Tropical Endocrinology – Part II

Tropical Endocrinology – Part II

<< Read Part I

In the previous article we met you with endocrinologists from the Asian and African region who told us more about the challenges they meet in their countries considering endocrinology care and how they deal with them. Here we continue our journey with the stories below.

6. What are the challenges faced by pediatric endocrinologists in the tropics?

Dr Malusi Ndiweni, Zimbabwe

Zimbabwe, market

Colorful textiles for sale in a craft market in Victoria Falls, Zimbabwe

The challenges are multiple. They are few qualified endocrinologists, and most paediatric endocrinology cases are managed by general

paediatricians. This impacts negatively on the quality of care. There is a need to train more paediatric endos with ongoing supportive education. The required supportive laboratory facilities are at best rudimentary; capacity building is required. Awareness about endocrine problems in general practitioners is poor, leading to delays in diagnosis and treatment.

Stunted growth due to malnutrition, rickets due to Vitamin D deficiency, and inadequately treated congenital hypothyroidism are some commonly encountered syndromes. Endocrinopathy due to sickle cell anemia and thalassemia is noted in certain populations.

7. Do infections present a major challenge in tropical endocrinology? How do you address this situation?

Dr Amos Ankotche, Cote d’Ivoire

Infection and endocrine disorders are connected in multiple ways. Infections can cause endocrinopathy, e.g., tubercular or fungal Addison’s disease, and viral subacute thyroiditis. They also occur more frequently in disorders characterized by immune deficiency, like uncontrolled Cushing’s syndrome and diabetes mellitus

Infection can modify the natural history of endocrine disorders, as in diabetic foot. Infections may be the presenting feature of endocrine dysfunction, e.g., Cushing’, syndrome and diabetes. At the same time, endocrine disorders may modify the clinical presentation of infections by masking or mimicking them. In some situations, infections can mimic endocrinopathy: leprosy and syphilis, for example, are differentials of diabetic neuropathy.

Endocrinopathy can lead to specific infections, like rhino cerebral mucormycosis and emphysematous pyelonephritis in diabetes. Management of infectious disease can lead to endocrine disorders, as seen with highly active anti-retroviral therapy (HAART). Endocrine therapy has also been known to cause infections e.g., cadaveric growth hormone leading to Creutzfeldt- Jacob disease. Modern glucose- lowering drugs like sodium glucose cotransporter 2 inhibitors (SGLT2i) are associated with a higher incidence of genital tract infections.

Hence, infections play an important role endocrinology, in the tropics as well as in non-tropical climates.

8. Could you suggest some proactive steps to enhance provision of evidence-based endocrine care in resource challenged setting?

Dr KVS Hari Kumar, India

The challenges in providing quality endocrine care include non-availability and high cost of certain drugs. Many Indian researchers have modified the endocrine testing protocols based on the local needs and availability. The revised protocols have been well validated in comparison to gold standard methods and are published in high impact journals. Such initiatives bridge the gap between developed and developing nations and deliver evidence based endocrine care in all the countries.

9. Please share a few best practices that have helped you manage “tropical endocrinology” challenges.

Dr Olufemi Fasanmade, Nigeria

Hospital in Africa

Tropical endocrinology challenges include poverty, illiteracy, deficiency of trained specialists, and medical and laboratory infrastructure deficits.  To overcome these has required great innovation. Harnessing of resources of better funded schemes like HIV/AIDS have supported diabetes care. Tropical endocrinologists must be trained in handling both acute and chronic care at the same time. They also have to play the role of dietitians, nurse educators and podiatrists. Illiteracy has been tackled by using audiovisual aids prepared in local languages.

10. How can International Society of Endocrinology facilitate South-South collaboration in endocrinology?

Dr Noel Somasundaram, Sri Lanka; President, South Asian Federation of Endocrine Societies (SAFES)

ISE can build bridges and create for South South exchange and showcasing of work done in the region. The modalities could be electronic, webinars, dedicated sessions in international and regional events, research grants, creation of consensus documents, and guidelines. Focus should be on fostering local research and showcasing it. A journal focusing on South South research and collaboration will be another way to foster these regional events are good forum for ISE to engage with a larger group of endocrinologists.