Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered mental status. With the “apathetic” variant of hyperthyroidism, the classical features may not be evident. This article is available only as a PDF. Please click on...

Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight reported cases of gynaecomastia as a presenting feature in thyrotoxicosis, and herein we describe an additional case. This article is available only as a PDF. Please...

Breast cancer is the most common cancer among women in Singapore with age-standardised incidence rates increasing markedly from 26.8 to 38.7 per 100 000 per year over the last decade. While many recognised risk factors exist for the development of breast cancer such as demographic factors (personal and family...

Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...

Cushing’s syndrome is usually easy to recognise clinically. Determining the cause of non-iatrogenic Cushing’s syndrome is, on the other hand, often a diagnostic enigma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Obesity is a risk factor for cardiovascular disease. This risk is partially mediated by the correlation between obesity and other coronary artery disease risk factors. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Hypercholesterolaemia is one of the major risk factors in the development of coronary artery disease (CAD). In recent years, many non-prescription treatments have become available for cholesterol lowering. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1% of the pancreatic mass. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia. This article...

The term “obesity” implies an excess of adipose tissue (fat) and excess adiposity is a health risk. In most cases it develops in the absence of any underlying disease process. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Obesity is one of the most common health problems in Singapore with escalating prevalence, affecting about 6% of the Singapore population above 18 years of age. The prevalence of obesity is 12.2% in Singapore children aged 6 to 7 years, 12.8% in children aged 11 to 12 years, and...

Essential hypertension and its complications, coronary heart disease, stroke and renal failure are leading causes of morbidity and mortality in western societies.1 While the aetiology of essential hypertension is not known, it is recognised as being a multifactorial disease caused by both genetic and environmental factors. This article is available...

The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a group of individuals at high risk for macrovascular and microvascular disease, it is essential that the diagnosis be made promptly. This article is available only as...

In 1989, the St Vincent Declaration was formulated by all European countries to address the growing problem of diabetes, with the general goals of improving health care and quality of life for the diabetic patient. One of the targets in the declaration was the need to implement effective measures...

Dear Editor, Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...

Diabetic ketoacidosis is generally believed to be the result of an acute and severe degree of insulin insufficiency, classically occurring at the presentation of a newly diagnosed individual with Type 1 diabetes. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The word obesity implies an excess of adipose tissue (fat) and not merely an excess of body weight. An increase in body weight may be due to fat (as in an obese person) or due to lean muscles (as in Hercules or in a body builder). This article is available...

Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...

Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become an epidemic with increasing prevalence in most parts of the world. This article is available only as a PDF. Please click on “Download PDF” on top...

The Angeles University College of Medicine (AUCOM) was established in 1983 with a curriculum that is conventionally teacher-centred. Biochemistry is a basic science subject introduced in the first year of the medical curriculum. This article is available only as a PDF. Please click on “Download PDF” on top to view...

The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...

Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively benign course in the majority of patients. In a 1981 study, the incidence of radiologically detectable bone disease was found in 24% of patients but...

Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...

Iodine is an essential component of thyroid hormone and is actively taken up by thyroid follicles. This is the physiological basis for the use of radioiodine in the treatment of thyrotoxicosis. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Chronic diseases are the main causes of morbidity and mortality in developed countries. In most developed countries, the problems of a rising prevalence of chronic disease and escalating costs have forced healthcare policymakers to look for ways to provide cost-effective healthcare for chronic disease patients. This article is available only...

Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually. This article is available only as a PDF. Please...

Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip fractures will occur in Asia in 50 years’ time. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Prior to 1997, the diagnosis of diabetes mellitus in asymptomatic individuals was based upon the 1985 World Health Organisation (WHO) diagnostic criteria in which, utilising the 75g oral glucose tolerance test (OGTT), diabetes was defined either by a fasting plasma glucose (FPG) concentration of >7.8 mmol/L or by a...

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative. This article...

Osteoporosis is a condition characterised by low bone mineral density, microarchitectural deterioration of bony tissue, and a consequent increase in fracture risk. With rapid ageing of the Asian population, osteoporosis has become one of the most prevalent and costly health problems. This article is available only as a PDF. Please...

Bone fragility in men has been receiving greater attention during the last few years. Epidemiological studies have been done in Caucasian and Asian populations. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...

The current practice and management of osteoporosis differs greatly from even the recent past. Up to 15 years ago, bone mineral density (BMD) measurements were not widely available, osteoporosis was still largely diagnosed only at the stage of fractures, the epidemiology of osteoporosis was not well studied yet and...

Osteoporosis affects predominantly elderly women; although younger women and men may also be affected. Demographically, the number and proportion of the elderly (aged 65 years and above) in many countries is increasing rapidly, and the problem of osteoporosis will increase concomitantly. This article is available only as a PDF. Please...

Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Osteoporosis twenty years ago was a very different disease from what we know of it today. At that time a diagnosis of osteoporosis was made at the point of sustaining a fracture as there was no routine method of pre-fracture diagnosis such as bone mineral density measurement. This article is...

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years. This article is available only as a PDF. Please click on “Download PDF” on top...

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...

Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control. This article is available only as a PDF. Please click on “Download PDF”...

A Malaysian Chinese male patient, CMO, first presented at the age of 22 years with a 2-week history of severe spontaneous low backache with no prior trauma or back injury. A lumbar spine X-ray showing marked osteopenia and compression fracture of the first lumbar vertebra led to findings of...

Free thyroxine (FT4), total tri-iodothyronine (T3) and thyrotropin (TSH) are the commonly measured biochemical indices in the assessment of thyroid function in a patient with suspected thyrotoxicosis. These indices give sufficient information regarding the functional status of the thyroid gland under most circumstances. This article is available only as a...

The long lasting debate on the role of generalists and specialists in the management of diabetes is still ongoing. Nonetheless, the last 3 decades have seen the increasing shift of chronic disease management from specialist outpatient clinic-based to more general practice-based services. This article is available only as a PDF....

In the present pandemic of diabetes and obesity, 60% of the affected population will come from Asia. Between India and China, these two most populous nations will contribute more than 100 million to the world’s population of people with diabetes, many of whom remain undiagnosed, untreated or suboptimally managed. This...

Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as a result of an imbalance between bone formation and bone resorption. This article is available only as a PDF. Please click on “Download PDF” on top...

Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram. Many aetiological factors, such as microvascular and endothelial dysfunction, have been implicated. This article is available only as a PDF. Please click on “Download PDF” on...

Right siting, defined as “patients treated in the most appropriate locations by medically competent teams at the lower possible cost”, has been on the national healthcare agenda for a number of years, even meriting mention and discussion in the Singapore Parliament. Internationally, the term “appropriate siting” is more commonly...

Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule of 10” where 10% are extra-adrenal, of which 10% are extra-abdominal, 10% are malignant, 10% occurs in normotensive patients and 10% are hereditary. This article is...

Diabetes mellitus is one of the most common chronic diseases affecting Singaporeans. In 2004, 8.2% of the population was afflicted, placing a significant burden on healthcare resources and affecting the well-being of the community. This article is available only as a PDF. Please click on “Download PDF” on top to...

With rapid development of therapy, the mortality from acute complications of diabetes mellitus (DM) has decreased, but mortality from chronic complications like diabetic nephropathy has increased. The incidence and prevalence of type 2 DM is increasing in developing countries. This article is available only as a PDF. Please click on...

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events. This article is available only as a...

Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity from complications, which lead to disability, poor quality of life and an enormous health cost. This article is available only as a PDF. Please click on...

Patients with type 2 diabetes mellitus are at an increased risk of developing atherosclerosis and cardiovascular diseases leading to higher morbidity and mortality. These complications cause serious economic burdens, not only to patients, but also to the family and society. This article is available only as a PDF. Please click...

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a fall. A brain computerised tomography (CT) revealed occipital skull fracture with bilateral subarachnoid haemorrhages, subdural haemorrhages and parenchymal contusions. He was admitted for close observation...

Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM). This usually occurs in adults and arises through insulin resistance or an insufficiency of insulin production. Diabetes is one of the priority non-communicable diseases targeted...