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.

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