SummaryDiabetes in acromegaly is usually noninsulin dependent and is secondary to insulin resistance caused by growth hormone excess. Diabetic ketoacidosis is a result ofrelative insulin deficiency and is a rare feature of acromegaly. We describe a case of acromegaly presenting with diabetic ketoacidosis. We demonstrate that growth hormone excess can cause diabetic ketoacidosis in the presence of relative, but not absolute insulin deficiency.Keywords: acromegaly, diabetic ketoacidosis, insulin resistance A 40-year-old man was admitted as an emergency with a one-month history of thirst, polyuria and weight loss of 7 kg. On direct questioning, the patient admitted to an increase in the size of his head, hands and feet over the last year. Friends had recently failed to recognise him. On examination, he was clearly acromegalic, severely dehydrated and exhibiting Kussmaul's respiration. Investigations revealed 3+ ketonuria on urinalysis. Blood glucose was 29.1 mmol/l, plasma bicarbonate 7 mmol/l, sodium 132 mmol/l, potassium 3.7 mmol/l, glycosylated haemoglobin (HbAl) 15.0%. Arterial blood gases pH 7.10, pCO2 1.0 kPa, base excess 27 mmolIl.Following the diagnosis of diabetic ketoacidosis, he was treated with an intravenous insulin infusion and fluids containing potassium supplements. Satisfactory diabetic control was achieved with 52 units of Human Mixtard insulin 30 ge daily, given subcutaneously in divided doses. The diagnosis of acromegaly was confirmed by the finding of a raised basal growth hormone level of 37.1 mU/ 1, increasing after a 75-g oral glucose load to >120 mU/l at 30 minutes and 66.2 mU/l at 120 minutes. The corresponding glucose and insulin measurements are shown in the figure and show significant levels of insulin but a flat response to the glucose load.There was evidence of hypogonadotrophic hypogonadism (luteinising hormone <1.0 IU/1, follicle-stimulating hormone 2.7 IU/1, testosterone 1.7 nmol/l), but levels of thyroidstimulating hormone (0.9 mU/l), prolactin (125

Caesarean sections were done due to impending eclampsia and eclampsia, 705 percent due to accidental haemorrhage and 5 percent due to IUGR. Maternal complication in study and control subjects. In the case group, maximum number of the women (16%) showed signs of impending eclampsia, while among control women, maximum number (10%) developed postpartum haemorrhage (PPH). 48 percent neonates were of low birth weight and in controls it was 13.3 percent. Both hyperbilirubinaemia (40%) and hypoglycaemia (30%) were more in study group than controls (16.66% and 20%, respectively). Perinatal outcome among study group and controls. Neonatal survival was 82.0 percent in study group and 86.7 percent in control group. Comparison of Perinatal outcome between the groups is not statistically significant. Most of the perinatal mortality was due to prematurity (8%) and intrauterine death (6%). In control group, most of the perinatal deaths were due to congenital anomalies (6.6%). Conclusion: The higher incidence among study group may be, in part, the result of more preterm birth or shortened gestational duration because early delivery is a consequence of preeclampsia. The higher rate in associated with preeclampsia was due to increased incidence of IUD and prematurity.

Introduction:Infertility is defined as the inability of a couple to conceive with one year regular unprotected intercourses. 1 The prevalence of women diagnosed with infertility is approximately 13% with a range from 7-28% 2 in world wide.About 25% of cases of infertility are attributed to male factors. In female infertility, untreated infection, anovulation and endometriosis are major causes. Tubal and peritoneal factors are responsible for 30% to 40% cases of female infertility.

Introduction:Cornual pregnancy is a rare form of ectopic pregnancy. Insterstitial pregnancies account for 2-4% of ectopic pregnancies and 20% of cases that advances beyond 12 wks of gestation ends in rupture 1 . As pregnancy location is within the myometrium there is greater room for expansion and rupture occurs characteristically during the fourth or fifth gestation 2 . It is very difficult to make a diagnosis of cornual pregnancy before rupture. We report a case where cornual pregnancy was diagnosed at 17 weeks of gestation after uterus rupture and profuse intraabdominal heamorrhage. Case Report:A 22 yrs old lady admitted in our hospital with history of severe abdominal pain and sweating for 5 hours at 17 weeks of gestation. . Her temperature recorded 96 0 F, pulse rate was 115 beats/min and blood pressure was 80/50 mm Hg. The lower abdomen A Ruptured Cornual Ectopic Pregnancy at 17 WeeksGestation : A Case Report KHAN MI a Here , we report a case where cornual pregnancy was diagnosed at 17 weeks of gestation after uterine rupture and profound haemorrhage . The patient underwent laparotomy followed by cornual resection with salpingectomy.