Context: The last few decades have witnessed an alarming increase in the prevalence of the metabolic syndrome (MetS) worldwide including India. Apart from the known risks of MetS in terms of cardiovascular risk and mortality, there is increasing evidence that it also leads to alteration in testicular function and fertility. Aims: To assess the presence of hypogonadism and Sertoli cell dysfunction in young adult males with MetS and correlate these parameters with different components of the MetS. Settings and Design: Cross-sectional study conducted in the Department of Endocrinology, Gauhati Medical College, a tertiary care hospital in North East India. Subjects and Methods: Young adult males with MetS aged 20–40 years and age-matched healthy males who served as controls were examined clinically. Laboratory investigations done in the fasting state included blood glucose, lipid profile, serum follicle-stimulating hormone (FSH), inhibin B and total testosterone (Te). Semen was collected after 3 days abstinence and analysis done. Statistical Analysis: Baseline parameters were presented as median and ‘Kruskal–Wallis’ test was used to compare them. Pearson test and multiple regression analysis were used to assess the correlation and association between variables. Results: Fifty cases with MetS and 30 controls were included in the study. Subjects with MetS had significantly lower levels of total Te, FSH and inhibin B. They also had significantly lower semen volume, sperm count and total as well as progressive motility. There was a significant negative correlation of waist circumference and positive correlation of inhibin B with total sperm count. A significant negative association of serum triglycerides with semen volume was also found. Conclusion: MetS is a state of hypogonadotropic hypogonadism as reflected by low total Te, FSH and inhibin B levels with semen abnormalities reflecting Sertoli cell dysfunction.

Background: The study was undertaken to evaluate the prevalence of peripheral neuropathy in newly diagnosed type2 Diabetes mellitus (DM) by clinical examination and nerve conduction study (NCS), and to correlate them with risk factors.Methods: Eighty newly detected cases of type2DM of age ≥18 years attending Endocrinology Department of Gauhati Medical College and Hospital, Assam, India were evaluated. Grading of symptoms and signs was done using the Neuropathy Symptoms Score (NSS) and Neuropathy Disability Score (NDS) respectively followed by NCS.  Neuropathy was diagnosed based on abnormal NSS, NDS or NCS.Results: Prevalence of peripheral neuropathy was 68.75 % based on abnormal NCS/NDS/NCS. The most common symptom was presence of paraesthesia in 70.9%, followed by weakness in lower limbs in 16.36%.  The most common sign was impairment of vibration perception in 76.3%, followed by absent ankle reflex in 56.36%. Abnormal NCS finding was seen in 55% of patients with neuropathy. Of all the patients with neuropathy, only 2.5% had subclinical neuropathy that is abnormal NCS finding in absence of sign and symptoms. Peripheral neuropathy had significant association with age at diagnosis, presence of hypertension, fasting plasma glucose(FPG), HbA1c, serum creatinine and estimated glomerular filtration rate(eGFR) (p<0.05). On multiple linear regression analysis, only age at diagnosis and FPG were independently associated with neuropathy (p<0.05).Conclusions: Patients with type 2DM have a high prevalence of peripheral neuropathy at diagnosis and very few of them harbour subclinical neuropathy. This study has shown that clinical examination still remains the main tool for detection of neuropathy.

Giant prolactinomas are large lactotroph adenomas, defined as those with maximum dimension of &gt;4cm. They constitute &lt;5% of all prolactin secreting tumors, and are more frequently seen in men. They present with features of hyperprolactinemia and hypopitutarism and are responsive to dopamine agonist therapies. In the current study we have shared our experience on management of giant prolactinomas over the last 15 years. We collected clinical data retrospectively from medical records of patients with giant prolactinoma managed at our institute over the last 15 years. This study describes the symptomatology, tumor characteristics and response to therapy. Our study included 21 patients with 15 males and 6 females. The mean age of presentation was 32 ± 10.3 years, ranging between 10 to 53 years. Vision defect was the predominant complaint (57%, 12 patients), followed by headache (52%, 11 patients). Erectile dysfunction was a presenting feature in 13% of men (2 patients) and amenorrhea/galactorrhea in 33% of women (2 patients). Seizure was seen in 10% of the patients (2 patients) and 10% (2 patients) were diagnosed with giant prolactinoma on evaluation for primary infertility. Tumor associated pituitary dysfunction manifested as hypogonadism in 67%, 14 patients, central hypothyroidism in 38%, 8 patients, and hypocortisolism in 1 patient. The median maximum tumor dimension was 4.4 cm with median basal PRL of 7168 ng/ml. Five patients underwent debulking surgery (24% of the patients) prior to endocrinology referral for indications such as apoplexy/raised intracranial tension. All patients received cabergoline and a mean dose of 2.1 ± 1.7 mg/week (range, 1-7 mg/week) was prescribed to attain a median nadir prolactin level of 48 ng/ml over a median period of 4 months (range, 1-40 months). The follow-up MRI data was analysed for 13 patients. Tumor shrinkage of &gt;50% from the baseline was seen in all but 1 patient (92%) and 2 patients had disappearance of radiologically detectable tumor. Although giant prolactinomas have a greater tumor burden than the more common macroprolactinomas, the responsiveness to dopamine agonist therapy is excellent and surgical therapy is reserved for any exceedingly large tumors to relieve compression on vital structures.

BACKGROUND: The correlation of serum phosphorus levels in DKA with prognosis of patient remains controversial; we prospectively evaluated the correlation in 50 consecutive patients with DKA. METHODS: This study was done on patients of DKA admitted to Victoria & Bowring & Lady Curzon hospitals attached to Bangalore Medical College, Bangalore. The total duration of the study was 2 years. A total of 50 patients of DKA were taken into the study. The diagnosis of DKA was based on ADA criteria. Venous blood samples were obtained from each patient and serum phosphorous levels were estimated at admission, day 2 and on day of improvement and discharge or at worsening /death of the patient. The correlation of serum phosphorus levels in DKA with prognosis of patient was studied using the One-Way Analysis of Variance test and Fisher LSD test. RESULTS: Type 1 DM constituted 30% while type 2DM made up 70% of the study group. In type 1 DM 53% were in the age group 18-28, while 47% were 29-38 in age group range. In type 2DM maximum patients were in age group 39-48 yrs accounting about 40%; 28% in range 49-58yrs and 29% in range >59yrs. In type 1 DM the most common precipitating cause of DKA was infection and noncompliance each accounting for 41%, with new onset DM seen in 18% of patients. In type 2 DM infection was the most common cause accounting for 42%, closely followed by noncompliance to treatment which came up to 41% of the patients of the precipitating infections UTI was the most common cause around 33%, while pneumonia accounted for 19%. The mean duration of hospitalization of DKA patients was 6.2days. On day 0, 72% of population had normal or high values of Phosphorous and hypophosphatemia was seen in 28% had hypophosphatemia at admission. On Day 2 of admission, incidence of hypophosphatemia increased to 69%. At discharge phosphorous values returned to normal with 95% of patients having normal levels. Significant correlation was observed in phosphorous levels in DKA patients between phosphorous levels on day 2 and phosphorous levels at discharge in type 1 and 2 DM. In study group 10% mortality was seen. Type 2 DM patients accounted for 80%, while Type 1DM patients accounted for 20% of the mortality. Among patients with DKA at death, hypophosphatemia was seen 60%. No significant correlation was observed between phosphorous level and duration of stay of patient in hospital. Significant correlation was observed between phosphorous level at Day discharge/Death and outcome of the patient i.e., recovery or death of the patient with point estimation values of 0.086 (CI= 0.008-0.93). CONCLUSION: The correlation of the serum phosphorous and prognosis of patient during hospital stay was significant as shown in our study and other studies as well. Hypophosphatemia is commonly encountered at diagnosis and during treatment of a patient with DKA. Serum phosphate levels do not accurately reflect intracellular phosphorus stores; hence symptoms may be present even with mild or moderate hypophosphatemia. The assessment of

Dengue infection is recognized worldwide as the most important arthropod vector borne disease in the last four decades and a major public health problem, assuming epidemic proportion in urban areas of tropical countries in South east Asia. It is caused by one of the four dengue virus serotypes DEN-1, DEN-2, DEN-3 and DEN-4. Aedes aegypti is the main mosquito vector. Dengue infection can be asymptomatic or can cause two clinical entities: dengue fever (DF) and dengue haemorrhagic fever/ dengue shock syndrome (DHF/DSS). Dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome. Thrombocytopenia may be frequently observed in DF, but is a constant feature and one of the diagnostic criteria of DHF/DSS. There is a need to identify various clinical presentations, complications and treatment outcome of Dengue patients. Hence, this study was undertaken to ascertain all the above mentioned clinical parameters in proven dengue patients who were admitted to this tertiary care hospital, with a special emphasis on correlation between platelet count and bleeding manifestations. MATERIALS AND METHODS: This cross sectional study was conducted for a period of 2 years from October 2010 to September 2012. 100 hospitalized and confirmed dengue cases were included and they were classified as having dengue fever (DF), dengue hemorrhagic fever (DHF)/ dengue shock syndrome (DSS) as per WHO criteria. A detailed clinical evaluation with appropriate laboratory investigations were done. All the patients were treated and followed up with clinical assessment and serial platelet counts. Data was analyzed with suitable software and appropriate statistical methods. RESULTS: There were 57 males and 43 females, with majority in the age group 21 to 40 years. Fever was the most common symptom present in all the patients (100%), followed by vomiting (24%), myalgia (23%), headache (21%), and pain abdomen (20%). Bleeding manifestation were noted in 18 patients (18%), out of which 5 patients had platelet count <20,000, 4 patients had 21,000-30,000, 2 patients 31,000-40,000, 5 patients 41,000-50,000 and 2 patients had >61,000 platelet count. There was no correlation between platelet count and bleeding manifestations (p value > 0.05). CONCLUSION: Dengue remains an important differential diagnosis for all acute fevers in India. Dengue should be suspected even in patients without classical presentation of dengue as many Dengue patients present with atypical manifestations. Due to lack of direct correlation between low platelet count and bleeding tendencies, low platelet count alone is not an indication for platelet transfusion and a close monitoring for bleeding manifestation and hemodynamic stability with reasonable judgment should be exercised in deciding the need for transfusion in Dengue patients. Prevention of uncomplicated Dengue fever going on for DHS and DSS will be crucial and will decrease the overall mortality and morbidity.