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Pituitary apoplexy (PA) is a clinical emergency arising from acute ischemia or hemorrhage of the pituitary gland. A small subset of pituitary adenomas present with an apoplectic crisis, with common symptoms being headache, nausea/vomiting, visual impairment, ophthalmoplegia, altered sensorium, panhypopituitarism, etc. Though diabetic ketoacidosis (DKA) is an established complication of uncontrolled diabetes mellitus, its association with PA is extremely rare. Likewise, supraventricular tachycardia (SVT) and acute limb ischemia (ALI) have rare, reported association with DKA. We present one such case of rare associations seen in our clinical practice. A 20-year-old woman was brought to our emergency room with headache, breathlessness, and altered sensorium. Clinical and biochemical evaluation revealed SVT, DKA, and right lower limb ALI. On enquiry, patient was found to be diagnosed with pituitary adenoma 2 years ago and lost to follow-up. PA was detected on neuroimaging and confirmed histopathologically. Possibility of PA presenting as DKA and its sequelae exists.

Genitourinary tract infections, mycotic as well as bacterial, as defined by clinical symptoms, are one of the common adverse effects associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients in clinical trials. However, Indian data in terms of the prevalence of culture-proven bacterial type of urinary tract infection (UTI), and the causative organism is limited.This study aimed to determine the prevalence and causative agents of bacterial UTI among patients with T2DM on SGLT2i.This was a prospective longitudinal study involving all patients with T2DM who were prescribed with SGLT2i, uncontrolled on other oral anti-diabetic medications, from June 2019 to February 2020. Prevalence of bacterial UTI was evaluated at baseline and 12 weeks after initiation of SGLT2i.A total of 80 patients were started on SGLT2i. One female patient on canagliflozin had significant asymptomatic bacteriuria and the causative agent wasIn this real-world study, SGLT2i as a class, was well tolerated with favorable safety profile, and risk of developing significant bacteriuria and/or symptomatic UTI was minimal.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or ‘inappropriately normal’ FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group.

Cystic lesions of the parathyroid gland are rare (0.5%–1% of all parathyroid pathologies). Macroscopic cysts larger than 1 cm in diameter are referred to as parathyroid cysts. These lesions can be either true parathyroid cysts or cystic degeneration of parathyroid adenomas. We present our experience of 4 patients with cystic lesions of the parathyroid gland. Three of these patients had parathyroid adenomas that were atypical due to their large size and cystic character. One patient had a true parathyroid cyst presenting with compressive features.

Background: Glucometers allow self-monitoring of blood glucose in a convenient manner. With the availability of various glucometers, there is a persistent attempt to improve the accuracy and the precision of these glucometer readings, so as to match the laboratory values of blood glucose. Objective: We compared the glucometers used in hospital and out-patient settings with the laboratory reference method. Materials and Methods: We analyzed a total of 105 blood samples collected from in-patient and out-patient from our tertiary care hospital. Venous blood samples were collected and checked on six glucometers and the same blood sample was sent to the laboratory for glucose estimation. The laboratory value was used as a reference for comparison. The accuracy was evaluated by the ISO criteria. The results were evaluated by Bland Altman graphs, correlation coefficients, scatter plots and Clarke′s error grid analysis. Results: We observed good correlation between bed side glucometer and laboratory automated analyzer. Among the in-patient glucometers Breeze 2, Performa and SureStep, the correlation coefficient was 0.97, 0.96 and 0.88 respectively. Among the outpatient glucometers One touch ultra 2, Active and Contour, the correlation coefficient was 0.97, 0.97 and 0.95 respectively. Conclusions: There is a good correlation between different glucometers and laboratory values especially in the out-patient settings. Among all in-patient glucometers, SureStep by Johnson and Johnson had least correlation coefficient, whereas all three out-patient glucometers correlated well with the laboratory values.

Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

Although laparoscopic adrenalectomy is well established for the treatment of adrenal pheochromocytomas, there is scant literature on a laparoscopic approach to extra-adrenal pheochromocytomas (EAP). We report on 2 patients with renal hilar pheochromocytomas treated by a laparoscopic resection. A 56-year-old hypertensive man was found to have a 3.5-cm tumor in the right renal hilum, which was confirmed to be a pheochromocytoma on the basis of elevated urinary vanillylmandelic acid levels and a positive 131I-MIBG scan. After pharmacological preparation, he underwent a laparoscopic excision. The recovery was uneventful and the final histopathology confirmed an EAP. The second patient, a 17-year-old hypertensive girl, was shown to have a 2.5-cm tumor in close proximity to the left renal vessels and a poorly functioning left kidney on a computed tomography scan. Subsequent isotope renogram showed 4% function in the left kidney. After adequate preparation, she underwent a laparoscopic left nephrectomy along with resection of the tumor. The postoperative period was uneventful. Histopathology showed an EAP. The kidney showed ischemic changes along with severe renal artery stenosis. The patients remain well 49 and 14 months post-surgery. In conclusion, careful preoperative preparation, expert intraoperative anesthetic management, and surgery performed by an experienced surgeon make laparoscopic resection of renal hilar pheochromocytomas a safe and feasible treatment option.

Introduction: The clinical spectrum of primary hyperparathyroidism (PHPT) has undergone a striking change with asymptomatic form predominant in developed countries, whereas symptomatic form predominant in developing countries. In this study, we have analyzed clinical presentation, investigations, management, operative findings in patients with PHPT at our center. Materials and Method: A retrospective, review of medical records of all patients with PHPT between 2000 and July 2012 at our institute was undertaken. A total of 96 patients were included in this study. Results: The mean age of patients was 50.8 years. Of the 96 patients, 63 were females (65.6%) and 33 were males (34.4%). Among them, 17.7% were asymptomatic and 82.3% were symptomatic. Bone pain was the most common complaint (52%) followed by renal stones (27%). Nearly 10.4% were part of familial PHPT, whereas others were sporadic adenomas. All patients had hypercalcemia (range 10.5–19.4 mg/dl) with elevated parathyroid (PTH) levels (range 32–3820 pg/ml). 25(OH) VitD levels were available in 86 patients (89.6%). There was no correlation between VitaminD levels and symptomatology. Sestamibi scan was true positive in 95.6%, false negative 2.2%, and inconclusive in 2.2%. Ultrasonography (USG) results were true positive in 84.2%, false positive in 6.3%, and false negative in 9.5%. Intraoperative PTH levels were measured in 83.3% patients. Postoperative complications were reported in 20.8% patients. Conclusions: Clinical spectrum of PHPT varies but bones and stones are still the predominant manifestations even in affluent society. Asymptomatic form also exists and can be detected by routine measurement of serum calcium. There was no correlation seen between the 25 VitD levels and clinical symptoms.