Review of Literature

Abstract Prolactin (PRL) secreting adenomas are the most common secreting pituitary tumors, accounting for approximately 45% of all pituitary tumours. Giant prolactinomas are a rare subset of macroadenomas, characterized by large size (more than 40 mm in diameter (an arbitrary size), high aggressiveness and massive extrasellar involvement. We describe an unusual giant prolactin producing macroadenoma of pituitary gland in female patients with type 2 diabetes mellitus and its response to cabergoline

Prevalence of diabetes mellitus in a Saudi community

<b>Background and Objectives :</b> Quantifying the prevalence of diabetes mellitus is important to allow for rational planning and allocation of resources. Therefore, we designed this study to determine the prevalence of diabetes among Saudi nationals. <b>Design and Setting :</b> A cross-sectional study among patients attending a primary care clinic in June 2009. <b>Patients and Methods :</b> Patients were interviewed with structured questionnaires to determine the presence of diabetes by questioning for history of the disease, and charts were reviewed to document any diabetic therapies that the patients may have undergone in the past or were undergoing at that time. <b>Results</b> : Of 6024 subjects, diabetes mellitus was present in 1792 (30&#x0025;) patients. The mean (SD) age of the patients was 55.3 (13.2) years. The prevalence of diabetes was 34.1&#x0025; in males and 27.6&#x0025; in females (<i>P</i>&lt;.0001). The mean (SD) age for onset of diabetes in males and females was 57.5 (13.1) and 53.4 (13.1) years, respectively (<i>P</i>&lt;.0001). Females &lt;50 years old had a higher prevalence than males in the corresponding age range-34.1&#x0025; and 25.1&#x0025;, respectively (<i>P</i>&lt;.0001). The prevalence of diabetes decreased in patients older than 70 years. The prevalence of body mass index of &#8805;25 was 72.5&#x0025;. Among patients with diabetes, the prevalence of body mass index of &#8805;25 was 85.7&#x0025; (<i>P</i>&lt;.0001). There was a higher prevalence of obesity (body mass index, &#8805;25) in females (87.7&#x0025;) as compared to males (83.1&#x0025;) (<i>P</i>=.008). <b>Conclusion</b> : The prevalence of diabetes is high among the Saudi population and represents a major clinical and public health problem. A national prevention program to prevent diabetes and address the modifiable risk factors at the community level, targeting high-risk groups, should be implemented soon

Glycogen hepatopathy in a 13-year-old male with type 1 diabetes

Glycogenic hepatopathy (GH ) is a rare cause of serum transaminase elevations in type 1 diabetes mellitus. We describe a 13-year-old male with a history of poorly controlled type 1 diabetes mellitus who presented with hepatomegaly and severe transaminase flares. Liver histology confirmed GH. Treatment consists of improving glycemic control. Hepatomegaly due to excess glycogen storage in poorly controlled type 1 diabetics has been associated with younger patients with poor glycemic control, occurring about 2-4 weeks after starting insulin treatment, and resolving upon glucose stabilization. We conclude that glycogenic hepatopathy can cause hepatomegaly and significant transaminase elevations in individuals with type I diabetes mellitus, The recovery of severe transaminase elevations in this patient illustrates the more benign course of GH, which is a condition with a far better prognosis. Clinician awareness of GH should prevent diagnostic delay and will provide better insight into the prevalence of GH

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline