Response of bisphosphonate therapy in recurrent tumoral calcinosis

Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masses. Surgical excision of the tumoral calcinosis lesion is a well-documented treatment, but recurrences are not uncommon. A case of 42 year old male patient of tumoral calcinosis presented to us with history of repeated surgical excision twice in past 8 years for recurrent swellings. He was started on IV zoledronic acid and the patient has shown improvement after two years with no recurrence in follow up.

Response of leuprolide on gonadal functions of women with overt hypothyroidism: a tertiary care centre study from Uttar Pradesh, India

Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and sometimes menorrhagia. It has also been seen to cause subfertility and pregnancy related complications. Various studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there which have done using a gonadotrophin response in that subset of patients. Present study evaluates the response of leuprolide on gonadal functions of women with overt hypothyroidism in a tertiary care centre at Meerut.Methods: In this study 50 females of age 20 to 40 years with newly diagnosed overt hypothyroidism were taken as cases and age and Body Mass Index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol was measured on 2nd day to 5th day of menstrual cycle. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. Post leuprolide test, stimulated LH, FSH and estradiol were measured. Basal and stimulated values were compared between both groups.Results: Basal LH was significantly higher in controls (8.2±3.2 mIU/L) when compared to cases (6.45±2.75 mIU/L) with a p value 0.03(<0.05). Basal estradiol and FSH levels were found to be nearly similar and non-significant in cases and controls. No significant differences were found between stimulated mean LH and estradiol in both the groups. Leuprolide response after stimulation test was found to be sluggish in patients with overt hypothyroidism compared to normal euthyroid controls. This study is the rare one done on human subject in tertiary care centre of India, however large sample and multicentric trials are necessary before establishing the biochemical results.Conclusions: Pituitary and gonadal (ovarian) response to leuprolide was found to have impaired (decreased) in overt hypothyroidism cases. This is the first study to be done in overt hypothyroid subjects to asses both basal and stimulated gonadotropin levels.

Assessment of gonadal functions in women with subclinical hypothyroidism in Western Uttar Pradesh, India

Background: In females, hypothyroidism can cause menstrual disturbances mainly oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility and pregnancy complications. Several studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there regarding subclinical hypothyroidism. Present study evaluates the gonadal functions of women with subclinical hypothyroidism.Methods: Total 20 females of age 18 to 35 years with newly diagnosed subclinical hypothyroidism were taken as cases and 20 age and body mass index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol were measured on 3rd or 4th day of menstrual cycle at 8 AM on fasting. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. One hour after injection, LH and estradiol were measured. Basal and stimulated values were compared between both groups.Results: Basal LH was significantly higher in controls (6.63�38 m IU/ml) when compared to cases (6.06�10 m IU) with a p value 0.01 (<0.05). No significant differences were found between stimulated LH and estradiol in both the groups.Conclusions: In mild thyroidal failure the response of pituitary gonadotrophs to leuprolide is normal in contrast to overt hypothyroidism where the response is sluggish. This is the first study to be done in subclinical hypothyroid subjects to asses both basal and stimulated gonadotropin levels. Further studies are required in large samples to confirm these findings.

Macrodystrophia Lipomatosa- A Rare Congenital Anomaly: A Case Report and Review of Literature.

Macrodystrophia lipomatosa is a rare presentation and only few cases are reported in scientific literature. We report a case of Macrodystrophia lipomatosa in a 7 year young girl from a tertiary care hospital Mumbai. Case presentation: A 7 year old female was presented to outpatient department with progressive enlargement of right lower limb with increase in size of right great toe since birth. On clinical examination there was non tender fluctuant soft tissue swelling with good functional limb. Scannogram showed reduction of the medial compartment of right knee joint and the right lower limb length was slightly longer compared to the left side with presence of soft tissue swelling on medial distal thigh and knee region. MRI showed un-encapsulated subcutaneous fatty tissue involving the entire right lower limb along its medial aspect up to the great toe with fatty infiltration of the vastus medialis muscle suggestive of macrodystrophia lipomatosa. Arterial and venous colour Doppler study of right lower limb was normal. Conclusion: Macrodystrophia lipomatosa is a rare congenital, non hereditary condition with localized macrodactyly and proliferation of mesenchymal element and marked increase in fibroadipose tissue. X-ray and MRI are investigation of choice. Doppler study shows normal vascularity.

McCune-Albright Syndrome with hypophosphatemic rickets / Journal of the ASEAN Federation of Endocrine Societies

@#Fibrous dysplasia (FD) is sometimes accompanied by extraskeletal manifestations that can include any combination of café-au-lait macules, hyperfunctioning endocrinopathies, such as gonadotropin-independent precocious puberty, hyperthyroidism, growth hormone excess, FGF23-mediated renal phosphate wasting, and/or Cushing’s syndrome, as well as other less common features. The combination of any of these findings, with or without FD, is known as McCune-Albright syndrome (MAS). The broad spectrum of involved tissues and the unpredictable combination of findings is because of a molecular defect due to dominant activating mutations in the widely expressed signalling protein Gsα. These mutations arise sporadically, often early in development, prior to gastrulation and can distribute across many or few tissues.1,2 We present a case of a 3½ year-old-girl who presented simultaneously with precocious puberty and hypophosphatemic rickets, along with fibrous dysplasia and café au lait macules.