Comparison of low dose short synacthen test [1 microgram] with standard dose short synacthen test [250 microgram] in patients of adrenal insufficiency

To determine the diagnostic accuracy of low dose 1 microg short synacthen test taking standard dose 250 microg short synacthen test as gold standard. A descriptive study. Department of Chemical Pathology and Endocrinology Armed Forces Institute of Pathology Rawalpindi from Jan 2006 to Jan 2007. Thirty patients with clinical suspicion of adrenal insufficiency and equal number of age matched healthy males and females as controls were included in the study. Relevant clinical history and physical examination was recorded on designated proforma. Short synacthen test was performed between 0800 - 1000 h by using ACTH doses of 1 microg and 250 microg with interval of 3 days in all patients and controls. Three blood samples were obtained for cortisol [basal, 30 min and 60 min after l/M ACTH injection]. Using 250 microg short synacthen test as a standard test, the 1 microg short synacthen test had sensitivity of 100%, specificity of 72%, positive predictive value of 71% and negative predictive value of 100% and 83% accuracy. The low dose 1 microg short synacthen test is as sensitive as standard dose 250 microg short synacthen test but less specific in the diagnosis of adrenal insufficiency

Common anthropometric indices and insulin resistance

To correlate common anthropometric indices with insulin resistance. A cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, between April 2004 to March 2006.The target population constituted subjects who presented at the institute for evaluation of their glucose fasting. A total of 141 subjects were selected for the study and they were categorized into 4 groups depending upon their glucose levels. Normoglycemic [plasma glucose fasting /= 5.6 to 6.9 mmol/L] diabetes mellitus [plasma glucose fasting 7.0 to 9.9 mmol/L] and severe diabetes mellitus [plasma glucose fasting >/= 10 mmol/L]. Common anthropometric indices including weight, body mass index, waist circumference, waist to hip ratios, waist to height ratios and body mass index adjusted for waist to hip ratio were measured on each individual as per World Health Organization guidelines on physical status. Homeostasis Model Assessment for Insulin Resistance was used as a marker for measuring insulin resistance and the calculations were made following Mathew's method. Waist to hip ratio proved to be the most useful anthropometric index in the evaluation of insulin resistance and obesity [r= +0.5361]; while it's adjustment with body mass index or with waist to hip ratio did not improve the diagnostic performance[r= +0.507 and r=+0.333 respectively]. Parameters like weight [r=+0.137], waist circumference [r= +0.196] and body mass index [r= +0.299] were not useful in the assessment of insulin resistance. Waist circumference correlated better with insulin resistance than other routinely used anthropometric parameters. Waist to hip ratio can be used for evaluation of insulin resistance and obesity

Spectrum of lipid and lipoprotein indices in human subjects with insulin resistance syndrome

Insulin resistance syndrome or metabolic syndrome is one of the major metabolic threats our recently urbanized society is going to face in near future. The management of this syndrome requires a very effective biochemical marker for screening. The objective of this cross sectional study were to compare various lipid and lipoprotein indices in human subjects with insulin resistance syndrome This study was carried out between April 2004 to January 2006 at the department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of forty-seven subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP. Forty-seven age and sex-matched healthy controls were also included in the study. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. The various lipid and lipoproteins, their ratios and log-transformed versions were evaluated for differences between subjects with metabolic syndrome and controls. Finally the diagnostic performances of these candidate lipid markers were evaluated. Results between subjects with metabolic syndrome and controls were found to be significant for serum triglyceride [P < 0.05], HDL-C [P < 0.05], triglyceride/HDLC [P < 0.01], Log triglyceride/HDL-C [P < 0.01], total cholesterol/HDL-C [P < 0.01], LDL-C/HDL-C [P < 0.01]. However there was weak correlation between these lipid based markers and HOMA-IR [[serum triglyceride: r= 0.225], [HDL-C: r= -0.235], [triglyceride/HDL-C: r= 0.333], [total cholesterol/HDL-C: r= 0.239]]. The AUCs for the diagnosis of metabolic syndrome remained highest for HOMA-IR [0.727 [95%CI: 0.642-0.812]], followed by triglyceride/HDL-C [0.669 [95%CI: 0.572-0.766]] and LDLC/ HDL-C [0.639 [95%CI: 0.537-0.742]]. The differences for lipids and lipoproteins between subjects with metabolic syndrome and controls remained significant. However, these markers have shown poor correlations with HOMA-IR along-with weaker diagnostic accuracy for the diagnosis of metabolic syndrome. Recommended cut-offs must be used, once these markers are employed in the diagnosis of metabolic syndrome

Hypertension and metabolic syndrome: impact of clustering of hypertension in subjects with metabolic syndrome

To compare insulin resistance between hypertensive and non-hypertensive subjects. It is a comparative cross-sectional study which was carried out between April 2004 to March 2006 at department of chemical pathology and endocrinology, Armed Forces Institute of Pathology, Rawalpindi. A total of sixty-three subjects with metabolic syndrome were selected as per the criteria of National Cholesterol Education Program, Adult Treatment Panel III [NCEP, ATP III] from a target population diagnosed to have impaired glucose regulation at AFIP, along with forty-seven age and sex-matched controls. Insulin resistance was calculated by the method of HOMA-IR, using the formula of Mathew's et al. Blood pressure was measured as per recommendations of JNC7 report on prevention, detection, evaluation and treatment of high blood pressure. The difference for hypertension for diastolic blood pressure between subjects with and without metabolic syndrome were found to be significant [Metabolic syndrome: 86.79 mm of Hg [95% CI: 83.75-89.84], Age and sex matched controls: 80.21[95% CI: 76.80-83.62] [p<0.05]. However the difference for systolic blood pressure were not found to be significant between the two groups [p=0.860].Hypertensive individuals had higher HOMA-IR [[n=33]: 2.87 [95% CI: 2.37-3.05]] than non-hypertensive [[n=30]: 1.76[95% CI: 1.53-2.05]] [p<0.05].The effect of obesity as determined by waist circumference between patients with and without hypertension remained significant [p=< 0.05]. Hypertensive individuals have higher insulin resistance than subjects without hypertension. Thus it is recommended that vigorous search be made to diagnose insulin resistance in subjects diagnosed to have hypertension, and to demonstrate other components of metabolic syndrome