Panhypopituitarism in an Adult Male and Hypogonadism as a First Clue.

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.

Correlation of Ball Circumference with Body Weight in 5-10 Years Aged Bangladeshi Children.

This cross sectional, descriptive and analytic study was conducted among 5-10 years aged 109 Bangladeshi children (70 male and 39 female) at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat), Bangladesh from January 2016 to December 2016. Sample collection was done by nonrandom purposive sampling technique. Any kind of congenital and acquired foot deformity was excluded to construct standard measurement. The present anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding ball circumference, to measure its correlation with body weight and this attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. Weight of the subject was measured with the digital weighing machine and ball circumference was measured using flexible measuring tape. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean ball circumference of right side of 5, 6, 7, 8, 9 and 10 years aged male were 16.93±1.05cm, 17.00±0.72cm, 18.10±1.28cm, 18.33±.99cm, 19.37±1.12cm and 19.94±1.30cm respectively and those of female were 16.27±1.10cm, 16.85±0.59cm, 17.44±0.92cm, 18.02±0.82cm, 18.00±1.58cm and 19.23±1.40cm respectively. The mean ball circumference of left side of 5, 6, 7, 8, 9 and 10 years aged male were 16.86±1.05cm, 16.94±.70cm, 18.02±1.29cm, 18.26±.99cm, 19.27±1.12cm and 19.87±1.29cm respectively and those of female were 16.18±1.10cm, 16.77±0.62cm, 17.36±0.92cm, 17.98±0.87cm, 17.90±1.58cm and 19.13±1.40cm respectively. In this study on both sides, ball circumference showed non-significant positive correlation with body weight in 5 years old male and female, 6 years old male and female, 7 years old male and female, 8 years old female, 9 years old male and female and 10 years old male and female. In case of 8 years old male, it showed non-significant negative correlation with body weight.

A Patient with Grave's Disease and Tuberculous Lymphadenitis.

Immune reactivity between Mycobacteria and human antigens can play an important role in the pathogenesis of autoimmune disease. We report a case of Graves's disease and tuberculous lymphadenitis to explain the mechanism of correlation between immune-mediated diseases and tuberculosis and to raise awareness of the importance of screening for TB in this context, especially in endemic country. Screening for latent TB at immune mediated disease diagnosis and regular timely screening thereafter may be beneficial.

Gastrointestinal manifestations as initial presenting features in a 40 years old woman with systemic lupus erythematosus.

Gastrointestinal (GI) symptoms are common in patients with systemic lupus erythematosus (SLE). These symptoms can be due to primary GI disorders like peptic ulcer disease, pancreatitis or intestinal obstruction. But they can be due to SLE itself or complications of treatment of SLE. In this case report, we describe a 40 years old woman who presented initially with GI complaints. Later she was diagnosed as a case of SLE with chronic intestinal pseudo-obstruction (CIPO). The problems related to diagnosis and management is also discussed.

Branchial cadmium and copper binding and intestinal cadmium uptake in wild yellow perch (Perca flavescens) from clean and metal-contaminated lakes.

Branchial binding kinetics and gastro-intestinal uptake of copper and cadmium where examined in yellow perch (Perca flavescens) from a metal-contaminated lake (Hannah Lake, Sudbury, Ontario, Canada) and an uncontaminated lake (James Lake, North Bay, Ontario, Canada). An in vivo approach was taken for gill binding comparisons while an in vitro gut binding assay was employed for gastro-intestinal tract (GIT) uptake analysis. By investigating metal uptake at the gill and the gut we cover the two main routes of metal entry into fish. Comparisons of water and sediment chemistries, metal burdens in benthic invertebrate, and metal burdens in the livers of perch from the two study lakes clearly show that yellow perch from Hannah L. are chronically exposed to a highly metal-contaminated environment compared to a reference lake. We found that metal-contaminated yellow perch showed no significant difference in gill Cd binding compared to reference fish, but they did show significant decreases in new Cd binding and absorption in their GITs. The results show that gill Cd binding may involve low-capacity, high-affinity binding sites, while gastro-intestinal Cd uptake involves binding sites that are high-capacity, low-affinity. From this we infer that Cd may be more critically controlled at the gut rather than gills. Significant differences in branchial Cu binding (increased binding) were observed in metal-contaminated yellow perch. We suggest that chronic waterborne exposure to Cu (and/or other metals) may be the dominant influence in gill Cu binding rather than chronic exposure to high Cu diets. We give supporting evidence that Cd is taken up in the GIT, at least in part, by a similar pathway as Ca(2+), principally that elevated dietary Ca(2+) reduces Cd binding and uptake. Overall our study reveals that metal pre-exposure via water and diet can alter uptake kinetics of Cu and Cd at the gill and/or the gut.

Tissue-specific cadmium and metallothionein levels in rainbow trout chronically acclimated to waterborne or dietary cadmium.

Rainbow trout were exposed to a sublethal concentration of waterborne Cd (0 or 3 microg/L) or dietary Cd (0 or 500 mg/kg dry wt) for 30 days to induce acclimation, and tissue Cd and metallothionein (MT) levels were examined. The greatest Cd concentrations were observed in the kidney followed by the gills and liver of the fish exposed to Cd via water, but in the gut tissues followed by the kidney, liver, and gills for dietary-exposed fish, reflecting a variation depending on the route of Cd exposure. Some MT was found in the nonacclimated naïve fish with no experience of elevated Cd exposure, and these background MT levels were quite high in the posterior intestine (480 microg/g), cecae (257 microg/g), and liver (248 microg/g) relative to other tissues (7-50 microg/g). With exposure to both waterborne and dietary Cd, MT levels rose significantly in all observed tissues. The increases relative to the control levels of MT in naïve fish were in the order: kidney (5.4 times) > gills (4.6) > liver (1.3) for the waterborne exposure group, and in the order kidney (19.3 times) >> cecae and posterior intestine (approximately 6.5 times) > liver and stomach (approximately 5 times) > midintestine (4.3 times) > gills (2.1 times) for the dietary exposure group. At 24 hours after an acute gastrointestinal dose of Cd (276 microg/kg) infused into the stomach of dietary exposure groups, large increases of total Cd but not MT levels were found in the gut tissues of nonacclimated fish; in the Cd-acclimated fish, the posterior intestine was greatly affected with decreases in Cd (71%), Zn (33%), Cu (70%) and MT (46%) levels, suggesting an enhanced sloughing of tissue materials after infusion. Exposure to Cd did not cause any notable decrease of Zn or Cu in any tissue, except that found in the posterior intestine. However, a molar analysis indicated that although Cd levels remained less than MT binding capacity in both waterborne and dietary exposure groups, the total metal levels (Cd + Zn + Cu) greatly exceeded MT binding capacity in all tissues of Cd-exposed fish, suggesting a potential competition of Cd with other metals for binding sites on MT and non-MT proteins in the tissues.

Effects of dietary calcium and cadmium on cadmium accumulation, calcium and cadmium uptake from the water, and their interactions in juvenile rainbow trout.

The objective of this study was to examine the effects of chronically elevated dietary Ca2+ (as CaCO3), alone and in combination with elevated dietary Cd, on survival, growth, and Cd and Ca2+ accumulation in several internal compartments in juvenile rainbow trout (Oncorhynchus mykiss). In addition, effects on short-term branchial uptake and internal distribution of newly accumulated waterborne Ca2+ and Cd during acute waterborne Cd exposure (50 microg/L as CdNO3 for 3 h) were monitored using radiotracers (45Ca, 65Cd). Fish were fed with four diets: 20 mg Ca2+/g food (control), 50 mg Ca2+/g food, 300 microg Cd/g food, and 50 mg Ca2+/g + 300 microg Cd/g food for 30 days. There were no significant effects on growth, mortality, or total body Ca2+ accumulation. The presence of elevated Ca2+, Cd, or Ca2+ + Cd in the diet all reduced waterborne Ca2+ uptake in a short-term experiment (3 h), though the inhibitory mechanisms appeared to differ. The effects were marked after 15 days of feeding, but attenuated by 30 days, except when the diet was elevated in both Ca2+ and Cd. The presence of elevated Ca2+ in the diet had only modest influence on Cd uptake from the water during acute Cd challenges but greatly depressed Cd uptake from the diet and accumulation in most internal tissues. None of the treatment diets prevented the decreases in waterborne Ca2+ uptake and new Ca2+ accumulation in internal tissues caused by acute exposure to waterborne Cd. In conclusion, there are complex interactions between waterborne and dietary effects of Ca2+ and Cd. Elevated dietary Ca2+ protects against both dietary and waterborne Cd uptake, whereas both waterborne and dietary Cd elevations cause reduced waterborne Ca2+ uptake.

Physiological effects of dietary cadmium acclimation and waterborne cadmium challenge in rainbow trout: respiratory, ionoregulatory, and stress parameters.

A suite of respiratory, acid-base, ionoregulatory, hematological, and stress parameters were examined in adult rainbow trout (Oncorhynchus mykiss) after chronic exposure to a sublethal level of dietary Cd (500 mg/kg diet) for 45 days and during a subsequent challenge to waterborne Cd (10 microg/L) for 72 h. Blood sampling via an indwelling arterial catheter revealed that dietary Cd had no major effects on blood gases, acid-base balance, and plasma ions (Ca(2+), Mg(2+), K(+), Na(+), and Cl(-)) in trout. The most notable effects were an increase in hematocrit (49%) and hemoglobin (74%), and a decrease in the plasma total ammonia (43%) and glucose (49%) of the dietary Cd-exposed fish relative to the nonexposed controls. Dietary Cd resulted in a 26-fold increase of plasma Cd level over 45 days (approximately 24 ng/mL). The fish exposed to dietary Cd showed acclimation with increased protection against the effects of waterborne Cd on arterial blood P(aCO2) and pH, plasma ions, and stress indices. After waterborne Cd challenge, nonacclimated fish, but not Cd-acclimated fish, exhibited respiratory acidosis. Plasma Ca(2+) levels declined from the prechallenge level, but the effect was more pronounced in nonacclimated fish (44%) than in Cd-acclimated fish (14%) by 72 h. Plasma K(+) was elevated only in the nonacclimated fish. Similarly, waterborne Cd caused an elevation of all four traditional stress parameters (plasma total ammonia, cortisol, glucose, and lactate) only in the nonacclimated fish. Thus, chronic exposure to dietary Cd protects rainbow trout against physiological stress caused by waterborne Cd and both dietary and waterborne Cd should be considered in determining the extent of Cd toxicity to fish.

Gastrointestinal uptake and fate of cadmium in rainbow trout acclimated to sublethal dietary cadmium.

Adult rainbow trout were pre-exposed to a sublethal concentration of dietary Cd (500 mg/kg dry wt.) for 30 days to induce acclimation. A gastrointestinal dose of radiolabeled Cd (276 microg/kg wet wt.) was infused into the stomach of non-acclimated and Cd-acclimated trout through a stomach catheter. Repetitive blood samples over 24 h and terminal tissue samples were taken to investigate the gastrointestinal uptake, plasma clearance kinetics, and tissue distribution of Cd. Only a small fraction of the infused dose (non-acclimated: 2.4%; Cd-acclimated: 6.6%) was internalized across the gut wall, while most was bound in the gut tissues (10-24%) or remained in the lumen (16-33%) or lost from the fish (approximately 50%) over 24 h. Cadmium loading during pre-exposure produced a profound increase of total Cd in the blood plasma (approximately 28-fold) and red blood cells (RBC; approximately 20-fold). The plasma Cd-time profiles consisted of an apparent rising (uptake) phase and a declining (clearance) phase with a maximum value of uptake in 4 h, suggesting that uptake of gastrointestinally infused Cd was very rapid. Acclimation to dietary Cd did not affect plasma Cd clearance (approximately 0.5 ml/min), but enhanced new Cd levels in the plasma (but not in the RBC), and resulted in a longer half-life for plasma Cd. Tissue total and new Cd levels varied in different regions of the gastrointestinal tract, and overall levels in gut tissues were much greater than in non-gut tissues, reflecting the Cd exposure route. Dietary Cd, but not the infused Cd, greatly increased total Cd levels of all gut tissues in the order posterior-intestine (640-fold) > cecae (180-fold) > mid-intestine (94-fold) > stomach (53-fold) in Cd-acclimated fish relative to naïve fish. Among non-gut tissues in the Cd-acclimated fish, the great increases of total Cd levels were observed in the liver (73-fold), kidney (39-fold), carcass (35-fold), and gills (30-fold). The results provide some clear conclusions that may be useful for environmental risk assessment of dietary Cd exposure in fish.

Effect of temperature on the uptake of waterborne strontium in the common carp, Cyprinus carpio (L.).

The effect of temperature on the uptake kinetics of strontium (Sr) in the common carp (Cyprinus carpio) was studied in vivo, exposing pre-acclimated fish to a wide range of Sr concentrations in water (Sr(total)=0.2-10,000 microM; Ca(total)=348 microM) at 10, 20, 25 and 30 degrees C. Sr uptake rates were determined in the whole body, gills and blood of the fish after an exposure period of 3 h and were analyzed as a function of the free-ion activity of Sr and Ca in water. The uptake of Sr(2+) by the whole body, gills and blood increased with temperature and showed saturation kinetics with the increase of Sr(2+) activity. Analyzing the observed uptake rates with a Michaelis-Menten type model showed that the kinetic parameters (J(max), K(m) and K(i)) for both Sr(2+) and its analogue Ca(2+) are temperature dependent. Thermodynamic analysis of the temperature effects indicates that the Arrhenius activation energies (E(a)) required for Sr(2+) uptake (91.9 kJ mol(-1)) and Ca(2+) uptake (105.9 kJ mol(-1)) in the whole body of carp were constant over the temperature range 10-25 degrees C and showed a break in the Arrhenius plots above this temperature. The Arrhenius plot for the Sr(2+) uptake in blood was similar to that for the whole body uptake with an E(a) of 98.1 kJ mol(-1). However, the E(a) for Sr(2+) uptake in gills was much smaller and constant (58.1 kJ mol(-1)) over the temperature range of 10-30 degrees C. For a temperature change from 10 to 25 degrees C, the Q(10) for Sr(2+) uptake in whole fish, gills and blood were 3.71, 2.29 and 4.05, respectively. Compared with Ca(2+) uptake, Sr(2+) uptake appears to require a lower activation energy for transport across the solution body interface in carp. The similar pattern of Arrhenius plots and magnitude of activation energies for Sr(2+) uptake both in blood and whole fish suggest that the uptake into the blood across the basolateral membrane is the rate-limiting energy barrier and hence dictates the overall uptake rate of Sr(2+) in whole fish.

A mechanistic model for the uptake of waterborne strontium in the common carp (Cyprinus carpio L.).

The release of radioactive strontium to the environment is of concern due to the strong accumulation of this calcium resembling element in the bone and other tissues. To predict the effects of changes in environmental conditions on the uptake of Sr2+ and Ca2+ by freshwater fish, a Michaelis-Menten type model is introduced that accounts for the effects of chemical speciation, hydrogen ion activity, and metal ion competition. The uptake kinetics were characterized in vivo from short-term exposure experiments using the common carp (Cyprinus carpio) as the model organism. Fish were exposed to a wide range of waterborne Sr2+ (0.2-10,000 microM) and Ca2+ (10-10,000 microM) concentrations and water pH (5.0-8.5). Strontium uptake by the whole body of fish increased with increasing Sr2+ activity, displaying saturation kinetics, but decreased significantly with increasing Ca2+ and H+ activities in the water. Likewise, calcium uptake by the fish decreased with increasing Sr2+ and H+ activities in the water. The model fitted to the pooled data explains 97.5% of the variation in Sr2+ uptake and 86% in Ca2+ uptake over the wide range of exposure conditions and reveals that Sr2+ and Ca2+ inhibit each other completely competitively, while H+ inhibits the uptake of both metal ions in a partially noncompetitive way. This model can be used as a mechanistic tool to predict the uptake of these metals in carp under variable conditions.