AIM:To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS:The study was performed on 72 Indian patients with cirrhosis (63 male, 9 female; aged < 50 years). Etiology of cirrhosis was alcoholism (n = 37), hepatitis B (n = 25) and hepatitis C (n = 10). Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density (BMD) was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS:Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium: protein ratio and calcium: phosphorus ratio. Vitamin D deficiency was highly prevalent (92%). There was a high incidence of hypogonadism (41%). Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor (IGF) 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low (68%) and urinary deoxypyridinoline to creatinine ratio was high (79%), which demonstrated low bone formation with high resorption. INTRODUCTIONMetabolic bone disease is a common complication of long-standing liver disease, ranging from cholestatic disorders to alcoholic, autoimmune and post-viral cirrhosis [1] . Often known as hepatic osteodystrophy (HO), Bone mineral density and disorders of mineral metabolism in chronic liver diseaseJoe George, Hosahithlu K Ganesh, Shrikrishna Acharya, Tushar R Bandgar, Vyankatesh Shivane, Anjana Karvat, Shobna J Bhatia, Samir Shah, Padmavathy S Menon, Nalini Shah BRIEF ARTICLESwww.wjgnet.com it is well-recognized among individuals with chronic liver disease (CLD). Its etiology is poorly understood and is thought to vary according to the type, severity and progression of the liver disease, along with a multitude of other contributing factors including the ethnicity of the population studied. It can result in spontaneous low-trauma fractures that significantly impact on the morbidity, quality of life, and even survival, through pain, deformity and immobility. With liver transplantation steadily taking the center stage in treatment of end-stage cirrhosis of varying etiology and offering long-term survival, bone disease has snowballed into one of the major determinants of survival and quality of life in this cohort [1] . Keeping in view the numerous therapeutic options for bone disease [2] already available and those under development, it is prudent to characterize this condition in order to give these patients a better chance of survival. The medical...

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We report clinical presentation, response to medical treatment, and long-term follow-up of 39 children and adolescents with prolactinoma (F:M; 30:9) (30 macro and 9 microadenoma) diagnosed at the age of 9-20 years. Mean duration of follow up was 56 months. All patients were treated with bromocriptine (BC) at doses ranging from 2.5 to 20 mg/day or by cabergoline at doses ranging from 0.5 to 2 mg/week orally. Two patients received external conventional radiotherapy after surgery. In patients with macroprolactinoma (F:M; 21:9), headache and/or visual defects were the first symptoms. All females had primary or secondary amenorrhea. Growth arrest was not observed in any patient and pubertal development was appropriate for their age. Spontaneous or provocative galactorrhea was observed in 23 patients (all females) and none of male patient had gynecomastia. Mean serum prolactin (PRL) concentration at the time of diagnosis was 322.50 ng/ml in patients with microadenoma, 522.38 ng/ml in patients with macroadenoma and 2,294.86 ng/ml in patients with macroadenoma with suprasellar extension. In 25 patients, BC normalized PRL levels and caused variable, but significant, tumor shrinkage. Cabergoline normalized PRL concentrations in 14 patients. Pregnancy occurred in 6 patients while on treatment. Pregnancies were uncomplicated, and the patients delivered normal newborns at term. Impairment of other pituitary hormone secretion was documented at the time of diagnosis in only one patient. Postoperatively six patients had other pituitary hormone deficiencies. In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolactinoma with onset in childhood, allowing preservation of the anterior pituitary function.

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