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BACKGROUND: Data on pituitary Magnetic Resonance Imaging (MRI) in patients with abnormal pituitary hormones in Saudi Arabia are very scarce. OBJECTIVE: To define the frequency of normal pituitary MRI in patients with abnormal pituitary hormones in a well-defined population. DESIGN: Retrospective analysis of radiological and hormonal data of patients with pituitary MRI between January 2008 and December 2015. SETTINGS: Departments of Endocrinology and Radiology at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. PATIENTS: 459 patients with clinical, hormonal and radiological data. MAIN OUTCOME MEASURES: The frequency of normal pituitary MRI in patients with abnormal pituitary hormones. RESULTS: Over the 7-year period, Out of 459 patients; 129 (28.1 %) were males and 330 (71.9 %) were females with mean age of 35.4 ± 13.7. Positive MRI compared to normal MRI were seen in 268 (58.4 %) and 191 (41.6 %) subjects respectively. Subjects with Positive MRI were significantly older, 36.8 ± 14.1 vs. 33.5 ± 12.9, p value=0.01. Hyperfunctiong pituitary hormones were significantly associated with positive MRI, 259 (63.2%) vs. 151 (36.8) where as hypofunctiong pituitary hormones were associate with normal MRI, 40 (81.6%) vs. 9 (18.4%), p value < 0.001. Females with hyperfunctioning pituitary hormones were significantly associated with positive MRI whereas males with hyporfunctioning pituitary hormones were significantly associated with normal MRI. Three types of hyperfunctioning pituitary gland were seen such as hyperprolactinemia, somatotroph adenoma, and corticotroph adenoma were associated with more frequent positive MRI as to Five types of hypofunctioning pituitary gland were seen such as panhypopituitarism, secondary hypogonadism, growth hormone deficiency, central hypothyroidism and central adrenal insufficiency which were associated with more frequent normal MRI. CONCLUSION: The current study indicates hyperfunctioning pituitary gland was significantly associated with positive MR whereas hypofunctioning pituitary gland was associate with normal MRI. In the absence of registry data, larger cooperative studies involving diverse population samples from multiple centers could help to provide further information on the true frequency nationally. LIMITATIONS: Question of clustering of cases within the study region and limited study sample size.

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BACKGROUND: Data on pituitary adenoma (PA) prevalence in Saudi Arabia are scarce. OBJECTIVE: To estimate the epidemiology of PA in a well-defined population. DESIGN: Retrospective analysis. SETTING: Departments of Endocrinology and Radiology at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. PATIENTS AND METHODS: Radiological and hormonal data of patients with pituitary adenoma by MRI were reviewed for the period January 2008 to December 2015. MAIN OUTCOME MEASURES: Prevalence of PA and hormonal abnormalities. RESULTS: Of 537 patients; 249 subjects (46.4%), 70 (28.1%) males and 179 (71.9%) females, were diagnosed to have PA with mean age 36.3 (14.1) years. Microadenoma and macroadenoma were seen in 171 (69%) and 78 (31%) subjects, respectively. Microadenomas were more prevalent than macroadenomas (68.7% vs. 31.3%). Microadenomas were significantly more prevalent in females, 131 (73.2 %) vs. 40 (57.1%) whereas macroadenomas were significantly more prevalent in males, 30 (42.9%) vs. 48 (26.8%) (P < .001 for both comparisons). Patients with microadenomas were significantly younger than patients with macroadenomas (P < .0001). Advanced age was significantly associated with a larger PA size (r=0.39, P < .0002). Three types of hyperfunctioning PA were seen: prolactinoma, somatotroph adenoma, and corticotroph adenoma. Five types of hypofunctioning PA were seen: panhypopituitarism, secondary hypogonadism, growth hormone deficiency, central hypothroidism and central adrenal insufficiency. Non-functioning PA were within normal laboratory hormonal values in 2% of cases. CONCLUSION: Our study showed that the prevalence of PA was greater than previously reported. This increased prevalence may have important implications when prioritizing funding for research and treatment of PA. LIMITATIONS: Clustering of cases within the study region might have affected estimates and limited study sample size.

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Multiple liver cysts can be an isolated disease (isolated polycystic liver disease [PLD]) or they can be part of multi-organ involvement in other diseases, such as adult autosomal dominant polycystic disease (APD), which is the most frequently inherited polycystic disease affecting 1 in 1,000 of the population. About 33% of APD patients are expected to develop PLD. Cysts in the liver, as opposed to cysts in the kidney, grow dramatically in number and size. They are usually asymptomatic but may present with signs and symptoms of compression of adjacent organs as the cysts grow. We present a case of a 73 year-old female patient with PLD and a large (25 × 19 × 18 cm) infected cyst which caused the displacement of the inferior vena cava, right kidney, and pancreas. We also discuss the management of this patient along with a review of the literature.

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We present a rare case of gastric outlet obstruction due to compression of the duodenum by a pancreaticoduodenal artery (PDA) aneurysm 2.5 cm in diameter, in a 43-year-old man from Saudi Arabia who presented with persistent vomiting and epigastric pain. The initial investigations and blood works were negative, and esophagogastroduodenoscopy (EGD) was unremarkable. A CT abdomen demonstrated a mass around the duodenum and dilatation of the stomach, and CT angiography showed the PDA aneurysm. The patient was stabilized and then referred to a tertiary center for embolization. Our case demonstrates a diagnostic challenge that physicians may encounter in patients who present with vomiting and epigastric pain.

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Thyrotoxic periodic paralysis (TPP) is rare in non-Orientals, and sporadic case reports were reported world-wide. Eight cases were reported in Arabs, including 3 Saudis. We present an additional case of TPP in a 38-year-old Saudi man, and review the literature on TPP in Arabs. Our patient presented with complete flaccid quadriplegia, 5 weeks after he was diagnosed with Graves' disease that was treated with carbimazole and propranolol. He was hyperthyroid, and his potassium was extremely low (1.5 mmol/L). During initial evaluation in the emergency room, he developed transient asystole manifested by syncope. He was resuscitated and his hypokalemia was corrected, and he had a full recovery. This case emphasizes the notion that TPP can occur in patients of any ethnic background. The development of serious cardiac complications in our patient underscores the importance of early and correct diagnosis of this potentially life-threatening complication of hyperthyroidism.

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CONTEXT: Current screening tests for gestational diabetes mellitus (GDM) are inconvenient. Therefore, alternative screening tests for GDM are desirable. The use of glycohemoglobin A1c (HbA1c) in screening for GDM remains controversial. AIM: We undertook this study to evaluate the utility of HbA1c in screening for GDM. SETTINGS AND DESIGN: Retrospective study in a tertiary teaching hospital. MATERIALS AND METHODS: Laboratory records were reviewed to identify pregnant women who underwent both oral glucose tolerance test (OGTT) and HbA1c measurements over a 16-months period. The association of OGTT with HbA1c was evaluated. STATISTICAL ANALYSIS USED: Data were collected using SPSS software. Comparisons of the means and calculations of sensitivities were performed. RESULTS: Of 145 eligible patients, 124 had GDM and 21 patients did not, per OGTT. The percentages of patients with HbA1c values (reference range of 4.8%-6.0%) equal to or above sequential cut-point values of 5.0%, 5.5%, 6.0%, 6.5% and 7.0% (i.e., sensitivity values) were 100%, 98.4%, 87.1%, 62.9% and 39.5%, respectively. The mean HbA1c of the patients with GDM was 6.9 + 0.8% compared to 6.4 + 0.6% for those without GDM (P< 0.006). At an arbitrary cut-off value of 6.0% (the upper limit of normal), HbA1c would have picked up 87.1% of patients with GDM. CONCLUSIONS: This study suggests that HbA1c is a reasonably sensitive screening measure of GDM in this high-risk population. Acknowledging limitations resulting from the study design, further prospective studies are warranted to verify this conclusion, and to evaluate the specificity of HbA1c as a screening test for GDM.