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Background: Hypothyroidism in childhood typically leads to delayed puberty, rarely can it cause precocious puberty - this latter complex is eponymously known as Van-Wyk Grumbach syndrome. Case description: We report a case of a seven and a half-year-old girl who was referred with vaginal bleeding after a diagnosis of primary hypothyroidism and starting treatment with levothyroxine. This case report illustrates the typical features of this rare syndrome for primarily educational purposes. Many case reports of Van Wyk Grumbach syndrome have been published in world literature over the past seven decades after the initial description. Though the features of this syndrome are fairly well described previously, the understanding of pathophysiological mechanisms is speculative and still evolving. Clinical relevance: Further widespread awareness of the complex will encourage primary physicians and pediatricians to counsel the family of a child before starting treatment for hypothyroidism which will help avoid unnecessary worry and more importantly inadvertent procedures or intervention.

Background: Neuronal hypoxia and neuro-inflammation accompanying conditions like traumatic brain injury, stroke, cerebrovascular accidents and sub-arachnoid haemorrhage has been associated with hypopituitarism. Neuronal insults of similar magnitude and hypopituitarism [Growth Hormone (GH), gonadotropin and TSH deficiency in 27.2%, 9.0% and 2.2% patients respectively] has also been noted in a single study till date conducted in patients of ventricular arrhythmias requiring cardio-pulmonary resuscitation1. Patients with heart block, a more frequent form of cardiac arrhythmia usually presents with haemodynamic compromise and may be predisposed for developing either acute or delayed hypopituitarism which has never been studied before. Aims and objective: Our study was aimed at exploring whether pituitary dysfunction occurs in patients presenting with heart block and requiring pacemaker implantation. We analysed anterior pituitary functions in these cohort of patients during acute hospitalization and later during follow. Study design: Cross sectional prospective study Materials and Methods: Fifty-one patients were included in the study (mean age-65.98±10.9years; 34 men & 17 women). Pituitary hormonal profile was done within 48 hours of presentation and after a mean follow up of 12.52 ± 2.2 months. Total T3, total T4, free T4, TSH, FSH, LH, Testosterone (in men), Estradiol (in women), Prolactin, and random Cortisol were measured in all participants at baseline and in follow-up. Fixed dose Glucagon (weight<90kg-1mg; ≥90kg-1.5mg) stimulation test was done in follow-up to assess GH and cortisol axes. Results: Among 30 (out of 50) patients who turned up for follow-up, GH, cortisol and TSH deficiency was noted in 50% (n-15), 13.3% (n-4) and 3.2% (n-1) of subjects, respectively. Pan-hypopituitarism characterised by deficiency of at least two hormonal axes was seen in 16.7% (n-5) patients. Conclusion: Significant delayed hypopituitarism especially GH deficiency was seen among patients of heart block. Implications: This novel finding if reproduced in subsequent studies will result in unearthing of a significant etiology of hypopituitarism which could potentially become the most common cause of acquired adult onset hypopituitarism considering the huge burden of patients with heart block. Heightened cardiovascular risk due to hypopituitarism in these patients may be reversed by active screening and replacement of deficient hormones. References: (1) Simsek, Kaya, Tanriverdi et al. (2014) Evaluation of long-term pituitary functions in patients with severe ventricular arrhythmia: a pilot study. J Endocrinol Invest 37:1057-1064Keywords: Cortisol, GH deficiency, Heart block, Hypopituitarism, Pituitary Disclosure: Authors have nothing to disclose

Even with the best of resources tuberculosis remains one of the leading causes of morbidity and mortality in the developing countries. With the 0 by 25 initiative taken up by the International Society of Nephrology, renal tuberculosis still remains an important, albeit ignored cause of acute kidney injury in low resource settings. With proper evaluation considerable morbidity can be minimised and the quality of life of patients can be improved upon.