Kripa Elizabeth Cherian

Association between dental health and osteoporosis: A study in South Indian postmenopausal women

Aim: This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals. Materials and Methods: A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner. Results: About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4.2 (95% confidence interval = 2.4–7.3). Conclusion: Postmenopausal women with osteoporosis had significantly higher number of tooth loss. Tooth loss may thus be used as a surrogate marker to predict osteoporosis.

Endocrine glands and hearing: Auditory manifestations of various endocrine and metabolic conditions

The aetiology of hearing loss in humans is multifactorial. Besides genetic, environmental and infectious causes, several endocrine and metabolic abnormalities are associated with varying degrees of hearing impairment. The pattern of hearing loss may be conductive, sensori-neural or mixed. The neurophysiology of hearing as well as the anatomical structure of the auditory system may be influenced by changes in the hormonal and metabolic milieu. Optimal management of these conditions requires the integrated efforts of the otolaryngologist and the endocrinologist. The presence of hearing loss especially in the young age group should prompt the clinician to explore the possibility of an associated endocrine or metabolic disorder for timely referral and early initiation of treatment.

The heart of the matter: Cardiac manifestations of endocrine disease

Endocrine disorders manifest as a disturbance in the milieu of multiple organ systems. The cardiovascular system may be directly affected or alter its function to maintain the state of homeostasis. In this article, we aim to review the pathophysiology, diagnosis, clinical features and management of cardiac manifestations of various endocrine disorders.

Uncommon cause for anorexia and weight loss

A 51-year-old woman presented with anorexia, abdominal fullness and weight loss of 1 year duration. There was a history of bilateral facial paralysis 4 years ago. There was no history of fever, cough polyarthralgia or altered bowel habits. Examination revealed bilateral lower motor neuron type facial palsy and non-tender hepatomegaly. Haematological workup revealed normocytic normochromic anaemia (9 g/dL) with an elevated erythrocyte sedimentation rate (85 mm/hour) and a WCC of 8800/cu.mm. Her blood biochemistry showed increased levels of alkaline phosphatase—685 U/L (40–125), gamma-glutamyltransferase of 1251 U/L (<38) and angiotensin-converting enzyme—102 U/L …

Impact of curative surgery on bone in a patient with osteitis fibrosa cystica of primary hyperparathyroidism

A 28-year-old woman presented with bone pains and progressive proximal muscle weakness of 2 years duration. Examination revealed significant bony tenderness over the spine and both hips and severe proximal muscle weakness in the lower limbs. The rest of the examination was normal. Biochemical evaluation showed parathyroid hormone (PTH)-dependent hypercalcaemia (serum calcium 12.4 mg/dL (normal 8.4–10.2); PTH >1900 pg/mL (normal 8–50)). Remaining blood bone biochemistry was as follows: phosphorus 2 mg/dL (normal 2.5–4.5), alkaline phosphatase 1112 U/L (normal 40–125), creatinine 0.9 mg/dL (normal 0.6–1.2) and 25 hydroxy vitamin D 12.5 ng/mL (normal 30–75). A skeletal survey performed was diagnostic of osteitis fibrosa cystica with multiple cystic lesions secondary to brown …

Klinefelter syndrome with low gonadotropin levels

Klinefelter syndrome is usually characterised by the presence of a eunuchoid body habitus and testes that are usually small and firm, with low testosterone, and elevated luteinising hormone and follicle-stimulating hormone levels, consistent with hypergonadotropic hypogonadism. Low levels of gonadotropins in karyotypically proven cases are not expected, they are extremely rare occurrences. We report a case of a patient who was diagnosed to have Klinefelter syndrome (47 XXY) with low gonadotropin levels. The rest of his anterior pituitary hormonal profile was normal with no lesions in the pituitary gland on imaging. He was continued on androgen replacement therapy.

Carcinoma pancreas and fibrocalcific pancreatic diabetes: a dual association for weight loss

A 52-year-old man presented with upper abdominal pain and weight loss of 10 kg over 6 months. He had suffered from diabetes mellitus for the past 10 years and was on oral antidiabetic agents. He did not drink alcoholic. He had a history suggestive of steatorrhoea, which worsened following the intake of a fat-rich meal. On clinical examination, his body mass index was 20.5 kg/m2 and there was no evidence of nutritional deficiencies. Abdominal examination was unremarkable. His biochemical evaluation was as follows—haemoglobin 12.7 g/dL (normal range (N) 13–18), glycated haemoglobin 10.5% (N <5.7), S.alkaline phosphatase 90 U/L (N 40–125), serum creatine: 0.9 mg/dL (N 0.6–1.2). An abdomen X-ray showed pancreatic calcification (figure 1 …