Adrenal insufficiency in patients with stable non-cystic fibrosis bronchiectasis.

BACKGROUND & OBJECTIVES: Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores. METHODS: In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values. RESULTS: Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-µg cosyntropin testing. Baseline cortisol (mean difference -2.0 µg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 µg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses. INTERPRETATION & CONCLUSIONS: Our results showed that the impaired adrenal responses to 1-µg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-µg cosyntropin test.

Visceral adiposity in young patients with coronary artery disease-a case control study.

AIMS: Central obesity is associated with an increased cardiovascular risk. We carried out a hospital based case control study in young patients with coronary artery disease (CAD) to assess the importance of visceral fat METHODS: Coronary artery disease was established by coronary angiogram in all cases. Controls were age- and sex-matched subjects with normal coronary angiogram. Computed tomography scan performed at the level of the umbilicus to measure subcutaneous and visceral fat area (VFA). RESULTS: Cases and controls were well matched in height, weight, and body mass index (BMI). Visceral fat area was significantly higher (122.58 ± 37.59 vs. 88.4 ± 36.95 cm(2); P=0.003) in cases whereas subcutaneous fat area was similar in cases and controls. Visceral fat area was an excellent predictor of cardiovascular risk (area under receiver operating characteristics curve 0.915 cm(2)). Visceral fat area correlated with BMI, waist hip ratio, blood sugar, triglycerides, and C-reactive protein significantly. CONCLUSION: Visceral adiposity is associated with an increased risk of CAD and it correlated with anthropometric, metabolic, and inflammatory markers.

Rare case of gastrointestinal stromal tumor presenting with scrotal metastasis.

While gastrointestinal stromal tumors frequently metastasize, the scrotum is an extremely rare site of involvement. This case is of a 48-year-old male who, having undergone debulking surgery for metastatic gastrointestinal stromal tumor (GIST) of the small intestine 2 years ago, presented with bilateral scrotal swelling. Ultrasound showed hypoechoic mass lesions surrounding the testis and epididymis bilaterally with extension into the spermatic cord and biopsy established a diagnosis of metastatic GIST of the scrotum. As the processus vaginalis is an extension of the peritoneal cavity, we postulate that it may serve a route of spread in malignancies that involve the peritoneal cavity, as in this case.