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   2011| September  | Volume 15 | Issue 7  
    Online since September 13, 2011

 
 
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REVIEW ARTICLES
Growth charts: A diagnostic tool
Vaman Khadilkar, Anuradha Khadilkar
September 2011, 15(7):166-171
DOI:10.4103/2230-8210.84854  PMID:22029020
Context: Assessment of growth by objective anthropometric methods is crucial in child care. India is in a phase of nutrition transition and thus it is vital to update growth references regularly. Objective: To review growth standards and references for assessment of physical growth of Indian children for clinical use and research purposes. Materials and Methods: Basics of growth charts and importance of anthropometric measurements are described. A comparison between growth standards and references is provided. Further, Indian growth reference curves based on the data collected by Agarwal et al. and adopted by the Indian Academy of Pediatrics, World Health Organization growth standards for children under the age of 5 years (2006) and contemporary Indian growth references published on apparently healthy affluent Indian children (data collected in 2007-08) are discussed. The article also discusses the use of adult equivalent body mass index (BMI) cut-offs for screening for overweight and obesity in Indian children. Results and Conclusions: For the assessment of height, weight and BMI, WHO growth standards (for children < 5 years) and contemporary cross sectional reference percentile curves (for children from 5-18 years) are available for clinical use and for research purposes. BMI percentiles (adjusted for the Asian adult BMI equivalent cut-offs) for the assessment of physical growth of present day Indian children are also available. LMS values and Microsoft excel macro for calculating SD scores can be obtained from the author (email: [email protected]). Contemporary growth charts can be obtained by sending a message to 08861201183 or email: [email protected]
  28,920 2,963 35
The orgasmic history of oxytocin: Love, lust, and labor
Navneet Magon, Sanjay Kalra
September 2011, 15(7):156-161
DOI:10.4103/2230-8210.84851  PMID:22029018
Oxytocin has been best known for its roles in female reproduction. It is released in large amounts during labor, and after stimulation of the nipples. It is a facilitator for childbirth and breastfeeding. However, recent studies have begun to investigate oxytocin's role in various behaviors, including orgasm, social recognition, bonding, and maternal behaviors. This small nine amino acid peptide is now believed to be involved in a wide variety of physiological and pathological functions such as sexual activity, penile erection, ejaculation, pregnancy, uterine contraction, milk ejection, maternal behavior, social bonding, stress and probably many more, which makes oxytocin and its receptor potential candidates as targets for drug therapy. From an innocuous agent as an aid in labor and delivery, oxytocin has come a long way in being touted as the latest party drug. The hormone of labor during the course of the last 100 years has had multiple orgasms to be the hormone of love. Many more shall be seen in the times to come!
  17,890 3,627 30
Imaging of the pituitary: Recent advances
Vikas Chaudhary, Shahina Bano
September 2011, 15(7):216-223
DOI:10.4103/2230-8210.84871  PMID:22029027
Pituitary lesions, albeit relatively infrequent, can significantly alter the quality of life. This article highlights the role of advanced imaging modalities in evaluating pituitary-hypothalamic axis lesions. Magnetic resonance imaging (MRI) is the examination of choice for evaluating hypothalamic-pituitary-related endocrine diseases. Advanced MR techniques discussed in this article include dynamic contrast-enhanced MRI, 3T MRI, magnetization transfer (MT) imaging, diffusion-weighted imaging (DWI), proton MR spectroscopy, fluorine-18 fluorodeoxyglucose-positron emission tomography, single-photon emission computed tomography, intraoperative MRI, and intraoperative real-time ultrasonography.
  16,474 2,305 27
Management of diabetes insipidus in children
Garima Mishra, Sudha Rao Chandrashekhar
September 2011, 15(7):180-187
DOI:10.4103/2230-8210.84858  PMID:22029022
Diabetes Insipidus (DI) is a heterogeneous clinical syndrome of disturbance in water balance, characterized by polyuria (urine output > 4 ml/kg/hr), polydypsia (water intake > 2 L/m 2 /d) and failure to thrive. In children, Nephrogenic DI (NDI) is more common than Central DI (CDI), and is often acquired. The signs and symptoms vary with etiology, age at presentation and mode of onset. Neonates and infants with NDI are severely affected and difficult to treat. Diagnosis is based on the presence of high plasma osmolality and low urinary osmolality with significant water diuresis. Water deprivation test with vasopressin challenge, though has limitations, is done to differentiate NDI and CDI and diagnose their partial forms. Measurement of urinary aquaporin 2 and serum copeptin levels are being studied and show promising diagnostic potential. Magnetic Resonance Imaging (MRI) pituitary helps in the etiological diagnosis of CDI, absence of posterior pituitary bright signal being the pathognomic sign. If pituitary stalk thickening of < 2 mm is present, these children need to be monitored for evolving lesion. Neonates and young infants are better managed with fluids alone. Older children with CDI are treated with desmopressin. The oral form is safe, highly effective, with more flexibility of dosing and has largely replaced the intranasal form. In NDI besides treatment of the underlying cause, use of high calorie low solute diet and drugs to ameliorate water excretion (thiazide, amelioride, indomethacin) are useful. Children with NDI however well treated, remain short and have mental retardation on follow up.
  11,765 2,572 10
Contemporary issues in precocious puberty
Anurag Bajpai, PSN Menon
September 2011, 15(7):172-179
DOI:10.4103/2230-8210.84855  PMID:22029021
Precocious puberty poses significant diagnostic and therapeutic challenge to the physician. Recent advances in the understanding of pathophysiology of precocious puberty have resulted in improved management. Timely intervention is mandatory to achieve successful outcome. The identification of critical role of KISS-1-kisspeptin-GPR54 system has gone a long way to provide an insight into pubertal physiology. It is likely that the system would become an important diagnostic and therapeutic target in children with precocious puberty. Epidemiological studies point toward earlier thelarche. This is, however, associated with slower progression as the age of menarche is static. These changes have led to suggestions of lowering the age cutoffs for precocious puberty in girls. New developments in assessment of precocious puberty including gonadotropin releasing hormone (GnRH) agonist test have made characterization of precocious puberty easier. Longstanding GnRH analogs have become the mainstay of treatment of gonadotropin-dependent precocious puberty, while aromatase inhibitors and inhibitors of sex hormone action are increasingly being used in gonadotropin-independent precocious puberty.
  12,467 1,730 4
Pituitary apoplexy
Salam Ranabir, Manash P Baruah
September 2011, 15(7):188-196
DOI:10.4103/2230-8210.84862  PMID:22029023
Pituitary apoplexy is rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary gland. This disorder most often involves a pituitary adenoma. Occasionally it may be the first manifestation of an underlying adenoma. There is conflicting data regarding which type of pituitary adenoma is prone for apoplexy. Some studies showed predominance of non-functional adenomas while some other studies showed a higher prevalence in functioning adenomas amongst which prolactinoma have the highest risk. Although pituitary apoplexy can occur without any precipitating factor in most cases, there are some well recognizable risk factors such as hypertension, medications, major surgeries, coagulopathies either primary or following medications or infection, head injury, radiation or dynamic testing of the pituitary. Patients usually present with headache, vomiting, altered sensorium, visual defect and/or endocrine dysfunction. Hemodynamic instability may be result from adrenocorticotrophic hormone deficiency. Imaging with either CT scan or MRI should be performed in suspected cases. Intravenous fluid and hydrocortisone should be administered after collection of sample for baseline hormonal evaluation. Earlier studies used to advocate urgent decompression of the lesion but more recent studies favor conservative approach for most cases with surgery reserved for those with deteriorating level of consciousness or increasing visual defect. The visual and endocrine outcomes are almost similar with either surgery or conservative management. Once the acute phase is over, patient should be re-evaluated for hormonal deficiencies.
  12,485 1,640 19
Sheehan's syndrome: Newer advances
C Shivaprasad
September 2011, 15(7):203-207
DOI:10.4103/2230-8210.84869  PMID:22029025
Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum hemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.
  11,555 2,121 26
Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder
Binu P Pillai, Ambika Gopalakrishnan Unnikrishnan, Praveen V Pavithran
September 2011, 15(7):208-215
DOI:10.4103/2230-8210.84870  PMID:22029026
Hyponatremia occurs in about 30% of hospitalized patients and syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of hyponatremia. SIADH should be differentiated from other causes of hyponatremia like diuretic therapy, hypothyroidism and hypocortisolism. Where possible, all attempts should be made to identify and rectify the cause of SIADH. The main problem in SIADH is fluid excess, and hyponatremia is dilutional in nature. Fluid restriction is the main stay in the treatment of SIADH; however, cerebral salt wasting should be excluded in the clinical setting of brain surgeries, subarachnoid hemorrhage, etc. Fluid restriction in cerebral salt wasting can be hazardous. Sodium correction in chronic hyponatremia (onset >48 hours) should be done slowly to avoid deleterious effects in brain.
  7,121 1,619 14
Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements
Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa
September 2011, 15(7):224-232
DOI:10.4103/2230-8210.84872  PMID:22029028
The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.
  6,239 1,327 2
Adult growth hormone deficiency
Vishal Gupta
September 2011, 15(7):197-202
DOI:10.4103/2230-8210.84865  PMID:22029024
Adult growth hormone deficiency (AGHD) is being recognized increasingly and has been thought to be associated with premature mortality. Pituitary tumors are the commonest cause for AGHD. Growth hormone deficiency (GHD) has been associated with neuropsychiatric-cognitive, cardiovascular, neuromuscular, metabolic, and skeletal abnormalities. Most of these can be reversed with growth hormone therapy. The insulin tolerance test still remains the gold standard dynamic test to diagnose AGHD. Growth hormone is administered subcutaneously once a day, titrated to clinical symptoms, signs and IGF-1 (insulin like growth factor-1). It is generally well tolerated at the low-doses used in adults. Pegylated human growth hormone therapy is on the horizon, with a convenient once a week dosing.
  6,404 879 11
History of growth hormone therapy
Vageesh S Ayyar
September 2011, 15(7):162-165
DOI:10.4103/2230-8210.84852  PMID:22029019
Although the importance of the pituitary gland for growth was recognized in late 19 th century, Growth hormone (GH) therapy was made available for severely GH-deficient children and adolescents only in late 1950s. Use of GH for other conditions was limited because of the limited supply of human pituitary-derived hormone. With unlimited availability of recombinant human GH (rhGH), the scenario of GH treatment has been changed enormously. Currently there is ever increasing list of indications of GH treatment in children, adolescents, and adults.
  4,611 924 19
CASE REPORTS
Management of prolactinoma with cabergoline treatment in a pregnant woman during her entire pregnancy
Sukhwinder Kaur Bajwa, Sukhminder Jit Singh Bajwa, Praveen Mohan, Anita Singh
September 2011, 15(7):267-270
DOI:10.4103/2230-8210.84883  PMID:22029039
Management of prolactinoma in pregnancy is a big challenge for the treating obstetrician as prolactin levels are normally raised in pregnancy and this creates a possibility of missing the diagnosis of prolactinoma. Women with micro adenomas and intrasellar macro adenomas do not require serial magnetic resonance imaging (MRI) or visual field testing as required in macro adenomas with extrasellar extension. A strict and vigil monitoring during each trimester for any clinical signs and symptoms related to tumor will suffice for the diagnosis of enlarging prolactinoma and for any active intervention required thereof. Dopamine agonists are the first choice of drugs to treat these tumors during pregnancy. Cabergoline is reported to be more effective and better tolerated as compared to traditional bromocriptine, with minimal risk of spontaneous abortion, congenital malformations or menstrual abnormalities. We are reporting a patient with macro prolactinoma who was treated successfully throughout her pregnancy with cabergoline. We achieved a very good control of prolactinoma without any significant alteration of dose and also without any adverse effects. We convey that cabergoline can be a first choice drug to treat macro prolactinomas in pregnancy also.
  4,197 641 7
Hypopituitarism as unusual sequelae to central nervous system tuberculosis
S Mageshkumar, Devendra V Patil, JA Philo Aarthy, K Madhavan
September 2011, 15(7):259-262
DOI:10.4103/2230-8210.84881  PMID:22029037
Neurological tuberculosis can very rarely involve the hypophysis cerebri. We report a case of an eighteen year old female who presented with five months duration of generalised apathy, secondary amenorrhea and weight gain. She was on irregular treatment for tuberculosis of the central nervous system for the last five months. Neuroimaging revealed sellar and suprasellar tuberculomas and communicating hydrocephalus requiring emergency decompression. Endocrinological investigation showed hypopituitarism manifesting as pituitary hypothyroidism, hypocortisolism, hypogonadotropic hypogonadism, and hyperprolactinemia. Restarting anti-tuberculosis treatment, hormone replacement therapy, and a ventriculo-peritoneal shunt surgery led to remarkable improvement in the general condition of the patient.
  4,393 377 -
Acromegaly with no pituitary adenoma and no evidence of ectopic source
Deepak Khandelwal, Rajesh Khadgawat, Amar Mukund, Ashish Suri
September 2011, 15(7):250-252
DOI:10.4103/2230-8210.84878  PMID:22029034
More than 99% of patients with acromegaly harbor a growth hormone (GH) secreting pituitary adenoma. As the time from onset of signs/symptoms to diagnosis of acromegaly is long (symptom onset to diagnosis is often 4-10 years), pituitary adenomas that cause GH excess are often large and are nearly always visible on conventional magnetic resonance imaging (MRI). However, in rare circumstances, acromegalic patients without an ectopic source will not have imaging evidence of a pituitary adenoma. Management of these patients poses special challenge, and once ectopic source of GH/growth-hormone-releasing hormone (GHRH) is ruled out, an exploration of pituitary might be useful. We herein report a case of acromegaly with imaging evidence of sellar floor osteoma, but no pituitary adenoma, and negative work up for an ectopic source of GH/GHRH tumor, and on surgical exploration pituitary adenoma could be identified and removed and confirmed on histopathologic examination.
  3,486 716 1
Surgical excision of hypothalamic hamartoma in a twenty months old boy with precocious puberty
Rajesh K Ghanta, Kalyan Koti, Srikanth Kongara, Gautham E Meher
September 2011, 15(7):255-258
DOI:10.4103/2230-8210.84880  PMID:22029036
A twenty months old boy presented to our department with true precocious puberty due to hypothalamic hamartoma. Total surgical excision of pedunculated hypothalamic hamartoma was done successfully by the pterional trans-sylvian approach as he could not afford medical management. Patient had uneventful post-operative course with normalization of serum testosterone levels and regression of secondary sexual characters.
  3,315 346 5
ORIGINAL ARTICLES
Pituitary metastasis as a presenting manifestation of silent systemic malignancy: A retrospective analysis of four cases
P Dutta, Anil Bhansali, VN Shah, Rama Walia, SK Bhadada, S Paramjeet, A Pathak, KK Mukherjee, N Khandelwal
September 2011, 15(7):242-245
DOI:10.4103/2230-8210.84875  PMID:22029031
Background: Pituitary metastasis as a presenting manifestation of silent systemic malignancy is rare. We describe four such cases. Materials and Methods: Four patients (0.7%) of malignancy with pituitary metastasis out of 540 patients of sellar mass within a period of 10 years were analyzed for clinical, hormonal and radiological findings. Result: The age range of these patients was 39-60 years with lag time ranging from 2to 5 months. Pituitary pathology was presenting manifestation in all 4 patients including diabetes insipidus, ophthalmoplegia and variable anterior pituitary hormone deficiency. 2 patients had bronchogenic carcinoma and one each had squamous cell and adenocarcinoma with unknown primary. Diagnosis of pituitary metastasis was confirmed in three on pituitary mass histopathology and in one it was based on rapidly appearing mass in a short time. Conclusion: Rapidly appearing mass in the sellar region, short lag time,sudden onset of ophthalmoplegia, -symptoms and signs disproportionate to the size of mass, presence of diabetes insipidus and destroyed but normal sized sella should invoke the suspicion of pituitary metastasis.
  3,002 325 -
CASE REPORTS
Primary pituitary tubercular abscess mimicking as pituitary adenoma
Rakesh Ranjan, Pankaj Agarwal, Shweta Ranjan
September 2011, 15(7):263-266
DOI:10.4103/2230-8210.84882  PMID:22029038
Tubercular abscess of the pituitary fossa is rare and may lead to diagnostic uncertainty in a patient with absence of tuberculosis elsewhere in the body. We present a rare case report of a young lady who presented with sellar and suprasellar cystic mass. She was diagnosed as a case of pituitary macroadenoma and was intraoperatively found to harbor pus in the lesion. She did not have any symptoms of infection. The case underlines the importance of considering such a possibility in the differential diagnosis of cystic sellar lesions and further diagnostic tests should be done for confirmation and treatment of this rare and potential life threatening illness.
  2,906 379 5
BRIEF COMMUNICATIONS
Growth hormone in male infertility
Navneet Magon, Suneeta Singh, Ajit Saxena, Rakesh Sahay
September 2011, 15(7):248-249
DOI:10.4103/2230-8210.84877  PMID:22029033
Growth hormone (GH) is expressed in a variety of tissues, including the testes, and has autocrine and paracrine functions as well. This, along with other factors, exerts autocrine and paracrine control over spermatogenesis. GH, used as an adjuvant therapy, induces spermatogenesis in non-responder patients with hypogonadotropic hypogonadism, who are not responding to gonadotropin or pulsatile luteinizing hormone (LH) therapy. GH has an important physiological role to play in spermatogenesis and male fertility.
  2,733 441 11
EDITORIALS
Growth charts
Vaman Khadilkar, Sanjay Kalra, Anuradha Khadilkar
September 2011, 15(7):154-155
DOI:10.4103/2230-8210.84848  PMID:22029017
  2,432 662 -
ORIGINAL ARTICLES
Selective preservation of anterior pituitary functions in patients with Sheehan's syndrome
Bashir Ahmad Laway, Shahnaz Ahmad Mir, Tariq Gojwari, Tariq Rashid Shah, Abdul Hamid Zargar
September 2011, 15(7):238-241
DOI:10.4103/2230-8210.84874  PMID:22029030
Background: Sheehan's syndrome manifests as hypopituitarism following a child birth usually preceded by postpartum hemorrhage. The symptoms range from vague feelings of ill health to symptoms of a full blown panhypopituitarism. A large series of such patients is not described in the literature. Materials and Methods: We present the details of ten women with partial Sheehan's syndrome. They presented with post-partum hemorrhage and lactation failure. Results: After delivery, seven out of ten patients had regular menstrual cycles indicating preservation of gonadotroph function. Lactotroph, thyrotroph, and somatotroph failure were present in all and corticotrophs preservation was documented in four out of ten patients. The hypophysial magnetic resonance imaging (MRI) confirmed empty sella in all. Conclusion: lactotroph, somatotroph and thyrotroph failure are common in patients with Sheehan's syndrome. In addition to known preservation of gonadotroph axis, corticotroph axis may be preserved in some of these patients arguing against the universal treatment of these patients with glucocorticoids.
  2,388 530 6
BRIEF COMMUNICATIONS
Growth hormone in the management of female infertility
Navneet Magon, Swati Agrawal, Sonia Malik, KM Babu
September 2011, 15(7):246-247
DOI:10.4103/2230-8210.84876  PMID:22029032
Growth hormone (GH) is involved in the regulation of male and female infertility and has been used in the management of both male and female infertility. GH is also produced by the ovary apart from it being produced from pituitary. GH helps in monofollicular growth. GH therapy is one of the adjuvant treatment used in ovarian stimulation and Assisted Reproductive Technologies Assisted Reproductive Technology (ART). GH supplementation has been shown to improve pregnancy rates in poor responders. Growth hormone cotherapy has a definite role to play in ovarian stimulation and is effective in appropriately selected cases. However, it cannot be recommended indiscriminately in every patient undergoing ovarian stimulation or assisted reproductive technology.
  2,115 531 6
EDITORIALS
Hypopituitarism in the tropics
Sanjay Kalra, Dinesh Dhanwal, Vaman Khadilkar
September 2011, 15(7):151-153
DOI:10.4103/2230-8210.84845  PMID:22029016
  2,134 484 3
ORIGINAL ARTICLES
Hypothalamic pituitary dysfunction in acute nonmycobacterial infections of central nervous system
Dinesh K Dhanwal, Sanjay Kumar, Annirudha Vyas, Alpana Saxena
September 2011, 15(7):233-237
DOI:10.4103/2230-8210.84873  PMID:22029029
Background and Objective: Acute and chronic central nervous system (CNS) infections are not uncommon in tropical countries and are associated with high morbidity and mortality if specific targeted therapy is not instituted in time. Effects of tubercular meningitis, a form of chronic meningitis on hypothalamic pituitary axis, are well known both at the time of diagnosis and after few months to years of illness. However, there are few reports of pituitary dysfunction in subjects with acute CNS infections. Therefore, this study was aimed at evaluating the pituitary hormonal profile in patients with nonmycobacterial acute meningitis at the time of presentation. Materials and Methods: This prospective case series study included 30 untreated adult patients with acute meningitis, meningoencephalitis, or encephalitis, due to various nonmycobacterial agents, admitted and registered with Lok Nayak Hospital, Maulana Aazd Medical College, New Delhi, between September 2007 and March 2009. Patients with preexisting endocrine diseases, tubercular meningitis and patients on steroids were carefully excluded from the study. The basal pituitary hormonal profile was measured by the electrochemilumniscence technique for serum cortisol, luetinizing hormone (LH), follicular stimulating hormone (FSH), prolactin (PRL), thyrotropin (TSH), free tri-iodothyronine (fT3), and free thyroxine (fT4). Results: The cases (n = 30) comprised of patients with acute pyogenic meningitis (n = 23), viral meningoencephalitis (n = 4), brain abscess (n = 2), and cryptococcal meningitis (n = 1). The mean age of patients was 28.97 ± 11.306 years. Out of 30 patients, 14 (46.7%) were males and 16 (58.1%) were females. Adrenal insufficiency both absolute and relative was seen in seven (23.3%) and hyperprolactinemia was seen in nine (30.0%) of the patients. One study subject had central hypothyroidism and seven (23.3) showed low levels of LH and/or FSH. None of patients showed clinical features suggestive of central diabetes insipidus. Conclusion: Acute infections of the CNS are associated with abnormalities in the pituitary hormone profile. Further studies are required to evaluate the hypothalamic pituitary axis using dynamic tests and imaging by MRI.
  2,181 389 4
LETTERS TO THE EDITOR
Cavity in lung in a case of Cushing's disease
Sandeep Kharb, Abhay Gundgurthi, MK Dutta, MK Garg
September 2011, 15(7):273-274
DOI:10.4103/2230-8210.84886  PMID:22029042
  1,766 232 -
CASE REPORTS
Congenital hypopituitarism and renal failure
Gaurav Atreja, Porus Bustani
September 2011, 15(7):253-254
DOI:10.4103/2230-8210.84879  PMID:22029035
Congenital hypopituitarism is potentially fatal in the newborn period but treatable if the diagnosis is made early. We report a neonate who presented with hypothermia and severe hypoglycemia. He also had undescended testis and micropenis. Initial screening revealed panhypopituitarism, which was corrected promptly. He developed renal failure due to initial cardiovascular compromise related to hypotension but recovered quickly with standard management. Magnetic resonance imaging revealed absent stalk of anterior pituitary.
  1,598 295 -
LETTERS TO THE EDITOR
Delayed recovery of hypothalamo-pituitary-adrenal axis
Sandeep Kharb, Aditi Pandit, Abhay Gundgurthi, MK Garg
September 2011, 15(7):272-273
DOI:10.4103/2230-8210.84885  PMID:22029041
  1,284 243 -
Frequency of anticardiolipin Ac in patients with hyperprolactinemia
Carolina G.S Lećes, Bįrbara T.M Santos, Caroline K Kramer, Miriam C Oliveira
September 2011, 15(7):271-272
DOI:10.4103/2230-8210.84884  PMID:22029040
  647 80 -
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