Adrenal insufficiency

Introduction Adrenal insufficiency arises when the adrenal gland is destroyed by disease, or atrophies following pituitary failure or chronic corticosteroid use or abuse. In these situations, the amount of cortisol produced from the adrenal gland is insufficient to meet the body’s needs during periods of physical and psychological stress or severe illness. The condition is … Read more


Introduction Hypothyroidism is a condition associated with reduction in thyroid hormone production. Thyroid hormone is required for normal metabolism and growth. Its deficiency has major consequences on foetal development as well as intellectual and physical development in infants and children (cause of cretinism). In adults, it may be the cause of several problems including heart … Read more


Introduction A goitre is a swelling of the front of the neck due to enlargement of the thyroid gland. It may affect persons of any age. Not all neck swellings are goitres. Goitres are usually benign but may occasionally be malignant. They could be associated with normal, reduced or excessive function of the thyroid gland. … Read more


Introduction There is ample evidence linking high blood cholesterol levels to Cardiovascular Disease (CVD) events, including myocardial infarction, strokes, and peripheral vascular disease. On the other hand, there is also evidence for significant reduction in morbidity and mortality from CVDs by reducing blood cholesterol levels in those at risk (primary prevention) and those who have … Read more

Treatment induced hypoglycaemia

Introduction Hypoglycaemia refers to a blood glucose level below 3.6 mmol/L. Treatment induced hypoglycaemia on the other hand refers to an established hypoglycaemia as a result of treatment. Hypoglycaemia is more common in elderly diabetics and those with kidney function impairment as well as those on long-acting oral anti-hyperglycaemic medications or insulin. Severe hypoglycaemia (blood … Read more

Diabetic Ketoacidosis

Introduction Diabetic ketoacidosis (DKA) is a condition associated with high blood glucose (usually > 18 mmol/L), which nonetheless, is unavailable to the body tissues as a source of energy. Fat is therefore broken down as an alternative source of energy, releasing toxic chemicals called ketones as a by-product. Additionally, there is severe dehydration and electrolyte … Read more

Diabetes Mellitus

Introduction Diabetes mellitus is a common metabolic disorder characterised by persistent hyperglycaemia, a consequence of defects in the action or secretion of insulin resulting in disturbances of metabolism of carbohydrates, fat and protein. It is associated with acute as well as long-term complications affecting the eyes, kidneys, feet, nerves, brain, heart and blood vessels . … Read more

Diabetes in Pregnancy

Introduction Gestational diabetes mellitus (GDM) is any degree of glucose intolerance first recognised in pregnancy. If inadequately managed, GDM is associated with increased risk of perinatal morbidity and mortality. Diagnosis and prompt institution of therapy reduce the risks of poor outcomes Screening for GDM When: Between 24 and 28 weeks of gestation Who: Women with: … Read more

Diabetic Foot Problems

Introduction People with diabetes are at increased risk of foot ulcers and amputations which are major causes of morbidity and disability. Both foot ulcers and amputations can be prevented by education, anticipation, early recognition and prompt management. The most common predisposing factors for ulcers and amputations are: Peripheral neuropathy with loss of sensation Poor foot … Read more


Introduction Thyrotoxicosis refers to the clinical, physiological and biochemical manifestation of the effect of excess thyroid hormone in tissues as opposed to hyperthyroidism which simply means hyperfunctioning of the thyroid gland. There is a female preponderance due to the role of autoimmunity in the aetiology. Causes of thyrotoxicosis Grave’s disease (commonest cause) Toxic nodule Toxic … Read more