Real-World Clinical Experience of Rosuvastatin as a Lipid-Lowering Therapy for Primary and Secondary Prevention of Cardiovascular Events (REAL ROSE).

Background Rosuvastatin effectively reduces endogenous cholesterol synthesis and low-density lipoprotein (LDL) cholesterol and increases high-density lipoprotein (HDL) cholesterol. This study aimed to evaluate the clinical characteristics of patients and treatment patterns of rosuvastatin as a lipid-lowering therapy for primary and secondary prevention of cardiovascular events in Indian settings. Methods This real-world, retrospective multi-centric observational study included patients aged >18 years who received treatment with a rosuvastatin/rosuvastatin-based combination. Demographic and data about concomitant diseases and medications were recorded. Results Out of 1,816 patients, the majority were men (66.2%); the mean age was 54.1 years. The patients prescribed rosuvastatin for primary and secondary prevention of cardiovascular events were 71.9% and 28.1%, respectively. Rosuvastatin 10 mg (56.8%) was the most commonly prescribed dose. For primary prevention, 10 mg (65.0%) was the most preferred dose, and for secondary prevention, 20 mg (54.3%) was the most preferred dose. Rosuvastatin treatment significantly (pre- vs. post-treatment) reduced the levels of total cholesterol (227.2 vs. 178.4 mg/dL), triglycerides (212.6 vs. 154.4 mg/dL), and LDL cholesterol (167.0 vs. 125.6 mg/dL), and increased HDL cholesterol levels (40.7 vs. 44.3 mg/dL) (p<0.0001). A total of 1,196 patients received combination therapy with rosuvastatin (aspirin, 34.0%, and fenofibrate, 21.9%). Adverse events were reported in 0.4% of the study population (leg pain, nausea, muscle cramps/pain, bleeding, and myalgia). Conclusion This study demonstrated the clinical effectiveness and safety of moderate- to high-intensity rosuvastatin (5-40 mg) for primary and secondary prevention of cardiovascular events in the Indian population. A primary prevention strategy with statins can reduce cardiovascular events and associated morbidity and mortality.

WhatsApp-Based virtual consultation in clinical practice during COVID times: A prospective institutional study.

Background: As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic. Materials and Methods: This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation. Results: Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic. Conclusions: More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.

RésuméContexte: Alors que la nouvelle maladie à coronavirus 2019 (COVID-19) poursuit sa poussée pandémique à l'échelle mondiale, l'attention portée au traitement des maladies non-COVID est devenue difficile. Les systèmes logiciels et les plates-formes de médias sociaux pourraient fournir des alternatives pour garantir soins de santé courants maladies non COVID. Dans ce contexte, nous avons évalué notre propre expérience de consultation virtuelle (VC) pour la gestion des patients en chirurgie endocrinienne pendant la pandémie actuelle de COVID. Matériels et méthodes: Cette étude prospective a été menée dans le service de chirurgie endocrinienne s'étendant sur 4 mois d'avril à juillet 2020. Nous avons utilisé la visioconférence de groupe basée sur WhatsApp pour VC avec les nouveaux patients et les patients de suivi. Nous avons évalué le quotient de satisfaction des patients, concernant les trois types de consultations (pas consultation, CV et consultation directe) sur une échelle ordinale de trois modes de consultation. Résultats: Une consultation virtuelle a été effectuée avec 102 nouveaux patients et 285 patients suivis. Les goitres, les signes cliniques et les plaies/cicatrices (dans les cas postopératoires) ont été évalués virtuellement. Le dosage du remplacement de la thyroxine, de la supplémentation en calcium et d'autres médicaments a été prescrit en fonction des résultats et des antécédents. Les patients qui chirurgie nécessaire (25/102 cas) ont reçu un rendez-vous approprié. Plus de 82 % des patients des deux groupes ont préféré la CV au cours de cette Pandémie de covid. Conclusions: plus de 82 % des nouveaux patients et des patients de suivi ont préféré la CV à la consultation directe ou à l'absence de consultation pendant cette période. Pandémie de covid. Nos résultats suggèrent que la CV via les plateformes de médias sociaux est capable d'assurer un traitement et un suivi appropriés pour les maladies endocriniennes. Mots-clés: COVID, endocrinien, suivi, chirurgie, thyroïde.

Management of Glucocorticoid-Induced Hyperglycemia.

Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.

Selfie-driven thyroid disease leads: A study on a unique sign and its utility in clinical practice.

Introduction: Taking a photograph of self alone or with a group called selfie, has become modern-day rage with spurt in smartphone technology. It has catapulted from a hobby into psychiatric ailment, especially among teens and young adults. Although it is considered a psychiatric ailment keeping them aloof from social interactions, we observed an inadvertent advantage in this process. In this context, we present some intriguing findings in this study. Materials and Methods: This retrospective study was based on compilation of 14 cases from endocrine surgery outpatient cum inpatient database collected over 2 years' period. The inclusion criteria are the chief complaint (CC) was noted only after watching the selfie picture and not otherwise; the CC leads them to consult physician; the picture was captured by oneself or other person who was also part of that image; and the CC leads to definitive diagnosis of thyroid disease requiring treatment. All other clinical, investigative, and treatment (medical and surgical) were studied. Results: In all, we had 14/5820 (0.0024%) cases meeting the above criteria. CC and later confirmed in pictures were four cases of Grave's disease associated ophthalmopathic exophthalmos, eight cases of goiter, and two cases of facial puffiness (myxedema related). All these CC helped in investigating for the diagnosis of Graves' disease (4), nodular goiter (8), and hypothyroidism (2) confirmed by appropriate investigations. Ten cases underwent thyroidectomy (two of the nodular goiter cases were papillary thyroid cancer) and four cases took conservative medical treatment. Conclusions: Although selfie is considered a modern-day lifestyle-induced psychiatric illness, it can inadvertently help in picking up thyroid diseases in earlier stages.

RésuméIntroduction: Prendre une photo de soi seul ou avec un groupe appelé selfie, est devenu une rage moderne avec une poussée dans le smartphone La technologie. Il est passé d'un passe-temps à une maladie psychiatrique, en particulier chez les adolescents et les jeunes adultes. Bien qu'il soit considéré comme un maladie psychiatrique les gardant à l'écart des interactions sociales, nous avons observé un avantage par inadvertance dans ce processus. Dans ce contexte, nous présentent des découvertes intéressantes dans cette étude. Matériels et méthodes: Cette étude rétrospective a été basée sur la compilation de 14 cas de Base de données de chirurgie endocrinienne ambulatoire et hospitalière collectée sur une période de 2 ans. Les critères d'inclusion sont la plainte principale (CC) a été noté seulement après avoir regardé la photo selfie et pas autrement; le CC les amène à consulter un médecin ; l'image a été capturée par soi-même ou une autre personne qui faisait également partie de cette image ; et le CC conduit au diagnostic définitif d'une maladie thyroïdienne nécessitant un traitement. Tous les autres clinique, d'investigation et de traitement (médical et chirurgical) ont été étudiés. Résultats : Au total, nous avons eu 14/5820 (0,0024%) cas répondant aux critères ci-dessus Critères. CC et confirmés plus tard en images étaient quatre cas d'exophtalmie ophtalmopathique associée à la maladie de Grave, huit cas de goitre, et deux cas de gonflement du visage (liés au myxoedème). Tous ces CC ont aidé à enquêter pour le diagnostic de la maladie de Graves (4), nodulaire goitre (8) et hypothyroïdie (2) confirmées par des examens appropriés. Dix cas ont subi une thyroïdectomie (deux des cas de goitre nodulaire étaient un cancer papillaire de la thyroïde) et quatre cas ont suivi un traitement médical conservateur. Conclusions : Bien que le selfie soit considéré comme un maladie psychiatrique induite par le mode de vie, il peut aider par inadvertance à contracter des maladies thyroïdiennes à un stade précoce. Mots-clés: endocrinien, exophtalmie, goitre, selfie, thyroide, thyroidectomie.

Bariatric surgery and diabetes remission: Who would have thought it?

Type 2 diabetes mellitus (T2DM) and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes) study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1(st) year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.

Bariatric surgery and diabetes remission: how far have we progressed?

Obesity and type 2 diabetes mellitus have been associated with higher morbidity and mortality. Bariatric surgery results in substantial and sustained weight loss in morbidly obese patients and improves obstructive sleep apnea. Furthermore, bariatric surgery improves diabetes control, hypertension, quality of life, stroke, myocardial infarction and reduces mortality. Interestingly, bariatric surgery induces high rates of short and long-term diabetes remission. While the exact mechanisms behind this are not completely understood, improved insulin action, ß-cell function and a complex interplay of hormones in the entero-insular axis appear to play major roles. Insulin action improves proportionally to weight loss and it gets completely normalized especially after bilio-pancreatic diversion. ß-Cell function also seems to improve after a variety of bariatric surgeries. Seemingly, baseline ß-cell function is able to predict future diabetes remission. This article will review the effectiveness of bariatric procedures on the remission and improvement of diabetes and its implicated mechanisms.

A case of Liddle's syndrome; unusual presentation with hypertensive encephalopathy.

Liddle's syndrome is a rare cause of secondary hypertension. Identification of this disorder is important because treatment differs from other forms of hypertension. We report an interesting case of a 35-year-old lady, a known diabetic and hypertensive patient, who presented with features of hypertensive encephalopathy. The family history was unremarkable. Past treatment with various combinations of antihypertensive medications including spironolactone, all at high doses, failed to control her blood pressure. Upon evaluation, the patient had hypokalemic alkalosis, low 24-h urine potassium and suppressed plasma renin activity. Although these findings were similar to hyperaldosteronism, plasma aldosterone was lower than the normal range. Blood pressure decreased markedly after administration of amiloride. Along with hyporeninemic hypo-aldosteronism, the non-responsiveness to spironolactone and good response to amiloride established the diagnosis of Liddle's syndrome.

Genetic analysis of a family with complete androgen insensitivity syndrome.

Androgen insensitivity causes impaired embryonic sex differentiation leading to developmental failure of normal male external genitalia in 46 XY genetic men. It results from diminished or absent biological actions of androgens, which is mediated by the androgen receptor (AR) in both the embryo and secondary sexual development. Mutations in the AR located on the X chromosome are responsible for the disease. Almost 70% of affected individuals inherit the mutation from their carrier mother. We hereby report a 10-year-old girl with all the characteristics of complete androgen insensitivity syndrome (CAIS). Similar scenario was observed in 3 maternal aunts, Sequencing of the AR gene in all the family members revealed C 2754 to T transition in exon 6. It was concluded that the C 2754 to T transition rendered the AR incapable of both ligand-binding and activating the transcription and was the cause of CAIS in the patient.

Type 2 diabetes mellitus: An unusual association with Down's syndrome.

Down's syndrome (DS) is known to be associated with autoimmune disease including type 1 diabetes. To the best of our knowledge, there are no reports of DS with type 2 diabetes mellitus in the literature. We hereby report two cases of DS with type 2 diabetes.

Metabolic pancreatitis: Etiopathogenesis and management.

Acute pancreatitis is a medical emergency. Alcohol and gallstones are the most common etiologies accounting for 60%-75% cases. Other important causes include postendoscopic retrograde cholangiopancreatography procedure, abdominal trauma, drug toxicity, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown (idiopathic pancreatitis). Metabolic conditions giving rise to pancreatitis are less common, accounting for 5%-10% cases. The causes include hypertriglyceridemia, hypercalcemia, diabetes mellitus, porphyria, and Wilson's disease. The episodes of pancreatitis tend to be more severe. In cases of metabolic pancreatitis, over and above the standard routine management of pancreatitis, careful management of the underlying metabolic abnormalities is of paramount importance. If not treated properly, it leads to recurrent life-threatening bouts of acute pancreatitis. We hereby review the pathogenesis and management of various causes of metabolic pancreatitis.

Surgical revascularization techniques for diabetic foot.

Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5-10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15-20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

Fetal endocrinology.

Successful outcome of pregnancy depends upon genetic, cellular, and hormonal interactions, which lead to implantation, placentation, embryonic, and fetal development, parturition and fetal adaptation to extrauterine life. The fetal endocrine system commences development early in gestation and plays a modulating role on the various physiological organ systems and prepares the fetus for life after birth. Our current article provides an overview of the current knowledge of several aspects of this vast field of fetal endocrinology and the role of endocrine system on transition to extrauterine life. We also provide an insight into fetal endocrine adaptations pertinent to various clinically important situations like placental insufficiency and maternal malnutrition.

Carotid intima media thickness in type 2 diabetes mellitus with ischemic stroke.

BACKGROUND: Diabetes mellitus is associated with high cardiovascular risk. Carotid intima media thickness (CIMT) is used commonly as a noninvasive test for the assessment of degree of atherosclerosis. The objective of this study was to find out the cut-off point for CIMT for ischemic stroke in patients with type 2 diabetes mellitus (T2DM) and to correlate CIMT with various parameters like smoking, hypertension, lipid profile and duration of T2DM. MATERIALS AND METHODS: A total of 80 subjects in the age group of 30-75 years (M:F = 57:23) were selected and divided into three groups, i.e. diabetes with ischemic stroke, diabetes and healthy subjects. All the participants were subjected to B-mode ultrasonography of both common carotid arteries to determine CIMT, along with history taking, physical examination and routine laboratory investigations including included fasting and 2-hour postprandial blood sugar, blood urea, serum creatinine, lipid profile, glycated hemoglobin, and microalbuminuria. RESULTS: Patients with T2DM with or without ischemic stroke were found to have significantly higher prevalence of increased CIMT and a value greater than 0.8 mm was found to be associated with the occurrence of stroke. The mean carotid IMT of the group as a whole was 0.840 ± 0.2 mm. The mean carotid IMT was not significantly different between T2DM patients with or without ischemic stroke (1.06 ± 0.2 vs. 0.97 ± 0.26 mm, P = 0.08). However, the mean CIMT was significantly higher in diabetic subjects compared to healthy subjects (1.01 ± 0.28 mm vs. 0.73 ± 0.08, P = 0.006). Other parameters like higher age, smoking, hypertension, hyperlipidemia, low HDL cholesterol, the glycemic parameters and the duration of diabetes were independently and significantly related to CIMT. CONCLUSION: A high CIMT is a surrogate and reliable marker of higher risk of ischemic stroke amongst type 2 diabetic patients. Our study demonstrates the utility of carotid IMT as a simple non-invasive screening test for the assessment of atherosclerosis risk/prognosis in type 2 diabetics.

Coexistence of pheochromocytoma with uncommon vascular lesions.

BACKGROUND: Pheochromocytoma/paragangliomas have been described to be associated with rare vascular abnormalities like renal artery stenosis. Coexistence of physiologically significant renal artery lesions is a compounding factor that alters management and prognosis of pheochromocytoma patients. Apart from individual case reports, data on such association in Indian population is not available. The aim of this study is to find the nature and prevalence of associated vascular abnormalities. MATERIALS AND METHODS: From 1990 to 2010, a total of 50 patients were diagnosed with pheochromocytoma/paragangliomas. Hospital charts of these patients were reviewed retrospectively to identify those with unusual vascular abnormalities. Available literature was also reviewed. RESULTS: Of the 50 patients with pheochromocytoma, 7 (14%) had coexisting vascular lesions including renal artery stenosis in 4, aortoarteritis in 1, aortic aneurysm in 1 and inferior vena cava thrombosis in 1. Pheochromocytoma was adrenal in 42 and extra adrenal in 8. Laparoscopic adrenalectomy was done in the patients. One patient with renal artery stenosis due to intimal fibrosis was subjected to percutaneous balloon angioplasty; the other three improved after adrenalectomy and lysis of fibrous adhesive bands. The patient with aortoarteritos was treated with oral steroids. Inferior vena cava thrombosis was reversed with anticoagulants. The patient with abdominal aortic aneurysm was advised for annual follow-up on account of its size of 4.5 cm and asymptomatic presentation. CONCLUSION: There are multiple mechanisms that can lead to renal artery stenosis and other vascular abnormalities in a case of pheochromocytoma. A high index of suspicion is necessary to enable both entities to be diagnosed preoperatively and allow proper planning of surgical therapy. Incomplete diagnosis may lead to persistent hypertension postoperatively in a case of associated renal artery stenosis.

Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes.

OBJECTIVE: The objective of the present study was to prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of T2DM and related metabolic abnormalities. METHODS: All patients underwent II +DSG. They had T2DM≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/or insulin. The primary outcome was remission of diabetes (HbA1C<6.5% without OHAs/insulin), and secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome. RESULTS: We report the preliminary postoperative follow-up data of 9.1±5.3 months (range: 3-21 months). There were 17 patients (male:female=12:5) with mean age of 50.7±8.1 (range, 34-66 years), duration of diabetes of 15.1±5.8 years (range, 5-30 years), and preoperative body mass index of 29.2±7.5 kg/m(2)(range, 22.4-37.5 kg/m(2)). Eight patients (45%) had hypertension, while dyslipidemia and microalbuminuria was present in 7 patients (39%) each. Twelve patients (70.5%) had diabetes remission. Seven/eight (87.5%) patients had remission in hypertension. All participants had weight loss ranging between 15% and 30%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (p<0.05). Two patients had vitamin B12 deficiency 1 year after surgery. CONCLUSION: Ileal interposition combined with DSG addresses both foregut and hindgut theories and brings about remissions in T2DM patients with reasonable safety. Our preliminary observations demonstrated the feasibility and efficacy of this novel surgical procedure as a promising option in T2DM.

Efficacy and safety of statin and fibrate combination therapy in lipid management.

Adequate control of hyperlipidemia is of paramount importance for prevention of vascular events. Statins and fibrates are well established treatments for hyperlipidemia. Combination therapy with a statin and fibrate offers significant therapeutic advantage for the treatment of severe or refractory mixed hyperlipidemia. Although such a combination does increase the risk of myopathy, with an incidence of approximately 0.12%, this small risk of myopathy rarely outweighs the established morbidity and mortality benefits of achieving lipid goals. Nevertheless, a higher incidence of myopathy has been reported with statin monotherapy. Statin+fibrate therapy should be considered if monotherapy or adding other drugs (e.g. cholesterol absorption inhibitors, omega-3 fatty acids or nicotinic acid) did not achieve lipid targets or is impractical. The current article focuses on recent studies highlighting the beneficial effects of this combination.

Sturge-Weber syndrome: presentation with partial hypopituitarism.

Sturge-Weber syndrome (SWS) is a rare disorder involving central nervous system abnormalities. It manifests with a facial port-wine birthmark and a vascular malformation of the brain. Infants and children present with seizures and stroke-like episodes with focal neurologic deficits. Patients with Sturge-Weber syndrome carry the additional risk of developing hypothalamic-pituitary dysfunction, secondary to their central nervous system dysfunction. Although one would suspect the hypothalamic-pituitary axis would be at risk for impairment given the abnormalities that often occur in Sturge-Weber syndrome, they are not commonly recognized by clinicians. Increased awareness of this potential complication in patients with this rare disease of Sturge-Weber syndrome is needed. We hereby report a case of SWS with partial hypopituitarism and consider it to be important that these patients should undergo routine evaluation of pituitary function in the face of any relevant clinical manifestations.

Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl.

A 16-year-old girl presented with primary amenorrhea and excess hair growth on her body and face for the last three years, along with pain and a mass in her lower abdomen for last one year. Examination revealed hirsutism and other virilizing features, with an irregular mass in the lower abdomen corresponding to 16 weeks'gestation. Serum testosterone was 320 ng / dl and ultrasonogram of the pelvis revealed a solid mass of 5 × 4 cm in the left adnexa. Suspecting it to be a virilizing tumor of the left ovary, the patient was subjected to staging laparotomy, which revealed stage 1a ovarian involvement amenable to surgical resection alone. Histopathological examination confirmed the diagnosis of granulosa cell tumor of the ovary. Postoperatively the serum testosterone returned to 40 ng / dl and her menstrual cycle started after two months of surgery.