Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder with diverse reproductive and metabolic features. It is caused by insulin resistance that is exacerbated by obesity. Lifestyle modification is the first line treatment in PCOS, but it is associated with low adherence and sustainability. In small studies, metformin improves outcomes such as menstrual cycle problem, reduces the features of hyperandrogenism (hirsutism) and metabolic parameters (lipid profile). This study aimed to compare clinical and biochemical outcome of patients with polycystic ovary syndrome managed with life style modification or combination with metformin.Methods: This prospective interventional study was carried out at Endocrine OPD, BIRDEM, from November 2016 to March 2018. Newly detected cases of PCOS were taken as study sample. Sampling technique was purposive and then randomly selected into two groups; Group A (n=40) with lifestyle modification and Group B (n=40) with lifestyle modification plus metformin (500mg TDS). The clinical [weight, body mass index (BMI), waist circumference, menstrual problem, hirsutism) and biochemical [serum testosterone, LH, FSH, fasting lipid profile] outcome of intervention with lifestyle modification and combination with metformin was studied.Results: Baseline characteristics of both groups had no significant difference. After 12 months, there was significant improvement in hirsutism, menstrual problem and significant decrease in weight, BMI, waist circumference in both groups. Among hormonal profile there was significant reduction of testosterone in Group B (p=0.01), whereas LH, FSH and LH: FSH ratio showed no significant difference. There was significant improvement of HDL (in both groups) and reduction of triglyceride (TG) (p=0.005, in group B). Outcome differences between two groups had shown significant improvement in weight, BMI, testosterone, HDL, TG level and on menstrual regulation. But there was no significant difference in waist and Ferriman-Gallwayscore in between groups.Conclusion: lifestyle management is the first and most important step in the management of PCOS and addition of metformin to lifestyle modification appears to provide additional advantages. These results suggest the combination of lifestyle with metformin has a role to play in weight management: a key concern for women with PCOS. Addition of metformin also causes reduction of TG and testosterone, which is vital for PCOS management and found in this study.
Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison's disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn's syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn's syndrome and don't forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.
Bardet Biedl syndrome is a rare heterogenous autosomal recessive disorder. A very few cases were reported in Bangladesh. A 12-year-old boy presented with childhood obesity, polydactyly in all 4 limbs, bilateral gynaecomastia, acanthosisnigricans, night blindness and mental retardation. After hormonal evaluation he was found to have hypogonadotrophichypogonadism, dislipidaemia, renal impairment, elevated liver enzymes and retinitis pigmentosa. We advised him to reduce weight and implemented and weight reducing diet. Levothyroxine and metformin were started. He was scheduled for eye check-up every 3 months and follow up at endocrinology.
Birdem Med J 2019; 9(2): 162-164
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