Thyroxine Therapy Treating Infertility and Pituitary Tumor: Primary Hypothyroidism Leading to Pituitary Hyperplasia.

Pituitary lesions can occur as a consequence of primary hypothyroidism and the biochemical imbalance associated with it, making its diagnosis a challenging task necessitating a thorough patient assessment by the treating physicians. We describe a young patient with pituitary hyperplasia due to primary hypothyroidism who presented with complaints of menstrual irregularities and weight gain. The patient was treated with thyroxine (T4) for primary hypothyroidism. The patient reported improvement in her symptoms along with the normalization of thyroid profile and interval reduction in the size of pituitary lesion on follow-up MRI scan.

Insulinoma Mimicking Psychiatric Illness: A Covert Endocrine Tumor.

Insulinomas are rare neuroendocrine tumors with an annual incidence of four cases per million people in the general population. They have varied presentations making their diagnosis a challenging task necessitating a thorough patient assessment to ascertain early detection of this clinical entity by treating physicians. Insulinomas are characterized by the presence of Whipple's triad comprising of hypoglycemic symptoms, biochemical demonstration of hypoglycemia, and improvement of those symptoms after glucose administration. Biochemical detection of insulinoma by supervised 72-hour fasting test with plasma glucose, insulin, C-peptide, and proinsulin level measurements remains the gold standard of diagnosis. In this report, we present an interesting case of delayed diagnosis of pancreatic insulinoma. He was treated for more than six years as a psychiatric illness before receiving the correct diagnosis and treatment. Herein, a middle-aged man with a history of recurrent episodes of altered talk and confusion that resolved after eating something sweet. Biochemical investigations were suggestive of endogenous hyperinsulinemia. Pancreatic insulinoma was localized by a computed tomography scan. The patient underwent surgical resection of the tumor with complete resolution of his symptoms.

Case Report: A Challenging Clinical Problem of Calcitonin-Negative Medullary Thyroid Cancer Diagnosis and Surveillance.

Medullary carcinoma of the thyroid is a rare neuroendocrine carcinoma that originates from the malignant proliferation of parafollicular C cells. In almost 100% of the cases, medullary carcinoma of the thyroid is associated with high levels of calcitonin and carcinoembryonic acid (CEA). Both carcinoembryonic antigen and calcitonin are used for the diagnosis and surveillance of medullary carcinoma of the thyroid. Calcitonin-negative medullary carcinoma of the thyroid is an extremely rare entity that is characterized by classic medullary carcinoma of the thyroid morphology without raised serum calcitonin levels. We describe the case of a middle-aged lady who presented with a few-month history of neck swelling associated with compressive symptoms. CT of the neck showed a large right thyroid nodule with central necrosis and retrosternal extension to the superior mediastinum. There was also a 360-degree encasement of the right common carotid artery. She underwent fine needle aspiration (FNAC) of the right thyroid nodule, and histopathology showed typical features of medullary carcinoma of the thyroid. Immunohistochemical staining for calcitonin and carcinoembryonic antigen was negative but positive for other neuroendocrine markers, i.e., synaptophysin and chromogranin A. Serum calcitonin and carcinoembryonic antigen levels were also in the normal range. So, a rare diagnosis of calcitonin-negative medullary carcinoma of the thyroid was made. As the disease was inoperable because of vascular encasement, a plan for external beam radiation therapy (ERBT) to the neck was made. Medullary carcinoma of the thyroid with normal serum levels of calcitonin is a very rare entity, with only a few cases reported in the literature. In this case report, we have presented a rare case of medullary thyroid carcinoma (MTC) with normal-range serum calcitonin levels, how it was diagnosed, and how to follow up postoperatively.

Role of Biochemical Markers in Invasive Ventilation of Coronavirus Disease 2019 Patients: Multinomial Regression and Survival Analysis.

Background and objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic. The disease mainly affects the respiratory system of the patient, in particular, the lungs, which leads to patients presenting with acute respiratory distress syndrome and acute respiratory failure, with 5-15% of patients requiring observation in the intensive care unit (ICU) with respiratory support in the form of ventilation. This study was aimed at identifying the role of biochemical markers in the risk stratification of invasive and non-invasive ventilation of hospitalized COVID-19 patients. Materials and methods The study was conducted as a prospective, observational study of all admitted COVID-19 patients. A comparative analysis was performed of the survivors who were on invasive versus (vs) non-invasive ventilation and the non-survivors similarly. After computing the descriptive statistics, a multinomial logistic regression model was applied to obtain an unadjusted odds ratio (OR) at 95% confidence interval (CI), with Hosmer-Lemeshow (HL) goodness-of-fit test used to predict the fitness of the data. Kaplan-Meier survival curves were obtained for each of the laboratory investigations predicting survival along with the intensive care stay and invasive ventilation. A log-rank test was carried out to compare the survival distributions. Results A total of 373 included patients in the study had a mean age of 52.78 ± 15.76 years with females younger than males, and indifference amongst invasive vs non-invasively ventilated (p=0.821). Females were slightly more prone to invasive ventilation (p=0.097). Overall, 39% of the subjects did not need respiratory support, while 13% were on a ventilator, 16% on bilevel positive airway pressure/continuous positive airway pressure (BiPAP/CPAP), and 31% on supplemental oxygen therapy. Among the laboratory markers, mean hemoglobin was evidently lower in the invasive group, leukocytosis and thrombocytopenia were present in both invasively ventilated and non-surviving patients, while neutrophilia and lymphocytopenia were statistically indifferent among the mode of ventilation. Elevated urea, creatinine, and sodium were also significantly deranged laboratory markers amongst the invasively ventilated group. C-reactive protein (CRP) and lactate dehydrogenase (LDH) were elevated significantly in the invasive group, while serum ferritin was more frequently raised in the non-invasively ventilated group. Procalcitonin (PCT) was significantly associated with invasive ventilation as opposed to the non-invasive group. D-dimer was equally raised in both the groups at admission but significantly elevated in the invasive group at discharge. A multinomial regression model signified D-dimer (OR: 16.301), hypernatremia (OR: 12.738), creatinine (OR: 12.589), urea (OR: 12.576), and LDH (OR: 12.245) most significantly associated with death, while those for invasive ventilation were D-dimer (OR: 8.744), hypernatremia (OR: 4.532), PCT (OR: 3.829), neutrophilia (OR: 3.804), leukocytosis (OR: 3.330), and serum urea (OR: 3.312). Kaplan-Meier curves conclude total leucocyte count (TLC), neutrophils, lymphocytes, urea, creatinine, sodium, CRP, LDH, PCT, and D-dimer all significantly contributing to an early death. Conclusion The most significant marker for mortality was D-dimer, followed by serum sodium, urea/creatinine, LDH, ICU stay, and invasive ventilation.