Clinical spectrum of adult onset spontaneous primary hypothyroidism

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Etiological aspects of Cushing's syndrome

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An aetiological profile of short stature in the Indian subcontinent

OBJECTIVE

To determine the aetiological causes of short stature in a developing region of the world.

METHODOLOGY

A retrospective analysis was made of data from 193 subjects who were primarily evaluated for short stature in the Endocrinology Department, Institute of Medical Sciences, Kashmir, India. These subjects had a height of more than 3 standard deviations (SD) below the mean for their age and sex, and were seen over a decade (January 1987 to December 1996). A logical and comprehensive clinical and investigative protocol was followed to identify the aetiology of short stature.

RESULTS

Growth hormone deficiency was the commonest identifiable cause of short stature and accounted for 22.8% of cases. Thirty-six subjects (18.7%) had a normal variant short stature. Renal tubular acidosis was diagnosed in 10.4%, primary hypothyroidism, malnutrition and hypothalamic syndrome in 7.8% each, and growth hormone insensitivity syndrome in 4.1% cases.

CONCLUSIONS

We conclude that, in addition to growth hormone deficiency and normal variant short stature, distal renal tubular acidosis and growth hormone insensitivity syndrome are significant causes of short stature in India.

Spontaneous remission in idiopathic hyperprolactinemia

In this report we describe a 37 year old lady who was demonstrated to have hyperprolactinemia causing amenorrhea-galactorrhea syndrome. Computerized tomography scan done twice did not reveal any sellar or suprasellar abnormality and there was no clinical or biochemical evidence of primary hypothyroidism. She had regression of galactorrhea, resumed regular menstrual cycles, and conceived twice on bromocriptine therapy. Following her second delivery she noticed spontaneous remission of galactorrhea and, prolactin levels estimated multiple times were normal.

Regular ovulatory menstrual cycles in a case of Sheehan's syndrome

In this report we describe an unusual case of postpartum pituitary necrosis who had clinical and biochemical suggestion of decreased thyrotroph, somatotroph, lactotroph, and corticotroph reserve but continued to have regular ovulatory menstrual cycles.

Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India

OBJECTIVE

To assess the magnitude of primary infertility and to study its etiologic aspects in India.

DESIGN

After proper randomization, 10,063 married couples were interviewed to ascertain the prevalence of primary infertility. A definitive protocol was followed to determine the etiology of primary infertility in 250 consecutive couples.

SETTING

Tertiary care medical center in the Kashmir valley of India.

PATIENT(S)

Couples married for > or = 1 year; 250 consecutive couples attending an endocrine clinic for primary infertility.

INTERVENTION(S)

A logical investigative protocol was followed to identify the etiology of infertility.

MAIN OUTCOME MEASURE(S)

Magnitude of primary infertility in the community as well as the male, female, or combined etiology of infertility.

RESULT(S)

Fifteen percent of the couples interviewed had primary infertility, among whom 4.66% had unresolved infertility at the time of the survey. The etiology of infertility in 250 consecutive couples revealed a female factor in 57.6%, a male factor in 22.4%, combined factors in 5.2%, and an undetermined cause in 14.8%.

CONCLUSION(S)

Primary infertility is as common and distressing a problem in India as in other parts of the world. Semen abnormalities (22.4%), anovulation (17.2%), ovarian failure (8.8%), hyperprolactinemia (8.4%) and tubal disease (7.2%) are common causes of infertility. The pattern of infertility in India is the same as in other parts of the world, except that infertile couples report late for evaluation.

A new vision of imaging

With employers squeezing health plans and health plans squeezing providers, the use of expensive procedures in diagnostic imaging is tumbling. Not surprisingly, so is the pay of radiologists. Despite dwindling salaries, some say that radiology may yet emerge as a stronger, more effective discipline. Maybe, but in the meantime, it's become a mean time.

Pre-operative and post-operative evaluation of circulating immune complexes in patients with gastric adenocarcinoma

Circulating immune complexes (CICs) in the sera of patients with histologically proven adenocarcinoma of stomach were sequentially studied. Serial CICs levels, quantitated using a sensitive method F(ab')2 anti-C3 ELISA, were measured before surgery and in a post-operative follow up. CICs could be detected in 85% of the patients pre-operatively, while ten days after surgery positivity decreased to 71%. Thirty days after surgery, the mean CIC levels decreased significantly and positivity fell to 46%. The results indicate that removal of primary tumor mass results in a sharp decline of CIC levels.

Clinical and immunological responses with Pr- beta-hCG-TT vaccine

Six different batches of Pr-beta-hCG-TT vaccine have been evaluated in 23 women for the antibody response. The anti-sera formed against these conjugates were capable of reacting immunologically with the whole hCG in radioimmunoassays and also neutralized the biological activity of hCG in radioreceptor assays. The antibody titres attained peak levels 4-6 months after the first injection. The peak titres could not be sustained and most of the subjects showed a spiky pattern. One subject was considered as non-respective, two others had fairly low titres. Amongst the conjugates tested, batch 108 with SPLPS (sodium pthalate denatured with lipo-polysaccharides from S. entritides) seemed more promising, but the addition of the adjuvant was found to be pyrogenic and unlikely to be accepted clinically.

Immunogenicity of three C-terminal synthetic peptides of the beta subunit of human chorionic gonadotropin and properties of the antibodies raised against 45-amino acid C-terminal peptide

Immunological studies were carried out in rhesus monkeys and rabbits on three C-terminal synthetic peptides of beta-hCG (115-145; 111-145 and 101-145) after conjugating these to tetanus toxoid (TT). The immunogenicity of the peptide conjugates was comparatively poorer with reference to Pr-beta-hCG-TT conjugates at similar doses and immunization schedule. Amongst the three peptides, the best response was obtained with the 45-amino acid c-terminal peptide (45-CTP; 101-145). The anti-45-CTP recognized native hCG and was devoid of cross-reaction with hLH. hCG-induced testosterone production by mouse Leydig cells was inhibited by anti-45-CTP antiserum, although its neutralization capacity decreased more rapidly upon dilution than anti-beta-hCG sera of comparable titres. Immune complexes formed by the anti-45-CTP with hCG had a lower sedimentation value than those formed by anti-beta-hCG antisera with hCG, suggesting the presence of a limited number of immuno-determinant regions in the 45-amino acid C-terminal synthetic peptide.