Microprolactinomas present usually with menstrual disturbance and galactorrhoea. The presence of visual field defects is not expected in these patients as the tumor does not involve structures outside the sella. Visual field defects in a case of microprolactinoma confuse the clinician and warrant extensive search for an alternate etiology. We present a young lady with microprolactinoma and visual field defects. Etiological work-up revealed a diagnosis of idiopathic intracranial hypertension (IIH) associated with microprolactinoma. Treatment with Acetazolamide and Cabergoline completely resolved the clinical symptoms and visual defects. The unusual occurrence of IIH in a case of microprolactinoma as the cause of visual field defect is highlighted in our case report.
Diopathic intracranial hypertension; microprolactinoma; visual field defect
Prolactinomas are solitary benign neoplasms and resistance to dopamine agonists occur in a small percentage of prolactinomas. Multiple pituitary adenomas are reported in less than 1% of pituitary adenomas and rarely result in resistant prolactinoma. We recently encountered an interesting patient of hyperprolactinemia with multiple pituitary microadenomas. Dopamine agonist use resulted in prolactin normalization and subsequent pregnancy resulted in drug withdrawal. Repeat evaluation after delivery showed a macroprolactinoma and dopamine agonist therapy resulted in biochemical cure without reduction in tumor size. We report the case for its presentation with multiple microadenomas progressing to macroprolactinoma suggesting polyclonal in origin.
Multiple pituitary adenoma; polyclonal; resistant prolactinoma
Chemotherapy induced infertility is a problem which is growing and often neglected. Fertility preservation strategy is an important component of the management in young patients with cancer. Gonadotropin releasing hormone analog therapy helps in ovarian suppression and the evidence is inconclusive for its benefit in fertility preservation. Other medical benefits with these drugs include reduction of vaginal bleeding in patients with thrombocytopenia.
Cancer; fertility; gonadotropin
Alteration in thyroid hormones are seen in critically ill patients admitted to intensive care units. Our objective was to study the thyroid hormone profile, prolactin and, glycosylated hemoglobin (HbA1c) at admission and analyze their correlation with mortality.
Materials and Methods:
In this single centre, prospective, observational study, 100 consecutive patients (52M; 48F) admitted to medical ICU irrespective of diagnosis were included. Patients with previous thyroid disorders and drugs affecting thyroid function were excluded. All participants underwent complete physical examination and a single fasting blood sample obtained at admission was analyzed for total triiodothyronine (T3), total thyroxine (T4), thyroid stimulating hormone (TSH), HbA1c, and prolactin. The patients were divided into two groups: Group 1 – survivors (discharged from the hospital) and Group 2 – nonsurvivors (patients succumbed to their illness inside the hospital). The data were analyzed by appropriate statistical methods and a P-value of <0.05 was considered significant.
The mean age of the participants was 58.7 ± 16.9 years and the mean duration of ICU stay was 3.3 ± 3.1 days. A total of 64 patients survived, whereas remaining 36 succumbed to their illness. The baseline demographic profile was comparable between survivors and nonsurvivors. Nonsurvivors had low T3 when compared with survivors (49.1 ± 32.7 vs. 66.2 ± 30.1, P = 0.0044). There was no significant difference observed between survivors and nonsurvivors with respect to T4, TSH, HbA1c, and prolactin.
Our study showed that low T3 is an important marker of mortality in critically ill patients. Admission HbA1c, prolactin, T4, and TSH did not vary between survivors and nonsurvivors.
Admission HbA1c; critically ill; medical ICU; thyroid hormone profile
The details about the research productivity in the neurology specialty from India is lacking. We analyzed the publishing trends and the research productivity of neurology-related articles in the Journal of the Association of Physicians of India (JAPI).
Materials and Methods:
We carried the bibliometric analysis of articles related to neurology specialty from JAPI published between 2000 and 2011. Data were derived from the journal's website and the articles were analyzed for type (original article, case reports, etc.), disease (infection, vascular, etc.), place, and timelines for publication.
Out of total 2977 articles published, 256 articles belong to neurology. Neurology contributed to 7--20% of the published articles per year in JAPI. Case reports (52%) constitute the majority type of articles followed by Original Articles (20%), Correspondence and Images (15% each). Infections (27%), structural disorders (19%), cerebrovascular and peripheral nervous system disorders (16% each) contribute the majority of research articles in Neurology. Mumbai (15%), Delhi (13%), and Chennai (9%) are the top three contributors followed by Lucknow and Varanasi. All types of articles took about 9--10 months for acceptance and another 4--5 months for publication. Letters to the Editor were published faster when compared to other articles (P=0.0035).
Neurology specialty contributes an average 14% of articles per annum in JAPI. Infections, vascular, structural, and peripheral nervous system disorders together account for 80% of published literature with a small representation from other diseases. Mumbai and Delhi are the leading contributors toward research productivity in neurology.
Biomedical journals; India; neurology; publication trends; research productivity
Primary hyperparathyroidism often presents with protean manifestations, resulting in delayed diagnosis. At times, aberrant development and migration of the gland leads to ectopic location leading to problems in localization. Judicious use of combination methods of localization is recommended in treatment failure or recurrent disease. We report the use of single photon emission computed tomography-CT in precise localization of parathyroid adenoma in a patient with failed initial surgery.
Ectopic parathyroid; hyperparathyroidism; emission computed tomography-CT
Disorders of sexual differentiation (DSD) are among the challenging problems in the field of endocrinology. When presenting late in an adult the therapeutic as well as diagnostic issues may be different and difficult. Bilateral anorchia is rare. The desire of future parenting is a real challenge when such patients ask for their own biological generations. This case depicts the late presentation of DSD in an anorchid adult and the management issues.
Adult; anorchia; bilateral; differentiation; 46; XY gonadal dysgenesis
The essence of communication is to convey a message, and readability tests have been developed to quantify this aspect of language. There is limited research on the readability tests of journal contents from India. In this study, we performed readability tests on the editorials of four popular Indian medical journals.
Materials and Methods:
The readability tests (Flesch score, Flesch grade, and text statistics) were calculated from the following journals: Indian Journal of Endocrinology and Metabolism (IJEM), Journal of Association of Physicians of India (JAPI), Journal of Indian Medical Association (JIMA), and International Journal of Diabetes in Developing Countries (IJDDC). The editorials published in these journals over the last 2 tears were included in this analysis.
A total of 64 editorials (IJEM – 19, JAPI – 18, JIMA – 16, IJDDC – 11) were analyzed in this study. The mean readability score was (IJEM 34.8 ± 9.5; JAPI 31.4 ± 11.4; JIMA 29.6 ± 10.1; IJDDC 26.1 ± 17.7) not different between the journals (P = 0.2666). Flesch score was less variable in IJEM an d JIMA than in JAPI and IJDDC (P = 0.0167). The editorials from IJEM and JAPI had a lower Flesch grade than the remaining two journals (P = 0.0253). The readability score was directly proportional to the sentence count and inversely proportional to the words per sentence (P < 0.0001).
Our results suggest that the editorials from all the medical journals have equal readability scores. The sentence count and words per sentence are important to achieve a high readability score while writing for a journal.
Editorial; flesch score; India; medical journals; readability test