Study of bone mineral density in resident doctors working at a teaching hospital

CONTEXT

The erratic lifestyle of resident doctors may affect their serum 25-hydroxy vitamin D [25-(OH)D] levels and bone mineral density (BMD).

AIM

To study BMD and the effect of environmental factors on it in resident doctors.

SETTINGS AND DESIGN

Prospective, cross-sectional study conducted in a tertiary healthcare centre.

MATERIALS AND METHODS

BMD was obtained by dual-energy X-ray absorptiometry and was correlated with various factors including weight, height, body mass index (BMI), sun exposure, physical activity, parathyroid hormone, 25-(OH)D, dietary factors. Statistical Analysis : SPSS software Version 10 (Unpaired t test was used to compare BMD of different groups and Pearson's correlation coefficient was used to calculate correlation).

RESULTS

Two hundred and fourteen apparently healthy resident doctors were enrolled in the study. Based on Caucasian normative data, osteopenia was noted in 104 (59.7%) males and 27 (67.5%) females. Thirty-two (18.39%) males and five (12.5%) females had osteoporosis. The BMD values of males were 0.947+/-0.086, 0.911+/-0.129 and 1.016+/-0.133 at lumbar spine, femur neck and total hip while those in females were 0.981+/-0.092, 0.850+/-0.101 and 0.957+/-0.103 respectively. BMD of our cohort was lesser by 12.5-18.2% and 4.2-14.5% than the Caucasian and available Indian figures, respectively. BMD had significant positive correlation with weight, height, BMI, physical activity, and dietary calcium phosphorus ratio. 25-(OH)D levels were insufficient in 175 (87.5%) subjects but had no correlation with BMD.

CONCLUSIONS

Young healthy resident doctors had significantly lower BMD, contributors being lower BMI, lower height, reduced bioavailability of dietary calcium and inadequate physical activity. Deficiency of vitamin D did not contribute to low BMD.

The value of an acute octreotide suppression test in predicting response to long-term somatostatin analogue therapy in patients with acromegaly

CONTEXT

The usefulness of the acute octreotide test in the selection of patients with acromegaly for chronic somatostatin depot analogues treatment is controversial.

AIMS

To determine the efficacy of acute octreotide suppression test (OST) in predicting response to long-term somatostatin analogue (Octreotide-long-acting repeatable, OCT-LAR) therapy in patients with acromegaly.

SETTINGS AND DESIGN

Prospective study (2006-2007) conducted at a tertiary healthcare centre in western India.

MATERIALS AND METHODS

Sixteen drug-naive patients with active acromegaly (postoperative+/-post radiotherapy) underwent 50 microg subcutaneous OST. Ten patients were treated with OCT-LAR for one year. Remission was defined as a nadir growth hormone (GH) < 1 ng/ml during 75 g oral glucose tolerance test (OGTT) (0, 10, 30, 60, 120, 180 min) and normal age, sex-matched insulin-like growth factor 1 (IGF1) levels.

STATISTICAL ANALYSIS

SPSS Software Version 11 was used for data analysis.

RESULTS

Using GH cutoff.

CONCLUSIONS

Nadir GH < 1 ng/ml following an OST is a useful predictive marker of achieving disease remission with long-term OCT-LAR therapy.

Autoimmune hypophysitis: a single centre experience

INTRODUCTION

Autoimmune hypophysitis (AH) is a rare primary autoimmune inflammatory disorder involving the pituitary gland.

METHODS

A retrospective analysis of the clinical features and outcome of patients diagnosed with AH between 1988 and 2006, was carried out.

RESULTS

15 patients (14 females and one male) with AH were identified. Three patients presented in the peripartum period. Headache, vomiting and visual field defects, suggestive of an expanding sellar mass, were the most common presenting symptoms (67 percent). The most common deficient hormone was adrenocorticotropic hormone (ACTH) (67 percent), followed by thyroid stimulating hormone (53 percent) and gonadotropins (40 percent). Imaging revealed a definite, enhancing sellar mass in 87 percent of the patients and stalk thickening in 33 percent of the patients. Three patients underwent surgery. On serial monitoring, the sellar mass regressed or disappeared spontaneously without any immunosuppressive treatment in the other ten patients with a definite sellar mass.

CONCLUSION

We report a higher female to male ratio and a lower incidence of peripartum cases in our series. Symptoms of mass effect were the most common presentation, while ACTH was the most commonly-deficient hormone. Surgery was rarely needed, and most patients experienced a spontaneous resolution of the mass.