Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p<0.05.Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution.

Unusual Presentation of Primary Hypothyroidism.

Primary hypothyroidism may present with myriad of unusual presentation apart from typically described signs and symptoms. We report an unusual case of primary hypothyroidism clinically presenting as acute psychosis and radiologically mimicking as pituitary macroadenoma. A 19-year-old female presented with h/o abnormal behaviour in the form of auditory hallucination, fearfulness, loss of memory and inability to recognise family members six months back. She also gave h/o multiple joint pain, easy fatigability, facial puffiness, somnolence, progressive weight gain, constipation and cold intolerance for similar duration. MRI brain revealed enlarged pituitary, while the thyroid function analysis pointed towards primary hypothyroidism. Patient improved with LT4.

Acute Psychosis Following Hydrocortisone Replacement in a Patient with Secondary Adrenal Insufficiency Due to Recurrent Postoperative Pituitary Macroadenoma.

Acute psychosis in patients receiving physiological corticosteroid replacement is rare. The exact mechanism of this disorder is not clear. We report a case of a 50 year old female with recurrent post operative pituitary macroadenoma who had presented to us with features of adrenocortical insufficiency. The patient was started on intravenous (iv) hydrocortisone and after receiving six doses, she developed features of acute psychosis. She was put on anti-psychotics and hydrocortisone was withheld for 24 hrs. The patient recovered in a couple of days and oral hydrocortisone was re-started at 5 mg per/day and increased to 15 mg/day without recurrence of symptoms of psychosis.

Thyroid Disorders in Pregnancy- Experience from North East India.

Aims: Thyroid dysfunction is commonly encountered in pregnancy and can affect maternal and Fetal outcomes. Limited data are available from north east India on the prevalence of various thyroid disorders in pregnancy. The present study was hence conducted to evaluate the prevalence of thyroid disorders in a large government hospital in Assam. Study Design: Prospective cohort study. Place and Duration of Study: Sample: Department of endocrinology and department of obstetrics, Gauhati medical college, Guwahati between may 2011 to April 2013. Methodology: Pregnant women irrespective of gestational age attending the antenatal clinic of Gauhati medical college were screened for thyroid dysfunction by estimation of serum free t34 (FT4), TSH and thyroid peroxidase antibodies (TPOAB). Subjects with known thyroid disorders, chronic illness or on medications known to affect thyroid status were excluded from the study. Results were interpreted as per the American thyroid association (ATA) 2011 guidelines. Results: A total of 542 pregnant women were enrolled for this prospective cohort study. The mean age was 23.85±4.04 yrs. Of the 542 women screened, 69.18% were Euthyroid, 21.58% had subclinical hypothyroidism (SCH), 5.35% had overt hypothyroidism (OH), hyperthyroidism was observed in 2.39% and 1.47% had gestational Thyrotoxicosis. TPOAB were positive in 18.08% of women. Conclusion: A high prevalence of thyroid disorders specially hypothyroidism were seen in this study using the newer ATA diagnostic criteria emphasizing the need for screening of all women during pregnancy.