Spironolactone; the ultimate blocker of RAAS cascade in hypertensive patients with special reference to its cardiovascular benefits: Revisiting the forgotten ways.

Acknowledgement: All the authors would like to express their heartfelt thanks to Dr Jagadeesh Tangudu, Mtech, MS, PhD and Sowmya Jammula, M Tech for their immense and selfless contribution towards manuscript preparation, language editing and final approval of text. Abstract: Hypertension is a major risk factor for various macro and microvascular complications in a patient with diabetes. Control of hypertension is of paramount importance in the care of a diabetes subject. The goals for blood pressure in diabetes subjects are below 130/ 80 mmHg and below 125/75 mmHg if accompanying renal impairment is there. Spironolactone is a medication that has been used to treat high blood pressure since the 1960s. While there is some belief spironolactone reduces blood pressure, there are concerns due to the potential for this drug to cause adverse effects. Previous Meta analysis has shown that spironolactone reduces systolic/diastolic blood pressure by approximately 20/7 mmHg compared to placebo. Spironolactone has also been shown to decrease morbidity and mortality in patients with heart failure. We have tried to emphasize upon the usage of this old but important drug in management of resistant hypertension with reference to its mode of action, benefits and recent studies pertinent to cardiovascular benefits of spironolactone. Data Source:We searched PUBMED and MEDLINE database for relevant articles including key words. References of each article were further reviewed for final synthesis of the manuscript.

Pheochromocytoma: An Uncommon Presentation of an Asymptomatic and Biochemically Silent Adrenal Incidentaloma

Pheochromocytomas are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific; as a result, pheochromocytomas often imitate other diseases. The diagnosis is usually established by biochemical studies, i.e., the measurement of catecholamines or their metabolites in urine or plasma, followed by radiographic and scintigraphic studies for localisation. Surgical removal of the tumour is the preferred treatment. We report a 30-year-old woman presenting with an adrenal incidentaloma that was 7.6 × 5.3 × 4.8 cm in size on an abdominal computed tomography scan. Investigations for adrenal hormones, including a low-dose dexamethasone suppression test, plasma aldosterone level, 24-hour urinary metanephrine and vanillylmandelic acid levels, and plasma metanephrine level were all within the normal ranges. During the surgical resection, the patient had a hypertensive spell. Surgery was postponed, and the blood pressure was adequately controlled with α blockers, followed by β blockers. After 2 weeks, the surgery was followed by a pathological biopsy that confirmed the pheochromocytoma diagnosis.

Central hypothyroidism.

A 15-mth-old male child of consanguineous parents, presented with classical features of congenital hypothyroidism. Serum total thyroxine (T4), total triiodothyronine (T3) and TSH were low. There was no evidence of deficiency of other pituitary hormones. Magnetic resonance imaging of the pituitary was normal. TSHB gene sequencing revealed a homozygous missense mutation due to single base substitution G?A at codon 85 resulting in change from Glycine to Arginine. This mutation in TSHB gene has been reported earlier in three cases with similar phenotype from Japan.

Letrozole as a booster therapy in growth hormone deficiency.

A 13 year old boy presented to us with short stature. Evaluation revealed growth hormone (GH) deficiency. He was treated with GH replacement for 10 months and to further boost up the growth potential, an aromatase inhibitor Letrozole was added to GH therapy. After one year of combination therapy, patient had significant improvement in predicted adult height without a negative impact on pubertal progression.

Association between thyroid hormones, insulin resistance, and metabolic syndrome

To determine the association between thyroid hormones, insulin resistance, and metabolic syndrome in euthyroid women. Forty-five women with no past medical history were studied in this cross-sectional study at the Department of Endocrinology, Medwin Hospitals, Hyderabad, India, from August 2008 to September 2008. The body fat was estimated using bio-impedance method, and fasting blood sample was analyzed for total triiodothyronine [T3], total thyroxine [T4], thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], lipid profile, insulin, and glucose. The mean age of the participants was 32.6 +/- 9.6 years with a body mass index [BMI] of 29.9 +/- 3.8 kg/m[2]. Evidence of homeostasis model assessment index for insulin resistance [HOMA-IR] more than 3 was seen in 34 [75%] and metabolic syndrome in 29 [64%] participants. Total T3 showed a positive correlation with triglycerides, low density lipoproteincholesterol [LDL-C], total cholesterol, insulin, HOMA-IR and negatively with body fat. Thyroid-stimulating hormone correlated positively with BMI, insulin, HOMA-IR, LDL-C and negatively with HDL-cholesterol [p<0.05]. Free triiodothyronine correlated positively with waist circumference and T4 did not correlate with metabolic syndrome parameters. Our preliminary data show an association between thyroid hormones and some components specific of the metabolic syndrome in euthyroid women. Total triiodothyronine and TSH correlated more with variables of metabolic syndrome than FT3 and T4

Hypothyroidism and obesity. Cause or Effect?

To establish relationship between obesity and hypothyroidism and to analyze the frequency the frequency of primary hypothyroidism in obese patients and frequency of obesity in primary hypothyroidism patients. We conducted this retrospective, observational study in the Department of Endocrinology and Obesity Clinic, Medwin Hospital, Hyderabad, India in Mar 2008. In the last 18 months [between September 2006 to February 2008], data on 625 consecutive primary hypothyroidism patients [Group I] and 450 patients from obesity clinic [Group II] were analyzed. Frequency difference between the 2 groups was assessed by Chi-square test. In Group I, 278/625 [44%] had body mass index [BMI] >25 kg/m2. Obesity was higher [46% versus 34%] in overt hypothyroidism than in subclinical hypothyroidism [p=0.21]. More patients were overweight in overt hypothyroidism group than in subclinical hypothyroidism group [p=0.02]. In obesity patients, overt hypothyroidism was present in 33% and subclinical hypothyroidism in 11% patients. Overall thyroid dysfunction was found more in obese individuals with varying degree of significance. Detailed studies are required to assess the cause and effect relation between obesity and hypothyroidism

Angiodysplasia of cardia of stomach--a case report.

Angiodysplasia of gastrointestinal tract is still thought to be an entity of unknown aetiology. This lesion is most commonly observed in elderly patients presenting with severe and persistent iron deficiency anaemia, following occult blood loss or acute episodes of haematemesis. In the stomach antral vascular ectasia is the most common presentation. We report an autopsy case of vascular ectasia in the cardia of stomach in a young patient with clinical symptoms of anaemia as the presentation and an associated secondary hemosiderosis of liver.