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Diabetic ketoacidosis (DKA) is more commonly seen in children with type 1 diabetes and acute acidosis is usually precipitated by infections, trauma and surgery. Rarely, ketoacidosis can be precipitated by dengue often leading to management challenges in achieving haemodynamic stability. Occurrence of both conditions together warrant meticulous monitoring of fluid balance and control of blood glucose levels to manage both conditions optimally. Both type1 and type 2 diabetes upsurge the release of pro-inflammatory cytokines by various mechanisms and intensify the risk of plasma leakage. As prevalence of diabetes is lower in children compared with adults, diabetic ketoacidosis presenting with dengue is rare in the paediatric age group. We report a 14-year-old diagnosed child with type1 Diabetes mellitus who presented with dengue fever and subsequently developed dengue haemorrhagic fever and diabetic ketoacidosis concurrently. Both conditions were successfully managed with appropriate use of intravenous fluids and insulin. He had a complicated course with secondary bacterial infection needing intravenous antibiotics for 14 days. Ultimately he was discharged with his routine regimen of insulin and follow up was arranged at the endocrinological clinic.

Tall stature is less commonly referred to specialist care. Familial, nutritional and hormonal causes are mainly encountered. Beckwith Wiedemann Syndrome (BWS) is a rare congenital disease, referred as an overgrowth syndrome. Affected children tend to be taller than their peers during childhood. Children with BWS are at increased risk of childhood cancer, regular screening will prompt for better outcome. We present a 7 year-old girl child with BWS referred for evaluation of tall stature.

Androgen insensitivity syndrome results from a mutation in androgen receptor gene. It has wide spectrum of phenotypic presentations. Mild androgen insensitivity syndrome (MAIS) is the milder form, present as undervirilized male syndrome. In some instances, the only observed abnormality appears to be male infertility; therefore, MAIS could explain some cases of idiopathic male infertility. Here we describe a case of MAIS in a 38 years old male who presented with azoospermia and infertility.

Introduction:The prevalence of childhood obesity has increased over the recent decades. Obesity is a major risk factor for chronic diseases and plays a central role in insulin resistance and metabolic syndrome. Methods:The aim of the study was to assess the prevalence of obesity and abdominal obesity by means of body mass index (BMI) and waist-to-height ratio (WHtR) in adolescent girls in a National school in Batticaloa, Sri Lanka. Based on age and sex specific BMI percentiles (CDC Chart), the students were classifiedas underweight (thpercentile), normal weight (5th-thpercentile), overweight (85th-thpercentiles), and obese (≥95thpercentile). Central obesity was categorized as WHtR ≥ 0.5. Adolescent girls (aged 14-19 years) attending the ten & twelve grades (n = 310) in a girl’s high school at Batticaloa were participated in the study. Results:The prevalence of obesity and overweight were 5.5% and 9.4% among the girls. The prevalence of central obesity was 21.6%. Around 11.16% of girls in the normal weight group were centrally obese. There was a significant relationship between WHtR and BMI status (P = 0.0001). Conclusion:Our study provides evidence showing a high prevalence of overall and central obesity in adolescent girls in our population. We emphasize the need for further large-scale surveillance programs and preventive strategies in our population to reduce the incidence of obesity.

Introduction: Thalassaemia major is an inherited haemoglobinopathy characterised by chronic anaemia. Excessive iron overload and suboptimal chelation result in deposition of iron in various tissues including endocrine glands. Objective: To estimate the prevalence of endocrinopthies in patients with thalassemia major among patients attending clinics at Teaching Hospital Batticaloa. Materials and Methods: Cross sectional descriptive study of patients with thalassemia major on active follow up from June 2015 to 2016 at Teaching Hospital Batticaloa. Height, weight, and tanner staging, serum ferritin, oral glucose tolerance test, bone profile, liver and renal function, thyroid function, cortisol for all patients and FSH, LH, testosterone or oestradiol for girls over 13 years of age and boys over 14 years of age were assessed. Results: A total of 95 patients including 50 females with the mean age of 11.83±4.53 years were evaluated. Shortstature was found in 55(57.8%). Hypocalcaemia was present in 36(37.8%) and 24(25%) had hypothyroidism. Diabetes mellitus and impaired glucose tolerance (IGT) were found in 7(7.4%) and 13(13.2%) respectively. Only 2 (2.1%) had cortisol deficiency. Among girls over 13 and boys over 14 years of age, 33(78.6%) had hypogonadism. Sixty six patients with mean serum ferritin level above 2500ng/mL had higher incidence of hypocalcaemia, hypothyroidism, hypogonadism, and short stature (28 vs 5;p=0.004, 18 vs 6;p=0.048, 28 vs 5;p=0.03, and 39 vs 16;p=0.054 respectively) than those who had less than 2500ng/mL. Patients who were above 9 years of age had higher incidence of hypocalcaemia (32 vs 2;p=0.00), short stature (33 vs 22;p=0.026), and IGT (11 vs 2;p=0.017) when compared to younger patients. Conclusions: A significant proportion of thalassemia major patients have endocrinopathies. Hypothyroidism and short stature develop very early and other endocrinopathies also develop earlier indicating the need for early screening compared to the recommended guidelines. As the duration of thalassemia increases the risk for developing endocrinopathies is high.

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Phaeochromocytoma is an endocrine tumour that originates in catecholamine producing chromaffin cells of the adrenal medulla. Approximately 10% are malignant but there are no precise histological or biochemical markers to distinguish these from benign ones. The presence of metastases at distant sites is the most reliable clue but histologic features utilized in several scoring systems aid in predicting malignancy. Malignant phaeohromocytoma predominantly secrete noradrenaline and there may be high dopamine levels. Increased levels of chromogranin A, negative staining for inhibin/activin beta subunit and presence of SDHB mutation are the other factors associated with malignant potential. Multi modality evaluation with combination of CT, MRI, SPECT and radionuclide scintygraphy augments the diagnostic yield. Recent advance in molecular diagnostic markers further improved the knowledge in predicting malignant potential. Currently available therapeutic options are surgical debulking, pharmacological therapy for excess catecholamines, radionuclide therapy, antineoplastic therapy and external radiotherapy. These modalities provide symptomatic relief and biochemical control, but with no significant survival benefit. The development in the field of molecular pathway responsible for the malignant potential of phaeochromocytoma gives a hope to future therapy.DOI: http://dx.doi.org/10.4038/sjdem.v4i1.7253Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2014; 4: 40-42

The etiology of slipped capital femoral epiphysis (SCFE) remains uncertain. The frequent findings of growth abnormalities in affected patients lead to the hypothesis that various endocrine disorders cause this condition. We encountered a 14-year old boy referred by an orthopedic surgeon with the clinical presentation of lack of age appropriate sexual maturation. He had bilateral slipped capital femoral epiphysis and underwent surgical correction. Further examination and hormonal assessment revealed hypogonadotrophic hypogonadism which persisted over the next six months.DOI: http://dx.doi.org/10.4038/sjdem.v1i1.4196 Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2011; 1: 48-50

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2: S1-S20 DOI: http://dx.doi.org/10.4038/sjdem.v2i2.4786

Objective(s):Diabetes mellitus, a carbohydrate metabolic disorder, occurs due to absolute or relative deficiency of insulin. Current treatment strategies involve either preventing or delaying the intestinal absorption of glucose to lower the levels of postprandial hyperglycemia (PPHG). Herbal remedies have been since ancient times for treating diabetes mellitus. Therefore, identifying novel phytocompounds with α-amylase and α-glucosidase inhibitory activity that would reduce the glucose absorption as well as the rise in postprandial blood glucose level is vital. Consequently, the present study was aimed to investigate the anti-hyperglycemic activity of Croton bonplandianusagainst these pancreatic enzymes. Materials and Methods: The methanol extract of C. bonplandianusleaf was prepared and further fractionation was performed with n-hexane, ethyl acetate and chloroform. The antioxidant activity and anti-hyperglycemic activity of the extracts and its fractions were determined. Further, GC-MS analysis was performed for the leaf extract. Results:The chloroform fraction (ChF) was found to contain highest quantity of polyphenols (114.28 µg/ml of GAE), flavonoids (95.68 µg/ml of quercetin) and tannins (63.80 µg/ml of GAE) and also possessed effective inhibitory activity against α amylase (IC5095.78 µg/ml) and α glucosidase (IC50 126.81 µg/ml). The antioxidant activity of ChF was also higher when compared to other fractions. Further, GC-MS analysis of ChF showed the presence of various components that may be responsible for the above mentioned activities. Conclusion:The study findings suggest that the components present in the leaves of C. bonplandianus, may provide a potential therapeutic source in developing treatment forhyperglycemia. Further bioassay guided fractionation procedure is required to identify the active constituents. [ABSTRACT FROM AUTHOR]