Specialized Diabetes and Endocrine Center

Riyadh, Saudi Arabia

Specialized Diabetes and Endocrine Center

Riyadh, Saudi Arabia
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Alkatari S.,King Khalid University | Aljohani N.,Specialized Diabetes and Endocrine Center | Aljohani N.,FOM Institute for Atomic and Molecular Physics
Clinical Medicine Insights: Case Reports | Year: 2012

Introduction: Pituitary tumors from lactotrope cells account for about 40% of all functioning pituitary cancers. Men tend to present with a larger, more invasive and rapid growth prolactinomas than women, possibly because hypogonadism features are less evident. Case report: A 27-year-old, previously asymptomatic Saudi man presented with a 3-day history of emesis with severe left-sided frontal headache, left face and right upper limb numbness, with signs of obstructive hydrocephalus. Brain Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a giant pituitary mass occupying several regions (sellar, infra-sellar, and supra-sellar) measuring 6.5 × 5.7 × 5.9 cm, and invading the sphenoid sinus as well as the cavernous sinuses bilaterally, with intra-pituitary hemorrhage compressing the third ventricle causing obstructive hydrocephalus. Prolactin levels were.200,000 mIU/L, consistent with invasive giant prolactinoma (IGP). He was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of IGP. Conclusion: This is a rare case of obstructive hydrocephalus with super-imposed intra-pituitary hemorrhage secondary to IGP, highlighting the importance of a full hormonal assessment for proper diagnosis and management. © the author(s), publisher and licensee Libertas Academica Ltd.

Hess K.,RWTH Aachen | Alzahrani S.H.,University of Leeds | Alzahrani S.H.,Specialized Diabetes and Endocrine Center | Price J.F.,University of Edinburgh | And 7 more authors.
Diabetologia | Year: 2014

Aims/hypothesis: Plasminogen activator inhibitor-1 (PAI-1) has been regarded as the main antifibrinolytic protein in diabetes, but recent work indicates that complement C3 (C3), an inflammatory protein, directly compromises fibrinolysis in type 1 diabetes. The aim of the current project was to investigate associations between C3 and fibrinolysis in a large cohort of individuals with type 2 diabetes. Methods: Plasma levels of C3, C-reactive protein (CRP), PAI-1 and fibrinogen were analysed by ELISA in 837 patients enrolled in the Edinburgh Type 2 Diabetes Study. Fibrin clot lysis was analysed using a validated turbidimetric assay. Results: Clot lysis time correlated with C3 and PAI-1 plasma levels (r=0.24, p<0.001 and r=0.22, p<0.001, respectively). In a multivariable regression model involving age, sex, BMI, C3, PAI-1, CRP and fibrinogen, and using log-transformed data as appropriate, C3 was associated with clot lysis time (regression coefficient 0.227 [95% CI 0.161, 0.292], p<0.001), as was PAI-1 (regression coefficient 0.033 [95% CI 0.020, 0.064], p<0.05) but not fibrinogen (regression coefficient 0.003 [95% CI -0.046, 0.051], p=0.92) or CRP (regression coefficient 0.024 [95% CI -0.008, 0.056], p=0.14). No correlation was demonstrated between plasma levels of C3 and PAI-1 (r=-0.03, p=0.44), consistent with previous observations that the two proteins affect different pathways in the fibrinolytic system. Conclusions/interpretation: Similarly to PAI-1, C3 plasma levels are independently associated with fibrin clot lysis in individuals with type 2 diabetes. Therefore, future studies should analyse C3 plasma levels as a surrogate marker of fibrinolysis potential in this population. © 2014 Springer-Verlag.

El-Kaissi S.,Specialized Diabetes and Endocrine Center | Wall J.R.,University of Sydney
Expert Opinion on Therapeutic Targets | Year: 2012

Introduction: The thyrotropin receptor (TSHR) is essential for thyroid growth and for the production of thyroid hormones. It is unique among the glycoprotein hormone receptors, in that some of the TSHRs undergo cleavage and shedding of the alpha subunit. Areas covered: This review discusses the structure and function of the TSHR, followed by an evaluation of its role in thyroid disease. Possible limitations of the TSHR as a therapeutic target are also discussed. Expert opinion: The TSHR is involved in a number of hereditary and acquired disorders of the thyroid making it of potential importance as a therapeutic target in thyroid disease. Expression of the TSHR in several non-thyroidal tissues and the development of systemic manifestations of thyroid disease suggest that the TSHR is also of interest as a therapeutic target outside the thyroid. © Informa UK, Ltd.

Alsubaie S.,King Faisal Specialist Hospital And Research Center | Almalki M.H.,Specialized Diabetes and Endocrine Center | Almalki M.H.,King Saud University
Clinical Medicine Insights: Case Reports | Year: 2014

Patients with invasive giant prolactinoma suffer from a constellation of symptoms including headache, blurred vision, lethargy, and sexual dysfunction. Cabergoline, a potent dopamine agonist, is a known medication prescribed for the treatment of invasive giant prolactinoma. Here, we report a case of invasive giant prolactinoma in a 52-year-old Saudi male with dramatic response to cabergoline treatment clinically, biochemically, and radiologically. © The authors, publisher and licensee Libertas Academica Limited.

Alshahrani F.,King Abdulaziz Medical City | Aljohani N.,Specialized Diabetes and Endocrine Center | Aljohani N.,King Saud bin Abdulaziz University for Health Sciences | Aljohani N.,King Saud University
Nutrients | Year: 2013

The plethora of vitamin D studies over the recent years highlight the pleomorphic effects of vitamin D outside its conventional role in calcium and bone homeostasis. Vitamin D deficiency, though common and known, still faces several challenges among the medical community in terms of proper diagnosis and correction. In this review, the different levels of vitamin D and its clinical implications are highlighted. Recommendations and consensuses for the appropriate dose and duration for each vitamin D status are also emphasized. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Alzahrani S.H.,University of Leeds | Alzahrani S.H.,Specialized Diabetes and Endocrine Center | Hess K.,University of Leeds | Hess K.,RWTH Aachen | And 9 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Diabetes is associated with increased incidence of atherothrombotic disease. The fibrin network forms the backbone of the arterial thrombus, and fibrin clot structure determines predisposition to cardiovascular events. Objectives: The aim of the study was to investigate fibrin clot structure/fibrinolysis in the largest type 2 diabetes cohort and analyze associations with cardiometabolic risk factors and vascular pathology. Design: Clot structure/fibrinolysis was assessed in 875 participants of the Edinburgh Type 2 Diabetes Study [age, 68 (range, 60-75) yr; 450 males] by turbidimetric assays, and clots were visualized by confocal microscopy. Four parameters of clot structure/fibrinolysis were analyzed, and plasma levels of fibrinogen and plasminogen activator inhibitor-1 were studied by Clauss assay and ELISA, respectively. Results: Clot maximum absorbance was increased in females compared with males (0.37 ± 0.005 and 0.34 ± 0.005 arbitrary unit, respectively; P ± 0.001), and took longer to lyse (803 ± 20 and 665 ± 12 sec, respectively; P < 0.001). These gender differences in clot structure and fibrinolysis were still evident after correcting for fibrinogen and plasminogen activator inhibitor-1 plasma levels. A prothrombotic fibrin structure profile was associated with increased body mass index and low levels of high-density lipoprotein in women and with inadequate diabetes control in men. Clot formation time was related to previous cardiac ischemic events in both men and women after adjusting for traditional risk factors [odds ratio, 1.22 (95% confidence interval, 1.07, 1.38); and 1.33 (1.15, 1.50), respectively], and prothrombotic clots were associated with low ankle brachial index, renal impairment, and smoking, regardless of gender. Conclusions: Women with type 2 diabetes have compact clots with compromised fibrinolysis compared with men. There are gender-specific associations between clotting parameters and cardiometabolic risk factors in this population, whereas vascular abnormalities, impaired renal function, and smoking are associated with prothrombotic clot structure profile regardless of gender. Copyright © 2012 by The Endocrine Society.

El-Kaissi S.,Specialized Diabetes and Endocrine Center | Wall J.R.,University of Sydney
Journal of Thyroid Research | Year: 2012

Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves' hyperthyroidism. Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves' disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement. Results. 31/39 patients had one or more enlarged EOM, of whom only 2 patients had clinical EOM dysfunction. Compared to Graves' disease patients with normal EOM volumes, those with EOM enlargement had significantly higher mean serum TSH (0.020 0.005 versus 0.007 0.002 mIU/L; P value 0.012), free-T4 (52.9 3.3 versus 41.2 1.7 pmol/L; P value 0.003) and technetium uptake on thyroid scintigraphy (13.51 1.7 % versus 8.55 1.6 %; P value 0.045). There were no differences between the 2 groups in anti-TSH-receptor antibody positivity, the proportion of males, tobacco smokers, or those with active ophthalmopathy. Conclusions. Patients with recently diagnosed Graves' disease and EOM volume enlargement have higher serum TSH and more severe hyperthyroidism than patients with normal EOM volumes, with no difference in anti-TSH-receptor antibody positivity between the two groups. © 2012 Samer El-Kaissi and Jack R. Wall.

El-Kaissi S.,Specialized Diabetes and Endocrine Center | Sherbeeni S.,Specialized Diabetes and Endocrine Center
Current Diabetes Reviews | Year: 2011

While lifestyle modifications and metformin are the cornerstone of the initial management of type 2 diabetes mellitus, there is an increasing array of second and third-line pharmacological agents for this condition. These include sulphonylureas, insulin, thiazolidinediones and alpha-glucosidase inhibitors, with the more recent addition of glucagonlike peptide-1 agonists, dipeptidyl peptidase-IV inhibitors and pramlintide. Moreover, insulin analogues that better simulate endogenous insulin secretion have been developed. This review aims to provide an update on the current pharmacological management of type 2 diabetes mellitus, and to highlight the benefits and limitations of each treatment. © 2011 Bentham Science Publishers.

Alsubaie S.,King Saud University | Almalki M.H.,Specialized Diabetes and Endocrine Center
Dermato-Endocrinology | Year: 2013

Acute pancreatitis frequently presents with abdomen pain but may presents with various skin manifestations as rashand rarely, pancreatic panniculitis. Metformin, one of the most effective and valuable oral hypoglycemic agents inthe biguanide class was linked to acute pancreatitis in few cases. Here, we report a case of metformin induce acutepancreatitis in young healthy man with normal renal function. © 2013 Landes Bioscience.

PubMed | King Abdulaziz University and Specialized Diabetes and Endocrine Center
Type: Journal Article | Journal: Journal of the Saudi Heart Association | Year: 2015

Dyslipidemia, a known cardiovascular risk factor, is extremely common among Saudis, both adults and children. The impact, however, of dyslipidemia and several other lipid disorders in patients with congestive heart failure in this particular population has not been documented. This study aims to fill the gap.This retrospective, single center study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Of the 500 cases seen during the period between 2002 and 2008, 392 were included in the study. Charts were reviewed and information on medical history, medications, and lipid status were documented.Low HDL-cholesterol level was the most common lipid disorder with 82.9%, followed by hypertriglyceridemia (35.2%), atherogenic dyslipidemia (27.8%), and hypercholesterolemia (9.2%). Diabetes mellitus was the single most significant predictor of mortality (p=0.001). Among the lipid disorders, only low levels of HDL-cholesterol contributed to significant mortality risk [OR 1.29 (Confidence Interval 1.04-1.59) (p-value<0.01)] adjusted for age, gender and statin use.The results of this study suggest that emphasis should be on the elevation of HDL-cholesterol levels among subjects with congestive heart failure, without compromising any ongoing management of LDL-lowering drugs. Management should not be limited to conventional statin use and should promote other treatments to elevate HDL-cholesterol levels.

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