Patients suffering from endocrine disorders should be counseled regarding pregnancy-Khursheed Khan


 Diabetes conference proceedings-III

Patients suffering from endocrine
disorders should be counseled
regarding pregnancy - Khursheed Khan

PCOS is a fairly common disease and its
prevalence is between 10-12%- Adrian

KARACHI: Prof. Naeemul Haque an eminent endocrinologist along with Dr. Qamar Masood chaired the first scientific session on Day two of the international conference on diabetes and endocrinology organized by SSIDE in collaboration with College of Family Medicine and Primary Care Diabetes Association. Dr. Saiful Haque from BIDE moderated this session.

Dr. Adrian from UK was the first speaker who talked about investigations and management of Polycystic Ovary Syndrome (PCOS). He pointed out that this is a common disorder and its prevalence is between 10-12%. Speaking about its features he mentioned hair growth on the face and body of female, hypertension, infertility, in a nutritionally rich environment patients put on weight quickly. PCOS is a metabolic syndrome. The patients have no periods or occasional periods. PCOS women have impaired glucose regulation. Prevalence of undiagnosed diabetes mellitus in these patients, he stated, is several times more as compared to the general population.

Giving details of a primary care based study in UK; Dr. Adrian said that it included 1797 women from GP practice. Tests done included early age of diagnosis. About 28% had ostradiol changes, LH accounted for 45% while another 45% of patients had FSH investigations. Low sex hormone and body globulin is a marker for metabolic syndrome. Some economic disadvantages are linked with BMI. He also talked about increased insulin resistance and metabolic syndrome. Weight gain, he opined, means lot of complications of diabetes, hypertension and cardiovascular diseases and PCOS. Social situation influence outcome in PCOS. All patients suffering from PCOS have increased risk of developing cardiovascular diseases. They should be diagnosed early and advised to have positive life style changes. Replying to a question during the discussion Dr. Adrian said that modified release form of Metformin will be the first choice for treating PCOS. PCOS can occur in teen age or soon after puberty, he added.

Prof. Khursheed Khan from Allama Iqbal Medical College Lahore was the next speaker whose presentation was on Management of endocrine disorders during pregnancy. These patients, he said, should be carefully examined, counseled when to become pregnant. Remember we have to treat mother and the fetus in such situations. He then referred to Hypothyroidism, Hyperthyroidism and prolactinaemia. Hypothyroidism, he opined, must be treated before ten weeks of gestation. It will have no adverse effects. These disorders can lead to spontaneous abortion, pre term birth weight, pre eclampsia and abruption. In Hypo LT4 are required and average dose requirement increases. These patients require frequent monitoring of TSH. He laid emphasis on pre conception education of hypothyroidism. Thyroid function needs to be optimized before and during pregnancy. Complications include still birth, SGA, pre term labour and 1-5% will develop neonatal thyrotoxicosis. Speaking about anti thyroid therapy during pregnancy, he said, T4, TSH level should be monitored at two and four weeks to know how the patient is doing. It is important to check fetal cord blood at delivery for TSH and T4.Thionamides are used for treatment. Breast feeding is safe and PTU is preferred.

Patients suffering from prolactinomas should be advised to become pregnant only once the adenomas have reduced in size. Adenoma growth should be monitored during pregnancy. Continue dopamine agonist in these patients. These patients do develop visual symptoms. Pituitary MRI is recommended in case of severe headache. Maroadenoma patients should be discouraged to become pregnant for atleast one year or a short period of time. Dopamine agonists should be stopped till the breast feeding is completed. Use of steroids in such conditions is controversial. He then talked about other disorders including Sheehan’s syndrome and Addison’s disease. Hydrocortisone, he opined, should be given if labour is prolonged. After delivery the dose can be tapered off and one should go to the original dose.

Prof. Abdul Jabbar another eminent endocrinologist from UAE discussed pitfalls in interpretation of thyroid function test. He pointed out that at times these tests are not matching with the clinical condition of the patient. TSH does not give right answer in some conditions, hence he advised the audience not to look at the TSH levels all the time as it can be misleading. He also talked about Grave’s disease and some other disorders with different test reports. He presented different tests reports and actively involved the audience in making the correct diagnosis bases on these test. He also referred to non thyroid illnesses and pointed out that in some cases there is a problem with compliance with therapy. He also talked about sub clinical hypothyroidism, NTI recovery phase, TSH resistance, adrenal insufficiency besides use of steroids and dopamine. Many drugs, he said, interfere with thyroid functions hence it is important to ask the patients which drugs they are taking. Iodine and lithium have some effects and interfere with thyroid functions. Metformin suppresses TSH. Always look at the clinical condition of the patient while looking at the test reports. He then highlighted some common errors in interpretation of thyroid function tests and pointed out that TSH alone may also lead to over treatment. Remember patients come to you after consulting Dr. Google and you cannot beat Dr. Google, hence be careful, Prof. Jabbar remarked.

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