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ABSTRACT: Syndrome of extreme insulin resistance (SEIR) is a rare spectrum disorder with a primary defect in insulin receptor signalling, noted primarily in children, and is often difficult to diagnose due to the clinical heterogeneity. SEIR was diagnosed in an adolescent girl with facial dysmorphism, exuberant scalp and body hair, severe acanthosis, lipoatrophy, dental abnormalities, and short stature (Rabson-Mendenhall phenotype). She had elevated fasting (422.95pmol/L) and post-glucose insulin levels (>2083pmol/L). Total body fat was decreased (11%; dual-energy X-ray absorptiometry). Basal growth hormone was increased (7.9µg/L) with normal IGF-1 (37.6nmol/L) suggestive of growth hormone resistance. She had fatty liver and polycystic ovaries. Echocardiography revealed ostium secundum type atrial septal defect (ASD). Blood glucose normalized with pioglitazone (30 mg/day). Delayed development, severe insulin resistance, mild hyperglycemia, absence of ketosis, and remarkable response of hyperinsulinemia and hyperglycemia to pioglitazone which persisted even after 1 year of diagnosis are some of the notable features of this patient. This is perhaps the first report of occurrence of congenital heart disease (ASD) in a patient of SEIR (Rabson-Mendenhall phenotype). This report highlights the clinical features of SEIR and the role of insulin sensitizers like pioglitazone in the management of such patients.
Journal of Clinical Research in Pediatric Endocrinology 06/2013;
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ABSTRACT: We were interested to read the article by Sridhar et al. [1] which suggested that pioglitazone therapy significantly decreases total, free and bioavailable testosterone in eugonadal men with type 2 diabetes mellitus. The authors also showed that the decrease in total testosterone was independent of any increase in SHBG, or change in body weight, body fat and HbA1c. Ozata et al showed that metformin and a hypocaloric diet can significantly reduce total testosterone levels in obese diabetic men. [2] Decreased levels were not correlated to changes in waist and hip circumference, waist to hip ratio, BMI, levels of fasting blood glucose, leptin, SHBG or dehydroepiandrosterone sulfate in this diabetic group. This could be a potential confounder in the final analysis of the study by Sridhar et al and it would be interesting to know the mean doses of metformin used in the placebo group compared to the pioglitazone group. © 2013 Blackwell Publishing Ltd.
Clinical Endocrinology 04/2013; · 3.17 Impact Factor
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ABSTRACT: Acquired perforating dermatosis (APD) is a rare disorder characterized by transepidermal elimination of contents from
dermis with minimal disruption of surrounding structures, believed to be due to altered expression of dermal proteins.
Its occurrence in patients with systemic mycosis has never been reported. We report a 60-y gentleman who presented
with features of adrenal insufficiency (nausea vomiting, hypotension and increased pigmentation) for 4 mo, multiple
hyperpigmented pruritic nodules with central keratinous plug over extensor surface of both lower limbs along with
hepatosplenomegaly of one month duration. Investigations revealed low cortisol (2.3 μg/dl; normal: 5–34 μg/dl), elevated
ACTH (68 pg/ml; normal: 5–15 pg/ml), enlarged bilateral adrenals with hepatosplenomegaly on CT. Methanamine silver
staining of fine needle aspiration from the adrenals and bone marrow aspiration showed numerous oval yeast cells
suggestive of histoplasma. Histopathology of biopsy of one of the skin nodules revealed transepidermal elimination
process characterized by invagination of epidermis with extrusion of collagen bundles suggestive of APD. Patient
improved with hydrocortisone replacement and there was clinical improvement with resolution of skin lesions following
amphotericin-B and itraconazole therapy. This is probably the first reported case of APD in a patient with disseminated
histoplasmosis who had presented with Addison’s disease.
Dermatoendocrinology. 03/2013; 5(1):1-4.
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ABSTRACT: Prediabetes (IPD; n=122) and normoglycemic individuals (n=100) underwent assessment of polymorphisms of TNFα (-238, -308) and IL6 (-174). After 27.25±5.64 months, 16 IPD had reverted to normoglycemia and 18 progressed to diabetes. TNFα -238AA/GA genotypes were significantly more common in IPD, had higher TNFα, higher progression to diabetes and lower reversal.
Diabetes research and clinical practice 01/2013; · 2.16 Impact Factor
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Diabetes Research and Clinical Practice 01/2013; · 2.75 Impact Factor
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ABSTRACT: Diabetic myonecrosis is an uncommon muscular complication of diabetes with significant morbidity. Clinical features and radiological findings are helpful in the diagnosis of myonecrosis. Management is conservative and focused on symptomatic relief and control of diabetes.
Clinical Diabetes. 01/2013; 31(2):53-58.
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ABSTRACT: Hypoparathyroidism is most commonly isolated and idiopathic. Hypoparathyroidism in autoimmune polyendocrine syndrome type-2 (APS-2) is extremely rare with few isolated reports and usually presents late. We present perhaps for the first time, hypoparathyroidism being the initial manifestation of APS-2 which was diagnosed in a 32 year lady with tingling of the extremities along with hypocalcemic tetany for 15 years. She also had generalized acral and mucosal hyperpigmentation of 2 years duration. Investigations were significant for low calcium (7.1mg/dl), elevated phosphorus (4.8mg/dl), vitamin-D insufficiency (27.4ng/ml), low intact parathyroid hormone (2.3pg/ml), low basal (4.7mcg/dl) and stimulated serum cortisol (9.2mcg/dl at half hour, 11.4mcg/dl at 1 hour post synacthen), elevated triiodothyronine (2.1ng/ml) and free tetraiodothyronine (2.4ng/dl) along with suppressed TSH (<0.005 U/L). Imaging relevaled mild cerebellar calcification, normal adrenals with diffuse uptake of Tc(99)- pertechnate. A diagnosis of hypoparathyroidism with Addison's and Graves' disease as a part of APS-2 was made. This report intends to highlight the clinical heterogeneity and varied presentation of APS-2. Routine screening of other hormonal function (especially adrenal function, thyroid function and blood glucose) in a patient with diagnosed hypoparathyroidism is advisable to decrease the chances of missing APS-2.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S495-7.
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ABSTRACT: OBJECTIVE: To present a rare case of gigantism. CASE REPORT: A 25-year-old lady presented with increased statural growth and enlarged body parts noticed since the age of 14 years, primary amenorrhea, and frontal headache for the last 2 years. She has also been suffering from non-inflammatory low back pain with progressive kyphosis and pain in the knees, ankles, and elbows for the last 5 years. There was no history of visual disturbance, vomiting, galactorrhoea, cold intolerance. She had no siblings. Family history was non-contributory. Blood pressure was normal. Height 221 cm, weight 138 kg, body mass index (BMI)28. There was coarsening of facial features along with frontal bossing and prognathism, large hands and feet, and small goitre. Patient had severe kyphosis and osteoarthritis of knees. Confrontation perimetry suggested bitemporal hemianopia. Breast and pubic hair were of Tanner stage 1. Serum insulin like growth factor-1 (IGF1) was 703 ng/ml with all glucose suppressedgrowth hormone (GH)values of >40 ng/ml. Prolactin was 174 ng/ml. Basal serum Lutenising Hormone (LH), follicle stimulating Hormone (FSH) was low. Oral glucose tolerance test (OGTT), liver and renal function tests, basal cortisol and thyroid profile, Calcium, phosphorus and Intact Parathyroid hormone (iPTH) were normal. Computed tomographyscan of brain showed large pituitary macroadenoma. Automated perimetry confirmed bitemporal hemianopia. A diagnosis of gigantism due to GH secreting pituitary macroadenoma with hypogonadotrophichypogonadism was made. Debulking pituitary surgery followed by somatostatin analogue therapy with gonadal steroid replacement had been planned, but the patient refused further treatment.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S285-7.
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ABSTRACT: Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430 mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus help in reducing disease morbidity.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S297-9.
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ABSTRACT: Gynaecomastia is a well-recognized manifestation of thyrotoxicosis occurring in a widely variable percentage. Some studies have reported the percentage to be high as 40% while others report it being around 10%. The variation can be attributed to the difference in the criteria used to define gynae-comaslia or racial factors. However, thyrotoxicosis presenting with gynaceomastia as an intial manifestation is very rare. Only handful case reports are found in literature. Here we present a case of 35-year-old Indian male, with thyrotoxcosis who presented initially with painful bilateral gynaceomastia.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S352-3.
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ABSTRACT: Cretinism is a condition of severely stunted physical and mental growth due to untreated congenital hypothyroidism. It has been largely eliminated in the developed world, though we still continue to see cases in India.
A 22-year-old male was brought to our Endocrine clinic by his brother due to his "not growing up". The patient was 83 cm in height (SDS - 16.98) and weighed 13.9 kg (<3(rd) percentile). He had dull look, puffy face with thick lips, macroglossia, and umbilical hernia. There was sexual infancy with prepubertal testes (<3 ml). He could sit without support, but could not stand, or walk without support and could only talk in monosyllables. He was born full term by normal vaginal delivery, and cried immediately after birth. The developmental milestones were delayed, and not achieved till date. He is the eldest of seven siblings, rest six of whom have no complaints. An X-ray of hand was done showing bone age of less than 1 year. A thyroid profile showed TSH >150 IU/ml, free T4 and T3 below the assay range. Ultrasound of neck showed absent thyroid tissue in neck. Iodine-131 uptake scan was consistent with thyroid aplasia. Diagnosis was myxematous cretinism due to thyroid aplasia was made, and patient was started on thyroxine supplementation.
This case represents the most severe form of untreated congenital hypothyroidism presenting as severely stunted physical and mental growth with delayed bone and sexual maturation.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S336-7.
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ABSTRACT: Adrenal myelolipoma is a benign metaplastic collection of reticuloendothelial cells and adipose tissue, believed to be secondary to chronic stimulation of the adrenals. Keratoconus is the most common corneal ectasia of unknown pathogenesis. Altered expression of proteinases, proteinases inhibitors, and cytokines are believed to have a role. We report for the first time, the occurrence of adrenal myelolipoma in a 52-year-old man with bilateral keratoconus with right corneal scarring for 13 years, who had presented with abdominal pain and heaviness for 4 weeks. Computerized tomography abdomen revealed 7.4 × 7.0 × 6.6 cm hypo-dense variegated left adrenal mass [-71 to -51 Hounsfield Unit (HU)] with smooth borders and poor contrast uptake, suggestive of adrenal myelolipoma, which was biochemically non-functional in view of normal overnight dexamethasone suppressed cortisol (1.4 mcg/dl), 24 h urinary fractionated metanephrines [metanephrines 57 mcg/day (53-341); normetanephrines 95 mcg/day (88-444)], androgen levels [dehydroepiandrostenedione-sulphate 112 mcg/dl (21-123); testosterone 542 ng/dl (275-1200)] with normal visualization of the contralateral adrenal. The cause of this association could not be determined. However, it may be hypothesized that altered adrenal steroid metabolism may have some role in the development of myelolipoma in our patient with keratoconus; in view of increased occurrence of myelolipoma in patients with congenital adrenal hyperplasia (CAH), isolated report of keratoconus in twins with CAH and mice model of keratoconus demonstrating the role of androgens in the development of keratoconus.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S364-6.
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Soumik Goswami,
Ajitesh Roy,
Rana Bhattacharjee,
K S Shivaprasad,
Partha P Chakraborty,
Chitra Selvan,
Anubhav Thukral,
Kaushik Biswas,
Sujoy Ghosh,
Satinath Mukhopadhyay, Subhankar Chowdhury
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ABSTRACT: Allgrove's syndrome is a rare autosomal-recessive disorder with only about 70 cases reported thus far and is characterized by alacrima, achalasia, and ACTH insensitivity among other clinical features. However, it has a widely variable clinical presentation, which may result in such cases remaining undiagnosed.
To report a patient with impending Allgrove's syndrome and to highlight the importance of clinical suspicion in diagnosing the same.
A 2.5-year-old girl was diagnosed with impending Allgrove's syndrome on the basis of clinical presentation, barium swallow study, Schirmer's test, and hormonal evaluation.
A 2.5-year-old girl, born of non-consanguineous marriage, presented with failure to thrive and developmental delay with occasional vomiting on taking solid or semi-solid food for past 6 months. Examination revealed stunted weight (SDS of -4.4) and height (SDS of -4.76), and barium swallow showed presence of achalasia. On direct questioning, her mother mentioned presence of decreased tears on crying since birth, and Schirmer's test confirmed the presence of dry eyes. Baseline ACTH was slightly elevated with normal basal and post-ACTH stimulation serum cortisol. Based on these findings, impending Allgrove's syndrome was diagnosed with a plan for follow-up study of adrenal function.
Allgrove's syndrome may be an under diagnosed disorder as aclarima is often overlooked. However, a high index of clinical suspicion may help in avoiding adrenal crisis by diagnosing the condition early.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S367-8.
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ABSTRACT: Tuberculosis is the most common cause of Addison's disease in India. The exact status of adrenal reserve in tuberculosis is still an enigma and recovery of adrenal function is unpredictable.
We report a case with a pre-Addisonian state and unchanged adrenal size after 1 year treatment.
A 31-year patient with adrenal tuberculosis was diagnosed and treated with anti tubercular drugs (ATDs) and steroid.
A 31-year male, presented with fever and weight loss for 3½ months with anorexia, nausea, hyperpigmentation of skin, and buccal mucosa and weakness with past h/o adequately treated pulmonary tuberculosis at 3 years of age. On examination, the patient was anemic. A non-tender, firm right (Rt.) submandibular lymphnode was palpable. Investigations revealed: High erythrocyte sedimentation rate (ESR), negative HIV, and sputum for acid fast bacilli (AFB). Initial cortisol was high but subsequently became low with negative short synacthin test (SST). Computed tomography showed bilateral (B/L) enlarged hypodense adrenal mass with inconclusive fine needle aspiration cytology (FNAC) and negative AFB culture. Rt. submandibular lymph node FNAC showed caseating granuloma. ATDs and steroids were started, the lymphadenopathy regressed and symptoms subsided. However, after 1 year of treatment steroid withdrawal failed and adrenal size remained the same.
The adrenal has considerable capacity to regenerate during active infection and ultimately become normal or smaller in size. However, in the case reported here, they failed to regress. Reversal of adrenal function following ATD is a controversial issue. Some studies have shown normalization following therapy, while others have contradicted it similar to the finding in our case.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S369-70.
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ABSTRACT: Renal tubular disorders are an important cause of refractory rickets. Wilson's disease, an inherited disorder of copper metabolism has varied presentations. We present a case of refractory rickets due to Fanconi's syndrome attributable to Wilson's disease. An adolescent girl presented with pain in the hip and knee joints and a knock-knee deformity since six years. She had received multiple doses of cholecalciferol with little improvement. There was no history of seizures, polyuria, jaundice, intake of drugs, or similar complaints in the family. Examination revealed a severely short stature with widening of the wrist joint and genu valgum. Examination of the central nervous system (CNS) was normal. Skeletal radiographs showed features suggestive of rickets at the hip and knee joints. Routine biochemistry was normal, 25-hydroxyvitamin D [25(OH)D] was adequate (57.1 ng/dL), with normal corrected calcium (9.24 mg/dL), low phosphate (2.76 mg/dL), elevated bone-specific alkaline phosphatase, and normal renal functions. Twenty-four-hour urine revealed phosphaturia, kaliuresis, and glucosuria with normal blood sugars and aminoaciduria. Blood gas analysis revealed normal anion gap metabolic acidosis with a urine pH of 7. Ammonium chloride (NH4CL) challenge test revealed proximal tubular acidosis. A search for causes revealed Kayser-Fleischer rings. The diagnosis of Wilson's disease was confirmed by low serum ceruloplasmin levels (6.5 mg/dL; normal: 18-35 mg/dL) with high 24-hour urine copper levels (433 mcg; normal: 20-50 mcg). She was started on a replacement of alkali, phosphate, calcium, and vitamin D, with zinc acetate for Wilson's disease. Rickets as a presenting feature of Wilson's disease has been reported rarely. Recognition of this entity is important, as treatment of the primary condition may improve tubular function as well.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S399-401.
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ABSTRACT: Renal phosphate-wasting disorders are the most common form of hereditary rickets and osteomalacia in western countries, but are rarely reported in India. Therefore, we report here a case of hypophosphatemic rickets.
To report a case of hypophosphatemic rickets presenting with recurrent pathological fractures.
A 34-year-old premenopausal lady presented with recurrent pathological fractures, bone pain, and muscle weakness since 14 years of age. A thorough history was taken followed by clinical examination, and relevant biochemical and radiological investigations were done.
Height was 125 cm, arm span 145 cm, body weight 30 kg, and body mass index (BMI) 19.2 kg/m(2). Dental caries, kyphoscoliosis, shortening of left lower limb, bilateral coxa vara deformity of knee, muscle weakness, and bone tenderness were present. Calcium was 9.4 mg/dL, phosphorus: 1.8 mg/dL, albumin: 4.0 gm/dL, alkaline phosphatase: 360 U/L, creatinine: 0.4 mg/dL, a normal ammonium chloride (NH4Cl) loading test,24-hour urine calcium excretion: 102 mg/day, 25-hydroxyvitamin D3 [25(OH)D3]: 21.6 ng/mL, intact parathyroid hormone (PTH): 43.74 pg/mL, fraction excretion of phosphate (PO4): 40%, tubular maximum reabsorption of phosphate per unit of glomerular filtrate (TmP/GFR): 0.65 mg/dL, and fibroblast growth factor (FGF)23: 321.4 RU/mL. Skeletal X-rays showed multiple old fractures and pseudofractures. Magnetic resonance imaging (MRI) of the whole body showed no evidence of tumor. Fludeoxyglucose ((18)F)-positron emission tomography (FDG-PET) computed tomography (CT) scan revealed metabolically active marrow with multiple areas of fracture and FDG-avid lesions in both lungs but no CT-based findings.
Hypophosphatemic rickets or osteomalacia, possibly hereditary, is a rare cause of recurrent pathological fractures.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S402-4.
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ABSTRACT: This cross-sectional clinic-based study assessed and compared lipid profile, presence of metabolic syndrome (MetS), and liver enzymes in subjects with IGT, new onset treatment naïve T2DM, and normal glucose tolerance (NGT).
Type 2 diabetes (T2D) and IGT patients have increased dyslipidemia, MetS, and alterations in liver enzymes.
To assess and compare lipid profile, presence of MetS, and liver enzymes in subjects with IGT, new onset treatment naïve T2DM, and NGT.
This cross-sectional clinic-based study examined 152 IGT and 158 recently detected T2D subjects aged between 30 and 69 years, never treated with any anti-hyperglycemic, anti-hypertensive, and lipid lowering drugs. One hundred and sixty age- and gender-matched controls with NGT were also selected. Anthropometry, lipid profile, dyslipidemia (ADA criteria), presence of MetS (NCEP, IDF), liver enzymes, insulin resistance (HOMA-IR and QUICKI), and β-cell function (HOMA β) were analyzed in all subjects.
T2D and IGT subjects had significantly higher BMI, waist circumference, blood pressure (BP), HOMA-IR, QUICKI, fasting insulin, HOMA-β, MetS, triglyceride, LDL-C, SGPT, GGT, and lower HDL-C compared to NGT (control). High LDL-C (>100 mg/dl) was the commonest dyslipidemia followed by low HDL-C and hypertriglyceridemia in IGT and T2D. We found no significant differences in BMI, waist circumference, insulin resistance, total/LDL-C/HDL-C, and presence of MetS between T2D and IGT subjects. Diabetics exhibited significantly higher BP, triglyceride, SGPT, GGT, lower fasting insulin, and HOMA-β-cell function compared to IGT.
IGT and recent onset T2D individuals had similar increased cardiovascular risk markers, liver enzymes, and prevalence of MetS. High LDL-C was the commonest dyslipidemia in IGT and T2D. T2D subjects had higher triglyceride, BP, SGPT, GGT compared to IGT.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S434-5.
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ABSTRACT: Fibrocalcific pancreatic diabetes (FCPD) is a rare cause of diabetes (<1%) of uncertain etiology associated with >100-fold increased risk of pancreatic cancer. We present 3 patients of FCPD with pancreatic cancer who had long duration of diabetes (19 years, 25 years, and 28 years, respectively), all of whom presented with anorexia, weight loss, and worsened glycemic control. Patient-1 in addition presented with deep venous thrombosis. All the 3 patients had evidence of metastasis at the time of diagnosis. Computerized tomography (CT) abdomen revealed atrophic pancreas, dilated pancreatic ducts, and multiple calculi in the head, body, and tail of pancreas in all of them. Patient-1 had 38 mm × 38 mm × 32 mm mass in the tail of pancreas with multiple target lesions were seen in the right lobe of liver. Patient-2 had a mass in the tail of pancreas (46 × 34 × 31 mm) encasing the celiac plexus and superior mesenteric artery infiltrating the splenic hilum and splenic flexure of colon. Patient-3 also had a mass in the tail of pancreas (33 × 31 × 22 mm), with multiple target lesions in the liver, suggestive of metastasis. All patients had elevated serum CA19-9 (828.8, 179.65, and 232 U/L, respectively; normal <40 U/L). Patients of FCPD with anorexia, weight loss, worsening of glycemic control should be evaluated to rule out pancreatic cancer. Studies are warranted to evaluate CA19-9 as a screening tool for diagnosing pancreatic cancer at an earlier stage in FCPD.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S486-8.
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ABSTRACT: Hypoparathyroidism in systemic sclerosis is extremely rare with only a single case reported till date. Idiopathic hypoparathyroidism with systemic sclerosis was diagnosed in a 59-year-old gentleman who had presented with recurrent seizures, instability of gait, skin thickening and tightening over both legs and forearms, and arthritis. Examination was significant for positive Trousseau sign and cerebellar ataxia. Evaluation revealed bilateral symmetrical cerebellar and basal ganglia calcification, sensorineural deafness, low serum calcium, elevated serum phosphorus, normal magnesium, normal vitamin D, low plasma parathyroid hormone, high titer of thyroid peroxidase antibody, positive centromere pattern antinuclear antibody, strongly positive anti-topoisomerase-1 (Scl-70) antibody, nonvisualization of parathyroids on neck ultrasonography and skin biopsy suggestive of hyperkeratosis, increased collagen in dermis, and perivascular lymphomononuclear cell infiltration compatible with scleroderma. Last evaluated 10 months after the diagnosis, his ataxia had improved, he remained seizure-free, Trousseau sign was negative, and he had low-normal calcium calcium with calcium carbonate and calcitriol supplementation and switch from phenytoin to valproate. Further studies are warranted to study the use of serum calcium as a screening test for hypoparathyroidism in patients with systemic sclerosis.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S396-8.
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ABSTRACT: Laboratory endocrinology forms an integral part of 21(st) century endocrinology. Perhaps, no other specialty of medicine is as closely associated with laboratory as endocrinology. This review intends to highlight the challenges faced by an endocrinologist before interpreting a hormone assay report. This review by no means is holistic but intends to highlight some of the pitfalls of laboratory endocrinology and arouse further interest in this important but neglected section of endocrinology. Lack of standardization, as well as rigorous implementation is some of the major challenges facing endocrine assays in our country. It is essential to be aware not only of the details of the method of analysis of a hormone, the pre-analytical requisites, but also disease-specific analytical issues to prevent unnecessary concern both for the patient, as well as the treating physician, as well as needless investigations. Problems with interpretation of serum prolactin, thyroglobulin, steroid hormone assays, rennin assay and vitamin-D assay have been highlighted.
Indian journal of endocrinology and metabolism. 12/2012; 16(Suppl 2):S275-8.
