Researcher: Dr Khaled Elmezughi.


Study: Characteristics and Outcome of Surgically Treated Pituitary Tumours at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban

Summary: Aims:To describe the clinical, biochemical, radiological and histological features and to determine the outcome of all patients with pituitary tumours treated surgically at Inkosi Albert Luthuli Central Hospital in Durban over a 5 year period.

Research design: Retrospective chart review from 2008 to 2012. Clinical, biochemical and radiologic data were collected before and one year after surgery. Histopathology findings and perioperative complications were recorded.

Results: Seventy patients were included (age 44.8±14.9 years, 55.7% female). Headache (84.1%) and visual disturbance (78.3%) were the predominant presenting symptoms. Most tumours were macroadenomata (97.1%). Trans-sphenoidal surgery was employed in the majority (90%). A single procedure was required in 55.7% patients, two procedures in 30% and up to six in others. Medical therapy was used in 22 (31.4%) and radiotherapy in 13 (18.6%). Complete resection was achieved only in 9 patients (12.8%), residual tumour post-surgery was found in 48 (68.6%) and there was no change in tumour size in 13 patients (18.6%). On biopsy, the most common pathology was non-functional adenoma in 33 (47.1%); 29 (41.4%) were secretory tumours. Overall mortaility was 4.3%. The commonest surgical complication was cerebrospinal fluid (CSF) leak (10%; n=7). New post-surgical pituitary hypofunction occurred in 62 (88.6%). The outcome at one year was similar to that on dischage.

Conclusions: Patients presenting to IALCH had large tumours and complete resection was achieved in a minority. There was a low overall mortality but high rate of post-surgical pituitary hypofunction.

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Publications in Peer Reviewed Journals

  • Saloojee S, Burns JK, Motala AA.  Metabolic syndrome in antipsychotic naive African patients with severe mental illness in usual care.Early Interv Psychiatry. 2017 Apr 12. doi: 10.1111/eip.12428. [Epub ahead of print]
  • Elmezughi KK, Pirie FJ, Motala AA.  Characteristics and outcome of surgically treated pituitary tumours in South Africa: a single-centre experience. Clin Endocrinol (Oxf). 2017 Apr;86(4):534-540. doi: 10.1111/cen.13279.
  • Gill G, Yudkin JS, Tesfaye S, de Courten M, Gale E, Motala A, Ramaiya K, Unwin N, Wild S. Essential medicines and access to insulin. Lancet Diabetes Endocrinol. 2017 May;5(5):324-325. doi: 10.1016/S2213-8587(17)30090-6. Epub 2017 Mar 18.
  • Garst J, L’Heveder R, Siminerio LM, Motala AA, Gabbay RA, Chaney D, Cavan D. Sustaining diabetes prevention and care interventions: A multiple case study of translational research projects. Diabetes Res Clin Pract. 2017 May 19;130:67-76. doi: 10.1016/j.diabres.2017.04.025. [Epub ahead of print]
  • Saloojee S, Burns JK, Motala AA.  High risk of metabolic syndrome among black South African women with severe mental illness. S Afr J Psychiat. 2017;23(0), a1089. sajpsychiatry.v23i0.1089
  • Gill G, Yudkin JS, Tesfaye S, de Courten M, Gale E, Motala A, Ramaiya K, Unwin N, Wild S. Essential medicines and access to insulin. Lancet Diabetes Endocrinol. 2017 May;5(5):324-325. doi: 10.1016/S2213-8587(17)30090-6. Epub 2017 Mar 18.
  • Ekoru K, Murphy GAV, Young EH, Delisle H, Jerome CS, Assah F, Longo-Mbenza B, Nzambi JPD, On’Kin JBK, Buntix F, Muyer MC, Christensen DL, Wesseh CS, Sabir A, Okafor C, Gezawa ID, Puepet F, Enang O, Raimi T, Ohwovoriole E, Oladapo OO, Bovet P, Mollentze W, Unwin N, Gray WK, Walker R, Agoudavi K, Siziya S, Chifamba J, Njelekela M, Fourie CM, Kruger S, Schutte AE, Walsh C, Gareta D, Kamali A, Seeley J, Norris SA, Crowther NJ, Pillay D, Kaleebu P, Motala AA, Sandhu MS. Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa. Int J Obes (Lond). 2017 Oct 3. doi: 10.1038/ijo.2017.240. [Epub ahead of print]
  • The Society for Endocrinology, Metabolism and Diabetes of South Africa Type 2 Diabetes Guidelines Expert Committee.  The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. JEMDSA 2017; 21(1)(Supplement 1): S1-S196.
  •  Hird TR, Young EH, Pirie FJ,  Riha J, Esterhuizen TM, O’Leary B, McCarthy MI, Sandhu, Motala AA. Study profile: the Durban Diabetes Study (DDS): a platform for chronic disease research. Global Health, Epidemiology and Genomics 2016; 1. January 2016, e5. DOI:
  • Ekoru K, Young EH, Adebamowo C, Balde N, Hennig BJ, Kaleebu P, Kapiga S, Levitt NS, Mayige M, Mbanya JC, McCarthy MI, Nyan O, Nyirenda M, Oli J, Ramaiya K, Smeeth L, Sobngwi E, Rotimi CN, Sandhu MS and Motala AA. H3Africa Multi-Centre Study of the Prevalence and Environmental and Genetic Determinants of Type 2 Diabetes in Sub-Saharan Africa. Global Health, Epidemiology and Genomics / Volume 1/ January 2016, e5. DOI:



  • Gurdasani D, Carstensen T, Tekola-Ayele F, Pagani L, Tachmazidou I, Hatzikotoulas K, Karthikeyan S, Iles L, Pollard MO, Choudhury A, Ritchie GR, Xue Y, Asimit J, Nsubuga RN, Young EH, Pomilla C, Kivinen K, Rockett K, Kamali A, Doumatey AP, Asiki G, Seeley J, Sisay-Joof F, Jallow M, Tollman S, Mekonnen E, Ekong R, Oljira T, Bradman N, Bojang K, Ramsay M, Adeyemo A, Bekele E, Motala A, Norris SA, Pirie F, Kaleebu P, Kwiatkowski D, Tyler-Smith C, Rotimi C, Zeggini E, Sandhu MS. The African Genome Variation Project shapes medical genetics in Africa. Nature. 2015 Jan 15; 517(7534): 327-32. doi: 10.1038/nature13997
  • Motala AA. Diabetes in the Middle East: from Bedouins and pearl divers to the scourge of diabetes. J Diabetes. 2015 Sep; 7(5): 610-2. doi: 10.1111/1753-0407.12300. Epub 2015 May 27.
  • Beagley J, Guariguata L, Weil C, Motala AA. Global estimates of undiagnosed diabetes in adults for 2013 for the IDF Diabetes Atlas. Diabetes Res Clin Pract. 2014 Feb; 103(2): 150-60. doi: 10.1016/j.diabres.2013.11.001.
  • Peer N, Kengne AP, Motala AA, Mbanya JC. Diabetes in the Africa region: 2013 update for the IDF diabetes Atlas. Diabetes Res Clin Pract. 2014 Feb; 103(2): 197-205. doi: 10.1016/j.diabres.2013.11.006.
  • Pirie FJ, Maharaj S, Esterhuizen T, Paruk IM, Motala AA. Retinopathy in subjects with type 2 diabetes at a tertiary diabetes clinic in Durban, South Africa: Clinical, biochemical and genetic factors. Journal of Clinical & Translational Endocrinology 1 (2014), e9-e12. doi: 10.1016/j.jcte 2013.12.002.
  •  Saloojee S, Burns JK, Motala AA. Very low rates of screening for metabolic syndrome among patients with severe mental illness in Durban, South Africa. BMC Psychiatry. 2014 Aug 12; 14(1): 228. [Epub ahead of print].
  •  Dillon DG, Pirie F, Pomilla C, Sandhu MS, Motala AA, Young EH; African Partnership for Chronic Disease Research (APCDR). Open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa. J Clin Epidemiol. 2014 Aug 15. pii: S0895-4356(14)00238-8. doi: 10.1016/j.jclinepi.2014.06.012.
  •  Shmendi A, Pirie F, Naidoo DP, Tlou B, Pilloy W, Motala AA. Myocardial perfusion imaging for evaluation of suspected ischemia and its relationship with glycemic control in South African subjects with diabetes mellitus. Diabetes MetabSyndr Obes. 2014 Nov 14; 7: 545-52. doi: 10.2147/DMSO.S72335. eCollection 2014.
  • Paruk IM, Esterhuizen TM, Maharaj S, Pirie FJ, Motala AA. Characteristics, management and outcome of primary hyperparathyroidism in South Africa: a single-centre experience. Postgrad Med J. 2013 Nov; 89(1057): 626-31. doi: 10.1136/postgradmedj-2012-131707.
  •  Gaziano TA, Pandya A, Steyn K, Levitt N, Mollentze W, Joubert G, Walsh CM, Motala AA, Kruger A, Schutte AE, Naidoo DP, Prakaschandra DR and Laubscher R. Comparative Assessment of Absolute Cardiovascular Disease Risk Characterization from Non-laboratory-based Risk Assessment in South African Populations. BMC Med. 2013 Jul 24; 11: 170. doi: 10.1186/1741-7015-11-170.
  •  Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, Levitt NS, Crowther NJ, Nyirenda M, Njelekela M, Ramaiya K, Nyan O, Adewole OO, Anastos K, Azzoni L, Boom WH, Compostella C, Dave JA, Dawood H, Erikstrup C, Fourie CM, Friis H, Kruger A, Idoko JA, Longenecker CT, Mbondi S, Mukaya JE, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Zinyama R, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Young EH, Smeeth L, Motala AA, Kaleebu P, Sandhu MS; African Partnership for Chronic Disease Research (APCDR). Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol. 2013 Dec; 42(6): 1754-71. doi:10.1093/ije/dyt198.
  • Beran D, Capewell S, de Courten M, Gale E, Gill G, Husseini A, Keen H, Motala A, O’Flaherty M, Ramachandran A, Swinburn B, Tesfaye S, Unwin N, Wild S, Yudkin JS. The International Diabetes Federation: losing its credibility by partnering with Nestlé? Lancet. 2012 Sep 1; 380 (9844): 805. doi: 10.1016/S0140-6736(12)61449-4.
  • Motala AA, Esterhuizen T, Pirie FJ, Omar MAK. The Prevalence of Metabolic Syndrome and Determination of the Optimal Waist Circumference Cutoff Points in a Rural South African Community. Diabetes Care. 2011 Apr; 34(4): 1032-7.
  • Paruk IM, Pirie FJ, Motala AA, Kolawole BA. High prevalence of abnormal liver enzymes in South African patients with type 2 diabetes mellitus attending a   diabetes clinic. JEMDSA 2011; 16(1): 43-47.
  • Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa.Lancet. 2010 Jun 26; 375(9733): 2254-66.
  • Pirie FJ, Motala AA, Pegararo RJ, Paruk IM, Govender I, Rom L. Variants in PPARG, KCNJ11, TCF7L2, and HHEX genes in South African subjects of Zulu descent with type 2 diabetes. African Journal of Diabetes Medicine 2010; 1: 17-21.
  • Motala AA, Mbanya JC, Ramaiya KL. Metabolic syndrome in sub-Saharan Africa. Ethn Dis. 2009; 19(2 Suppl 2): S2-8-10.
  • Motala AA, Esterhuizen T, Gouws E, Pirie FJ, Omar MAK. Diabetes mellitus and other disorders of glycaemia in a rural South African community: prevalence and associated risk factors. DCare 2008 Sep; 31(9): 1783-8.
  • Motala AA, Pirie F.J, Rauff S, Bacus HB. Cost-effective management of diabetes mellitus. Eth Dis. 2006 Spring; 16 (2 Suppl 2): 52-79-84.

  • Motala AA, Busson M, Al-Harbi EM, Khuzam MA, Al-Omari EM, Arekat MR, Almawi WY. Susceptible and protective human leukocyte antigen class II alleles and haplotypes in bahraini type 2 (non-insulin-dependent) diabetes mellitus patients. Clin Diagn Lab Immunol. 2005 Jan; 12(1): 213-7.
  • Al-Jenaidi FA, Wakim-Ghorayeb SF, Al-Abbasi A, Arekat MR, Irani-Hakime N,Najm P, Al-Ola K, Motala AA, Almawi WY. Contribution of selective HLA-DRB1/DQB1 alleles and haplotypes to the genetic susceptibility of type 1 diabetes among Lebanese and Bahraini Arabs.
  • J Clin Endocrinol Metab. 2005; 90: 5104-9.Pirie FJ, Pegoraro R, Motala AA, Rauff S, Rom L, Govender T, Esterhuizen TM. Toll-like receptor 3 gene polymorphisms in South African Blacks with type 1 diabetes. Tissue Antigens. 2005; 66(2): 125-30.

1. Al-Harbi EM, Abbassi AJ, Tamim H, al-Jenaidi F, Kooheji M, Kamal M, al-Mahroos S, al-Nasir F, Motala AA, Almawi WY.

Specific HLA-DRB and -DQB alleles and haplotypes confer disease susceptibility or resistance in Bahraini type 1 diabetes patients.
Clin Diagn Lab Immunol. 2004 Mar; 11(2): 292-6.

2. Almawi WY, Busson M, Tamim H, Al-Harbi EM, Finan RR, Wakim-Ghorayeb SF, Motala AA. 

HLA class II profile and distribution of HLA-DRB1 and HLA-DQB1 alleles and haplotypes among Lebanese and BahrainiArabs.

Clin Diagn Lab Immunol. 2004 Jul; 11(4): 770-4.

3. Hung CC, Pirie F, Luan J, Lank E, Motala A, Yeo GS, Keogh JM, Wareham NJ, O’Rahilly S, Farooqi IS. Studies of the peptide YY and neuropeptide Y2 receptor genes in relation to human obesity and obesity-related traits.
Diabetes. 2004 Sep; 53(9): 2461-6.

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