Belinda George

Thyroid ectopia: A case series and literature review

Thyroid ectopia is a dysgenesis of thyroid gland. A series of seventeen patients with ectopic thyroid tissue and dyshormonogenesis is presented here. Patient data were reviewed retrospectively for this descriptive study. At presentation, age of the patients ranged from 2 months to 50 years (mean age -13.7 yr). Male to female ratio is 1: 7.5. Hypothyroidism is present in 94.1% cases whereas 5.88% (one case) cases have thyrotoxicosis. Though dyshormonogenesis was the main reason for reference of these cases to our department, a variety of other symptoms like dysphagia (5.88%), obstructive sleep apnea (5.88%), swelling in the neck (17.6%), slow growth were also present (5.88%). Other than thyroid replacement therapy for hypothyroidism and radioactive iodine therapy for thyrotoxicosis, surgical removal was advised in two cases of persisting obstructive symptoms.

Endocrine management of male subfertility

Infertility in a couple is defined as failure to conceive after 12 months of regular unprotected intercourses. Male infertility due to impaired spermatogenesis may result from hypothalamic, pituitary or testicular disorders. Medical management of infertility associated with gonadotropin deficiencies have high success rate, but for primary testicular failure assisted reproduction techniques (ART) with adjunctive endocrine manipulation remains the best therapeutic option. This article discusses various therapeutic options and regimes using gonadotropins, anti-estrgens, aromatase inhibitors in management of male subfertiltiy.

“Riding high on low fuel” - Our experience with endogenous hyperinsulinemic hypoglycemia

Introduction: Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose. Materials and Methods: We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 2004 to June 2016 in our center, excluding those that were diagnosed with reactive hypoglycemia. We collected data regarding demographics, clinical presentation, laboratory results, localization techniques, and treatment administered. Results: Sixteen patients who were admitted for evaluation based on history suggestive of repeated hypoglycemic episodes were included in the study. All but one pregnant patient was subjected to a supervised fast in the hospital. All patients developed hypoglycemia (defined using Whipples triad) within the first 24 h. Three patients had autoimmune hypoglycemia which differed significantly from insulinoma-mediated hypoglycemia in certain clinical and laboratory parameters. They were older in age with marked fluctuations in the 24 h glucose profile ranging from frank hypoglycemia to frank hyperglycemia. The insulin levels were markedly elevated in this group of patients along with a significantly elevated insulin C peptide molar ratio (ICMR) when compared with patients with insulinoma-mediated hypoglycemia. Conclusions: Although insulinoma is the most common cause of EHH, autoimmune hypoglycemia should be considered as a differential diagnosis, particularly in older individuals with plasma glucose values increasing to the hyperglycemic range. Degree of elevation of insulin levels and ICMR may provide additional clues. Overall, the survival and prognosis of patients with EHH are excellent.

Shared decision making and patient choice for growth hormone therapy: current perspectives

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Megaduodenum in a patient with acromegaly.

Introduction: Acromegaly is associated with enlargement of all organs including the gastro intestinal system. However, there are no previous reports of occurrence of megaduodenum in patients with acromegaly. Discussion: We present the case of a 47 year old male who was diagnosed to have acromegaly 13 years ago and had undergone transsphenoidal surgery twice with incomplete removal of the pituitary macro-adenoma and received radiotherapy following the second surgery. Patient has been on replacement therapy for hypocortisolism, hypothyroidism and hypogonadism since 10 years. Post glucose growth hormone level continued to remain unsuppressed; however, patient never received any medical therapy for acromegaly. He was evaluated with esophago-gastro-duodenoscopy for recurrent abdominal pain and distension, which showed an elongated and tortuous megaduodenum. These findings were verified with a barium study which revealed dilated stomach, first and second part of duodenum with no evidence of a distal obstruction. Conclusions: We report this finding in view of the rare association.

Low density Lipoprotein cholesterol target: Changing goal posts

Elevated low density lipoprotein cholesterol (LDL) has been identified as one of the strongest correctable risk factors for cardiovascular disease in patients with diabetes. The reduction in cardiovascular events with pharmacological therapy aimed at LDL lowering is well documented in both primary prevention and secondary prevention. In this article, we review the evolving trend of aggressive LDL cholesterol lowering strategies.