No abstract

Fasting during the lunar month of Ramadan is a religious obligation for all adult Moslems. Under certain circumstances, afewgroupsareexemptfromfastingsuchasbeing"sick" asjudgedbyanexperienceddoctor.Recentcollaboration between the International Islamic FiqhAcademy and The Islamic Organization for Medical Sciences produced a comprehensive guidance based on extensive review of the evidence of possible risk to diabetic patients if they observefasting.Thenewguidancecategorizedpeoplewith diabetesinto4groupsaccordingtotheirrisk.Group1and 2areexemptedfromfastingastheyhaveriskfromfasting. Theseincludedpatientswithpoorglycemiccontrolorwith complicationsandseriouscoexistingillnessesinadditionto type1patientsandpregnantwomenwithdiabetes.Patients in groups 3 and 4 are those with moderate to low risk of harmfromfasting.Theseareexemplifiedbyuncomplicated patientswithstablecontrolonoraldrugsnotassociatedwith excessriskofhypoglycemia.Thesegroupsofpatientshave no harm but may even benefit from fasting. Doctors and religious scholars have a joint responsibility to properly assess and advise patients to choose to fast or not to fast inlinewiththeserecommendations.Theadviceshouldbe givenwith no complacencywith the potentialhealth risks butwithgreatsensitivitytothepatientsreligiousfeelings.

Approaches to the management of Type 2 diabetes mellitus during Ramadan varied across regions. Episodes of hypoglycaemia and insulin therapy predicted risk of hypoglycaemia during Ramadan and identified individuals who required Ramadan-specific education.

In 1992, Cuneo et al. (1992) reviewed, in this journal, the consequences of growth (GH) deficiency during adult life and coined the term 'Growth hormone deficiency (GHD) syndrome in adults'. Limited information was available then on cardiovascular disease and risk factors in adults with hypopituitarism. More data have been published since on cardiovascular morbidity in symptom-free hypopituitary adults. Several groups have also published results on the effects of GH therapy on cardiac structure and function and on the cardiovascular risk factors.We shall review here the epidemiological and experimental data on cardiovascular morbidity and mortality in adult hypopituitarism. We shall also examine the prevalence of cardiovascular risk factors in this group of patients and their potential causes focusing on the possible role of GH deficiency and the effects of GH replacement. Cardiovascular disease in hypopituitarism

Growth hormone replacement therapy in adults for 6 months increased lean body mass, total body water and exercise tolerance, and decreased body fat. Growth hormone replacement for longer than 6 months maintains the advantageous effects seen in shorter-term studies and may have additional effects on body fat distribution, muscle strength and psychological well-being.