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   2012| May-June  | Volume 16 | Issue 3  
    Online since May 5, 2012

 
 
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ORIGINAL ARTICLES
Comprehensive yogic breathing program improves quality of life in patients with diabetes
Viveka P Jyotsna, Ansumali Joshi, Smita Ambekar, Neeta Kumar, Anju Dhawan, Vishnubhatla Sreenivas
May-June 2012, 16(3):423-428
DOI:10.4103/2230-8210.95692  
Objective: To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life (QOL) in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Patients having HbA1c between 6 and 9% for at least 3 months with lifestyle modification and oral antidiabetic medication were included. They were followed-up and randomized at 6 months into two groups: one group receiving standard treatment of diabetes and the other group receiving standard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program (Sudarshan Kriya Yoga and Pranayam). Change in fasting and post-prandial blood sugars, glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF questionnaire were assessed. Results: There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following standard treatment alone, although this was not significant. There was significant improvement in physical, psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following standard treatment alone. Conclusion: There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following standard treatment alone.
  18 3,674 658
Vitamin D deficiency in newly diagnosed breast cancer patients
Saba Imtiaz, Neelam Siddiqui, Syed Abbas Raza, Asif Loya, Aasim Muhammad
May-June 2012, 16(3):409-413
DOI:10.4103/2230-8210.95684  
Aim: The aim was to determine serum vitamin D levels in breast cancer patients and to assess its risk association with grade and stage of the tumor. Materials and Methods: Ninety breast cancer patients and equal number of age-matched healthy females were recruited into the study by consecutive sampling over a period of 6 months for this case control study. Serum 25(OH)2D levels and CT bone mineral density was done. Results: The mean age was 46±1.5 years. Age, marital status, menopausal, residential area, parda observing status, and body mass index were similar in distribution among cases and controls. The mean serum vitamin D level in the breast cancer patients was 9.3 ng/ml and in the control group was 14.9 ng/ml (P value <0.001). Vitamin D deficiency was seen in 95.6% (86) breast cancer patients and in 77% (69) of the control group (P value <0.001). Among the breast cancer patients the tumor characteristics (histology, grade, stage, and receptor status) did not show any significant associations with serum levels of vitamin D. Premenopausal breast cancer females had a mean serum vitamin D level of 10.5 ng/ml and postmenopausal females had a mean value of 13.5 ng/ml (P value 0.015). Low BMD did not correlate significantly with vitamin D deficiency (P value 0.787). Conclusion: Invariably almost all patients with breast cancer were vitamin D deficient. Tumor characteristics did not show any significant associations with serum levels of vitamin D. Bone mineral density did not correlate significantly with vitamin D deficiency.
  17 2,635 677
REVIEW ARTICLES
Calcium and bone disorders in pregnancy
Shriraam Mahadevan, V Kumaravel, R Bharath
May-June 2012, 16(3):358-363
DOI:10.4103/2230-8210.95665  
Significant transplacental calcium transfer occurs during pregnancy, especially during the last trimester, to meet the demands of the rapidly mineralizing fetal skeleton. Similarly, there is an obligate loss of calcium in the breast milk during lactation. Both these result in considerable stress on the bone mineral homeostasis in the mother. The maternal adaptive mechanisms to conserve calcium are different in pregnancy and lactation. During pregnancy, increased intestinal absorption of calcium from the gut mainly due to higher generation of calcitriol (1,25 dihydroxy vitamin D) helps in maintaining maternal calcium levels. On the other hand, during lactation, the main compensatory mechanism is skeletal resorption due to increased generation of parathormone related peptide (PTHrP) from the breast. Previous studies suggest that in spite of considerable changes in bone mineral metabolism during pregnancy, parity and lactation are not significantly associated with future risk for osteoporosis. However, in India, the situation may not be the same as a significant proportion of pregnancies occur in the early twenties when peak bone mass is not yet achieved. Further, malnutrition, anemia and vitamin D deficiency are commonly encountered in this age group. This may have an impact on future bone health of the mother. It may also probably provide an opportunity for health care providers for prevention. Other metabolic bone diseases like hypoparathyroidism, hyperparathyroidism and pseudohypoparathyroidism are rarely encountered in pregnancy. Their clinical implications and management are also discussed.
  15 4,430 1,147
ORIGINAL ARTICLES
Low dose adrenocorticotropic hormone test and adrenal insufficiency in critically ill acquired immunodeficiency syndrome patients
PK Shashidhar, GV Shashikala
May-June 2012, 16(3):389-394
DOI:10.4103/2230-8210.95680  
Context: Prevalence of adrenal insufficiency (AI) is not uncommon in HIV infected population. However, AI is rarely diagnosed in clinical practice because many patients have non-specific symptoms and signs. Critical illness in such patients further complicates the evaluation of adrenal function. A 1μgm ACTH test can be used for diagnosis, since it results in more physiological levels of ACTH. A serum cortisol of <18 μg/dL, 30 or 60-minutes after ACTH test has been accepted as indicative of AI, but many experts advocate the normal cortisol response should exceed 25 μg/dL, in critically ill patients. Aim: To determine the prevalence of AI in critically ill AIDS patients, by using 1 μg ACTH test and also, to compare the diagnostic criteria for adrenal insufficiency between cortisol response of <18 μg/dL and <25 μg/dL. Settings and Design: This prospective study was done in the Department of Medicine. Materials and Methods: After taking blood for basal plasma cortisol from AIDS affected fifty adult men and women aged over 18 yrs, 1 μg ACTH was given intravenously, and blood samples were again collected at 30 and 60 minutes for plasma cortisol estimation. Statistical analysis: It was done by Mann-Whitney test. Results: Prevalence of AI was 74% (37 patients) and 92% (46 patients), when the peak stimulated cortisol level of <18 μg/dL and <25 μg/dL, respectively, was used. Conclusion: AI is more prevalent in critically ill AIDS patients. Hence, this test can be performed for early intervention and better management.
  14 1,506 321
REVIEW ARTICLES
Teriparatide - Indications beyond osteoporosis
Marilyn Lee Cheng, Vishal Gupta
May-June 2012, 16(3):343-348
DOI:10.4103/2230-8210.95661  
Osteoporosis is a condition of impaired bone strength that results in an increased risk of fracture. The current and most popular pharmacological options for the treatment of osteoporosis include antiresorptive therapy, in particular, oral bisphosphonates (alendronate, risedronate, ibandronate). Anabolic agents like teriparatide have widened our therapeutic options. They act by directly stimulating bone formation and improving bone mass quantity and quality. Two forms of recombinant human parathyroid hormone (PTH) are available : full-length PTH (PTH 1-84; approved in the EU only) and the 1-34 N-terminal active fragment of PTH (teriparatide, US FDA approved). This review aims to discuss the benefits of teriparatide beyond the currently licensed indications like fracture healing, dental stability, osteonecrosis of jaw, hypoparathyroidism, and hypocalcemia.
  14 6,417 1,574
Bisphenol A in dental sealants and its estrogen like effect
Manu Rathee, Poonam Malik, Jyotirmay Singh
May-June 2012, 16(3):339-342
DOI:10.4103/2230-8210.95660  
Bisphenol A or BPA-based epoxy resins are widely used in the manufacture of commercial products, including dental resins, polycarbonate plastics, and the inner coating of food cans. BPA is a precursor to the resin monomer Bis-GMA. During the manufacturing process of Bis-GMA dental sealants, Bisphenol A (BPA) might be present as an impurity or as a degradation product of Bis-DMA through esterases present in saliva. Leaching of these monomers from resins can occur during the initial setting period and in conjunction with fluid sorption and desorption over time and this chemical leach from dental sealants may be bioactive. Researchers found an estrogenic effect with BPA, Bis-DMA, and Bis-GMA because BPA lacks structural specificity as a natural ligand to the estrogen receptor. It generated considerable concern regarding the safety of dental resin materials. This review focuses on the BPA in dental sealants and its estrogen-like effect.
  13 2,669 699
Hypothyroidism in pregnancy
Rakesh Kumar Sahay, V Sri Nagesh
May-June 2012, 16(3):364-370
DOI:10.4103/2230-8210.95667  
Pregnancy is a period that places great physiological stress on both the mother and the fetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse fetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in influencing outcomes in a euthyroid woman, also needs further clarification. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a flare up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case finding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early confirmation of diagnosis and prompt treatment. Allied with regular post-partum follow up, is required to ensure favourable maternal and fetal outcomes.
  12 8,123 1,763
ORIGINAL ARTICLES
The metabolic syndrome in thyroid disease: A report from Nigeria
Anthonia O Ogbera, Sonny Kuku, Olusola Dada
May-June 2012, 16(3):417-422
DOI:10.4103/2230-8210.95688  
Background: The objective of this study was to determine the prevalence of the metabolic syndrome and its components in people with thyroid disorders. Materials and Methods: 112 subjects with a history of thyroid disorders were consecutively enrolled for the study. Clinical data were obtained by interviewing the patients and referring to their case folders and prescriptions. The subjects were categorized into three: thyrotoxic, those with hypothyroidism and those with nontoxic goiters, based on clinical parameters and or thyroid function tests. The study subjects were weighed and their anthropometric indices were documented. The laboratory parameters that were analyzed included total cholesterol, high-density and low-density cholesterol and triglyceride. Statistical analysis was performed using Student's t test, one-way analysis of variance (ANOVA) test and chi-square test. Results: The study subjects were aged between 14 and 76 years, with a mean age of 44.5 years, and the female:male ratio was 97:15. The mean age and anthropometric indices were comparable in subjects with thyrotoxicosis, hypothyroidism and euthyroidism. The overall prevalence of the metabolic syndrome was 28% and the frequency of occurrence of the metabolic syndrome in subjects with thyrotoxicosis, hypothyroidism and nontoxic goiter was 24%, 40% and 42%, respectively. The commonest occurring metabolic syndrome defining criterion was dysglycemia, while hypertension and elevated triglyceride were the least documented of the criteria. Conclusion: Metabolic syndrome occurs in 1 in every 4 persons with thyroid disorders, and as such, routine screening for this cardiovascular risk factor may be of benefit in this group of people, especially in those with hypothyroidism.
  9 2,838 526
REVIEW ARTICLES
Imaging of the thyroid: Recent advances
Vikas Chaudhary, Shahina Bano
May-June 2012, 16(3):371-376
DOI:10.4103/2230-8210.95674  
Although thyroid scintigraphy and ultrasound continues to be the mainstay of the diagnostic imaging of the thyroid gland, there have been several recent advances that are of interest to both radiologists and endocrinologists. In this review article, the authors discuss recent progress in imaging of the thyroid by use of radionuclide imaging including single photon-emission computed tomography/positron emission tomography, ultrasonography (USG), USG elastography, computed tomography (CT), magnetic resonance imaging (MRI), and optical coherence tomography.
  7 16,516 1,602
ORIGINAL ARTICLES
Molecular genetic analysis of CYP21A2 gene in patients with congenital adrenal hyperplasia
Eunice Marumudi, Arundhati Sharma, Bindu Kulshreshtha, Rajesh Khadgawat, Madan L Khurana, Ariachery C Ammini
May-June 2012, 16(3):384-388
DOI:10.4103/2230-8210.95679  
Context: Congenital adrenal hyperplasia (CAH) is one of the inborn errors of metabolic disorder inherited in an autosomal recessive manner caused by the defects in the steroid 21 hydroxylase CYP21A2 gene. We analyzed the genotype of 62 patients with classic CAH. Aims: To find out the underlying mutations of CYP21A2 gene. Settings and Design: Cohort of CAH patients. Materials and Methods: Sixty-two patients with CAH were recruited from the endocrine clinic at AIIMS. Electrochemiluminiscence method was used for estimating the levels of cortisol. Radioimmunoassay kit-based method was used for estimating the 17 OHP levels. Polymerase chain reaction amplification was done using specific primers to amply the CYP21A2 gene. Statistical Analysis Used: Statistical analysis was done by using Epi Info Version 3.5.1.2008. Results: Out of 62 patients, 50 were simple virilizers (SV) and 12 were salt wasters (SW). Fifty-six were females and six were males. Five 46, XX children were reared as males. Age at presentation varied from 8 months to 38 years. Molecular genetic analysis revealed that the highest number of patients harboured (In 2) IVS2-13 A/C > G (48%), followed by p.P30L (46%), p.Q318X (35%), (D 8 bp) deletion 8 bp (26%), p.I172N (26%), and p. R356W (20%) mutations. Conclusion: This is among the few studies to analyze the mutational spectrum of CYP21A2 gene in a large CAH cohort from India. Molecular diagnosis of CYP21A2 gene should be considered as part of the CAH evaluation to assess the risk of the patients/parents/siblings and to offer genetic counseling.
  6 4,514 742
CASE REPORTS
Ogilvie's syndrome in a case of myxedema coma
Uday Yanamandra, Narendra Kotwal, Anil Menon, Velu Nair
May-June 2012, 16(3):447-449
DOI:10.4103/2230-8210.95710  
Ogilvie's syndrome [acute colonic pseudo-obstruction (ACPO)] presents as massive colonic dilatation without a mechanical cause, usually in critically ill patients due to imbalanced sympathetic and parasympathetic activity. The initial therapy remains conservative with supportive measures (correction of metabolic, infectious or pharmacologic factors) followed by neostigmine and decompressive colonoscopy. Surgery is reserved for patients with clinical deterioration or with evidence of colonic ischemia or perforation. A 60-year-old lady presented with fever, altered sensorium, obstipation, bradycardia and abdominal distension. Investigation revealed hyponatremia and acute colonic pseudo-obstruction. Supportive measures and decompressive colonoscopy were not of great benefit. Thyroid profile was suggestive of primary hypothyroidism. Colonic motility was restored only on starting thyroxin. The case is illustrative of the need to consider hypothyroidism, a common endocrine disorder, in the differential diagnosis of Ogilvie's.
  4 2,259 365
Osteonecrosis of jaw associated with bisphosphonate use
Ashu Rastogi, Vidya Rattan, Sanjay Kumar Bhadada
May-June 2012, 16(3):450-452
DOI:10.4103/2230-8210.95711  
Bisphosphonates are associated with osteonecrosis of the jaw (ONJ) that is defined as an area of exposed, nonvital bone in the maxilla or mandible persisting over 6-8 weeks. We describe a case of 55-year-old female who developed ONJ after tooth extraction and had been receiving oral ibandronate for osteoporosis. Diagnosis of ONJ was confirmed on CT scan. The patient was managed conservatively as she denied teriparatide therapy because of cost constraints.
  4 2,207 540
A curious case of refractory hypothyroidism due to selective malabsorption of oral thyroxine
Nishikant Damle, Chandrasekhar Bal, Ramya Soundararajan, Praveen Kumar, Prashant Durgapal
May-June 2012, 16(3):466-468
DOI:10.4103/2230-8210.95716  
There are very few cases in the literature in which refractory persistent hypothyroidism responded only to parenteral doses of levothyroxine and no evidence of any malabsorptive disorder could be identified. Here, we present a rare case of a 35-year-old woman with refractory hypothyroidism who responded only to intravenous doses of levothyroxine. We also discuss possible causes for the same.
  4 2,450 590
CASE-BASED REVIEW OF LITERATURE
A rare case of lingual thyroid with hyperthyroidism: A case report and review of the literature
Mattakarottu Joseph Jacob, Mudalsha Ravina
May-June 2012, 16(3):441-443
DOI:10.4103/2230-8210.95708  
Lingual thyroid is a rare embryological anomaly resulting from failure of normal thyroid tissue to descend from the foramen cecum at base of tongue to its orthotopic location in front of the lower neck. It is a rare anomaly with a reported incidence of 1 in 3000 of the thyroid disorders. Lingual thyroid is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction, and often with hypothyroidism. Hyperthyroidism is extremely rare finding and till now there are very few case reports published. We present here a case of lingual thyroid with hyperthyroidism, which was treated successfully with radioiodine.
  4 3,593 335
LETTERS TO THE EDITOR
Pancytopenia with cellular bone marrow related to Graves' hyperthyroidism
Sujeet Raina, Rashmi Kaul, Mahesh Mruthyunjaya
May-June 2012, 16(3):478-479
DOI:10.4103/2230-8210.95739  
  4 1,704 314
A rare case of autoimmune polyglandular syndrome type IIIc
Rajesh Kumar Arya, Durgesh Kumar Gupta, Shyam Chand Chaudhary
May-June 2012, 16(3):480-480
DOI:10.4103/2230-8210.95741  
  4 1,554 347
REVIEW ARTICLES
Oral manifestations in growth hormone disorders
Gaurav Atreja, Shikha Handa Atreja, Nitul Jain, Urvashi Sukhija
May-June 2012, 16(3):381-383
DOI:10.4103/2230-8210.95678  
Growth hormone is of vital importance for normal growth and development. Individuals with growth hormone deficiency develop pituitary dwarfism with disproportionate delayed growth of skull and facial skeleton giving them a small facial appearance for their age. Both hyper and hypopituitarism have a marked effect on development of oro-facial structures including eruption and shedding patterns of teeth, thus giving an opportunity to treating dental professionals to first see the signs and symptoms of these growth disorders and correctly diagnose the serious underlying disease.
  4 4,748 1,093
CASE REPORTS
Dermopathy of Graves' disease: Clinico-pathological correlation
Sagili Vijaya Bhaskar Reddy, Sushil Kumar Gupta, Manoj Jain
May-June 2012, 16(3):460-462
DOI:10.4103/2230-8210.95714  
Dermopathy of Graves' disease is a classical, but uncommon extrathyroidal manifestation of Graves' disease. The images of a typical case of dermopathy of Graves' disease are presented along with clinico-pathological correlation.
  3 2,737 415
CASE-BASED REVIEW OF LITERATURE
Dysgerminoma in a female with turner syndrome and Y chromosome material: A case-based review of literature
Sunil Kumar Kota, Kotni Gayatri, Jaya Prakash Pani, Siva Krishna Kota, Lalit Kumar Meher, Kirtikumar D Modi
May-June 2012, 16(3):436-440
DOI:10.4103/2230-8210.95706  
We report a 17-year-old girl evaluated for primary amenorrhea. Cytogenetic analysis of the peripheral blood lymphocytes revealed normal autosomes with 46X inv (Y) confirming the diagnosis of Turner's syndrome with Y cell line. Treatment was initiated with conjugated estrogen while recommending bilateral prophylactic oophorectomy to the patient. One year later the patient presented with abdominal mass, biopsy of the specimen following resection confirmed dysgerminoma originating from right ovary with no invasion or metastasis. The literature is reviewed with regard to the various pathogenetic mechanisms proposed for the development of germ cell tumors in ovary, the cytogenetic findings and recommendations to handle such scenario.
  3 2,875 419
LETTERS TO THE EDITOR
Do we need sick-day guidelines for hypoparathyroidism?
Sanjay Kumar Bhadada, Anil Bhansali, Subbiah Sridhar, Ramanbir Singh, Sudhakar Rao
May-June 2012, 16(3):489-491
DOI:10.4103/2230-8210.95763  
  3 1,311 264
REVIEW ARTICLES
The eunuchs of India: An endocrine eye opener
Sanjay Kalra
May-June 2012, 16(3):377-380
DOI:10.4103/2230-8210.95676  
There are established guidelines for the endocrine and overall treatment of transsexual persons. These guidelines provide information about the optimal endocrine management of male-to-female and female-to-male transsexual persons. India has a large community of eunuchs, also known as hijras, who are men with gender identity disorders. While this community has been studied from a social and medical point of new, no endocrine work has been done in them. This exploratory article tries to discuss the endocrine status, health, and management of the eunuchs.
  3 3,385 539
The eye as a window to rare endocrine disorders
Rupali Chopra, Ashish Chander, Jubbin J Jacob
May-June 2012, 16(3):331-338
DOI:10.4103/2230-8210.95659  
The human eye, as an organ, can offer critical clues to the diagnosis of various systemic illnesses. Ocular changes are common in various endocrine disorders such as diabetes mellitus and Graves' disease. However there exist a large number of lesser known endocrine disorders where ocular involvement is significant. Awareness of these associations is the first step in the diagnosis and management of these complex patients. The rare syndromes involving the pituitary hypothalamic axis with significant ocular involvement include Septo-optic dysplasia, Kallman's syndrome, and Empty Sella syndrome all affecting the optic nerve at the optic chiasa. The syndromes involving the thyroid and parathyroid glands that have ocular manifestations and are rare include Mc Cune Albright syndrome wherein optic nerve decompression may occur due to fibrous dysplasia, primary hyperparathyroidism that may present as red eye due to scleritis and Ascher syndrome wherein ptosis occurs. Allgrove's syndrome, Cushing's disease, and Addison's disease are the rare endocrine syndromes discussed involving the adrenals and eye. Ocular involvement is also seen in gonadal syndromes such as Bardet Biedl, Turner's, Rothmund's, and Klinefelter's syndrome. This review also highlights the ocular manifestation of miscellaneous syndromes such as Werner's, Cockayne's, Wolfram's, Kearns Sayre's, and Autoimmune polyendocrine syndrome. The knowledge of these relatively uncommon endocrine disorders and their ocular manifestations will help an endocrinologist reach a diagnosis and will alert an ophthalmologist to seek specialty consultation of an endocrinologist when encountered with such cases.
  3 15,140 1,306
CASE REPORTS
Vitiligo, hypothyroidism and cardiomyopathy
Yashdeep Gupta, Ariachery C Ammini
May-June 2012, 16(3):463-465
DOI:10.4103/2230-8210.95715  
Vitiligo in association with autoimmune endocrine disorders, especially with hypothyroidism, is not uncommon. Some amount of pericardial effusion is usually present in long-standing/untreated hypothyroidism. Here we describe the case of young male with, long-standing progressive vitiligo, presenting with congestive cardiac failure due to dilated cardiomyopathy and primary hypothyroidism. Cardiac dysfunction progressively improved with thyroid hormone replacement over a period of 2 years.
  2 3,220 412
Large but benign adrenal mass: Adrenal oncocytoma
Viral N Shah, A Premkumar, Rama Walia, Santosh Kumar, Uma Nahar, Anil Bhansali
May-June 2012, 16(3):469-471
DOI:10.4103/2230-8210.95717  
Adrenal incidentalomas of more than 4 cm size are usually malignant. We describe a 28-year-old woman with a 7-cm, non-functioning, well-demarcated adrenal mass, which was identified as an oncocytoma on histopathological examination. Therefore, a large, non-functioning, unilateral adrenal mass with preserved tumor outline should invoke the suspicion of oncocytoma, which is invariably a benign tumor.
  2 1,698 291
EDITORIALS
The exaptation of endocrine pharmacology
Sanjay Kalra, Ganapathi Bantwal, Mathew John
May-June 2012, 16(3):329-330
DOI:10.4103/2230-8210.95658  
  2 1,205 328
LETTERS TO THE EDITOR
Ocular tissue responses to sex hormones
Sukhwinder Kaur Bajwa, Sukhwinder Singh, Sukhminder Jit Singh Bajwa
May-June 2012, 16(3):488-489
DOI:10.4103/2230-8210.95762  
  2 1,652 255
A rare case of Mauriac syndrome
Prem P Patidar, Rajeev Philip, Sanjay Saran, KK Gupta
May-June 2012, 16(3):486-487
DOI:10.4103/2230-8210.95759  
  2 2,208 480
Unassisted successful pregnancy in a case of Addison's disease with recurrent pregnancy loss
Mohd Ashraf Ganie, Riyaz Ahmed Bhat, Irfan-ul-Qayoom , Mushtaq Ahmed Dangroo, Suman Kotwal, Manzoor Ahmad Bhat, Sanjeed Ahmed, Saqib Hassan, Zaffar Amin Shah
May-June 2012, 16(3):481-482
DOI:10.4103/2230-8210.95747  
  2 2,492 294
ORIGINAL ARTICLES
Behavioral aggressiveness in boys with sexual precocity
Bindu Kulshreshtha, Manju Mehta, Nandita Gupta, Ariachery C Ammini
May-June 2012, 16(3):395-399
DOI:10.4103/2230-8210.95681  
Background: Some boys with sexual precocity are known to have behavioral problems like increased physical and verbal aggression and school and social maladjustments. It is believed to be due to premature androgen exposure. However, it is not clear why only some develop this problem, difference in etiology could be one explanation. Aim: The aim of the study is to assess behavioral aggression in boys with sexual precocity due to different disorders. Materials and Methods: Seven children, ages three to seven years, were enrolled for this study. Two were diagnosed to have congenital adrenal hyperplasia (CAH), three had testotoxicosis, while two had central precocious puberty. Parents of children with precocious puberty underwent the (CASP) questionnaire (children's aggression scale-parent version). Results: Testosterone levels were high in all patients. Parents denied any history of physical or verbal aggression in the two boys with CAH. Their CASP rating was 0. In contrast, the CASP ratings in the two boys with testotoxicosis and the two with precocious puberty for five domains ranged from 3.1 - 24.2, 2.6 - 8.3,1-5.6,0 - 7.1, and 0 - 1, respectively. In the present study, increased aggression was seen among all the patients with testotoxicosis and both with precocious puberty. In contrast, there were no symptoms of either increased verbal or physical aggression in either of the two patients with CAH. Conclusions: The hormonal milieu in the boys with CAH versus those with sexual precocity due to other causes differed in terms of cortisol and androgen precursors. The androgen excess in CAH children was a consequence of cortisol deficiency. It is possible that cortisol sufficiency is required for androgen-mediated behavioral effects.
  2 3,712 331
Evaluation of GnRH analogue testing in diagnosis and management of children with pubertal disorders
Hemchand K Prasad, Vaman V Khadilkar, Rahul Jahagirdar, Anuradha V Khadilkar, Sanjay K Lalwani
May-June 2012, 16(3):400-405
DOI:10.4103/2230-8210.95682  
Context: Gonadotrophin releasing hormone (GnRH) stimulation test is pivotal in the assessment of children with pubertal disorders. However, lack of availability and high cost often result in the test falling into disfavor. We routinely use the GnRH analogue stimulation test as an alternative at our center. Aim: To present the data on children with endocrine disorders who underwent GnRH agonist stimulation test in pediatric endocrine clinic of a tertiary care referral hospital. Setting and Design: Pediatric endocrine clinic of a tertiary care referral hospital. Retrospective analysis of case records. Materials and Methods: The details pertaining to clinical and radiological parameters and hormonal tests were retrieved from case records of 15 children who underwent GnRH agonist stimulation test from May 2010 to April 2011. Results: Indications for testing with GnRH analogue were evaluation of delayed puberty, diagnosis of precocious puberty, assessment of hormonal suppression in treatment of precocious puberty and micropenis in two, nine, three and one cases, respectively. The results of the test and clinical and radiological parameters were in concordance. The test was also crucial in diagnosing the onset of central precocious puberty in two children with congenital adrenal hyperplasia. Conclusion: GnRH agonist test is a convenient, safe test that can be performed on an out-patient basis and can help the clinicians in the correct diagnosis and appropriate treatment of various puberty-related disorders.
  2 8,752 1,278
Incidence of gall stone formation in acromegalic patients on octreotide therapy
Aditi A Chakravarty, Ajay Ajmani, Smita Manchanda, Bindu Kulshreshtha, Shweta Chopra
May-June 2012, 16(3):406-408
DOI:10.4103/2230-8210.95683  
Objective: Octreotide, a long-acting synthetic somatostatin analog, has been widely used for ac-romegalic patients. Gastrointestinal (GI) side effects and gall stones are predominant side effects. We report incidence of gall stones in our cohort of acromegalic patients treated with octreotide therapy. Design: Retrospective case observational study. Setting: Endocrinology Unit, Dr. Ram Manohar Lohia, Hospital, New Delhi. Materials and Methods: Patients of acromegaly on primary or secondary octreotide therapy. Intervention: Patients were enquired regarding complaints related to the GI system and their medical records were reviewed. Ultrasound films at various intervals while on octerotide therapy were evaluated by the radiologist for presence of sludge and development of gall stones. Results: Of seven patients, five developed gallstones and sludge was seen in three patients at intervals ranging from 11 to 36 months postoctreotide initiation. Conclusion: A high incidence of gall stone formation in the present study as compared to the West was noted, the reasons for which are not clear.
  2 1,473 288
CASE REPORTS
Short stature with umbilical hernia - Not always due to cretinism: A report of two cases
Sharvil S Gadve, Dipti Sarma, Uma K Saikia
May-June 2012, 16(3):453-456
DOI:10.4103/2230-8210.95712  
A 7-year-old boy presented with umbilical hernia and short stature. Growth retardation, recurrent upper respiratory tract infections and delayed developmental milestones were present from infancy. Umbilical hernia was diagnosed at the age of 5 years. On examination, he had short-trunk dwarfism, large head circumference, coarse facial features, joint stiffness, hepatosplenomegaly, and mild mental retardation. He had normal biochemical parameters, thyroid function tests and arterial blood gas analysis. Radiological evaluation showed that the child had Hunter syndrome with findings of J-shaped sellaturcica, proximal bulleting of metacarpals, spatulated ribs and anterior beaking of lumbar vertebrae. The second case was a 6-year-old girl with umbilical hernia, short stature, normal biochemistry and radiological findings of mucopolysaccharidosis. However, she also had corneal opacity; confirmed by slit-lamp examination, which led to the diagnosis of Hurler-Scheie syndrome. Enzymatic studies could not be done in both the cases, as they are not available at most centers.
  1 3,771 380
Acromegaly without acral changes: A rare presentation
Nilanjan Sengupta, Uma Sinha, Keshab Sinha Roy, Sudipta Saha
May-June 2012, 16(3):457-459
DOI:10.4103/2230-8210.95713  
Acromegaly is diagnosed clinically by the universal presence of acral enlargement and typical coarse facies. We report a short, elderly female developing acromegalic facies for last 10 years without acral overgrowth. She is a patient of primary hypothyroidism, well controlled for last 20 years. Acromegaly was proven by high level of serum insulin like growth factor-1 (IGF-1) and elevated and nonsuppressed level of growth hormone (GH), with other hormonal profile being undisturbed. She had mild insulin resistance and systemic hypertension in absence of any visual field defect. Magnetic resonance imaging (MRI) of brain revealed pituitary hyperplasia without any detectable adenoma. No source of ectopic secretion of GH or growth hormone releasing hormone (GHRH) could be localized. Therefore, atypical presentation of acromegaly needs high degree of suspicion even if some of the common features are lacking. Here, we have biochemically proved acromegaly with typical facies, short stature but no acral overgrowth and pituitary adenoma despite longstanding disease activity, and thus eluding diagnosis for years.
  1 2,386 306
CASE-BASED REVIEW OF LITERATURE
Childhood adrenocortical carcinoma: Case report and review
Abhay Gundgurthi, Sandeep Kharb, Manoj K Dutta, MK Garg, Abhisek Khare, M Joseph Jacob, Reena Bhardwaj
May-June 2012, 16(3):431-435
DOI:10.4103/2230-8210.95699  
Adrenocortical cancers in childhood are very rare tumors. The tumors have varied presentation - either virilizing forms or presentation with Cushing's syndrome, or both. In children, due to the rapid development of symptoms they come to attention early, however, if not diagnosed and treated early can have a downhill course. The last decade has seen the emergence of new diagnostic imaging modalities. There is also intense ongoing research in newer treatment modalities as these tumors can be unresectable or have a high recurrence rate.
  1 2,153 440
LETTERS TO THE EDITOR
Authors' reply
Sandeep Chopra, Soumia Peter
May-June 2012, 16(3):472-473
DOI:10.4103/2230-8210.95720  
  1 791 151
Images in endocrinology: Archibald's metacarpal sign
Vaishali Deshmukh
May-June 2012, 16(3):487-488
DOI:10.4103/2230-8210.95760  
  1 1,953 271
Stunning in post 131 I therapy scans after low-dose 131 I diagnostic whole body scans with differentiated thyroid cancer in the Indian patient population: Critical importance of interval between the two scans
Nishikant A Damle, Chandrasekhar Bal, Sanjana Ballal
May-June 2012, 16(3):477-478
DOI:10.4103/2230-8210.95733  
  1 950 234
Hyperandrogenemia due to ingestion of Butea superba
Kamon Chaiyasit, Viroj Wiwnaitkit
May-June 2012, 16(3):485-486
DOI:10.4103/2230-8210.95756  
  1 3,284 310
CASE-BASED REVIEW OF LITERATURE
Should neck pain in a patient with Hashimoto's thyroiditis be underestimated? A case and review of the literature
Umut Mousa, Anil Cuneyd, Gursoy Alptekin
May-June 2012, 16(3):444-446
DOI:10.4103/2230-8210.95709  
Hashimoto's Thyroiditis (HT) is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT) overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimoto's thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis.
  - 5,117 461
EDITORIALS
Celebrating life with Rita Levi-Montalcini: A hundred years and more
Sanjay Kalra, Manash P Baruah, Ambika Gopalakrishnan Unnikrishnan
May-June 2012, 16(3):327-328
DOI:10.4103/2230-8210.95657  
  - 1,510 342
ENDOCRINOLOGY AND THE ARTS
The breasts of Tutankhamun
Krishna G Seshadri
May-June 2012, 16(3):429-430
DOI:10.4103/2230-8210.95696  
Despite being an obscure pharaoh who ruled for a very short time, Tutankhamun, the boy king, has reigned popular consciousness since the discovery of his tomb in 1922. To endocrinologists, the depiction of the kings of the 18 th dynasty in an androgynous form complete with gynecomastia has been a source of intrigue and academic curiosity. Many explanations abound. But is the depiction just stylized art? Or did the kings indeed have familial gynecomastia, or aromatase excess with craniosynostosis. An inspired team of researchers used molecular genetic tests to truly lay the Tut controversy to rest..
  - 2,364 413
LETTERS TO THE EDITOR
Type 2 DM is not coronary artery disease equivalent
Vageesh S Ayyar
May-June 2012, 16(3):472-472
DOI:10.4103/2230-8210.95718  
  - 905 214
Hypoglycemia and myocardial infarction: Inhibition of ischemic preconditioning response
Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Suresh Ponnuswamy, Ponniah Thirumalaikolundusubramanian
May-June 2012, 16(3):473-474
DOI:10.4103/2230-8210.95723  
  - 1,202 255
Injection site lipodystrophy and the endocrinologist
Abhay Gundgurthi, Manoj K Dutta, Rajiv Pakhetra, MK Garg
May-June 2012, 16(3):474-475
DOI:10.4103/2230-8210.95729  
  - 1,266 216
Waist circumference cutoff and metabolic syndrome
Beuy Joob, Viroj Wiwanitkit
May-June 2012, 16(3):475-476
DOI:10.4103/2230-8210.95731  
  - 896 282
Panhypopituitarism presenting as azoospermia
K. V. S. Hari Kumar, Sai Priya, RP Singh, Richa Kalia
May-June 2012, 16(3):476-477
DOI:10.4103/2230-8210.95732  
  - 1,028 243
A tale of nonhormonal hairs
Rajeev Philip, Prem P Patidar, Praveen Ramachandra, Keshav K Gupta
May-June 2012, 16(3):483-485
DOI:10.4103/2230-8210.95754  
  - 2,430 240
ORIGINAL ARTICLES
Pulmonary function tests in patients with primary hyperparathyroidism
Sanjay Kumar Bhadada, Ahutosh Agrawal, Viral N Shah, Anil Bhansali, Arnanshu Behera, Anish Bhattacharya, Uma Nahar
May-June 2012, 16(3):414-416
DOI:10.4103/2230-8210.95685  
Context: There is limited information on respiratory muscle functions in patients with primary hyperparathyroidism (PHPT). AIM: To assess respiratory muscle dysfunction in patients with PHPT. Setting and Design: This prospective study was carried between January 2005 and December 2006 by the Department of Endocrinology at the Postgraduate Institute of Medical Education and Research, Chandigarh. Materials and Methods: PHPT was defined as elevated parathyroid hormone in the presence of hypercalcemia. Spirometry was performed using a dry rolling seal spirometer and spirometric indices like forced vital capacity (FVC), forced expiratory volume in first second (FEV 1 ), and FEV 1 /FVC ratio were measured using standard guidelines. Results: Thirty patients were studied with a mean age of 37.1 ± 2.4 years and 18 were women. The most common presenting symptoms were fatigue (75.0%) and bone pain (60.70%). The mean (±SD) of percentage predicted FVE 1 , FVC, FEV 1 /FVC ratio, PEF, and FEF were 98.7 ± 16.1, 93.9 ± 14.7, 84.5 ± 3.4, 89.3 ± 22.5, and 99.7 ± 33.6, respectively. Two had obstructive lung disease and two had restrictive lung disease. We did not find correlation with preoperative serum calcium, phosphate, and PTH with FVE 1 , FVC, FEV 1 /FVC ratio, PEF, and FEF. Conclusion: Elevated calcium, low phosphate, and elevated PTH levels in patients with moderate to severe PHPT do not significantly affect respiratory muscle functions.
  - 1,250 278
REVIEW ARTICLES
Osteoanabolics
Vishal Gupta, Mitul Abhaykumar Shah, Sagar Kirtibhai Shah, Jinen Mukeshbhai Shah
May-June 2012, 16(3):349-357
DOI:10.4103/2230-8210.95662  
Osteoporosis is characterized by reduced bone mass, impaired bone quality, and a propensity to fracture. An "osteoanabolic" should be referred to any therapy that helps increase bone mass. Bone mass represents 80% of bone mechanical strength. A low bone mass therefore provides the strongest association of future risk of fracture. This review aims to discuss all available and future therapies that attempt to increase bone mass be it organic or inorganic.
  - 2,969 429
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