Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study.

PURPOSE: Growth hormone-secreting pituitary adenomas (GH-PAs) with a low Knosp grade are typically associated with a good postoperative biochemical remission (BR) rate. However, a proportion of patients do not achieve remission. In this study, we aimed to investigate predictive factors of postoperative remission for lower Knosp GH-PAs. METHODS: In this retrospective study, we enrolled 140 patients who were diagnosed with lower Knosp (0-2) GH-PAs and received trans-sphenoidal surgery between December 2016 and June 2021 from the largest pituitary tumor surgery center in southern China. The univariate, binary Logistic regression, and receiver operating characteristic curve (ROC) analyses were employed to determine independent predictors and cutoff values of remission. The postoperative outcome was defined as remission using the 2010 consensus criteria of acromegaly. RESULTS: One hundred and thirty six patients (97.1%) achieved gross total resection. The postoperative long-term BR was 68.6%. Empty sella, tumor maximum diameter and postoperative GH levels were independent factors predicting remission. ROC revealed that postoperative 24 h GH ≤ 1.3 ng/mL and ≤ 1.23 ng/mL were valuable predictors for 3-month and long-term remission respectively, and that postoperative 3-month GH ≤ 1.6 ng/mL and tumor maximum diameter ≤ 17 mm were predictors for delayed remission. CONCLUSION: Early postoperative GH levels can be used as predictors of remission. However, BR was not associated with preoperative somatostatin analogs therapy or Knosp grade (0-2). For patients without residual tumor or recurrence and whose GH levels are slightly elevated within 1 year after surgery, adjuvant treatments may not be necessary.

Serum Iron Profile and Red Cell Indices in Children with Severe Acute Malnutrition in A Tertiary Level Hospital.

This cross-sectional analytical study was conducted in the department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from March 2017 to August 2018 to assess the pattern of serum iron profile and red cell indices in children with severe acute malnutrition. Seventy children having severe acute malnutrition were compared with 70 age matched children those had normal growth. Age range of the studied children was 6 months to 59 completed months. Male was found predominant (54.3%) in both study group and comparison group. Mean serum iron, serum ferritin, serum total iron binding capacity and transferrin saturation in severely malnourished children were 45.3±19.3µg/dl, 26.5±20.0ng/ml, 246.3±47.5µg/dl and 16.4±2.0% respectively which were significantly lower than that of healthy children (p<0.05). Mean Hb level in children with severe acute malnutrition was found 8.3±1.6gm/dl which was also found significantly lower than that of normal children (p<0.05). Anaemia was found in all (100%) severely malnourished children compared to 25.7% of children in comparison group. Mean MCV, MCH and MCHC in children with severe acute malnutrition was found 71.7±13.5fl, 24.0±5.8pg and 31.4±4.0gm/dl respectively which were significantly lower than that of comparison group (p<0.05). Serum iron profile and red cell indices should be routinely done in severely malnourished children for early intervention and management of iron deficiency anaemia.

Vitamin D Status in Newly Diagnosed Type 2 Diabetes Patients Attending in a Tertiary Hospital of Bangladesh.

Vitamin D deficiency is common in patients with type 2 diabetes mellitus (T2DM). Vitamin D status may have a causal role in the onset of T2DM and may influence glycaemic control in these patients. However, data on vitamin D status among Bangladeshi T2DM patients are scarce. The present cross-sectional study was done among newly diagnosed 50 T2DM patients attending outpatient department of Comilla Diabetic Hospital, Bangladesh to address this lacuna. Serum 25(OH)D was measured in all and classified as normal (≥30ng/mL), insufficient (>20 to 29.9ng/mL), and deficient (≤20ng/mL). Mean serum 25(OH)D level was 27.91±2.58ng/mL (mean±SEM). Among the study subjects, 30% were D-deficient, 36% were D-insufficient and 34% had normal 25(OH)D. There was no statistical difference of 25(OH)D level between the younger (age <40 years) and older (≥40 years) patients (28.31±4.3 vs. 27.44±2.6ng/mL, mean±SEM; p=0.869); males and females (26.79±2.1 vs. 31.09±8.2ng/mL, mean±SEM; p=0.470); among smokers, non-smokers and ex-smokers (26.86±4.31, 27.10±2.49 and 42.62±1.71ng/mL respectively, mean±SEM; p=0.363); among normal weight, overweight and obese (30.61±6.16, 35.61±9.52 and 24.27±1.71ng/mL respectively, mean±SEM; p=0.191); and among normotensive, borderline hypertensive and hypertensive (25.29±2.46, 32.57±5.32 and 20.84±3.66ng/mL respectively, mean±SEM; p=0.277) patients. 25(OH)D level showed significant negative correlation with body mass index (r= -0.391, p=0.017) and positive correlation (r=0.334, p=0.044) with fasting plasma glucose in male subjects. Age, sex, smoking status, BMI, systolic BP, diastolic BP, family history of DM and smoking status were not found to influence vitamin D level independently. Our study found high frequency of subnormal vitamin D in newly diagnosed T2DM patients. Screening for vitamin D status may be beneficial in T2DM patients.

A Comparative Study of Magnetic Resonance Imaging and Transabdominal Ultrasonography for the Diagnosis and Evaluation of Uterine Fibroids.

Uterine fibroids often cause symptoms of pelvic pain, pressure, and bleeding and a significant cause of morbidity for women of reproductive age. A new, Food and Drug Administration approved noninvasive treatment option is magnetic resonance guided focused ultrasound surgery, which has the potential to become a treatment of choice for selected patients. The purpose of the study was to compare and evaluate the usefulness of MRI and transabdominal ultrasonography for the diagnosis of uterine fibroids. A cross sectional study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of January' 2010 to December 2011. A total number of 40 consecutive patients having suspected uterine fibroids underwent MRI and transabdominal ultrasonography and they were followed up from the admission upto the tissue diagnosis of uterine fibroids for histopathological correlation were included in this study. The test of validity of MRI and transabdominal ultrasonography in diagnosis of uterine fibroids was calculated. In the diagnosis of uterine fibroids, USG was 88.2% sensitive, 66.7% specific, 85.0% accurate, 93.8% positive predictive values and 50% negative predictive values. However MRI was 97.1% sensitive, 83.3% specific, 95.0% accurate, 97.1% positive predictive values and 83.3% negative predictive values for prediction of uterine fibroids. The study shows that the MRI is more efficient diagnostic modality than transabdominal ultrasonography in detecting uterine fibroid presence and evaluation.

A 7 years old girl with abdominal lump and per-vaginal bleeding of hypothyroidism.

Hypothyroidism is a common endocrine disorder resulting from decreased secretion of thyroid hormone. The diagnosis of hypothyroidism is suggested from the clinical and laboratory findings. Here we present a case report on this disease with rare presentation of abdominal lump and pervaginal bleeding in childhood. A 7 years old girl admitted in a tertiary level hospital with abdominal lump and irregular per vaginal bleeding. Abdominal swelling was gradually increasing in size & associated with lower abdominal pain for last 5 months. On examination the girl was moderately anaemic, mildly oedematous, distended lower abdomen and a mass in left iliac region. Her thyroid function test, serum FSH, serum LH, serum Prolactin was done and high FSH, LH, Prolactin levels were found. Ultrasonography of lower abdomen revealed bulky uterus and bilateral ovarian cysts. MRI of Brain showed feature of pituitary microadenoma. Finally the patient was diagnosed as primary hypothyroidism and bilateral follicular ovarian cyst with pituitary adenoma developed as its consequence. The case is reported for clinical awareness & to share our experience.