Background: Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and short term complications of major limb among patients attending Government Medical College, Kozhikode, Kerala, India which is a tertiary care centre.Methods: This was a prospective, observational study that was conducted at Govt. Medical College, Kozhikode, for a period of 18 months. 81 patients underwent major limb amputations in our hospital during the study period.Results: The age ranged between 23 to 90 years (mean 59.23±14.79). Males outnumber females by a ratio of 4:1. Above knee (transtibial) amputations were the most common. Diabetes mellitus was the most common cause (39.5%) followed by chronic NDMVI (33.3%). Younger individuals who underwent amputation were mostly due to trauma. Most common post op complication was surgical site infection (21%) and the most common organism cultured from the wound was Pseudomonas (50%). The most common additional procedure done was wound debridement. Themortality rate was 10% and mean duration of hospital stay was 23 days.  Conclusions: Complications of diabetic foot ulcers and chronic vascular disease were the most common indications for major limb amputation in our environment. Trauma was the most common indication in younger individuals. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.

Background Generalized glucocorticoid resistance syndrome has a tremendously heterogenous and very broad clinical spectrum. This syndrome is caused by loss of glucocorticoid receptor (GR) function due to mutation leading impairment in GR signalling. It presents with hypercortisolism, hypertension, enlarged adrenal glands but no Cushingoid features. Extensive endocrinologic investigations and genetic analysis can determine this disease and help in managing the sequalae of this syndrome. We report this case after looking into its rarity and presentation which would give an insight about this disease. Case presentation A 26-year-old female presented with, hirsutism, acne, deep voice (which was patients main concern), hypercortisolism, raised testosterone, without features of Cushing’s. On examination she was normotensive, hirsutism and poorly developed breast with ambiguous genitalia. On investigation, she was found to have left adrenal mass, hypercortisolism and had resistance to dexamethasone suppression test. She underwent left open adrenalectomy followed by continued medication with dexamethasone. Conclusion This syndrome should be considered as a differential diagnosis in patients with hypercortisolism but without any features of Cushing’s syndrome. It is a difficult diagnosis for a urologist, endocrinologist help should be sought for better outcomes and adherence on long-term hormonal treatment.