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1.  Bone mineral density and factors influencing it in Asian Indian population with type 2 diabetes mellitus 
Objective:
To assess bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) patients and its relation, if any, to clinical, hormonal and metabolic factors.
Materials and Methods:
A prospective evaluation of 194 T2DM patients (97 men and 97 women) was carried out. BMD was done with dual energy X-ray absorptiometry (DXA) at the lumbar spine and total hip. Physical activity, nutritional intake and sunlight exposure were calculated. Biochemical and hormonal tests included serum 25 hydroxy vitamin D [25(OH) D], parathyroid hormone, estrogen, testosterone and urinary calcium-creatinine ratio. Glycosylated hemoglobin and complete lipid profiles were done in patients with diabetes. Five hundred and seventy one non-diabetic controls (262 males and 309 females) were evaluated for BMD alone.
Results:
BMD was normal (Z score > -2) in 156 (80.5%) and low (Z score ≤ -2) in 38 (19.5%) patients in the diabetes study group. BMD in the diabetes group was significantly higher than the control group in both sexes at the hip and spine. The difference was no longer significant on analysis of a BMI matched control subgroup. Weight and BMI showed significant correlation to BMD. Duration of T2DM, degree of glycemic control, use of drugs like statins and thiazolidinediones, 25(OH) D levels, calcium intake, sunlight exposure and physical activity did not significantly affect BMD in this cohort of individuals with diabetes.
Conclusions:
Bone mineral density of Asian Indian T2DM subjects was similar to that of healthy volunteers in this study.
doi:10.4103/2230-8210.140268
PMCID: PMC4192990  PMID: 25364679
Asian Indian; bone mineral density; obesity; type 2 diabetes mellitus; vitamin D deficiency
2.  Radioiodine therapy in patients with Graves’ disease and the effects of prior carbimazole therapy 
The use of radioiodine as the first line of treatment in Graves’ disease is restricted in India because of its limited availability and an unrealistic risk perception associated with it. Additionally, the effectiveness of radioiodine ablation in Graves’ disease is influenced by many factors. Prior medical antithyroid therapy is one such important factor.
Aims:
To analyze the efficacy of low dose radioiodine therapy (5 mCi) in treatment of naive patients of Graves’ disease in comparison to that in which it was already primed with an antithyroid drug, carbimazole.
Settings and Design:
A non-randomized, interventional study conducted in the Department of Medicine and Endocrinology of a tertiary care institute in South India.
Materials and Methods:
The study had two groups; Group A (36 treatment naive, uncomplicated Graves’ disease patients) and B (34 Graves’ disease patients on carbimazole prior to radioiodine therapy). Both groups had baseline clinical, biochemical evaluation and were reassessed at 3 and 6 months for evaluating the clinical status for possible documentation of cure.
Results:
The cure rate was 61.1% in drug naive group and 58.8% in pretreated group at 6 months following radioiodine (P = 0.845). Higher baseline 999m technicium (99m Tc) uptake, male gender, BMI and higher baseline free thyroxine (fT4) level predicted treatment failure following radioiodine therapy.
Conclusions:
Administration of carbimazole prior to low dose radioiodine therapy does not alter the efficacy of radioiodine. Low fixed dose (5 mCi) of radioactive iodine may be a safe and effective primary therapeutic option in Graves’ disease patients pretreated with antithyroid drugs.
doi:10.4103/2230-8210.139234
PMCID: PMC4171893  PMID: 25285287
Fixed low dose; Graves’ disease; radioiodine ablation; treatment failure; treatment naïve
3.  Black adrenal adenoma: distinction from PPNAD 
BMJ Case Reports  2012;2012:bcr0320126076.
A 22-year-old woman with features suggestive of Cushing’s syndrome was found to have right adrenal mass on imaging studies. She had paradoxical rise in basal cortisol on dexamethasone suppression testing. Black adenoma of the right adrenal cortex, a pigmented adenoma consisting of compact cells with numerous pigments suggestive of melanin and lipofuscin was laproscopically removed from this patient. This case illustrates that in the setting of unilateral adrenal mass with paradoxical cortisol response with dexamethasone suppression testing, pigmented adrenal adenomas should be also suspected in addition to primary pigmented nodular adrenocortical disease.The decision to go with either unilateral or bilateral adrenalectomy should be based on the attributes of contralateral adrenal gland.
doi:10.1136/bcr.03.2012.6076
PMCID: PMC3391401  PMID: 22761223
4.  Differential response of idiopathic sporadic tumoral calcinosis to bisphosphonates 
Context:
Tumoral calcinosis is a disorder of phosphate metabolism characterized by ectopic calcification around major joints. Surgery is the current treatment of choice, but a suboptimal choice in recurrent and multicentric lesions.
Aims:
To evaluate the efficacy of bisphosphonates for the management of tumoral calcinosis on optimized medical treatment.
Settings and Design:
The study was done in the endocrine department of a tertiary care hospital in South India. We prospectively studied two patients with recurrent tumoral calcinosis who had failed therapy with phosphate lowering measures.
Materials and Methods:
After informed consent, we treated both patients with standard age adjusted doses of bisphosphonates for 18 months. The response was assessed by X ray and whole body 99mTc-methylene diphosphonate bone scan at the beginning of therapy and at the end of 1 year. We also estimated serum phosphate levels and urinary phosphate to document serial changes.
Results:
Two patients (aged 19 and 5 years) with recurrent idiopathic hyperphosphatemic tumoral calcinosis, following surgery were studied. Both patients had failed therapy with conventional medical management − low phosphate diet and phosphate binders. They had restriction of joint mobility. Both were given standard doses of oral alendronate and parenteral pamidronate respectively for more than a year, along with phosphate lowering measures. At the end of 1 year, one of the patients had more than 95% and 90% reduction in the size of the lesions in right and left shoulder joints respectively with total improvement in range of motion. In contrast, the other patient (5-year-old) had shown no improvement, despite continuing to maintain normophosphatemia following treatment.
Conclusions:
Bisphosphonate therapy in tumoral calcinosis is associated with lesion resolution and may be used as a viable alternative to surgery, especially in cases with multicentric recurrence or treatment failure to other drugs.
doi:10.4103/2230-8210.137511
PMCID: PMC4138909  PMID: 25143910
Bisphosphonates; fibroblast growth factor 23; hyperphosphatemia; tumoral calcinosis
5.  A unique ca(u)se of quadriparesis 
BMJ Case Reports  2012;2012:bcr0120125578.
Primary hyperparathyroidism (PHPT) is an uncommon cause of neuromuscular weakness which is often ignored due to non-specific nature of complaints. The authors present a case of PHPT with severe 25-hydroxyvitamin D (25(OH)D) deficiency which presented with quadriparesis. Normocalcaemic hyperparathyroidism with hypophosphatemia was documented initially and correction of 25(OH)D deficiency unmasked hypercalcaemia. A parathyroid adenoma causing PHPT was localised with radiology and scintigraphy of neck. An ectopic supernumerary parathyroid adenoma was identified and removed from the right tracheoesophageal groove during bilateral exploration of neck and the patient was completely cured after surgery.
doi:10.1136/bcr.01.2012.5578
PMCID: PMC3387440  PMID: 22729325
6.  Congenital hypothyroidism – An usual suspect at an unusual age: A case series 
Menorrhagia is the most common menstrual irregularity in hypothyroid women. However, it is an uncommon presentation of congenital hypothyroidism (CH). In the era of newborn screening across the world, when CH is extremely rare, we came across four cases of CH due to delayed diagnosis, presenting in adulthood with severe menorrhagia.
Aims:
To signify the atypical presentation of CH in late adulthood due to delayed diagnosis and its sequelae; and to increase the awareness about this treatable condition.
Settings and Design:
This is a cross-sectional analysis of consecutive patients with CH presenting after 18 years between 2010 and 2012 from the CH registry of Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India.
Subjects and Methods:
Four patients of CH presenting late (>18 years) with atypical presentations out of total 16 cases of CH within a period of 3 years were analyzed for clinical, hormonal, and imaging findings.
Results:
Between the years 2010 and 2012, 16 cases of CH were registered at our center out of which four cases presented in late adolescence and adulthood with menorrhagia. Age range of these patients was 18-30 years. All four patients were females presenting with anemia secondary to menorrhagia and upon evaluation were found to have CH. All of them showed improvement after starting treatment and are currently doing well with regular menstrual cycles.
Conclusions:
Our study demonstrates the importance of thyroid evaluation in a patient presenting with menorrhagia along with short stature. There is need for awareness among clinicians regarding the clinical features of CH and nationwide screening for CH in our country.
doi:10.4103/2230-8210.119566
PMCID: PMC3830299  PMID: 24251153
Congenital hypothyroidism; menorrhagia; neonatal screening; short stature; thyroid dysgenesis
8.  Pregnancy in polycystic ovary syndrome 
Polycystic ovary syndrome affects 6 to 15% of reproductive age women worldwide. It is associated with increased risk of miscarriage, gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and birth of small for gestational age infant. Many studies on issues relating to pathophysiology and management of these complications have been published recently. These issues are being reviewed here using relevant articles retrieved from Pubmed database, especially from those published in recent past.
doi:10.4103/2230-8210.107830
PMCID: PMC3659904  PMID: 23776851
Early pregnancy loss; metformin; polycystic ovary syndrome; pregnancy
9.  Prevalence and Impact of Thyroid Disorders on Maternal Outcome in Asian-Indian Pregnant Women 
Journal of Thyroid Research  2011;2011:429097.
Aims. To establish the prevalence and the effect of thyroid dysfunction on pregnancy outcomes in Asian-Indian population. Subjects and Methods. The study cohort comprised of 483 consecutive pregnant women in the first trimester attending the antenatal clinic of a tertiary center in Mumbai, India. Thyroid hormone levels and thyroid peroxidase antibody were estimated. Patients with thyroid dysfunction were assessed periodically or treated depending on the severity. Subjects were followed until delivery. Results. The prevalence of hypothyroidism, Graves' disease, gestational transient thyrotoxicosis, and thyroid autoimmunity (TAI) was 4.8% (n = 24), 0.6% (n = 3), 6.4 % (n = 31), and 12.4% (n = 60), respectively. Forty percent of the hypothyroid patients did not have any high-risk characteristics. Hypothyroidism and TAI were associated with miscarriage (P = 0.02 and P = 0.001, resp.). Conclusions. The prevalence of hypothyroidism (4.8%) and TAI (12.4%) is high. TAI and hypothyroidism were significantly associated with miscarriage.
doi:10.4061/2011/429097
PMCID: PMC3140706  PMID: 21789274

Results 1-10 (10)