ago at LASUTH, presented with worsening generalized body pains which had been gradual and continuous, causing limitation to movement, there was associated headache, photophobia, decline in vision, menstrual irregularities, marked weight gain with round moon facies, poor wound healing, polyuria, polydipsia, paresthesia on the hands, occasional frothiness of urine, fatigue, recurrent itchy skin rashes, palpitations. Her height-1.45m, weight-65kg, BMI–30.9kg/m2, WC-110cm. 24-hour Urine Free Cortisol (UFC): 806.06 (3.5-45ug/24hr). Fasting 8 am Cortisol: 558.94(240-618)nmol/l. Random serum cortisol: 501.42nmol/l (<276nmol/l). ACTH: <5.00 (0-46pg/ml). HbAIc: 6.94%. FBS: 7.07mmol/l, 2HPP: 9.57mmol/l. Pituitary MRI, chest, and abdominopelvic CT scan revealed no abnormalities. Lumbosacral MRI reviewed osteoporosis and moderate insufficiency fracture of L2 and L4 vertebral bodies. She was commenced on Metformin 500mg b.d & Alendronate 70mg weekly. CONCLUSION This report highlights the rare occurrence of Cushing’s syndrome in a female adolescent. Therefore, early detection and prompt intervention are crucial in management.
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    Open Access
    Cardiovascular outcomes in long-term testosterone replacement therapy among men with late-onset hypogonadism and functional hypogonadism: systematic review.
    (Association of Clinical Endocrinologists of Nigeria, 2023-04-29) Olopade, O.B.; Odeniyi, I.A.; Adejumobi, S.; Ijeh, I.N.; Fasanmade, Olufemi Adetola; Kalhan, A.
    There is a worldwide increase in the prescription and use of Testosterone replacement therapy (TRT) in managing cases of hypogonadism with the dearth of evidence on long-term cardiovascular safety on the use of TRT in men with Late-Onset and functional hypogonadism. This systematic review seeks to establish whether long-term use of TRT is safe. METHODS An extensive systematic review was done using the preferred reporting items for systematic reviews and meta-analysis (PRISMA 2020) set of standard checklists. Six databases which are Embase, Wiley Library. Scopus, PubMed, Google Scholar and Cochrane Database of Systematic Reviews were the sites used for the journal retrieval. Distiller-SR software program was employed to screen the journal titles and abstracts, remove journal duplicates, and data extraction for the articles that met the eligibility criteria. RESULTS Twenty-three publications (10 RCTs and 13 cohort studies) that met the eligibility criteria were included in the review with a total of 102,139 participants involved. Only seven of the included Journal articles reported Major Adverse Cardiovascular Events (MACE), which is a composite of nonfatal stroke, nonfatal myocardial infarction and cardiovascular death as part of their outcome measures but many had measures on cardiovascular risk factors benefits and/or adverse effects. CONCLUSION Long-term use of TRT seems to have some cardiovascular benefits in men with LOH and FH when safe practices are followed. Testosterone therapy should be used with caution in hypogonadal men with underlying or established cardiovascular disease.
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    Open Access
    Management of adult male hypogonadism
    (Endocrinology and metabolism society of Nigeria, 2023-03-24) Fasanmade, O.A.
    Adult male hypogonadism is a common condition worldwide. Its prevalence increses from 2.1% in middle aged men to 38.7% in elderly males. There are 2 main types hypergonadotrophic and hypogonadotrophic hypogonadism based on the level of the gonadotrophins (FSH and LH). Hypogonadotrophic type could be due to congenital, acquired causes or due to complications of systemic diseaes like diabetes mellitus, renal or hepatic failure. Most hypogonadotrophic hypogonadism cases present with low libido and poor erections. There are other metabolic derangements that accompany it. The main stay of this type of hypogonadism is testosterone replacement therapy.There are other treatment options such as use of selective estrogen receptor modulators, DHEAs amongst others
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    Open Access
    Relationship between gestational diabetes mellitus and incidence of post-delivery dysglycaemia
    (Bioscientifica, 2022-11) Udo, C; Olopade, O.B; Odeniyi, I.A; Fasanmade, O.A
    Background Gestational diabetes mellitus (GDM) is defined as glucose intolerance resulting in hyperglycaemia of variable severity, with onset or first recognition during pregnancy. GDM is a risk factor for dysglycaemia in later life. The objective of the study was to determine the impact of GDM on glucose tolerance in the short term post-delivery in a cohort of women who attended the Lagos University Teaching Hospital (LUTH) Study Design This was a prospective observational study. Methods One hundred and twenty-eight pregnant women who attended LUTH antenatal clinics and who had no history of pre-gestational glucose intolerance were recruited in the first trimester of pregnancy. Pertinent data were collected via a questionnaire. The participants underwent a 75g oral glucose tolerance test (OGTT) at 24-28 weeks gestational age. Venous plasma glucose was measured viathe glucose oxidase method. GDM was diagnosed using the World Health Organization (WHO) 2013 criteria. The participants were followed up and OGTT repeated at 6-12 weeks post-delivery. Statistical Analysis Descriptive statistics were presented using mean and standard deviation. P-value %0.05 was considered statistically significant. Results Among the participants with GDM, the incidence rate of dysglycaemia at 6-12 weeks post-delivery, was 333 per 1000 person-years. Impaired glucose tolerance (IGT) was the most common (77.8%) dysglycaemia observed. Presence of hypertension (PZ0.004) and use of insulin during pregnancy (PZ0.024) were significantly associated with post-delivery dysglycaemia. Conclusions GDM had a significant impact on the incidence of dysglycaemia in the short-term, 6- 12 weeks post-delivery, in women who accessed care at LUTH. Hypertension and the requirement of insulin for glucose control increased the likelihood of abnormal glucose metabolism following delivery, in a pregnancy complicated by GDM. Keywords: Gestational diabetes mellitus, post-delivery dysglycaemia, Lagos
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    Open Access
    Intermediate metabolic states and diabetes mellitus in an urban Nigerian population
    (AACE, 2015) Enang, O; Otu, A; Essien, O; Fasanmade, O.A; Ohwovoriole, A.E
    Objective: Although the transition from Intermediate metabolic states including impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) that precede diabetes may take many years; current estimates indicate that many individuals with these intermediate states eventually develop diabetes. Since both categories identify individuals at risk for diabetes, the identification of individuals at risk for diabetes represents a strategic tool to prevent diabetes since the magnitude of the epidemic, coupled with the complex treatment requirements are difficult and costly to implement in both developing and developed countries. Methods: The study was a cross sectional survey of a representative sample of Calabar metropolis comprising 645 males (56.9%) and 489 females (43.1%) aged between 15 and 79 years. A multistage sampling method was applied to select participants for the study. Anthropometric data was obtained and an oral glucose tolerance test (OGTT) was performed on all participants following which participants were categorized as normal glucose tolerance (NGT), IFG, IGT and diabetes mellitus (DM). Anthropometric indices were expressed as mean (standard deviation). The categorisation was done using American Diabetes Association (ADA) classification (2003) and the result in percentages. Results: The prevalence of IFG was 8.8% (male 9.3%, female 8.2%), IGT 19.6% (male 21.1%, female 17.6%), isolated IFG 19% (male 17.2%, female 21.5%), isolated IGT 8.5% (male 9.8%, female 6.7%), combined IFG/IGT 4.5% (male 4.2%, female 4.9%), DM 6.5% (male 7.9%, female 4.7%). Discussion: A number of studies have recently tried to determine whether IGT or IFG is a better predictor of future diabetes. Although there are some differences between the studies, the following general conclusions may be drawn. The incidence of subsequent diabetes is highest in individuals with combined IGT and IFG. It tends to be similar in those with isolated IFG (I-IFG) and I-IGT, although there may be differences in some populations suggesting a higher incidence in those with I-IFG. However, because in most populations I-IGT is much commoner than I-IFG, it identifies a greater proportion of those who will develop diabetes. A substantial minority, well over a third, of individuals who develop diabetes have normal glucose tolerance at baseline. Conclusion: Identification of individuals with intermediate metabolic states is a necessary strategy for the prevention of diabetes mellitus given the high prevalence of individuals with IGT.