The risk of complications from type 2 diabetes mellitus (T2DM) is high. Achieving targets reduces the morbidity and mortality. This study aims to assess whether patients at the Helen Joseph Hospital's Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes. Methods: A retrospective clinical audit was carried out. The files of 321 patients with T2DM were reviewed. Glycated haemoglobin (HbA1c), blood pressure, abdominal circumference and lipograms were assessed. Results: The study population comprised majority black (n = 143; 44.6%) and coloured (n = 109; 34%) patients and was predominantly female (n = 200; 62.3%). The mean age was 59.4 years (SD 9.9 years). In total, 89.1% (n = 286) had hypertension, and 82.2% (n = 264) dyslipidaemia. The metabolic syndrome criteria were fulfilled by 266 (91.2%) patients. The majority did not exercise (n = 174; 56.3%). A small number smoked (n = 39; 12.5%) and used alcohol (n = 33; 10.6%). Mean HbA1c was 9.5% (SD 2.4; range 3.9-16.9%). Only 49 (15.3%) achieved the target HbA1c. Target blood pressure was achieved by 72 patients (25%). LDL target was achieved by 71 (22.6%) and abdominal circumference by 32 (11%) patients. Conclusions: Despite adequate protocols and access to tertiary medical care, a very small percentage of patients are achieving proposed targets. The reasons for this are likely multi-fold and further analysis is required to assess these.
Paraneoplastic or ectopic Cushing’s syndrome (CS) is a rare cause of endogenous hypercortisolism. It is due to ectopic adrenocorticotropic hormone (ACTH) secretion and has been reported in association with a variety of neuroendocrine tumors such as small-cell lung carcinoma, carcinoid tumors, and medullary carcinoma of the thyroid. Paragangliomas (PGLs) are rare neuroendocrine tumors that can secrete catecholamines. Case reports and reports of ectopic ACTH secretion from metastatic PGLs causing CS are exceedingly rare. We present a case of a 38-year-old female, who presented with typical signs, symptoms, and complications of CS, secondary to a PGL with widespread metastases, which eventually led to her demise.
A germline mutation is identified in almost 40% of Pheochromocytoma-Paraganglioma (PPGL) Syndromes. Genetic testing and counselling are essential for the management of index cases as well as pre-symptomatic identification and pre-emptive management of affected family members. Mutations in the genes encoding the mitochondrial enzyme succinate dehydrogenase (SDH) are well described in patients with hereditary PPGL. Amongst patients of African ancestry the prevalence, phenotype, germline mutation spectrum and penetrance of SDH mutations is poorly characterized. We describe a multifocal paraganglioma in a young African male with an underlying mis-sense SDHB mutation, with a history of three first-degree relatives who demised at young ages from suspected cardiovascular causes. The same SDHB mutation, Class V variant c.724C>A p.(Arg242Ser), was detected in one of his asymptomatic siblings. As there is limited data describing hereditary PPGL syndromes in Africa this report of an SDHB associated PPGL is a notable contribution to the literature in this growing field. Due to the noteworthy clinical implications of PPGL mutations, it highlights the existing need for broader genetic screening amongst African patients with PPGL despite the limited healthcare resources available in this region.
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