Evaluation of risk malignancy index in the pre-operative diagnosis of benign and malignant ovarian neoplasms

Background: Preoperative discrimination between benign and malignant ovarian neoplasm is necessary to optimally plan for an appropriate surgical treatment. Women with malignant ovarian tumours should be referred to a gynaecologic oncologist for the quality of cytoreductive surgery leading to increased survival. The aim of this study is to determine the role of Risk of Malignancy Index (RMI) incorporating menopausal status, serum CA 125 levels and ultrasound features in discriminating benign from malignant ovarian neoplasms.Methods: A prospective cohort study was conducted for 2 years among 110 women with ovarian neoplasms referred to Narayana Medical College and Hospital, Nellore a tertiary care centre for diagnosis and management. The sensitivity, specificity, positive and negative predictive values of menopausal status, ultrasound finding of ovarian neoplasms, levels of serum CA-125 separately and combined into the RMI were calculated and compared. (RMI = U X M X Serum CA- 125). Women of all ages admitted with ovarian masses in Narayana Medical College, Nellore. Women whose histopathology report turned out to be non-neoplastic ovarian tumours or other adnexal masses.Results: RMI >250 had a sensitivity of 70.8 % (95%CI 54.4-87.2), a specificity of 87% (95%CI 76.5-97.7), a positive predictive value of 81 % and negative predictive value of 79.4% for the diagnosis of malignant neoplasms.Conclusions: The risk of malignancy index is a simple scoring system and easily applicable and effective method for evaluating a patient in discriminating benign and malignant ovarian neoplasms efficiently to optimize therapy. It facilitates timely referral to gynecological oncology unit for adequate staging and optimal debulking

Management of resistant prolactinoma in infertile lady with successful maternal and perinatal outcome

Mrs. X of 28 years presented to the gynaecology department with primary infertility for 4 years, secondary amenorrhea for 6 months and galactorrhea for 3 months. She was investigated and diagnosed to have macroprolactinoma. Medical treatment with cabergoline was started. Patient became symptomatically free in 6 months with gradual reduction in serum prolactin levels as well as tumour size. After 2 years of therapy, failure of normalisation of prolactin levels and failure of significant tumour reduction observed and diagnosed it as resistant prolactinoma. Considering her infertility and future complications associated with resistant macroadenoma, she was treated with stereotactic radiosurgery using cyber knife radiation. Tumour regression in MRI with significant decrease in serum prolactin levels were observed in the post radiation period and monthly follow up done. She conceived spontaneously after 2 months of radiotherapy. She has been followed up with visual field testing during antenatal period. Her antenatal, intranatal period was uneventful with successful maternal and perinatal outcome.

Prevalence of glucose tolerance test abnormalities in women with polycystic ovarian syndrome

Background: PCOS is the most frequent endocrine disorder, often complicated by chronic anovulatory infertility and hyperandrogenism. High prevalence of impaired glucose tolerance and type 2 diabetes is observed due to peripheral insulin resistance. Holistic approach to the disorder to prevent long-term complications is required. The objective of the study was to study the prevalence of oral glucose tolerance test abnormalities (OGTT) in PCOS women and to study the significance of risk factors contributing to glucose intolerance in women with PCOS.Methods: Hospital based analytical cross sectional study was conducted for 1 and ½ years among 200 women with PCOS. Women diagnosed as PCOS according to Rotterdam’s criteria. Women with other causes of anovulation, premature ovarian failure and women already diagnosed to be diabetic.Results: Abnormal glucose tolerance was observed in 32 (16 %) of the 200 PCOS women. Among them 14.5% had impaired glucose tolerance (IGT) and 1.5% had diabetes. There was a significant trend towards increasing prevalence of IGT and diabetes in females with higher BMI, waist circumference, clinical and biochemical hyperandrogenism and patients with metabolic syndrome.Conclusions: High prevalence of IGT and Non-Insulin Dependent Diabetes Mellitus (NIDDM) in women with PCOS was observed than expected. They have accelerated conversion from IGT to NIDDM. IGT is often asymptomatic and is a known risk factor for type 2 DM and cardiovascular disease. OGTT with 75 gms of glucose is the best screening method for glucose intolerance and a good measure to diagnose type 2 DM in PCOS women

Pregnancy with Gilbert syndrome

A rare case of Gilbert syndrome during pregnancy was reported at Narayana Medical College and Hospital's obstetrics department. Due to the fact that it was an extremely rare case with a typical presentation, it was properly studied and analysed to provide a thorough case report. A 36-week-pregnant primigravida who had been having nausea, vomiting, stomach pain, myalgia, and a yellowish discoloration of both the skin and sclera for the past five days presented to Narayana Medical College and Hospital. She consistently suffered having similar symptoms at 14 and 24 weeks. She had icterus, signs of dehydration, a uterus that corresponds to period of gestation, and a good fetal heart rate. Examination revealed that all of the obtained investigations were normal, with the exception of mild unconjugated hyperbilirubinemia and hypoglycemia. After the dehydration and jaundice were treated, the patient's symptoms improved, and she was discharged from the hospital after a week. Later she underwent an emergency caesarean section due to fetal distress after being admitted during pregnancy at term, and she gave birth to a 3 kg female baby. Mother and baby both were fine postoperatively. Due to its rarity, this case was documented. Almost all of the patients had decreased uridine diphosphate glucuronosyl transferase activity (UDPGT)

Prevalence of subclinical and overt hypothyroidism in infertile women

Background: Hypothyroidism has a significant effect on fertility causing anovulatory cycles, luteal phase defect, hyperprolactinemia and sex hormone imbalances. To identify potential and overt hypothyroidism, thyroid screening should be done for all infertile women. The objective of the study was to find the prevalence of subclinical and overt hypothyroidism among infertile women, to find the correlation of hypothyroidism with hormonal and metabolic parameters associated with infertility.Methods: Hospital based analytical cross sectional study was conducted for one and half years among 300 infertile women with primary and secondary infertility. Women with primary and secondary infertility. All hypothyroid women on thyroxine supplementation, male factor infertility, female factor infertility like tubal factor, anomalies of the urogenital tract, obvious organic lesions in the pelvis and women unwilling to participate or sign the informed consent.Results: The prevalence of hypothyroidism in infertile women was 27%. Among them, 25% were subclinical hypothyroid and 2.33% overt hypothyroid. Menstrual dysfunction was observed in 52% of subclinical and 51.15% of overt hypothyroid women, predominant type being oligomenorrhea. We found a negative correlation of hypothyroidism with the family history of thyroid disease. 91.4% of hypothyroid infertile women were obese and the association was strongly significant. Prevalence of hyperprolactinemia in infertile women was 24.67%. The association of hyperprolactinemia with hypothyroidism was 23%. Raised LDL levels were observed in 80% of subclinical and 100% overt hypothyroidism infertile women.Conclusions: Hypothyroidism alters the Hypothalamo-Pituitary ovarian axis and is one of the important etiological factors of female infertility. Most of the women were asymptomatic. Hence every infertile woman should be screened for thyroid profile to open better prospects of conception