Effect of chronic morphine administration on glucose tolerance and insulin binding to isolated rat adipocytes.

Morphine addiction was induced in six male Wistar rats. Improved glucose tolerance (peak value less by 28%, p<0.01) was observed in chronically morphinized rats as compared to the control rats, injected with saline. An increase in the maximal specific binding of 125I-labeled insulin to unit membrane area of adipocytes was observed in the experimental group (p < 0.01). The changes in insulin receptor number could be responsible for the improved glucose tolerance observed during morphine addiction.

Late onset adrenal hyperplasia due to 3 beta-hydroxy-delta 5-steroid dehydrogenase deficiency in north Indian hirsute women.

The presence of late onset 3 beta-hydroxy steroid dehydrogenase (3 beta-HSD) type of congenital adrenal hyperplasia was studied in 58 north Indian hirsute women. The age range of these patients was 15 to 42 yr. Fifty two per cent of these patients had body mass index > 25. Basal serum testosterone, luteinizing hormone, follicle stimulating hormone, dehydroepiandrosterone sulphate (DHEAS), and 17 hydroxy progesterone (17 OHP) were estimated. All the patients underwent adrenocorticotropin (ACTH) stimulation test after an overnight dexamethasone suppression for the estimation of DHEAS, 17 OHP, and 17 hydroxy pregnenolone (delta 5-17p). Five (8.6%) hirsute women showed an exaggerated 17 OHP response to ACTH indicating 21-hydroxylase deficiency. Eight (13.8%) hirsute women had elevated basal DHEAS and ACTH-stimulated DHEAS as well as delta 5-17P responses indicative of 3 beta-HSD deficiency. In one patient hirsutism was the presenting manifestation of tumoural hyperandrogenism. Our findings indicate the presence of both 21-hydroxylase and 3 beta-HSD deficiency in north Indian hirsute women, with, 3 beta-HSD deficiency being the major cause of hirsutism in this population.

Nonmydriatic retinal color photography in young Indian diabetic patients.

Retinopathy was assessed using a Canon nonmydriatic retinal camera (CR-45NM) in 42 young Indian diabetic patients (26 with malnutrition-related and 16 with insulin-dependent diabetes). Four patients with malnutrition-related diabetes (15.38%) had retinopathy (Level 3 in all 4). The duration of diabetes in them was 3.25 years. None of the four had hypertension or albuminuria. Five patients with insulin-dependent diabetes mellitus (31.25%) had retinopathy (Level 2 in 1 patient, Level 3 in 2, Level 5 and 6.5 in 1 each). The duration of diabetes in this group was 9.7 years. Three each (60%) had albuminuria and hypertension. Thus, retinopathy seemed to occur earlier in patients with malnutrition-related diabetes, and its incidence was discordant with that of nephropathy.

Fine needle aspiration cytology, sonography and radionuclide scanning in solitary thyroid nodule.

One hundred and ninety three consecutive patients with solitary thyroid nodule (STN), with a mean age of 36.0 +/- 12.8 years and male to female ratio of 5.6:1, were studied. Ninety five percent of patients came from iodine deficient regions. Seventy two percent presented for local neck swelling, 12.4% for hyperthyroid state and in 7.7% STN was discovered incidentally. Scintigraphically, 77.7% of nodules were cold, 12.4% hot and 8.5% warm. Sonographic evaluation did not reveal any characteristic echotexture diagnostic of malignancy, but detected clinically nonpalpable accessory nodules in 20.6% of patients. Fine needle aspiration cytology was positive for malignancy in 6.2% of patients. Features of follicular and Hurthle cell neoplasm were seen in 12.9% of aspirates. Eighty eight (45.6%) STN were resected surgically. Histologically, there was one false positive and one false negative aspirate and a case of parathyroid adenoma on aspiration proved to be parathyroid carcinoma on histology.

Congenital adrenal hyperplasia among peripubertal girls with hyperandrogenism.

Fifteen girls with severe hyperandrogenism were investigated by us during the last 6 years. Thirteen of these were cases of untreated congenital adrenal hyperplasia (CAH) and 2 were cases of tumoral (one sertoli leydig cell tumor of the ovary and one adrenal adenoma) hyperandrogenism. Here we present the clinical profile and laboratory data of those with congenital adrenal hyperplasia. All the girls had masculinization of genitalia (clitoromegaly alone 5, clitoromegaly with varying degree of posterior labial fusion 8). Eleven cases had hirsutism and 9 had short stature. Two patients underwent unilateral adrenelectomy with diagnosis of adrenal adenoma. Hormonal profile confirmed the diagnosis of CAH with 21 hydroxylase deficiency (elevated 17 OHP levels with exaggerated 17 OHP response to ACTH) in 12 cases and 3 beta hydroxy steroid dehydrogenase deficiency (elevated DHEAS and 17 pregnenelone levels and exaggerated DHEAS and 17 pregnenelone response to ACTH) in one case.

Clinical utility of ketoconazole in cases of adrenocortical carcinoma.

Ketoconazole, an imidazole derivative is known to decrease adrenal steroid biosynthesis by inhibiting cytochrome P450 dependent adrenal enzymes. Three patients of adrenal carcinoma treated with ketoconazole, 600-1200 mg daily showed significant fall in plasma and urinary cortisol levels, but no reduction in tumor size, one patient developed liver dysfunction which reverted back to normal on discontinuing the drug.

Computed tomography in untreated congenital adrenal hyperplasia.

Six children with untreated congenital adrenal hyperplasia (CAH) were examined by computed tomography (CT). Three cases demonstrated diffuse enlargement of both adrenal glands with preservation of normal configuration and two showed tumorous transformation in one of the enlarged glands. One had equivocal enlargement of the adrenal gland. Even the youngest in this group (age 2 years) also showed bilateral hyperplasia.

Postural variation of exophthalmometry in Graves' ophthalmopathy.

30 patients with Graves' ophthalmopathy were subjected to exophthalmometry in the upright and supine positions to determine if the difference in exophthalmometer readings in these two situations are significantly different and would help in distinguishing the early and late Graves' ophthalmopathy patients. The cases were divided into two groups (of 15 patients each) of early Graves' ophthalmopathy (Grades 0,1,2) and late Graves' ophthalmopathy (Grades 3,4,5) according to the American Thyroid Association classification. In addition, 15 age and sex matched normal individuals who served as controls, also underwent similar investigation. Contrary to earlier observations, the results showed statistically insignificant increase in exophthalmometer readings when going from the erect to the supine position. It was concluded that postural change in exophthalmometer readings neither helps in distinguishing normal subjects from patients of Graves' ophthalmopathy nor can it differentiate between various grades of Graves ophthalmopathy.

Reproductive endocrine functions in men with primary hypothyroidism: effect of thyroxine replacement.

Reproductive endocrine functions were studied in men with primary hypothyroidism during the hypothyroid phase and after achieving euthyroid status with thyroxine substitution therapy. Hypergonadotropism [luteinising hormone (LH), 18.7 +/- 7.3 IU/l; follicle-stimulating hormone (FSH), 6.3 +/- 2.0 IU/l], low serum testosterone (6.1 +/- 2.8 nmol/l), low serum sex-hormone-binding globulin (SHBG; 13.2 +/- 2.0 nmol/l) and subnormal testosterone response to human chorionic gonadotropin hCG; (30% increase in serum testosterone following hCG) observed during the hypothyroid phase were restored to normal (LH, 7.2 +/- 2.0 IU/l; FSH, 2.7 +/- 0.9 IU/l; testosterone, 12.9 +/- 2.7 nmol/l; SHBG, 26.5 +/- 8.4 nmol/l, and 2-fold increase in serum testosterone following hCG) with thyroxine substitution therapy. Some improvement in sperm count and motility was also observed.

Testicular histology and gonadotropin levels in infertile men with non-obstructive oligo-/azoospermia.

The common histological abnormalities on testicular histology in 79 infertile virile men were hypospermatogenesis (35%), severe testicular atrophy (29%) and maturation arrest (19%). Sperm counts showed no correlation with testicular size, gonadotropin levels and histological classification. There was elevation of mean follicle stimulating hormone levels in males with maturation arrest (5.8±3.8 lUlL) and Sertoli-cell only syndrome (21.7±3.4 lUlL). Patients with severe testicular atrophy had elevated luteinizing hormone (15.1±11.8 lUlL) as well as follicle stimulating hormone (49.8±11.4 lUlL) levels. Patients with hypospermatogenesis and focal atrophy had normal luteinizing hormone and follicle stimulating hormone levels and all of them had normal testosterone and prolactin levels. Treatment with gonadotropins or clomiphene citrate was ineffective.

The Eluru survey: prevalence of known diabetes in a rural Indian population.

Asian Indian migrants have a strikingly high diabetes prevalence but prevalence in India has been considered to be relatively low. However, there have been few recent studies, especially in rural India. A house-to-house survey was undertaken in a defined area of Eluru, a small town in South India, and in four adjoining villages. A total of 9563 subjects (4729 male, 4834 female) were surveyed, of whom 5699 lived in Eluru and 3864 in the four villages. Enquiry was made for known diabetes in each household. In all, 157 known diabetic subjects (89 male, 68 female) were ascertained. The prevalence of known diabetes was 6.1% in all subjects aged 40 or over and rose to 13.3% in the age group 50-59 years. The overall crude prevalence of known diabetes was 1.6% (1.9% male, 1.4% female). The prevalence in Eluru (1.5%) was similar to that in the four villages (1.9%). The age-adjusted rates for known diabetes in the middle-aged and elderly subjects are unexpectedly high, considering the poor socio-economic circumstances, decreased health awareness and decreased access to medical facilities, and are comparable with those of similar surveys in relatively affluent Delhi, and in Southall, London. The prevalence in rural (as well as urban) India may be much higher than previously realised. Large formal prevalence studies are urgently required.

Spontaneous hypoparathyroidism: clinical, biochemical and radiological features.

The clinical, biochemical and radiological features of spontaneously occurring hypoparathyroidism in 13 patients (mean age 9 years, range 4 months to 20 years) are highlighted. Nine patients presented with a history of generalised seizures and 2 were in acute hypocalcemic crisis at the time of admission. Ocular involvement (corneal opacities, cataract) was present in 3 patients and vitiligo in 1 patient. The serum calcium level was low (mean 5.46 mg/dl, range 5.0-7.2) and serum phosphorus level was high (mean 8.49 mg/dl, range 6-14 mg/dl) in all the patients. Six patients had elevated serum alkaline phosphatase (greater than 20 KAU). Radiological examination revealed osteopenia in 3 patients. Nine patients underwent a head CT scan; 5 had evidence of basal ganglia calcification. The findings of elevated serum alkaline phosphatase and osteopenia are at variance with existing literature and may possibly reflect pre-existing vitamin D deficiency.

Effect of chronic opioid administration on glycosylated haemoglobin levels in heroin addicts.

Levels of stable form of HbA1 in blood were estimated in 20 male heroin addicts, so as to assess the effect of chronic opioid use on glucose metabolism. No significant difference in the levels of stable form of HbA1 was observed in the heroin addicts as compared to controls, indicating absence of any long-term impairment of glucose tolerance in heroin addicts.