ABSTRACT
Background: Pituitary Microadenomas can be defined as small lesions less than 1 cm in the pituitary and detected as incidentalomas. Partial development or late development around puberty leads to maldevelopment of secondary sexual characteristics due to pituitary adenomas. Clinically this may manifest as secondary amenorrhoea and may lead to hyperprolactinaemia, galactorrhoea and Amenorrhoea. ACTH secreting micro adenomas of the Pituitary Gland is a clinical entity where the role of surgery is contemplated. This study attempted to explore the management options and strategies for pituitary microadenomas. The aim of the study: To highlight the characteristics of Cushing’s disease and discuss the management strategies including trans-sphenoidal surgery to treat ACTH secreting pituitary microadenomas. Materials and methods: This was a non-randomised prospective observational study involving all adrenal tumors from 2007-2017 in Madras Medical College, Chennai. Two adrenocortical adenomas M.S. Senthil Kumar, Rajan Ganesan, A. Nithyanandham, V. Kannan, T. Suresh Babu, K. Prabhakaran. Study of management strategies in ACTH secreting pituitary microadenoma of Cushing’s disease. IAIM, 2019; 6(3): 253-258. Page 254 with virilising features were ruled out and 8 ACTH secreting Cushing's disease with microadenomas were identified. 3 Patients with ACTH secreting microadenomas of Cushing's disease underwent surgery whereas 3 underwent medical treatment based on which this paper attempted to discuss management strategies for Cushings disease. Results: ACTH levels were measurable with an average of 136.71pg/ml (normal 7.2-63.3 pg/ml) Corticotrophin releasing hormone test was planned to evaluate an exaggerated response of serum cortisol consistent with pituitary disease. It was not carried out and inferior petrosal sampling also was not done. Biochemical evaluation confirmed pituitary dependent Cushing’s disease. MRI revealed a prominent circumscribed lesion suggestive of a Pituitary Micro Adenoma in All 6 Cases. Conclusion: Pituitary micro adenomas are operable and in Cushing’s disease offer an effective cure. The outcome is good with minimal complications, but surgeons must have a thorough knowledge of the surrounding anatomy and potential complications.
ABSTRACT
Background: The prevalence of Neuromuscular disorders in thyroid disorders is reported to be from 20% to 60% and varies from neuropathy to proximal myopathy. This study attempts to evaluate the prevalence of neuromuscular disorders in thyroid disorders. Aim and objectives: To study the correlation and prevalence of Nerve conduction abnormalities in hypothyroidism and hyperthyroidism, to determine neuropathy and myopathy in subsect of patients with thyroid disorders. Materials and methods: This study setting was in tertiary medical care centres which are major teaching institutes confined to the same geographical zone with a similar type of patient inflow. The departments of Medical endocrinology Out Patient patients and Endocrine surgery along with Internal medicine were included to evaluate patients. All patients were subjected to evaluation by Neurologist, Endocrine surgeons, Physician and Nuclear Physician. A total number of 400 patients over a period of three years were included from 2015 till 2018 with one year follow-up after treatment. The inclusion M.S. Senthil Kumar, Rajan Ganesan, A. Nithyanandham, E. Prabhu. Evaluation of prevalence of neuromuscular disorders in thyroid disorders in tertiary care institution - An interdepartmental inter institutional study. IAIM, 2019; 6(3): 176-181. Page 177 criteria were newly detected thyroid dysfunction predominantly hypothyroidism and hyperthyroidism and a subset of patients refractory to medical treatment where intervention was total thyroidectomy. The exclusion criteria were toxic nodules, thyroiditis, unmarried girls and postoperative disease states. All Patients were subjected to a questionnaire and nerve conduction study was performed using standard RMS ENMG EP Mark Ii Machine to derive results for comparative analysis. Results: Out of the 400 patients studied 144 had neuropathy of which 4 patients had hyperthyroidism and 56 had hypothyroidism. 8 patients had mononeuropathy and 64 had polyneuropathy. Proximal Myopathy was present predominantly in hyperthyroidism especially Graves’ disease. Conclusion: The outcome of the evaluation in the study revealed that hypothyroid patients predominantly had Neuropathy and Hyperthyroidism patients had proximal Myopathy especially in Graves’ disease. The commencement of hyperthyroidism especially in Graves’ Disease is significant along with commencement of therapy to assess the progression of proximal Myopathy which is prevalent three fold in Graves Disease than in hyperthyroidism.