Subclinical Hypothyroidism: Frequency, clinical presentations and treatment indications

Objective: To determine the frequency, modes of clinical presentation and indications for replacement therapy in a cohort of patients with subclinical hypothyroidism [SCH]

Methods: This study was conducted at the Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre from September 2007 - October 2015. This was a retrospective chart analysis of prospectively collected data in which the medical records of 4448 patients who had presented to the Endocrine Clinic from 2007 to 2015 were reviewed. A total of 2760 [62.05%] patients were diagnosed with thyroid disorders, whereas 260 [9.42%] patients had SCH. The SCH patients were between the age of 12 to 70 years; TSH was >4mlU/l with normal levels of FT3 and FT4. Patients were enrolled using a predesigned structured proforma. Those having chronic systemic diseases were excluded from this study. SPSS 13 was used to evaluate the data

Results: Female patients comprised 93.8% [244 patients] of those with SCH, whereas only 6.2% [16 patients] were male. Common presenting symptoms were, lethargy in 146 patients [56.2%]; increase in weight in 102 patients [39.2%] and menstrual irregularities in 90 patients [34.6%]

TSH level of < 10mlU/l [4-10] was seen in 177 patients [68.1%] and 83 patients [31.9%] had TSH > 10mU/l. Thyroxine was given to 183 [70.4%] of these patients. Common treatment indications were TSH of > 10, which was seen in 83 patients [31.9%], subfertility in 32 patients [12.3%], troublesome symptoms suggestive of hypothyroidism in 31 patients [11.9%] and high titers of antibodies in 23 patients [8.8%]

Conclusion: SCH is frequently seen in our population, with most patients complaining of lethargy. The most common treatment indications were a TSH > 10mlU/l, whereas troublesome symptoms of hypothyroidism and subfertility were the common treatment indications in patients who had a TSH of < 10mlU/l

Clinical spectrum of disorders of sexual differentiation

Objective: To describe the mode of presentation and causes of the disorders of sexual differentiation in patients presenting in the Endocrine Clinic. Study Design: Observational study. Place and Duration of Study: The Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre [JPMC], Karachi, from July 2012 to July 2014

Methodology: Patients with phenotypic, psychosocial gender confusion or absence of gender appropriate secondary sexual maturation were enrolled in the study. Patients having chronic systemic disease, as cause of delayed puberty, were excluded from the study. SPSS 13 was used to evaluate the data

Results: A total of 48 patients registered in the study with mean age of 19.9 +/- 8 years. Female gender was assigned to 28 [58.3%] of which 8 [28.57%] had genital ambiguity. Male gender was assigned to 20 [41.66%] patients at the time of birth and 7 [35%] of them had ambiguous genitalia. Karyotyping could be done in 36 [75%] patients of which 17 [47.2%] were females and 19 [52.7%] were males. Karyotypic gender of the 19 [48.57%] male patients was 46 XX, 46 XY and 47 XXY; in 4 [21.05%], 5 [26.3%] and 10 [52.6%] patients, respectively with 9 Klinfelter syndrome. Karyotypic gender of 17 [47.42%] female patients were 46 XX, 46 XY and 45 X0; in 5 [29.4%], 3 [17.64%] and 9 [52.9%] patients, respectively

Conclusion: Disorder of sexual development constitutes a small but difficult area of endocrinology with disastrous consequences, especially if assigned wrong sex at birth. Mode of presentation of these cases was diverse ranging from delayed puberty, to gender confusion, to pregnancy in a male. Eventually in an adult patient assignment or reassignment of gender identity was primarily the patient's prerogative

Magnetic Resonance Spectroscopy: Novel Non-invasive Technique for Diagnosing Brain Tumors

Objective: To determine the accuracy of MR Spectroscopy [MRS] in diagnosing brain tumors

Study Design: Analytical study

Place and Duration of Study: Neurosurgery Department, Jinnah Postgraduate Medical Centre, Karachi, from November 2010 to April 2011

Methodology: Fifty cases with brain tumors, who presented to Neurosurgery Department of Jinnah Postgraduate Medical Centre, Karachi, during the study period, were included in the study. All patients underwent MRS and later brain. Those with recurrent disease were excluded. Data was collected with the help of proforma. Data was analyzed using SPSS version 16. Comparison of MRS findings and biopsy diagnosis was done. Sensitivity, specificity, negative and positive predictive values [NPV and PPV] were determined keeping histopathology as the gold standard

Results: Out of the 50 patients, there were 20 [40%] females and 30 [60%] males with mean age of 37 +/- 13.24 years. The commonest presenting complaint was headache [76%] followed by weakness [62%] and seizures [30%]. MRI had diagnosed 27 [51%] as neoplastic lesion. Spectroscopy reported 44 [88%] as neoplasms, while on histopathology, 42 [84%] were confirmed to have neoplasm. The accuracy of MRS was 94%, with 97.6% sensitivity, 71.42% specificity, 95.45% PPV and 83.3% NPV

Conclusion: Magnetic resonance spectroscopy can readily help in differentiating neoplasm from non-neoplastic brain tumors, thus an invasive brain biopsy procedure can be avoided