Spectrum of Endocrine Disorders in Central Ghana

Background. Although an increasing burden of endocrine disorders is recorded worldwide, the greatest increase is occurring in developing countries. However, the spectrum of these disorders is not well described in most developing countries. Objective. The objective of this study was to profile the frequency of endocrine disorders and their basic demographic characteristics in an endocrine outpatient clinic in Kumasi, central Ghana. Methods. A retrospective review was conducted on endocrine disorders seen over a five-year period between January 2011 and December 2015 at the outpatient endocrine clinic of Komfo Anokye Teaching Hospital. All medical records of patients seen at the endocrine clinic were reviewed by endocrinologists and all endocrinological diagnoses were classified according to ICD-10. Results. 3070 adults enrolled for care in the endocrine outpatient service between 2011 and 2015. This comprised 2056 females and 1014 males (female : male ratio of 2.0 : 1.0) with an overall median age of 54 (IQR, 41–64) years. The commonest primary endocrine disorders seen were diabetes, thyroid, and adrenal disorders at frequencies of 79.1%, 13.1%, and 2.2%, respectively. Conclusions. Type 2 diabetes and thyroid disorders represent by far the two commonest disorders seen at the endocrine clinic. The increased frequency and wide spectrum of endocrine disorders suggest the need for well-trained endocrinologists to improve the health of the population

Thyroid scintigraphy in the management of benign thyroid disease

Thyrotoxicosis as a clinical entity has varied aetiologies. Accurate distinction of the underlying aetiology is important to guide therapy. Clinical findings are not always accurate in identifying the underlying aetiology. There is considerable overlap between the various aetiologies when using serum T3/T4 ratio. Although ultrasound is widely available and has reasonable sensitivity, it is operator dependent and misses many cases of early Grave's disease. 99mTc scintigraphy is a simple and accurate modality for assessing the functional status of the thyroid gland and delineating the aetiology of thyrotoxicosis. This paper seeks to inform on the use of thyroid scintigraphy in the management of benign thyroid disorders. Funding: None Keywords: Scintigraphy, thyroid gland, functional imaging, Grave’s disease, Ghan

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know

Cushing’s syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing’s syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing’s syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing’s syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines

Spectrum of Endocrine Disorders in Central Ghana

Background. Although an increasing burden of endocrine disorders is recorded worldwide, the greatest increase is occurring in developing countries. However, the spectrum of these disorders is not well described in most developing countries. Objective. The objective of this study was to profile the frequency of endocrine disorders and their basic demographic characteristics in an endocrine outpatient clinic in Kumasi, central Ghana. Methods. A retrospective review was conducted on endocrine disorders seen over a five-year period between January 2011 and December 2015 at the outpatient endocrine clinic of Komfo Anokye Teaching Hospital. All medical records of patients seen at the endocrine clinic were reviewed by endocrinologists and all endocrinological diagnoses were classified according to ICD-10. Results. 3070 adults enrolled for care in the endocrine outpatient service between 2011 and 2015. This comprised 2056 females and 1014 males (female : male ratio of 2.0 : 1.0) with an overall median age of 54 (IQR, 41–64) years. The commonest primary endocrine disorders seen were diabetes, thyroid, and adrenal disorders at frequencies of 79.1%, 13.1%, and 2.2%, respectively. Conclusions. Type 2 diabetes and thyroid disorders represent by far the two commonest disorders seen at the endocrine clinic. The increased frequency and wide spectrum of endocrine disorders suggest the need for well-trained endocrinologists to improve the health of the population

Graves Disease in Central Ghana: Clinical Characteristics and Associated Factors

Background Graves disease (GD) has increased in prevalence over the past decade in Africa. Despite this, the condition is not well described, especially in sub-Saharan Africa. Objective We have described the clinical characteristics and associated factors of GD in a cohort of patients attending a resource-limited setting tertiary hospital. Methods Patients were examined thoroughly and systematically tested for the degree of clinical and biochemical thyroid status. Thyroid volume, characteristics, and blood flow were assessed at presentation using ultrasonography. Factors associated with an inability to achieve clinical and biochemical thyroid remission were evaluated using multiple logistic regression analysis. Results Overall, 182 patients were studied, 152 (83.5%) were women with a female:male ratio of 5.1:1.0. The mean age at presentation was 39.9 ± 14.7 years with women significantly older than men. Thyroid-associated orbitopathy (TAO) was observed in 56% of the participants and pretibial myxoedema in 6%. About 84% of the participants were hyperthyroid at presentation, 9% were euthyroid, 4% were hypothyroid, and 3% had subclinical hyperthyroidism. Inability to achieve biochemical and clinical remission at 24 months was associated with increased thyroid volume (odds ratio [OR]: 2.35, 95% confidence interval [CI]: 1.85-2.52, P < .001), presence of TAO (OR: 2.15, 95% CI: 2.12-2.33, P < .001), increased FT3/FT4 ratio (OR: 1.33, 95% CI: 1.24-2.56, P = .004), and missed clinic appointment (OR: 5.2, 95% CI: 4.55-7.89, P < .001). Conclusions Graves disease among Ghanaians is associated with significant signs at presentation. Inability to achieve remission within the first 24 months is associated with increased thyroid volume, TAO, an increased FT3/FT4 ratio, as well as missed clinic appointment

The Effect of Thyroid Dysfunction on the Cardiovascular Risk of Type 2 Diabetes Mellitus Patients in Ghana

Background. Thyroid dysfunction is known to exaggerate the coronary heart disease (CHD) risk associated with type 2 diabetes mellitus (T2DM) among whites. The effect is yet to be studied among African populations. Methods. This is a cross-sectional study involving 780 T2DM patients enrolled in a diabetes clinic in Kumasi, Ghana. CHD risk was estimated using the Framingham and UKPDS risk scores. Risks were categorised as low (<10%), intermediate (10–19%), and high (≥20%). Associations between metabolic risk factors, thyroid dysfunction, and CHD risk were measured using Spearman’s partial correlation analysis while controlling for age and gender. Differences were considered statistically significant at p<0.05. Results. 780 T2DM patients (57.7% females), mean ± SD age of 57.4 ± 9.4 was analysed. The median (IQR) 10-year CHD score estimated using the Framingham and UKPDS risk engines for males and females was 12 (8–20), 9.4 (5.7–13.4), p<0.0001 and 3 (1–6), 5.8 (3.4–9.6), p<0.0001, respectively. Positive correlation was found between CHD risk and HbA1c, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and thyroid stimulating hormone. Conclusion. The presence of thyroid dysfunction significantly increased the CHD risk associated with T2DM patients in Ghana

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010–2015- a retrospective cohort study

Abstract Background Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana. Methods This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA. Results The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84–5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21–2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22–12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06–1.22, p < 0.001), male gender (HR: 3.50, CI:2.88–5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58–10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51–7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05–1.25, p = 0.03), hypertension (HR:1.14, CI:1.12–3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21–8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39–9.53, p < 0.001). Conclusion The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA