Abhishek Singhai

Oncocytic adrenal tumour presenting as Cushing syndrome: rare presentation of a rare tumour

Oncocytic neoplasms are well recognized in organs such as the kidney, thyroid and salivary glands. They are seen rarely in other sites such as the adrenal cortex. To date, around 20 cases of oncocytic adrenocortical neoplasm have been reported; most of them were benign and nonfunctioning. We report the case of hypersecreting adrenocortical oncocytoma in a 52-year-old woman. The patient was tested because of cushingoid features. The patient underwent a laparotomy for right adrenal gland mass. The pathology report confirmed adrenocortical oncocytoma.

Carotid intima medial thickness as a marker of atherosclerosis in ankylosing spondylitis

Background: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton; peripheral joints and extraarticular structures are also frequently involved. The present study was planned to generate more data on this subject with the aim of measuring the CIMT in AS, as these patients are more prone to develop early atherosclerosis and develop early macro vascular complications like CAD. Methods: It was a cross-sectional study with a sample size of 60 patients. The study group included 30 patients with a known history or clinical features suggestive of AS. The control group included 30 normal adult subjects without any previous history. All subjects included in the study underwent detailed clinical history, analysis, physical examination and necessary investigations. Results: CIMT in the control group was 0.54±0.19 mm and in the AS group was 0.65±0.21 mm. The difference was found to be statistically significant (P<0.05), showing a higher CIMT in the AS group in comparison to the control group. The mean age in the control group was 30.43±6.14 years and in the AS group was 29.3±10.1 years. The difference was found to be statistically not significant (p>0.05), showing comparable age between the two groups. The age to CIMT showed positive correlation which was statistically significant (r=0.405, p=0.026). Conclusions: Results of this study showed that there is a higher prevalence of subclinical atherosclerosis (20%) in AS patients as compared to controls as evidenced by a higher CIMT. Every effort should be made in order to control inflammation and traditional risk factors in this population, to avoid the consequences of accelerated atherogenesis.

Diagnosis of diabetes mellitus on the basis of HbA1c: Is this true in hypothyroidism also?

Background: Hypothyroidism may leads to hypoproliferative anemia. It is possible that this reduced erythropoiesis may result false elevation of HbA1c in some cases and further leading to an erroneous diagnosis of pre diabetes or diabetes. Aims and Objective: This study was planned to assess changes in HbA1c after initiation of thyroxine replacement in patients with subclinical and overt hypothyroidism. Settings and Design: This prospective study was conducted at Department of General Medicine of a tertiary care centre over one year. Methods and Material: 100 subjects were recruited for the study. Fasting blood glucose, serum creatinine, hemoglobin, HbA1c, reticulocyte count, serum free T4 and TSH estimation done in all subjects. Hypothyroid patients were started on thyroxine. After three months of documentation of euthyroidism, same investigations were repeated. Statistical analysis used: Statistical software, SPSS version 17.0 was used for analysis. Results: After correction of hypothyroidism, TSH decreased from 92.3(±30.9) to 3.4±2.9 µIU/L and 12.2(±4.5) to 4.4±2.9 µIU/ml in overt hypothyroidism and subclinical hypothyroidism respectively. There was a statistically significant fall in the HbA1c (SD) from 5.9% (0.8) to 5.6% (0.6) and 6.0% (0.3) to 5.7% (0.3) following the correction of hypothyroidism in overt hypothyroidism and subclinical hypothyroidism respectively. However, there were no statistically significant changes in the fasting as well as postprandial blood glucose. Conclusions: Our study demonstrated that HbA1c values are falsely increased in patients with hypothyroidism. This falsely raised HbA1c became normal after thyroxine supplement. Asian Journal of Medical Sciences Vol.7(6) 2016 36-39

Neuromyelitis optica with Hashimoto's thyroiditis: A new syndrome or just coincidence

Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system that affects the optic nerves and spinal cord. NMO with endocrinopathies has been described as being unique to black Antillean and Afro-Brazilian women. We describe one case of NMO with hashimoto′s thyroiditis in a young female, probably first case report in India.

Pattern of thyroid carcinoma in Gizan region of Saudi Arabia

Objective: To study the frequency, clinical features, and histopathological types of thyroid carcinoma in Gizan region of Saudi Arabia. Research Design and Methods: We analyzed the clinical features, laboratory data, histopathological reports, and outcome of 32 patients diagnosed with thyroid carcinoma out of 231 patients who underwent thyroidectomy at King Fahd Central Hospital (KFCH), Gizan and peripheral hospitals over a period of 6 years. Results: The papillary thyroid carcinoma (PTC) was present in 25 patients and follicular thyroid carcinoma (FTC) in 5 cases. Anaplastic cell variety was found in two cases. The mean (±SD) were significantly different (P = 0.015) when the groups with PTC and FTC were compared (43.1 ± 12.7 vs. 61.3 ± 15.4). Fine needle aspiration cytology (FNAC) was done in all 32 cases; it was negative in 11 cases. Conclusions: In Gizan, incidence of thyroid carcinoma is about 14% among total patients undergoing thyroidectomy. Painless thyroid nodule is the most common clinical feature. PTC is the most common variant. FNAC is a useful tool for diagnosis but it can be false negative also.

Effect of sleeve gastrectomy and gastric bypass on diabetic control in Indore, India

Background: Individual with morbid obesity and type 2 diabetes benefits from weight loss, as this allows better glycemic control and modifies the coexisting risk factors for coronary heart disease, namely hypertension, dyslipidemia, insulin resistance, sleep apnea, and other comorbidities that constitute the metabolic syndrome. Aims: The purposes of the present study were to investigate whether weight loss after bariatric surgery can correct glycemic control and reduces the need of antidiabetic treatment in morbidly obese patient with type 2 diabetes, and whether sleeve gastrectomy or gastric bypass is associated with better control. Settings and Design: This study was performed in Sri Aurobindo Medical College, Indore, India. Sampling taken was nonrandom and purposive. Subjects and Methods: Forty patients with diabetes type-2 and body mass index (BMI) >35 (20 of which undergone sleeve gastrectomy and other 20 undergone gastric bypass) were enrolled in study, all these patient had undergone bariatric surgery. Their obesity status in terms of height, weight and BMI, Glycemic status and glycosylated hemoglobin (HbA1c), and treatment status in terms of oral hypoglycemic agents and insulin were noted in details preoperatively. Qualitative variables were tested using Chi-square test and P values were calculated between two groups. P ≤0.05 was considered statistically significant. Results: This study showed good control of glycemic status with mean HbA1c within desired level after 6 months of bariatric surgery, while gastric bypass surgery was associated with better glycemic control and weight loss. Conclusions: This study showed that the bariatric surgery was an effective option for morbidly obese patients with type 2 diabetes mellitus. Gastric bypass surgery was associated with better diabetic control and weight loss than sleeve gastrectomy.

Shock: A possible presenting manifestation of autoimmune polyendocrine syndrome type II

Autoimmune polyendocrine syndrome Type II (APS II), also known as polyglandular autoimmune syndrome Type II or Schmidt syndrome, is constellations of multiple endocrine gland insufficiencies. It is a rare, but most common of the immunoendocrinopathy syndrome. It is characterized by the obligatory occurrence of autoimmune Addisons disease in combination with thyroid autoimmune diseases and/or Type I diabetes, hypogonadism, hypophysitis, myasthenia gravis, vitiligo, alopecia, pernicious anemia, and celiac disease. Here, we report a case of 38-year-old female patient presented with shock, further diagnosed to have APS II.

Radioactive iodine therapy for hyperthyroidism: Our experience

Context: Radioactive iodine (RAI) therapy for hyperthyroidism is safe and definitive, although, post-treatment hypothyroidism and the need for life-long thyroxine are to be expected. The optimal dose of I-131 for hyperthyroidism is still debated. Aims: The aim of this study is to evaluate the response rate of hyperthyroidism to RAI treatment, optimum effective dose, effect of pre-treatment with anti-thyroid medications, ophthalmopathy, and hypothyroidism incidence post RAI therapy. Subjects and Methods: A prospective study was conducted in a tertiary care center to look at the therapeutic practice of use of RAI in the treatment of hyperthyroidism, to determine whether the expected or desired therapeutic outcome is achieved. Seventy consecutive subjects of hyperthyroidism, treated with RAI were followed-up. Results: Grave′s disease was the most common cause of hyperthyroidism. The dose of RAI ranged from 4 mCi to 17.5 mCi. Over 95% cure rate achieved with RAI dose 4-7 mCi. Hypothyroidism occurred in 52.17% cases with this dose. Goiter size significantly decreased with RAI therapy. No deterioration of eye signs observed with RAI therapy. Pre-treatment with anti-thyroid drugs had no influence on outcome. Conclusions: RAI treatment is an effective modality for definitive treatment of hyperthyroidism with long-term cure approaching 95%. Its efficacy, safety and low cost made it the preferred definitive treatment for most patients with hyperthyroidism.

Severe Vitamin D deficiency causing kyphoscoliosis

Vitamin D deficiency is common among Indian population. Women are especially at risk for severe vitamin D deficiency. The risk is higher for those who are multiparous and postmenopausal. Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity and malabsorption are also important risk factors. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage and lower back) have also been misdiagnosed as musculoskeletal disorders, including fibromyalgia, polymyalgia rheumatica and ankylosing spondylitis. Here, we report two cases presented with kyphoscoliosis, diagnosed to have severe vitamin D deficiency.