Frequency of nonalcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with metabolic syndrome

Obesity and metabolic syndrome is an epidemic seen in the developed, as well as developing countries. Early recognition of this disorder may prevent major non-communicable diseases such as type 2 diabetes mellitus, hypertension and dyslipidemia. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are the hepatic manifestations of metabolic syndrome. Prospective, observational, cross-sectional study was conducted in Endocrine Clinic of Jinnah Postgraduate Medical Centre, Karachi from June 2008 to September 2010. This study was conducted in patients suspected to have metabolic syndrome, as defined by International Diabetes Federation. Patients fitting the clinical consensus definition, having either palpable liver or ultrasound evidence of fatty infiltration were enrolled. Detailed history, physical examination, anthropometrics and biochemical measurements were recorded. Liver biopsies were performed where possible and were assessed according to Brunt et al's classification. A total of 101 patients who met the inclusion criteria were enrolled in the study. Liver biopsy was done in 31 patients. On biopsy, non-alcoholic fatty liver disease was confirmed in 28 [90%], non-alcoholic steatohepatitis in 18 [58%] and fibrosis in 8 [25%] patients. Of the biopsied cases, fatty infiltration on ultrasound was seen in 14 [87.5%] cases. Alanine aminotransferase was higher in patients having fibrosis. There was a direct correlation of histopathological changes with rising waist circumference, total cholesterol, triglyceride, low density lipoprotein and alanine aminotransferase. There was high prevalence of non-alcoholic fatty liver disease / non-alcoholic steatohepatitis in patients with metabolic syndrome and liver biopsy confirmed this in 90.3% patients who consented to this procedure

Male partial hypogonadotrophic hypogonadism with gynaecomastia and metabolic syndrome

The causal association of childhood obesity and hypogonadotrophic hypogonadism needs to be studied to unravel the cause and effect relationship between the two conditions. The relationship of hypogonadism to the Metabolic Syndrome [MetS] remains valid even when using different definitions of MetS, and following the patients prospectively for over 10 years. This is a case of 19 years male who presented with micropenis, marked gynaecomastia and weight gain. Childhood obesity and family history of diabetes predisposed him to future MetS. Presence of micropenis reflects intrauterine hypogonadotrophic hypogonadism. Both entities exacerbated each other

Virilization with adrenal myelolipoma, adrenal hyperplasia, and fibroadenoma of breast

Adrenal myelolipoma is a rare, benign and usually hormonally inactive tumour. We report a case of a young female who presented with hormonally active tumour causing virilization and associated type-2 Diabetes mellitus. Laparoscopic adrenalectomy was done after CT finding of a large left adrenal mass that was producing large amounts of androgens. Adrenal myelolipoma with cortical hyperplasia was diagnosed on histopathological examination. Her diabetes progressively regressed after the removal of tumour and glucose tolerance remained normal up to 1 year of follow-up after surgery and there was no recurrence of tumour. She also had a lump in her breast which proved to be a fibroadenoma. We report this case due to its rarity, multiplicity of tumours and adrenal cortical hyperplasia-presenting as an unusual cause of severe virilization