Context: Medullary thyroid carcinoma (MTC), being an aggressive disease, requires meticulous follow-up and multidisciplinary management. The clinical presentation, management, outcome of MTC varies among different populations. Aims: An audit was conducted to evaluate the demography, clinical presentation, management, and outcome of MTC in a tertiary care center in South India. Settings and Design: A retrospective analysis was conducted of data from hospital records of patients with MTC treated at our center from 2004 to 2019. Statistical Analysis: All analyses were performed with SPSS software (version 16). Results: Among the 82 patients (M 42, F 40), mean age was 42.07 years (SD 14.5), 46 were operated at our center and 36, outside. Follow-up data were not available for all patients. Median duration of the disease was 36 months and median follow-up was 28 months. Lymphnode dissection was more common (37/46) in patients operated at our center than outside operated patients (17/36) ( P < 0.01). At presentation, more than half of the patients had stage IV disease and 8 had distant metastases. Bone, lung, and liver were the common sites of metastases. Persistent hypercalcitoninemia >50 pg/mL was seen in 49.9%. Salvage surgeries of the neck were necessary in 29 patients (38.2%). Mean survival was 66 months and 10-year survival was 35%. Male gender ( P = 0.008) and Stage IV disease at presentation ( P = 0.038) were associated with poorer survival. Conclusion: MTC, in our population, presented at an advanced stage. Male gender and stage IV at presentation had poor survival. Early diagnosis, aggressive initial neck clearance, close follow-up with tumor markers, appropriate imaging, along with prompt surgical intervention will help to improve outcome.

Context:Insulin autoantibody syndrome (IAAS) is considered to be a rare cause of hyperinsulinaemic hypoglycaemia. Lack of familiarity with the varied clinical manifestations leads to underdiagnosis. Localization techniques aimed at insulin-secreting neoplasms and nesidioblastosis, which are expensive often are ordered when the correct diagnosis is not made.Aims:We describe the myriad of clinical manifestations associated with IAAS based on single centre experience.Settings and Design:Retrospective analysis of patients who got admitted with symptoms suggestive of hypoglycaemia and underwent mixed meal test and prolonged hypoglycaemic test from 2016 to 2019.Subjects and Methods:Retrospective data of 12 patients with IAAS who were diagnosed in the threeyear time period between 2016 and 2019 are included in this analysis. Clinical details, biochemical parameters and imaging modalities were analysed.Statistical Analysis:All analyses were performed with SPSS software (version 17).Results:Total of twelve patients 12 (5 male and 7 females) were identified as IAAS. Median age of presentation was 57 years. Median insulin levels and median C-peptide levels were 300 miu/ml and 18.5 ng/ml respectively. Only 3 (25%) patients had spontaneous resolution. Steroid induced remission occurred by 3 months in the remaining patients. Intermittent hyperglycaemia was seen in 9 (75%) patients. Implicatable drug use preceding the occurrence of the clinical symptoms was observed in five patients.Conclusion:IAAS is not uncommon in India. The diagnosis should be pursued in patients with hyperinsulinaemic hypoglycaemia especially when insulin levels are very high or when there is intermittent hyperglycaemia.

Introduction: Pheochromocytoma is a catecholamine-secreting tumor arising from adrenomedullary chromaffin cells that has a varied clinical presentation. Identification of this tumor, which has episodic symptoms, is a diagnostic challenge for clinicians. Diagnosis at an appropriate time is important because it is associated with significant morbidity and mortality. This study aims to mitigate the limited availability of data in our geographical area. Aims and objectives: To assess the clinical, biochemical, and radiological features and outcomes of patients diagnosed with pheochromocytoma at our center. Materials and methods: This is a retrospective study. Patients diagnosed with pheochromocytoma during 2015-2023 were included in the study. Clinical, biochemical, and radiological data were collected at presentation, post-surgery, discharge, and until the last follow-up; data were retrieved from hospital records. Statistical analysis was done using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results: This study included 19 patients, of whom 10 (52.6%) were female. The most common clinical presentation was a hypertensive crisis in patients with pre-existing hypertension (63.1%), followed by headache (47.3%). The classical triad of headache, palpitation, and sweating was seen in only three patients (15.7%). The mean tumor size was 5.01±2.06 cm, with a range of 2.5 to 12 cm. All patients underwent adrenalectomy; six patients (31.5%) had perioperative complications, with post-operative hypotension being the most common at 21% (n = 4), followed by an acute coronary event during alpha blockade in one patient (0.05%) and an intra-operative hypertensive crisis in one patient (5%). A biochemical remission rate post-surgery was achieved in 17 (89.47%) patients. Conclusions: Hypertensive crisis in patients with pre-existing hypertension was the predominant presenting feature in most of our patients. Female predominance was noted (52.3%) compared to males. Perioperative complications were observed in 31.5% of patients, with post-operative hypotension being the most common complication.

Introduction:Endogenous hyperinsulinemic hypoglycemia (EHH) is a condition in which the insulin levels are inappropriately high in the presence of low plasma glucose.Materials and Methods:We did a retrospective analysis of case records of those patients admitted and evaluated for EHH from June 2004 to June 2016 in our center, excluding those that were diagnosed with reactive hypoglycemia. We collected data regarding demographics, clinical presentation, laboratory results, localization techniques, and treatment administered.Results:Sixteen patients who were admitted for evaluation based on history suggestive of repeated hypoglycemic episodes were included in the study. All but one pregnant patient was subjected to a supervised fast in the hospital. All patients developed hypoglycemia (defined using Whipple's triad) within the first 24 h. Three patients had autoimmune hypoglycemia which differed significantly from insulinoma-mediated hypoglycemia in certain clinical and laboratory parameters. They were older in age with marked fluctuations in the 24 h glucose profile ranging from frank hypoglycemia to frank hyperglycemia. The insulin levels were markedly elevated in this group of patients along with a significantly elevated insulin C peptide molar ratio (ICMR) when compared with patients with insulinoma-mediated hypoglycemia.Conclusions:Although insulinoma is the most common cause of EHH, autoimmune hypoglycemia should be considered as a differential diagnosis, particularly in older individuals with plasma glucose values increasing to the hyperglycemic range. Degree of elevation of insulin levels and ICMR may provide additional clues. Overall, the survival and prognosis of patients with EHH are excellent.

Background: Subclinical thyrotoxicosis is a condition in which serum thyroid hormone levels are within the reference range, but serum thyrotropin (TSH) levels are subnormal. It is not known whether differences in patterns of thyroid hormone levels between endogenous and exogenous subclinical thyrotoxicosis result in disparate effects on the skeletal system. There is a paucity of data on patients with subclinical thyrotoxicosis and their bone health status. Objectives: To estimate bone mineral density in patients with subclinical thyrotoxicosis in patients due to different aetiologies in premenopausal women. Methods: This cross-sectional study was conducted at Ramaiah medical college for a period of one year. A total of twenty-six patients were included. Demographical data was analysed by descriptive statistics and expressed as mean with standard deviation. Bone mineral density was measured by hologic v2.0. Results: A total of 26 individuals were included in the study. The mean age of the study population was 34.2 ± 8.1 years. The etiology for subclinical thyrotoxicosis was Graves’ disease in 11 (42.3%), multi-nodular goiter 4 (15.3%), toxic adenoma 3 (11.6%), and iatrogenic in 8 (30.7%) patients. The mean BMI was 25.8 ± 7.2 kg/m2. The mean corrected calcium was 9.15 ± 0.26 mg/dl and phosphorus was 2.98 ± 0.36 mg/dl. The mean 25 hydroxy vitamin D level was 30.3 ± 4.41 ng/dl. Mean BMD at hip and spine was 0.96 ± 0.14 g/cm2 and 0.90 ± 0.06 g/cm2 respectively. No patient had a Z score of <-2 S.D in the hip and spine. The mean Z score at the hip and spine was +0.55 ± 0.88 and +0.22 ± 0.75 respectively. There was no significant difference between the endogenous and exogenous etiology subgroup in BMD at the hip or spine [p = 0.668 CI (-0.0629 - 0.0429)] and [p = 0.604 CI (-0.0879 - 0.1479)]. Conclusion: There was no significant reduction in bone mineral density at the hip or spine as measured by DXA in our cross-sectional study of premenopausal women with subclinical thyrotoxicosis of both endogenous and exogenous etiology. In young females with adequate serum25 hydroxy-vitamin Dlevels, endogenous subclinical thyrotoxic state may not have a deleterious effect on bone health in the short term.