Autoimmune Hypophysitis: A Case Report

Autoimmune hypophysitis is an autoimmune inflammation of the pituitary gland. It may result in hypopituitarism depending upon the part of pituitary affected. Here, we report the case of autoimmune hypophysitis in a 30-year-old male who was admitted with complaints of generalised swelling for one month and fever and cough for one week. The patient’s Thyroid-stimulating hormone (TSH) was more than 139, anti-thyroid peroxidase antibody (anti-TPO) was more than 1000 and serum sodium was 107 and a tiny streak of tissue along the periphery with an empty sella as seen on MRI. The patient was given tablet Levothyroxine 100 microgram, Telmisartan 40 mg and Hydrocortisone 10mg twice daily. With medications, the patient improved and was discharged

Obesity: a global health problem

Since time immemorial, obesity has engulfed the mankind. It’s a pandemic. The prevalence is increasing by leaps and bound. Evidences date back to 30,000 BC. Earlier it was linked to wealth and status and it took a long time for it to be considered as a disease. This change in mind-set of the people occurred in mid-19th century. Different formulas for calculating the BMI (Body Mass Index) were invented which was different for the world and the South-East Asians. Slowly it became a topic for research among the scientific society and first priority was given to finding out the cause of obesity. It could not be pointed down to one as many factors were found to contribute to the menace of obesity. Age, gender, genetics, environment, food habits, various co-morbid conditions and the list of contributing factors is endless. Studies done at the molecular level have shown that various cytokines like TNF, Interleukins, Monocyte Chemoattractant Protein, adipokines, etc., have been implicated in the pathogenesis of obesity. The first line in the management of obesity is to take preventive measure. Those who have started to develop the disease should undergo a few non-pharmacological treatment options like lifestyle modification, change in food habits and behavioural therapy. Initially drugs like fenfluramine and sibrutramine were developed. With newer researches coming up more safer and consistent molecules like Tesofensin have been found and undergoing trial. If not benefited by medical treatment the last option what remains for the patient is bariatric surgery but they are too costly for general population to afford. Finally, it is best seen that it is wise enough to follow the saying “Prevention is better than cure” for a disease with such a vast etiology.

Primary laryngeal tuberculosis: a rare cause of chronic laryngitis.

Tuberculosis (TB) is not only a major public health problem of developing countries like India, since its incidence is increasing due to increasing immune-depressive states including HIV, malignancies and cytotoxic chemotherapy. Laryngeal TB occurs usually a secondary to associate with pulmonary disease, and primary form is very rare in immune-competent people. We report a 49‑years‑old non-smoker, non-diabetic, immunocompetent man presenting with chronic dry cough and hoarseness without any constitutional symptoms, family or contact history of TB. The chest X-ray was normal. Laryngoscopy showed congested larynx without any ulcer or mass and normal vocal cords. Biopsy from aryepiglottic fold was suggestive of TB, but caseation was absent. Diagnosed to be primary laryngeal TB, he responded well to anti-tubercular therapy. Primary laryngeal TB without pulmonary TB can mimick chronic laryngitis. Before anti-tubercular drug use, in the 1950’s, it was a common and frequently fatal disease but it’s clinical features, age group involved and prognosis has changed over the last few decades. It is more infectious than pulmonary form primarily due to delayed diagnosis. It can mimick a common condition like chronic laryngitis, although different macroscopic lesions are described. Diagnosis needs a high index of suspicion, confirmed by histological examination, as it still can occur occasionally in immunocompetent persons. Response to specific treatment is good after diagnosis.

Non alcoholic fatty liver disease and its relationship with hsCRP in type 2 diabetes mellitus.

Background: Diabetes mellitus is assuming an epidemic form in India. Non-alcoholic fatty liver disease worldwide is increasing too and is a major cause of liver transplant in the west. Diabetes is a strong risk factor for non-alcoholic fatty liver disease, and some of them go on to develop steatohepatitis which is associated with a more rapid disease progression leading to chronic liver disease including hepatocellular carcinoma. This association of diabetes with fatty liver disease is least investigated. Liver biopsy is not routinely done in clinical practice and various non-invasive markers for fatty liver or steatohepatitis are used frequently to identify patients at risk of fatty liver disease. Methods: 116 Type 2 Diabetics Mellitus on therapy with oral anti-diabetic drugs and atorvastatin for at least 3 months’ duration were included and sonologically evaluated for fatty liver after proper exclusion of other causes of fatty liver. Serum hsCRP, an acute phase reactant, was measured in them. Liver function tests, BMI and other necessary investigations were done. 144 healthy controls were also taken. Results: The absolute risk of developing fatty liver was significantly high in T2 diabetics compared to controls. hsCRP was significantly associated with fatty liver and uncontrolled glycemic status. In addition AST/ALT > 1 also showed significant differences amongst the same groups. Conclusions: High hsCRP is a cheap, easily available laboratory marker to suspect fatty liver and possibly steatohepatitis in T2 Diabetics in our region. It can identify a subgroup of diabetic patients in whom liver biopsy may be advisable to confirm steatohepatitis which is important for prognosis and therefore need aggressive intervention.

Overview of functional bowel disorders.

The true incidence of functional physical disorders is higher in general practice including functional bowel disorders. It leads to a high socio-economic burden by way of delayed diagnosis. ROME III criteria are used to diagnose these disorders. Although there are specific clinical diagnostic features, definite diagnostic investigations are unavailable. Recent scientific studies link the mind and body as part of a system where their dysregulation can produce illness and disease where psycho-social factors do play a role in addition to genetic susceptibility and environmental factors. The brain-gut axis is now an area of intense research in studying these functional disorders and psychotherapy behavioral modification and psycho-pharmacotherapy are are becoming increasingly important to manage such disorders.

Spinal tuberculosis mimicking malignancy: atypical imaging features.

Here is reported a 14-year-old boy with spinal tuberculosis. The imaging features were suggestive of non hodgkin's lymphoma with sparing of intervertebral disc. The atypical imaging features of spinal tuberculosis is discussed.

Sweat gland carcinoma with lung metastases.

Sweat gland carcinoma is a rare skin tumor. The tumor has propensity to spread to lymph nodes and distant metastases has been reported. Their exact incidence in the Indian setting is not known. Aspects related to treatment are also not clearly defined. Though surgery forms the initial treatment approach, adjuvant treatment has not been properly explored. We report here a case of sweat gland carcinoma with bilateral lung metastases.

The TACRD association is distinct from VACTERL association--a case report.

Tracheal agenesis is a rare malformation. A case of tracheal agenesis with associated ventricular septal defect, gastric hypoplasia, hiatus hernia, duodenal atresia, isomerism of the lungs, hypoplastic spleen with polysplenia, Meckel's diverticulum and fused crossed ectopia of the kidneys is presented. This case fits into a newly proposed TACRD association, an extremely rare condition composed of tracheal agenesis, cardiac, renal and duodenal malformations. It is distinct from the more common VACTERL association of which tracheo-esophageal fistula and not tracheal agenesis is a part. TACRD association has complex internal malformations and lacks the external skeletal manifestations of VACTERL association. Awareness amongst pathologists conducting neonatal autopsies is necessary for correct identification of this condition.

Congenital airway abnormalities in neonates.

Airway malformations such as laryngeal atresia, tracheal agenesis and subglottic stenosis are rare and present at birth with significant respiratory distress with or without stridor. There may be an initial improvement on bag and mask ventilation. Repeated attempts at intubation are met with failure. The related embryology and clinical aspect of airway malformations have been discussed. The prognosis in tracheal agenesis is universally fatal but cases with laryngeal atresia and subglottic stenosis may be saved with prompt tracheostomy and later surgical reconstruction.