Correlation of Body Mass Index with Anthropometric and Biochemical Parameters Among Polycystic Ovary Syndrome Phenotypes.

This was a prospective observational study, conducted at a tertiary care health centre in Rajasthan. A total of 68 women with PCOS (Rotterdam criteria) attending OPD at Department of Obstetrics and Gynecology qualified as per inclusion and exclusion criteria were included in the study. Each participant was examined for anthropometric and biochemical parameters. The largest phenotypic group was phenotype A, (41.17%); followed by B (26.47%); C (20.58%), and D (P + O) phenotypes (11.76%). Hyperandrogenic phenotypes (A, B, C), had significantly higher prevalence of deranged serum glucose (fasting and postprandial), lipid profile and serum TSH than normoandrogenic phenotype D. BMI was strongly correlated with anthropometric (p < 0.001) and biochemical parameters (p < 0.05) in phenotype A among four phenotypes of PCOS. Phenotype A was the most common form of PCOS and a strong correlation of BMI with waist circumference (WC), dyslipidemia and Sub-clinical hypothyroidism (SCH) was observed in women of this phenotype of PCOS. These results indicate that phenotype A is at increased risk of CVD and diabetes and phenotype D has least metabolic risks.

New-Onset Graves' Disease in the Background of Hashimoto's Thyroiditis: Spectrums of the Same Disease With Changing Autoantibodies.

Hashimoto's thyroiditis and Graves' disease represent two spectrums of the same autoimmune thyroiditis. Evolution from Graves' disease to Hashimoto's thyroiditis is a common scenario but conversion is a rare occurrence that we observed in the presented case of a 56-year-old Hispanic female with a history of Hashimoto's thyroiditis with positive anti-thyroperoxidase (TPO) antibodies who was euthyroid on levothbefore75 µg for six years prior to her presentation to the emergency department (ED) with complaints of palpitations, exertional dyspnea, and unintentional weight loss of 20 lbs for four months. The patient denied any recent change in levothyroxine dosage. The patient was noted to have tachycardia at rest, hyperdynamic circulation, and fine tremors on outstretched hands-on examination but no exophthalmos, thyromegaly, or pedal swellings. Her initial laboratory workup revealed thyroid-stimulating hormone of <0.01 mIU/L, with elevated free T3 and free T4 levels. Levothyroxine was held and beta-blockade therapy was started for symptom control. Further workup showed elevated thyroid-stimulating immunoglobulin and thyroid receptor antibody levels and normalization of anti-TPO antibody levels. The radioactive iodine uptake scan was initially delayed because the patient underwent a pulmonary angiogram in the ED. A later scan showed thyromegaly with heterogeneous uptake of 82% in both lobes. Hence, the patient was diagnosed with Graves' disease and managed with radioactive iodine ablation therapy. On follow-up, the patient developed post-ablation hypothyroidism; she was started back on levothyroxine therapy and became euthyroid. This case highlights that patients can develop Graves' disease in the background of a hypothyroid state, and this conversion might be postulated secondary to a combination of atypical destructive thyroiditis and a switch of autoantibodies from blocking to stimulating ones. Clinicians should suspect the possibility of changing antibodies when there is a change in the patient's euthyroid state.

An Unusual Presentation of Adrenocortical Carcinoma (ACC): Panic Attacks and Psychosis.

BACKGROUND Adrenocortical carcinoma (ACC) is a very rare disease, with an incidence of 1.02 per million population per year. The most commonly secreted hormone in ACC is cortisol, often presenting as a rapidly progressive Cushing syndrome (CS). We describe a case of ACC with an unusual presentation, mainly with psychiatric manifestations, including panic attacks and hallucinations. CASE REPORT A 52-year-old woman presented with episodes of acute anxiety, hallucinations, palpitations, hot flashes, gastrointestinal upset associated with paroxysmal hypertension, tachycardia, and flushing for 1 week. The initial workup was aimed at ruling out causes of acute psychosis and/or anxiety such as substance use, and organic diseases such as pheochromocytoma (PCC). Our initial suspicion of PCC was ruled out based on the negative serum and urinary metanephrines (MN) and normetanephrines (NMN). Recurrent metabolic alkalosis and hypokalemia despite fluid and potassium supplementation prompted us to work up for hyperaldosteronism. Her renin level was elevated and the aldosterone level was appropriately suppressed. Elevated cortisol, positive dexamethasone (DXM) suppression test, low adrenocorticotropic hormone (ACTH), imaging revealing an adrenal mass, and postoperative histology confirmed the diagnosis of cortisol-producing ACC. CONCLUSIONS It is essential to recognize psychiatric presentations of CS to achieve early diagnosis and prevent mortality and morbidity. Panic attacks, a common presentation of CS, can present with features mimicking pheochromocytoma (PCC), including palpitations, sweating, tachycardia, and paroxysmal hypertension. A comprehensive workup is warranted to reach a diagnosis, with a combination of hormonal levels, imaging, and histology.

Randomized pilot trial of bariatric surgery versus intensive medical weight management on diabetes remission in type 2 diabetic patients who do NOT meet NIH criteria for surgery and the role of soluble RAGE as a novel biomarker of success.

OBJECTIVE: To compare bariatric surgery versus intensive medical weight management (MWM) in patients with type 2 diabetes mellitus (T2DM) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products (sRAGE) is a biomarker to identify patients most likely to benefit from surgery. BACKGROUND: There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35. METHODS: Fifty-seven patients with T2DM and BMI 30 to 35, who otherwise met the criteria for bariatric surgery were randomized to MWM versus surgery (bypass, sleeve or band, based on patient preference). The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance (HOMA-IR) and diabetes remission. Secondary outcomes included changes in HbA1c, weight, and sRAGE. RESULTS: The surgery group had improved HOMA-IR (-4.6 vs +1.6; P = 0.0004) and higher diabetes remission (65% vs 0%, P < 0.0001) than the MWM group at 6 months. Compared to MWM, the surgery group had lower HbA1c (6.2 vs 7.8, P = 0.002), lower fasting glucose (99.5 vs 157; P = 0.0068), and fewer T2DM medication requirements (20% vs 88%; P < 0.0001) at 6 months. The surgery group lost more weight (7. vs 1.0 BMI decrease, P < 0.0001). Higher baseline sRAGE was associated with better weight loss outcomes (r = -0.641; P = 0.046). There were no mortalities. CONCLUSIONS: Surgery was very effective short-term in patients with T2DM and BMI 30 to 35. Baseline sRAGE may predict patients most likely to benefit from surgery. These findings need to be confirmed with larger studies.ClinicalTrials.gov ID: NCT01423877.

Comparative study of feasibility of day-care surgery in rural and urban patients.

BACKGROUND: Day-care surgery is a common procedure in most of the hospitals. It has the advantages of early discharge and thus contributes to cost effectiveness. OBJECTIVES: The aim of this study was to compare the feasibility of day-care surgery in rural and urban patients. MATERIAL AND METHODS: Around 200 cases undergoing day-care surgeries of various types in urban and rural patient were enrolled randomly in the study. RESULTS: The maximum number of patients in both the groups were between the range of 21-40 years. The most frequent surgery in rural group was dilatation and curettage (25%) and in urban group was herniotomy (20%). In follow up only 1% complication occurred in rural group with 6% patients were lost in follow up and 4% changed the treatment center. In urban patients follow up was uneventful. The urban group people were more educated than the rural group. CONCLUSION: Day-care surgery is overall a beneficial procedure but understanding of the patient regarding the surgery and importance of follow up according to educational standard and intellectual status are very important criteria.