Etiological profile of short stature.

OBJECTIVE: To study the frequency of various causes of short stature and their etiological contribution in a referral endocrinology and metabolism clinic at a tertiary care hospital. METHODS: 352 children with growth retardation attending endocrine clinic between Feb 1999 to Mar 2001 were investigated for etiology of short stature. Agrawal's growth chart was used for percentiles and height velocity. Various relevant radiological, biochemical and hormonal investigations were performed. RESULTS: Normal variant short stature was the most common cause of short stature followed by endocrine causes. CONCLUSION: In males most common cause of short stature was constitutional growth delay, while in females most common cause of short stature was familial short stature.

Cerebral salt wasting syndrome in a patient with a pituitary adenoma.

Cerebral salt wasting syndrome (CSWS) is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate CSWS from the syndrome of inappropriate ADH secretion, as this would alter the management of hyponatremia. We describe a case of CSWS that occurred in association with a non-functioning pituitary adenoma.

Immunoreactive insulin response to a single dose of glimepiride in lean type 2 diabetic subjects.

BACKGROUND: The best method for glucose lowering in lean type 2 diabetes remains controversial and this study was undertaken to study the 24 hour insulin response of these diabetics to glimepiride, a sulfonylurea with distinctive properties. METHODS: Twenty five consecutive newly diagnosed diet-unresponsive lean type 2 diabetics (BMI < 19 kg/m2) without any vascular complications were given single dose (1 mg) of glimepiride and insulin responses were measured 2,4,8,12 and 24 hours later. Pre and post-glimepiride blood glucose levels were also measured. RESULTS: All the post-glimepiride insulin levels were significantly higher than basal values. Increase in insulin secretion peaked at four hours and benefits lasted for at least 24 hours. This was accompanied by clinically and statistically significant reductions in fasting and postprandial blood glucose levels. Maximum secretory response correlated positively with beta cell function (HOMA) and negatively with fasting glucose. CONCLUSIONS: Glimepiride improved insulin secretion and hyperglycemia in lean type 2 diabetic subjects, with benefits lasting for 24 hours. The degree of response was proportional to the beta cell reserve, and occurred irrespective of the presence or absence of markers of insulin resistance.

Clinical and biochemical profiles of young diabetics in North-Eastern India.

OBJECTIVE: We compared the clinical and biochemical profiles of young diabetics in North Eastern India. METHODS: Seventy diabetics who were detected at less than 30 years of age were studied. Patients with ketoacidosis or ketonuria on insulin withdrawal were grouped as insulin dependent diabetes mellitus (IDDM), patients with history of chronic abdominal pain with or without exocrine pancreatic dysfunction who either on ultrasonography (USG) or endoscopic retrograde cholangiopancreaticoduodenography (ERCP) revealed pancreatic calcification and/or ductal dilatation were grouped as fibrocalculous pancreatic diabetes (FCPD), those having BMI < 19 kg/m2 with history or stigmata of childhood malnutrition and who were ketosis resistant were taken to be protein deficient diabetes mellitus (PDDM)/malnutrition modulated diabetes mellitus (MMDM) and those who neither had ketonuria nor history of chronic abdominal pain, malabsorption or stigmata of malnutrition were grouped as NIDDM of young (NIDDY). RESULTS: Amongst the young diabetics studied FCPD constituted 32.9%, IDDM 28.6%, MMDM 21.4% and NIDDY 17.11%. USG abnormalities were observed in 21 of the 23 patients of FCPD. Seven out of these showed pancreatic head calcification on X-ray while 14 showed pancreatic duct dilatation and calcification or calculi on USG. In the two remaining patients, ERCP revealed tortuousity of main pancreatic duct and calcification which were not detected on USG. Majority of FCPD and MMDM patients revealed insulin resistance on insulin tolerance test (ITT). HDL was significantly lower in NIDDY, while VLDL and triglycerides were significantly higher in FCPD and MMDM as compared to controls. Microvascular complications of diabetes were seen in all these groups, with peripheral neuropathy being more common in FCPD (43.5%) and background diabetic retinopathy in NIDDY (41%). CONCLUSIONS: We conclude that FCPD and MMDM together form majority (54.29%) of young diabetics at our center and a sizeable proportion of them may have microvascular complications, even at the time of diagnosis.

Cranial irradiation--an unusual cause for diabetes insipidus.

Central diabetes insipidus frequently occurs due to tumours in the region of pituitary or hypothalamus or following surgical trauma to these regions. Rarely it has been reported following cranial irradiation. We report the case of a middle aged woman who underwent surgical removal of a frontal capillary hemangioblastoma and received cranial irradiation. She presented ten months later with features of diabetes insipidus which was confirmed to be of central origin. She responded well to desmopressin nasal spray. Radiation induced damage to the hypothalmo-pituitary axis presents usually with anterior pituitary hormone deficiencies, most commonly that of growth hormone. Presentation as central diabetes insipidus is very uncommon.

Histoplasmosis: an unusual presentation.

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Robinow syndrome.

Robinow syndrome is a rare congenital abnormality. It is characterized by mesomelic brachymelia, hemivertebrae, dysmorphic facies, genital hypoplasia, micropenis, clinodactyly, camptodactly, hypoplastic nails and moderate short stature. We are documenting the case on the account of its rarity and additional features.

Insulin resistance and urinary excretion of sodium in hypertensive patients with non-insulin dependent diabetes mellitus.

BACKGROUND: Hyperinsulinemia has been implicated in the pathogenesis of hypertension both in non-diabetic and diabetic patients. A causal relationship between renal sodium retention and hyperinsulinemia is speculated to play role in the development of hypertension in diabetes mellitus. MATERIAL AND METHODS: Twenty patients (12 males; 8 females) with hypertension and non-insulin dependent diabetes mellitus (NIDDM) and twenty normotensive patients (11 males, 9 females) with NIDDM were included in the present study. Blood samples for glucose and immunoreactive insulin (IRI) assay were collected at 0, 30, 60 and 120 minutes after 75 g of glucose per oral. Urinary sodium excretion in 24 hrs was estimated by flame photometry. Insulin response to glucose and correlation between basal insulin secretion and urinary sodium excretion were evaluated. RESULTS: Mean fasting plasma glucose value was significantly raised in hypertensive group in comparison with normotensive group of diabetic patients. Patients with diabetes and hypertension and significantly higher level of serum IRI than normotensive patients with diabetes mellitus. Urinary sodium excretion was significantly lower in diabetic patients with hypertension than in diabetic patients without hypertension. A negative correlation between basal insulin level and urinary Na+ excretion was observed in hypertensive patients with NIDDM. CONCLUSION: A negative correlation between hyperinsulinemia and 24 hrs urinary Na+ excretion was observed in patients with diabetes and hypertension. The study highlights that patients with diabetes mellitus have tendency to retain sodium under the influence of insulin but this needs further evaluation.