Clinical proceedings of Pakistan Endocrine Society’s 14th annual conference-III


 Clinical proceedings of Pakistan Endocrine
Society’s 14th annual conference-III

ISLAMABAD: The first session on the third day of Pakistan Endocrine Society’s 14th annual conference held here from November 18-20, 2016 was chaired by Prof. Zaman Sheikh from Karachi. It was devoted to Bone and Mineral Disorders. Dr. Atif Munir was the first speaker who spoke on DEXA Bone Densitometry: Indications and interpretation. He pointed out that one should not treat the patient unless there is fracture. Vertebral fractures are most common. Hip fractures come next.  Patients with rheumatoid arthritis, liver, renal disorders, diabetes mellitus and Vitamin D deficiency should be screened for osteoporosis. He also talked about hyperthyroidism and hypothyroidism, Cushing’s syndrome and history of bone mineral density. DEXA Scan, it was stated, was the best investigation, it has minimal radiation and it is recommended by WHO but it should not be performed in children and men less than fifty years of age.

Dr. Ali Asghar talked about emerging therapies in osteoporosis. He highlighted the importance of life style measures, prevention from fall, stopping smoking, use of calcium and Vitamin D supplements, bisphosphonates, calcitonin and anabolic therapy. Efficacy, safety of these drugs, concerns of the patients, cost of drugs and patient’s affordability were also discussed in detail. He suggested that one should start with oral bisphosphonates. Long term safety data is available but one has to be careful about adverse effects. He then talked about indications for Denosumab therapy which is not considered initial therapy in most patients. One injection after six months is enough. Tibolone was another agent but there is risk of stroke.

Prof. Saeed Mahar chairing one of the scientific sessions during the PES annual conference held at Islamabad
while photographed during the conference from (L to R) are Prof. A.H. Amar, Dr. Faisal Masood 
and Dr. Asad Abbas from OBS Pakistan.

Prof. Najmul Islam from AKUH made a presentation on management of PTH mediated hypercalcemia. He discussed in detail the clinical features, causes, pathophysiology, approach to treatment and management. He pointed out that about 5% of hospitalized patients and 0.5% of population suffer from hypercalcemia. Measurement of eight is considered normal. He also talked about primary hyperparathyroidism, localization of abnormal parathyroid glands.  Success rate   of parathyroid surgery depends on high volume of patients. He also mentioned about likely complications, hungry bone syndromes. Symptomatic Patients with failure of medical therapy should go for surgery but those patients who are not suitable for surgery should be offered medical therapy. He also briefly referred to hormone replacement therapy.  Make every effort to preserve bone mass and lithium was associated with hypercalcemia, he added.

Prof. Tasnim Ahsan along with Dr. Sobia Sabir Ali chaired the next session.  Dr.  Abdolreza Norouzy from Tehran University of Medical Sciences Iran discussed Glycemic control during TPN therapy. He pointed out that about 30-50% of patients admitted in hospital ICU suffer from malnutrition and TPN is indicated in about 3.6% of these patients. Intensive insulin therapy is needed to maintain blood glucose to reduce morbidity and mortality. It can also increase risk of hypoglycemia and it can increase mortality. Moderate glucose control, he opined, was best. One has to be very careful and have a balanced approach of not too much and not too little blood glucose control.

Prof.Abdul Basit from BIDE Karachi spoke about primary prevention of diabetes mellitus. Reduction in diabetes, he said,  has been achieved with life style modification which has been achieved in many countries. Cycling is mandatory in Argentina, low salt in crisp is being implemented in Europe. No soft drink is allowed in schools in Saudi Arabia, Dieter’s Pizza has been developed. FTO gene, he further stated, predisposes to type 2 diabetes. He then referred to a study being done in eight countries to determine effects of maternal nutrition on fetal outcome. We at BIDE, he stated, have started work on GDM Registry and we will be developing guidelines on GDM. For this community based data is needed. Diabetes educators will be trained and we also wish to start MSc in Non-Communicable Diseases.

Dr. Qamar Masood from Aga Khan University talked about glycemic control during critical illness. During the discussion it was stated that stress hyperglycemia and pain management was also extremely important.

Prof. A.H. Amar presenting mementoes to chairpersons and speakers at the PES annual conference
held  at Islamabad recently.

Prof. A.H.Amir from Peshawar was the first speaker in the last scientific session. Speaking about Year in Diabetes, he highlighted the number of journals, papers being published on diabetes almost every year. Dr.Khurshid Khan spoke about pitfalls in diagnosis and referred to inadequate response to a drug or drug tolerance. Prof. Zaman Sheikh gave an Update on Androgen Replacement Therapy. He briefly talked about major functions of testis and clinical picture of testosterone. These patients suffer from depression and low self-esteem. They have poor concentration. While managing these patients one should always ask about past medical history. He then highlighted the findings from Meta-Analysis of thirty studies of Androgen deficiency in men wherein 100mg of Viagra was used.  Monitoring of treatment in these patients is important.  He concluded his presentation by stating that feeling old is optional but getting old is natural.

Dr. Salman Kirmani from AKUH talked about syndromes which every endocrinologist should know and also discussed two cases of Pheochromocytoma. In case there is positive family history, it is hereditary.  It has early onset under forty years of age. Family history is the best friend and lot of information is now available to manage these cases. Prof. Saeed Mahar from NICVD discussed management of hot flashes in post WHI era and gave details from the Guidelines prepared by PES. He discussed in detail vasomotor symptoms, sleep disturbances, Genitourinary and mood changes, heat, intense sweating flushing affecting the face besides hormonal therapy for menopausal symptoms. He was of the view that one should alleviate symptoms without using hormone therapy. He then discussed the clinical management of patients taking hormone therapy, monitoring of therapy and annual assessment of these patients. He concluded his presentation by stating that menopausal hormonal therapy is not so effective, one should individualize therapy based on patient’s preference. These patients should be screened for cardiovascular diseases and breast cancer before initiating therapy.

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