Objectives:The purpose of the study was to access the efficacy and response of the endoscopic transsphenoidal surgery in pituitary adenomas.Methods:It was descriptive case study, conducted at Neurosurgery Department in collaboration with the Endocrine Unit (Medical Unit-II) Of Jinnah Post Graduate Medical Center Karachi from January 2015 to July 2017. Patients with sellar, supra sellar and para sellar tumors were enrolled in the study. Patients with prolactinoma and recurrent pituitary tumors were excluded. Data was analyzed using SPPS 17.Results:Sixty three patients were included in the study with mean age of 42±8.34 years. There were 40(63.5%) male patients and 23(36.5%) female patients with pituitary adenoma. Headache and visual impairment were the main presentation 55(87.3%) and 56 (88.8%) respectively. Out of all these patients the pituitary adenomas, 51(81%) patients had non secretory and 12 (19%) patients had secretory tumor. Out of these pituitary adenomas 53(84.1%) were macroadenomas and 10(15.9%) were microadenoma. Post operatively marked improvement in the headache was in all 100% patients and vision improved in 54 (96.4%). The most common post operative complication was cerebrospinal fluid (CSF) leak in 10 (15.9%) with 44 (69.8%) having no post complications at all. Mortality was reported to be just 1.6% i-e one patient.Conclusion:The endoscopic transsphenoidal approach for pituitary adenoma is the safest procedure with marked improvement in complications and reduction in patient’s hospital stay.
Objective:To determine the frequency, modes of clinical presentation and indications for replacement therapy in a cohort of patients with subclinical hypothyroidism (SCH).Methods:This study was conducted at the Endocrine and Diabetes Unit of Jinnah Postgraduate Medical Centre from September 2007 – October 2015. This was a retrospective chart analysis of prospectively collected data in whichthe medical records of 4448 patients who had presented to the Endocrine Clinic from 2007 to 2015 were reviewed. A total of 2760 (62.05%) patients were diagnosed withthyroid disorders, whereas 260 (9.42%) patients had SCH. The SCH patients were between the age of 12 to 70 years; TSH was> 4mIU/l with normal levels of FT3 and FT4. Patients were enrolled using a predesigned structured proforma. Those having chronic systemic diseases were excluded from this study. SPSS 13 was used to evaluate the data.Results:Femalepatients comprised93.8% (244 patients) of those with SCH, whereas only 6.2% (16 patients) were male. Common presenting symptoms were, lethargy in 146 patients (56.2%); increase in weight in 102 patients (39.2%) and menstrual irregularities in 90 patients (34.6%). TSH level of < 10mIU/l (4 - 10) was seen in 177 patients (68.1%) and 83 patients (31.9%) had TSH ≥ 10mU/l. Thyroxine was given to 183 (70.4%) of these patients. Common treatment indications were TSH of ≥ 10, which was seen in 83 patients (31.9%), subfertility in 32 patients (12.3%), troublesome symptoms suggestive of hypothyroidism in 31 patients (11.9%) and high titers of antibodies in 23 patients (8.8%).Conclusion:SCH is frequently seen in our population, with most patients complaining of lethargy. The most common treatment indications were a TSH ≥ 10mIU/l, whereas troublesome symptoms of hypothyroidism and subfertility were the common treatment indications in patients who had a TSH of < 10mIU/l.
Introduction: It has been observed that 5% of adolescents are affected by pubertal timing disorders. However, there is limited data about this in Pakistan. This cross-sectional study aimed to observe the patterns and causes of delayed puberty (DP) among patients presenting at the endocrine clinic of a tertiary care hospital in Karachi.Methods: This observational study was conducted at the endocrine clinic of Jinnah Postgraduate Medical Centre (JPMC) Unit II from 2007 to 2015. A detailed history was obtained from patients presenting with DP. We noted the available demographic data, main complaints, and family history of DP. Physical examinations were performed and the data recorded. Tanner staging was used to assess pubertal development. Relevant laboratory and imaging investigations were performed; data analysis was performed using SPSS 17 (IBM Corp., Armonk, NY).Results: A total of 2670 patients were registered in the endocrine clinic during the study period, of which 171 presented with DP; 119 were males and 52 were females. There was a wide variation in age at presentation ranging from 10 to 32 years. The majority of patients presented with short stature -69 (57.98%) males and 19 (36.53%) females. Small testes were present in 28 patients (23.52%); 19 (15.96%) males presented with absent secondary sexual characteristics and infertility was present in three (2.54%) males, primary amenorrhea was observed in 25 (48.07%), both primary amenorrhea and short stature were the presenting symptoms of five (9.61%), and failure of breast development was seen in three (5.76%) females. Constitutional delayed growth and puberty (CDGP) was diagnosed in 42 patients (24.6%). The definitive diagnosis of idiopathic hypogonadotropic hypogonadism (IHH) was made in 18 (10.5%) patients. In another 18 (10.5%) patients, we could not differentiate between CDGP and IHH. Functional hypogonadotropic hypogonadism (FHH) due to non-endocrine illness was present in 16 patients (9.4%). The cause of DP was hypogonadotropic hypogonadism in 33 (19.3%) patients whereas 44 patients presenting with DP could not be classified due to incomplete data.Conclusion: This study showed that CDGP was the most common cause of DP in our patients with the most common presentation being short stature in males and amenorrhea in females. It is essential to differentiate CDGP in children from a small fraction of the pathological and treatable causes of DP.
Objective: Gender/sex assignment is a crucial process in patients with genital ambiguity. This is a case report of a patient who had an anatomic anomaly and was misassigned with indeterminate sex and wrongfully assigned male sex for rearing. Methods: A 22-year-old unmarried male presented via the surgery department with progressively enlarging mass in the abdomen and vague abdominal discomfort. Examination revealed female secondary sexual characteristics and lack of facial/body hair. Radiologic investigations revealed a pregnancy of 26-weeks gestation. Karyotyping confirmed 46,XX. Results: Gender re-assignment was undertaken with multidisciplinary support. Baby was delivered at term, while maintaining strict confidentiality. This case reflects how flawed assessment and management of sexual ambiguity can be, even in cases handled in large tertiary care hospitals, despite the absence of clear sexual ambiguity. Careful handling of the social issues with regards to changes in gender expression and the fate of the baby may have saved lives in this case. Conclusion: A multidisciplinary conference of specialists interested in gender issues should be held in all cases of gender confusion so that mistakes like this do not happen. (AACE Clinical Case Rep. 2018;4:e217-e220) See accompanying article, p. e267.
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