Primary Adrenal Insufficiency in Autoimmune Polyglandular Syndrome Type 1 - A Case Report and Literature Review

Autoimmune Polyglandular Syndrome (APS) type 1 is a rare autosomal recessive disorder secondary to AIRE gene mutation, that is classically characterized by autoimmune hypoparathyroidism, chronic mucocutaneous candidiasis and Addison’s disease. A review of the literature shows that these disease manifestations may present in any order in different age groups. Patients with APS type 1 are also at risk for other endocrinopathies. We present the case of a female patient with a history of APS type 1 and type 1 diabetes who presented with new onset hypoglycemia and decreased insulin requirement and was diagnosed with new onset adrenal insufficiency due to Addison’s disease. One challenge we experienced in this patient diagnosed with concomitant autoimmune hypoparathyroidism and adrenal insufficiency was regulation of serum calcium, as cortisol replacement therapy contributes to urinary calcium loss. The goal calcium level is thus maintained at the lower limit of normal

قرآن وسنت کی روشنی میں قوامیت مرد کی وجوہات،ایک عصری وتحقیقی جائزہ: Reasons of Man Supremacy in the light of Qur'an and Sunnah: Contemporary Research review

Islam Guides us in every field of life. Family is a blessing of Allah Almighty. Family is the first institute of a society which plays vital role in the moral, ethical and social development of an individual unit of society. Islam gives us strong and complete code of family life. Allah Almighty distributed responsibilities of every member of family according to his / her abilities. Family has two basic components Husband and wife. As a male member ,Allah has put all main responsibilities of family on male’s shoulders to make him head of the family. Now husband has to provide all necessities to his family. He is responsible to give protection, respect and all other requisites to his family. While fulfilling these responsibilities, he faces many problems, works harder day and night and provides all possible facilities to his beloved ones. Contemporary family system is going to lose its impact on individual and collective level as well. Positive role of family is abolishing rapidly in different aspects. Woman should have equal powers and authorities. She has to be a family head instead of man. She should have equal decision powers like man. In this article, I will highlight the reasons of male Dominance in Family as well as in society in the light of Quran and Sunnah. I will also highlight that the difference in the responsibilities and rights of men and women is not a sign of contempt for women and the superiority of men, but it also refers to the difference in the scope of work with the interests and passions of men and women

The Journey From Knee to Heart: A Case of Methicillin-Sensitive Staphylococcus aureus Infective Endocarditis Secondary to Septic Prepatellar Bursitis.

Staphylococcus aureus is a cause of life-threatening gram-positive bacteremia and the most common causative organism of septic bursitis. Although there are several case reports of infective endocarditis complicated with septic bursitis and other rheumatic complications, there are very few cases reports of septic bursitis leading to infective endocarditis (IE). We present a patient with a history of recurrent prepatellar bursitis requiring catheter drainage, who presented with sepsis and IE

الاقتباس الشعري في كتابيات الشيخ أبي الحسن على الندوي

Poetic quotation in Abu al Hasan Ali Nadwi’s books Arabic literature is very vast in itself. Scholars and researchers of sub-continent have done a lot of work on Arabic literature. Abul Hasan Ali Nadwi is also one of them, who has performed prominent services for Arabic literature. Besides Indo Pak subcontinent, Bangladesh, Afghanistan, he has also got his literary services acknowledged in Arabic countries. Not only non-Arab scholars but also Arab scholars praises his Arabic skills as well.  Abul Hasan Ali Nadwi is a great Islamic scholar of 20 century. He born in subcontinent of Pak-India. He wrote many books in Arabic and Urdu literature. His work Was so nominated even Arabs has praised him. He was also a great thinker of Islam. Therefore, he translated many Iqbal poetry to Arab Nation to wake them up and convey them Allama Iqbal’s message and Islamic thoughts. In his work and books, he many times used quotations of Arabic poetry which is clear evidence of his high command on Arabic literature. In this article I want to show the method of shaikh that how he uses these quotations. I just took some of examples and samples for study. I hope this study will open new ways to researchers in this field work

Thyrotoxic Periodic Paralysis: Acute Paralysis as the Initial Presentation of Graves’ Disease

Description: Thyrotoxic periodic paralysis (TPP) is a form of hypokalemic paralysis marked by transient muscle weakness. Often triggered by exertion or high-carbohydrate meals, it primarily affects East Asian and middle-aged men and may be the first sign of hyperthyroidism despite the absence of classic symptoms. Case Report: A 35-year-old Haitian man presented with sudden bilateral lower limb weakness preceded by thigh cramps for 3 days. He had no thyroid-related symptoms. Employed in a warehouse, recent staffing shortages led to more exertion. On examination, he was afebrile, hemodynamically stable, with thyromegaly, reduced hip strength, and diminished reflexes. Laboratory tests showed hypokalemia (2.1 mmol/L), elevated creatine kinase, low thyroid-stimulating hormone, high T4/T3, and positive thyroid antibodies. Electrocardiogram showed U waves, and ultrasound confirmed hypervascular thyroid parenchyma. Diagnosed with hypokalemic TPP, he was treated with methimazole and potassium replacement. His potassium normalized, and his symptoms improved. Discussion: TPP, often linked to Graves’ disease, results when excess thyroid hormone overactivates the sodium-potassium ATPase pump in muscle cells, shifting potassium intracellularly and causing paralysis. Epinephrine and insulin exacerbate this shift, explaining why TPP episodes often follow exertion or high-carbohydrate intake. It is more common in men and shows seasonal variation, possibly due to potassium loss in humid climates. The usual lack of hyperthyroid symptoms complicates TPP diagnosis. Patients often show hypokalemia and respective electrocardiogram changes. Management involves cautious potassium replacement to avoid rebound hyperkalemia, while treatment targets the underlying hyperthyroidism. Conclusion: This case underscores the importance of recognizing TPP as a rare but reversible cause of acute paralysis, even in non-Asian populations and those without overt hyperthyroid symptoms. Early diagnosis and treatment are crucial to preventing complications and ensuring patient recovery. Targeting the underlying hyperthyroidism remains essential for long-term management and recurrence prevention

Bilateral Adrenal Hemorrhage After Laminectomy: A Rare Complication

Introduction: Bilateral Adrenal Hemorrhage (BAH) is an exceedingly uncommon complication of laminectomy, with few cases reported in the literature. In patients with history of any surgical procedure who present with unexplained symptoms of abdominal pain, back pain, hypotension, fever, confusion, or electrolyte abnormalities especially hyponatremia, acute adrenal insufficiency (AI) should be highly suspected. We herein describe a case of BAH following laminectomy. Clinical Case: 63-year-old male with past medical history of hypertriglyceridemia was admitted for post traumatic L1 burst fracture and was treated with T11-L3 fusion and T12-L3 laminectomy. The patient had normal bilateral adrenal glands after the fall on CT thoracic/lumbar spine imaging. The course was complicated by thrombocytopenia initially thought to be induced by therapeutic heparin since heparin antibody was positive. Serotonin-release assay returned negative weeks later ruling out heparin induced thrombocytopenia. Two weeks later, he developed unexplained tachycardia and CT angiogram was done which showed segmental pulmonary embolism and bilateral adrenal nodules measuring at least 3.9 cm on right side and 3.3 cm on left side. He was treated with Eliquis and was discharged home. Two weeks later, he was readmitted with weight loss of 30 lbs, weakness and altered mental status. His vital signs were significant for hypotension and tachycardia. Initial work up showed profound hyponatremia (sodium 121 mEq/L), hyperkalemia (potassium 6.1 mEq/L), hypoglycemia (Glucose 58 mg/dL), hypercalcemia (calcium 11.7 mg/dL) and acute kidney injury (creatinine 2.58 mg/dL). Repeat CT scan of chest/abdomen/pelvis without contrast showed bilateral hyperdense 4 cm adrenal mass/hematoma. Since initial CT of thorax/spine done after the fall showed normal adrenal glands, the new bilateral hyperdense adrenal masses noted post procedure is suggestive of adrenal hemorrhage/ hematoma. Undetectable cortisol and high ACTH confirmed AI. Patient was treated with stress dose hydrocortisone followed by slow taper. MRI of pituitary gland showed partial empty Sella however since ACTH was high, empty sella was only an incidental finding and not the cause of AI. He is maintained on hydrocortisone 15 mg in the morning and 5 mg in the evening plus fludrocortisone 0.1 mg daily. His fatigue has improved, he is gaining weight and electrolytes are normal. Conclusions: This case report emphasizes the significance of timely diagnosis and management of BAH, which leads to primary AI. BAH is a rare complication following laminectomy. Clinicians should be aware of this possibility and consider it in the differential diagnosis of postoperative abdominal pain and electrolyte abnormalities, especially hyponatremia. Timely recognition and high index of suspicion should prompt empiric glucocorticoid replacement to decrease mortality

Endocrine and metabolic alterations in response to systemic inflammation and sepsis: a review article

Abstract Severe sepsis is cognate with life threatening multi-organ dysfunction. There is a disturbance in endocrine functions with alterations in several hormonal pathways. It has frequently been linked with dysfunction in the hypothalamic pituitary-adrenal axis (HPA). Increased cortisol or cortisolemia is evident throughout the acute phase, along with changes in the hypothalamic pituitary thyroid (HPT) axis, growth hormone-IGF-1 axis, insulin-glucose axis, leptin, catecholamines, renin angiotensin aldosterone axis, ghrelin, glucagon, hypothalamic pituitary gonadal (HGA) axis, and fibroblast growth factor-21. These changes and metabolic alterations constitute the overall response to infection in sepsis. Further research is essential to look into the hormonal changes that occur during sepsis, not only to understand their potential relevance in therapy but also because they may serve as prognostic indicators