Intracranial germinoma – a case report

Intracranial germinomas belong to the class of germ cell tumors which are relatively rare intracranial tumors. Early recognition of this neoplasm is vital as germinomas are highly radiosensitive and effective/early radiation therapy can result in relatively favourable overall prognosis. In this article we describe a 19 years old man who presented with pituitary tumor in the suprasellar region for which transsphenoidal decompression and biopsy was done. The histopathological examination confirmed it to be germinoma and he underwent craniospinal radiotherapy

Primary empty sella and associated pituitary hormonal abnormalities in children: An observational study

Objective: To find out the spectrum of pituitary hormonal abnormalities in children with primary empty sella syndrome. Materials andMethods: This retrospective observational hospital-based study was carried out in a tertiary care teaching hospital. Children referred tothe pediatric endocrinology clinic with clinical features of pituitary hormonal abnormalities were evaluated. Children who were found tohave empty sella were included in the study and hormonal profile of these children were studied. Results: There were 14 patients in thestudy group. Isolated growth hormone deficiency was the most common associated abnormality (64%) followed by multiple pituitaryhormone deficiencies in 5 (35%) children. Hypothyroidism was observed in 4 patients (28%) and hypocortisolism in 2 cases (14%).Hypogonadism was observed in one girl on follow-up (7.1%). Conclusions: Significant numbers of children with pituitary hormoneabnormalities have primary empty sella as a cause. Therefore, these children need to be evaluated for all pituitary hormones and shouldbe regularly followed up for evolving hormonal deficiencies

Advances in differential diagnosis and management of growth hormone deficiency in children

Growth hormone (GH) deficiency (GHD) in children is defined as impaired production of GH by the pituitary gland that results in growth failure. This disease might be congenital or acquired, and occurs in isolation or in the setting of multiple pituitary hormone deficiency. Isolated GHD has an estimated prevalence of 1 patient per 4000–10,000 live births and can be due to multiple causes, some of which are yet to be determined. Establishing the correct diagnosis remains key in children with short stature, as initiating treatment with recombinant human GH can help them attain their genetically determined adult height. During the past two decades, our understanding of the benefits of continuing GH therapy throughout the transition period from childhood to adulthood has increased. Improvements in transitional care will help alleviate the consequent physical and psychological problems that can arise from adult GHD, although the consequences of a lack of hormone replacement are less severe in adults than in children. In this Review, we discuss the differential diagnosis in children with GHD, including details of clinical presentation, neuroimaging and genetic testing. Furthermore, we highlight advances and issues in the management of GHD, including details of transitional care

A clinical comparative study on the effects of metformin and pioglitazone on clinical symptoms in cases of polycystic ovarian syndrome

Background: The present study was aimed to evaluate the efficacy of pioglitazone and comparing the efficacy of pioglitazone with metformin in improvement of clinical characteristics of the PCOS patients.Methods: The present study was a prospective, parallel group trial in 40 proven cases of PCOS, all the patients underwent clinical evaluations at baseline that include height, weight, BMI, waist to hip ratio (WHR) and hirsutism (FG score). There were two groups in this study group A (unmarried) and group B (married) each divided in two subgroups each having 10 patients, A1 (unmarried - metformin), A2 (unmarried - pioglitazone), B1 (married - metformin), B2 (married - pioglitazone) therapy was given for six months with regular clinical evaluation of the patients after every two months. WHR (Waist to hip ratio) was measured according to World Organization Criteria (2003), BMI was calculated by using Quetelets Index formula WHO (1995), the grade of hirsutism was detected using Ferriman-Gallwey score (1961).Results: On comparing metformin and pioglitazone it was observed that both the drugs equally decreased the FG score; metformin significantly decreased the BMI and WHR whereas pioglitazone significantly increased the BMI and WHR.Conclusions: Pioglitazone significantly increased the BMI and WHR, whereas it significantly decreased FG score. On comparing metformin and pioglitazone it was observed that both the drugs equally decreased the FG score, metformin significantly decreased the BMI and WHR whereas pioglitazone significantly increased the BMI and WHR

Awareness of lifestyle modification in females diagnosed with polycystic ovarian syndrome in India: explorative study

Background: Polycystic ovarian syndrome (PCOS) adversely affect women at varying stages of their life and imperative to emphasis on prevention strategies since incidence of PCOS is on the rise. Study aims to explore perception on PCOS, awareness on life style modification, emotional attributes, concern regarding PCOS and utilization of physiotherapy services.Methods: The study was conducted in Mumbai and Navi Mumbai, India. Self-made validated questionnaire was administered. Descriptive analysis was done. Perception on PCOS, lifestyle modification, emotional attribution and biggest concern were calculated as absolute frequencies and were reported as overall percentages. Chi square test was applied on the demographic factor’s influence on level of awareness.Results: 21% of the respondents are very well aware about PCOS. 51% reported as doctor was their main source of information about PCOS. 81% expressed that PCOS is manageable one. 62% aware that exercise helps in the management of PCOS. Out of this, 39% are doing exercise on a regular basis. However all the study participants reported, they have not had any consultation from physiotherapist for their structured exercise program.32% attributed to anxiety after the diagnosis of PCOS. 64% of the respondents aware that changing in diet or eating habits can influence in PCOS. However 95% of the subjects concurred to follow life style modification.Conclusions: Efforts need to intensify in creating awareness on the general public about PCOS. Absolute majority of the study participant uncoerced to follow lifestyle modification however emphasis needs to address on multidisciplinary approach in managing PCOS

Low dose-extended letrozole versus double dose-short letrozole protocol for ovulation induction in polycystic ovary syndrome

Background: Letrozole, an aromatase inhibitor has been regarded as the first line drug for ovulation induction in anovulatory PCOS patients because of its monofollicular growth and there is no chance of hyperstimulation by letrozole. Traditional protocol of letrozole includes administration of letrozole for 5 days in first half of follicular phase which induces ovulation in 61.7% cases. Few recent studies have shown that extended letrozole protocol causes more follicles to grow and induces more ovulation than the traditional protocol. The aim was to compare the effects of low dose-extended letrozole protocol and double dose-short letrozole protocol for ovulation induction in infertile PCOS patients.Methods: A randomized controlled trial (RCT) was conducted in the department of reproductive endocrinology and Infertility at Bangabandhu Sheikh Mujib Medical University (BSMMU) on seventy infertile polycystic ovary syndrome patients. Low dose-extended letrozole group or experimental group received tablet letrozole 2.5 mg daily for 10 days and double dose-short letrozole group or control group received tab. Letrozole 5 mg daily for 5 days starting from the 2nd day of menstrual cycle or withdrawal bleeding. The ovarian response was assessed by folliculometry on day 12 of menstrual cycle by transvaginal sonography for measurement of total number of growing follicles, biggest follicle size and endometrial thickness. Mid luteal serum progesterone was measured on day 21-23 to confirm ovulation.Results: The mean number of growing follicle was 1.44±0.95 versus 0.99±0.65 in low dose-extended letrozole group and double dose-short letrozole group respectively generating p value of 0.001. The mean size of the dominant follicle at day 12 was greater in low dose-extended letrozole group than the other displaying 17.69±3.63 mm and 16.6±3.49 mm respectively but the difference was not statistically significant. The number of ovulating patients was greater in low dose-extended letrozole group (76.5% versus 71.9%), but without significant statistical difference. Pregnancy rate was insignificantly greater in low dose-extended letrozole group (23.5% versus 18.8%) as well.Conclusions: Low dose-extended letrozole protocol produces more multifollicular growth and larger size dominant follicle with a trend to raise the ovulation rate and pregnancy rate, though insignificantly

Accuracy and limitations of the growth hormone (GH) releasing hormone-arginine retesting in young adults with childhood-onset GH deficiency

Background: Re-testing for GH secretion is needed to confirm the diagnosis of GH deficiency (GHD) after adult height achievement in childhood-onset GHD (COGHD). Aim: To define the cut-off of GH peak after retesting with GH-releasing hormone plus arginine (GHRHarg) in the diagnosis of permanent GHD in COGHD of different etiology. Patients and methods: Eighty-eight COGHD (median age 17.2 y), 29 idiopathic GHD (IGHD), 44 cancer survivors (TGHD) and 15 congenital GHD (CGHD) were enrolled in the study; 54 had isolated GHD (iGHD) and 34 had multiple pituitary hormone deficiencies (MPHD). All were tested with insulin tolerance test (ITT) and GHRHarg. IGHD with a GH response to ITT 656\ub5g/L were considered true negatives and served as the control group, and patients with a GH response <6\ub5g/L as true positives. Baseline IGF-I was also measured. The diagnostic accuracy of GHRHarg testing and of IGF-I SDS in patients with GHD of different etiologies was evaluated by ROC analysis. Results: Forty-six subjects with a GH peak to ITT 656\ub5g/L and 42 with GH peak <6 \ub5g/L showed a GH peak after GHRHarg between 8.8\u2013124\ub5g/L and 0.3\u201326.3\ub5g/L, respectively; 29 IGHD were true negatives, 42 were true positives and 17 with a high likelihood GHD showed a GH peak to ITT 656\ub5g/L. ROC analysis based on the etiology indicated the best diagnostic accuracy for peak GH cutoffs after GHRHarg of 25.3 \ub5g/L in CGHD, 15.7 in TGHD, and 13.8 in MPHD, and for IGF-1 SDS at 122.1 in CGHD, 121.5 in TGHD, and 121.9 in MPHD. Conclusions: Our findings indicate that the best cut-off for GH peak after retesting with GHRHarg changes according to the etiology of GHD during the transition age. Based on these results the diagnostic accuracy of GHRHarg remains questionable