Mohd Ashraf Ganie

Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome

OBJECTIVEnTo determine whether subclinical hypothyroidism (SCH) alters the phenotype, insulin resistance, or lipid parameters in young women with polycystic ovary syndrome (PCOS).nnnDESIGNnProspective case-control study.nnnSETTINGnTertiary care setting.nnnPATIENT(S)nSixty-two young women with PCOS and SCH (group I) and 291 euthyroid women with PCOS (group II).nnnINTERVENTION(S)nRecording of clinical, biochemical, hormonal profile, and parameters of insulin resistance.nnnMAIN OUTCOME MEASURE(S)nWhether SCH has any association with clinical parameters like hirsutism, menstrual disturbances, lipid profile, and parameters of insulin sensitivity.nnnRESULT(S)nMean (±SD) TSH was 7.13±1.28 IU/L in group I and 2.51±1.21 IU/L in group II, with comparable free triiodothyronine and free thyroxine. The two groups were comparable in age, weight, and body mass index. Parameters like blood pressure, menstrual pattern, and degree and duration of hirsutism did not differ between the two groups. Serum concentrations of triglycerides were significantly higher in the SCH group compared with controls. Plasma glucose concentrations both in fasting and after oral glucose tolerance test were similar between the two groups. Fasting insulin and other parameters of insulin resistance were not altered by SCH.nnnCONCLUSION(S)nMild TSH elevation in the face of normal serum free triiodothyronine and free thyroxine results in a mild increase in serum lipids. Subclinical hypothyroidism is not associated with alteration in phenotypic expression and insulin resistance in young women with PCOS.

Presentation and clinical course of Wolfram (DIDMOAD) syndrome from North India

Diabet. Med. 28, 1337–1342 (2011)

Conservative management of emphysematous pyelonephritis.

Emphysematous pyelonephritis, though uncommon, is a severe necrotizing kidney infection common in patients with diabetes. Surgical treatment has been advocated as the treatment of choice in most of the patients. We present the clinical course of an elderly lady who presented with emphysematous pyelonephritis and was successfully managed with medical treatment despite the presence of adverse prognostic factors like acute renal failure and thrombocytopenia.

Association of polycystic ovary syndrome and Graves' disease: Is autoimmunity the link between the two diseases

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrinopathy of women of child-bearing age. Although some studies have suggested an association between PCOS and autoimmune thyroiditis, to our knowledge, only a few cases indicating association between PCOS and Graves’ disease are reported. Objective: We aim to describe this first case series of six women presenting with PCOS and Graves’ disease together. Materials and Methods: Women attending the endocrinology clinic at a tertiary care centre in north India and fulfilling the AE-PCOS criteria for diagnosis of PCOS were studied using a predefined proforma for any clinical, biochemical and imaging features of Graves’ disease. Results: The series consisted of six women with a mean age of 27.5 years and menarche as 12.6 years. All women were lean with mean BMI of 22.73 kg / m2 and three out of six had waist circumference <80 cm. The mean FG score of subjects was 16.66 and average total testosterone was 77.02 ng / dl (25.0-119.64). All the patients had suppressed TSH, the average being 0.052 μIU/ml (0.01-0.15). Thyroid gland was enlarged in all clinically and on ultrasonography and imaging with 99mTc and/or RAIU revealed diffuse increased uptake. Conclusions: The association of a rare disorder like Graves’ disease with a relatively common disorder like PCOS is unlikely to be because of a chance alone and may point to a common aetiopathogenic linkage leaving a scope for molecular characterization.

Reference range of thyroid function (FT3, FT4 and TSH) among Indian adults

OBJECTIVESnTo generate thyroid hormone reference norms using electro-chemiluminescence technique.nnnDESIGN AND METHODSnCross sectional study on apparently normal 4349 Delhi adults (18-86 years). Predetermined exclusion criteria (goiter, hypoechogenicity or nodularity on ultrasound, elevated anti-thyroid peroxidase antibody, hypo or hyperthyroidism and family history of thyroid dysfunction) excluded 2433 subjects leaving 1916 (916 males and 1000 females) as the reference population.nnnRESULTSnMean age and BMI of the reference population were 41.2 ± 18.1 years and 24.5 ± 4.4 kg/m(2) respectively. Median urinary iodine excretion was 233.6 μg/L (79-458;3rd-97th centile). The population was categorized into various age groups (18-30, 31-40, 41-50, 51-60, 61-70 and ≥ 70 years). Overall FT3 and FT4 values in the reference population irrespective of age, ranged from 2.4-8.8 (mean 4.6 ± 0.9) pmol/L and 10.1-24.8 (mean 15.40 ± 2.0) pmol/L, respectively. Mean TSH value in the reference population was 2.2 ± 0.9 mIU/L which was significantly lower than that of total population (3.8 ± 6.1; p<0.001).nnnCONCLUSIONnFT3 values were observed to be significantly higher in men than women (p=0.001). The centiles (3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th) of FT3, FT4 and TSH were derived for reference purposes in Indian adults. This community based study in Indian adults has established mean reference intervals for FT3, FT4 and TSH for different age groups for both sexes separately using strict exclusion criteria. These can be used as reference norms for Indian adults.

Thiamine responsive megaloblastic anemia syndrome associated with patent ductus arteriosus: First case report from Kashmir Valley of the Indian subcontinent.

Thiamine responsive megaloblastic anemia syndrome, an autosomal recessive inherited disorder characterized by a triad of anemia, diabetes mellitus and sensorineural deafness is caused by a deficiency of a thiamine transporter protein. The disorder is rare and has not been reported from our community which has high background of consanguinity. We report a six years old girl who presented with diabetes mellitus which remitted after thiamine replacement. The girl in addition had sensorineural deafness, reinopathy, atrial septal defect and megaloblastic anemia which responded to high doses of thymine. This is the first case reported from Kashmir valley and third from India. The presentation and management in such cases is discussed.

Hyperglycemic emergencies in Indian patients with diabetes mellitus on pilgrimage to Amarnathji yatra

Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two distinct metabolic derangements manifested by insulin deficiency and severe hyperglycemia, with estimated mortality rates of 2.5–9%. In patients with type 2 diabetes mellitus (DM) controlled by diet or oral agents, DKA does not occur unless there is significant severe stress such as severe sepsis, major surgery, trauma, etc. We observed many such emergencies occurring in pilgrims. Objective: We analyzed the data of 13 patients with DM admitted in our endocrine department with hyperglycemic emergencies during 2 years of the annual pilgrimage (yatra) to Amarnathji. Materials and Methods: We reviewed and analyzed the case records of 13 yatris with DM who were referred and admitted in our hospital with hyperglycemic emergencies during the yatra season (July–August) of 2006 and 2007. Results: Eleven of 13 had DKA and 1 each had HHS and hypoglycemia. After initial clinical assessment and blood sampling for blood counts, electrolytes, blood gases, urinalysis, chest radiography, and electrocardiography, these cases were managed with standard protocol published by American Diabetes Association (ADA) for the management of DKA and HHS. Average blood glucose was 466 mg/dl and nine subjects had moderate to severe ketonuria. All the cases, except one, were in stable condition at the time of discharge. Conclusion: High altitude, strenuous exertion of going uphill, withdrawal of insulin or oral hypoglycemic drugs, starvation, sepsis, and alcohol intake were recorded as predisposing factors. Therefore, there is an immense need for institution of a special health education program to all the yatris before taking the endeavor.

Nonreversal of adrenal hypofunction after treatment of adrenal tuberculosis

Tuberculosis of the adrenal glands is a common cause for Addison′s disease in developing countries. Whether treatment of tuberculosis normalizes adrenocortical function in these patients is controversial. We are reporting two cases of Addison′s disease because of adrenal tuberculosis, in whom treatment with antitubercular drugs did not restore normal adrenal functions. We conclude that treatment of tubercular Addison′s disease does not lead to normalization of adrenocortical function.

Spontaneous pregnancy in a patient with a combination of ovarian and thyroid failure

Premature ovarian failure has an overall prevalence of 0.3% to 0.9% in general population. If fertility is a concern, treatment usually consists of estrogen therapy as hormone replacement and oocyte donation. Spontaneous pregnancy in affected women is uncommon. We report a case of a 34-year old woman, who had premature ovarian failure and primary hypothyroidism, and conceived spontaneously eleven years after the development of premature ovarian failure and correction of hypothyroidism.