Journal of Endocrinology, Metabolism and Diabetes of South Africa - March 2021 Vol. 26 No. 1

Introduction

Focus on Saxenda® solution for injection

The World Obesity Federation recognises obesity as a “chronic relapsing disease process”, defined as having a body mass index (BMI) equal to or greater than 30 kg/m2 and has been identified as a strong predictor of cardiovascular disease. The challenge with weight loss is keeping it off because of changes in appetite regulating hormones that occur after weight has been lost, leading to increased hunger and decreased satiety. Liraglutide is a glucagon-like peptide-1 (GLP-1) analogue which, by virtue of its mechanism of action, increases satiety and decreases hunger, leading to weight loss.

Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa

Nausea and vomiting in pregnancy have been documented throughout history. Medical literature cites Antoine Dubois, a consultant surgeon and a head obstetrician to Napoleon Bonaparte and his second wife Empress Marie Louise, as the first physician to describe the condition in 1852. Dubois described the syndrome as a ‘pernicious vomiting of pregnancy’ and the aetiology was unknown but hypothesised to be due to ‘irritation of the vomiting reflex from the stretching of the uterine fibres,’ and ‘irritation of the cervix’. Since then, hyperemesis gravidarum has been increasingly recognised as an important cause of maternal and foetal morbidity and even mortality.

Prevalence of succinate dehydrogenase deficiency in paragangliomas and phaeochromocytomas at a tertiary hospital in Cape Town: a retrospective review

Phaeochromocytomas (PCs) and paragangliomas (PGLs) are rare neural crest-derived tumours that arise in the adrenal medulla and sympathetic or parasympathetic ganglia. The World Health Organization defines PCs as tumours of chromaffin cells that arise in the adrenal medulla while extra-adrenal PGLs are defined as tumours originating from neural crestderived paraganglion cells in the region of the autonomic nervous system ganglia and autonomic nerves. Sympathetic PGLs are catecholamine secreting tumours and include those in the adrenal gland (PC) as well as extra-adrenal sites, predominantly the thorax and abdomen (thoraco-abdominal PGLs –TAPGLs). Parasympathetic PGLs are extra-adrenal, do not secrete catecholamines and occur predominantly in the head and neck region (head and neck PGLs – HNPGLs).

Bone health in patients undergoing surgery for primary hyperparathyroidism at Tygerberg Hospital, Cape Town, South Africa

Primary hyperparathyroidism (PHPT) is the most common cause of chronic hypercalcaemia in the outpatient population worldwide. It is defined as a raised serum calcium level with a simultaneously elevated or inappropriately unsuppressed parathyroid hormone (PTH) level. PHPT affects bone mineral metabolism and renal calcium handling early in the course of the disease. The adverse skeletal effects can be independent of symptoms; thus the quantification of bone involvement is of paramount importance. The chronic exposure of the skeleton to excess parathyroid hormone in PHPT is characterised by high bone turnover with osteoclastic activity and resultant bone resorption predominating over bone formation. This leads to skeletal pathology ranging from a subclinical decrease in bone mineral density (BMD) to osteoporosis with fragility fractures and osteitis fibrosa cystica (OFC).  Osteoporosis, irrespective of evidence of fragility, is considered to be an indication for surgical parathyroidectomy

Acute effects of single-bout exercise in adults with type 2 diabetes: a systematic review of randomised controlled trials and controlled crossover trials

The pancreas is largely responsible for the regulation of blood glucose through the secretion of the hormones insulin and glucagon. Insulin is secreted to maintain homeostasis when blood glucose concentrations are elevated. Chronically elevated levels of insulin and glucose are indicative of insulin resistance and T2D, respectively. The pathogenesis of insulin resistance is not yet fully understood; however, it is known to be complex and multi-factorial, with an array of possible causes that include genetic predisposition, lifestyle and environmental factors. Lack of physical activity (low energy expenditure), high caloric dietary intake and obesity are amongst the environmental factors that induce insulin resistance and T2D. Despite exercise and physical activity being reported to improve insulin resistance and T2D, exercise remains a relatively underutilised approach in the treatment of the disorders, in comparison with medicinal and/or pharmaceutical approaches.