Search

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

Background: Dapagliflozin, a selective renal sodium-glucose cotransporter-2 inhibitor (SGLT2i), lowers plasma glucose by increasing urinary excretion of glucose. This study evaluated the efficacy and safety of dapagliflozin as add on therapy for a selected group of Bangladeshi type 2 diabetic patients. Methods: This was a 24-week, open-label, prospective, real-life study including type 2 diabetic patients with glycated hemoglobin (HbA1c) 7.0–10% (N =53). Study subjects were selectively assigned to dapagliflozin 5 mg once-daily in the morning along with ongoing oral anti-diabetic drug (OAD). The primary end point was to see the safety (adverse events) and efficacy (reduction of fasting and post-prandial blood glucose, HbA1c) of dapagliflozin. Results: Mean HbA1c changes from baseline to week 24 was – 1.15 ± 0.82 % (P = 0.000) and weight reduction was – 2.49 ± 0.32 kg from base line (P=0.000). Among total study subjects, 6 (11.3 %) had developed urinary tract infection (UTI). There were no major episodes of hypoglycemia or renal function deterioration. Conclusion: Dapagliflozin showed significant reduction of HbA1c as add on therapy. The low incidence of hypoglycemia and UTI make dapagliflozin as an acceptable addition to existing treatment option for type 2 diabetes in Bangladeshi population. Birdem Med J 2021; 11(1): 57-62

Background: Since March 2019 the outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Bangladesh. There is variable presentation of COVID-19. Though SARS-CoV-2 primarily involves respiratory system, as time passing on it is evident that it can affect any other system including gastrointestinal, cardiovascular and neurological system. This study described the characteristics of the patients admitted in Department of Endocrinology, BIRDEM General Hospital with non-COVID illness and later revealed positive for SARS-CoV-2. Methods: This observational study was conducted during the period of 13th April to 14thOctober, 2020.Data of all patients admitted in Department of Endocrinology, BIRDEM General Hospital during this period was retractedretrospectively from hospital electronic medical records with prior permission from institutional head. Though admitted for non-COVID illness, patientshavingsymptoms or supportive lab investigations of COVID- 19 were advised RT-PCR for SARS-CoV-2. All hospital records of these suspected COVID-19 cases wererecoded and analyzed by SPSS version 20. Results:Total patients were 63. Among them 21(33.3%) patients were admitted with uncontrolled diabetes (DM),19(30.2%) had other endocrinopathies(later query revealed history of fever),8(9.5%) had newly detected DM,11(7.5%)had hypoglycemia,6(9.6%) had general weakness. Though all study subjects were advised to do RT-PCR for COVID, 22(34.9%) refused the test either due to symptom denial or due to cost of the test and 24(38.1%) become positive. Conclusion: Non-critically ill COVID-19 patients had variable clinical characteristics. This study shows that uncontrolled diabetes mellitus, newly detected diabetes and hypoglycemia are found in patients with COVID- 19 and may not have typical clinical features. Birdem Med J 2020; 10, COVID Supplement: 29-32

Adrenal sarcomatoid carcinoma (ASC) are very rare and aggressive malignant tumors of adrenal glands containing both epithelial (carcinomatous) and mesenchymal (sarcomatous) components. ASC presents a diagnostic challenge due to its atypical symptoms and histological patterns which influence treatment.At the time of diagnosis, a large percentage of patients are already at the metastatic stage and succumb within a few months. Here, we report a case of functional sarcomatoid carcinoma in right adrenal gland in a 37-year-old female, who presented with new onset hypertension. The patient underwent right sided adrenalectomy and she was alive at the time of writing the current report.To the best of our knowledge, ASC reported in literature to date showed only few patient presented with endocrine hypersecretion and only one patient presented with both hypertension and endocrine dysfunction. So, our case is the rarest among the rare. Birdem Med J 2020; 10(1): 73-75

Objective: The study was aimed to describe the patterns of single anti-diabetic agents used by type 2 diabetic patients and their glycemic status during hospital admission.Study design and methods: This cross-sectional study was carried out in BIRDEM among hospitalized type 2 adult diabetic patients of different ages and both sexes. Data were collected during admission that included detailed history, medical records review, clinical examination and laboratory investigations.Results: Subjects (n=253; 174 female, 79 male) had age (years) as mean ± SD: 55.28 ±13.45 (15- 90 years), BMI (kg/m2) as mean ±SD: 24.67±4.97 and HbA1c (%) as mean ±SD: 10.56±2.98. Use of pre-mixed insulin 90 (35.57%) and split-mixed insulin 70 (27.66%) were more common than other drugs. Glycaemic control was poor in all age groups as evidenced by raised HbA1c, significantly higher in patients

Primary hyperparathyroidism is often asymptomatic, may be detected during routine investigations or may present with features of hypercalcaemia. Vitamin D deficiency causing secondary hyperparathyroidism presents with musculoskeletal symptoms. Studies have shown an association between primary hyperparathyroidism and vitamin D deficiency. It has also been observed that when co-exist, these two conditions contribute to each other’s disease presentation and severity. This case report depicts initial asymptomatic hyperparathyroidism developing symptoms due to co-existing parathyroid adenoma and vitamin D deficiency in a 26-year-old muslim Bangladeshi female who responded well to adequate pre, per and post parathyroidectomy medical managementBirdem Med J 2015; 5(2): 104-106

A 50-year-old, prematurely postmenopausal diabetic woman was admitted in the Endocrinology department of BIRDEM with the complaints of vomiting, loose motion, lethargy, profound weakness. Previously she suffered from several episodes of electrolyte imbalance and after investigations adrenal insufficiency was diagnosed on 2010. No evaluation was done for her premature menopause. During this episode of illness, she was found with postural hypotension, hyponatremia, dyslipidemia and panhypopituitarism. MRI of sella and parasellar region was done which revealed features suggestive of empty sella. This case gives insight that early menopause warrants proper evaluation and during evaluation, along with other factors hypopituitarism should be considered as an etiology for this condition. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12362 Birdem Med J 2012; 2(1) 52-55

Aim and Background: Free IGF-1 and IGFBP-1 are associated with obesity which is one of the major features of insulin resistance. But very few studies exist on free IGF-1 and IGFBP-1 in IGT subjects. The present study was undertaken to investigate the association of free IGF-1 and IGFBP-1 with insulin sensitivity in IGT subjects. Subjects and Methods: Ninety-one subjects with impaired glucose tolerance (IGT) were studied along with age- sex- and BMI-matched sixty-one healthy Controls without family history of diabetes or prediabetes. Insulin, free IGF-1 and IGFBP-1 were measured by standard ELISA method. Insulin secretory capacity (HOMA B) and insulin sensitivity (HOMA S) were calculated using fasting glucose and fasting insulin by HOMA-CIGMA software. Results: Fasting free IGF-1 and IGFBP-1 levels were not significantly different among the study groups. In stepwise multiple regression analysis, when free IGF-1 was considered as a dependent variable with other independent variables, model 1 (β = −0.352, p = 0.03), model 2 (β = −0.355, p = 0.033) and model 5 (β = −0.378, p = 0.026) have shown significant association of fasting glucose with free IGF-1. Similarly when IGFBP-1 was considered as a dependent variable, model 4 (β = −0.865, p = 0.03) and model 5 (β = −0.1.07, p = 0.004) have shown negative association of fasting glucose with IGFBP-1. In this analysis model 5 have also shown negative association of HOMA S with IGFBP-1 (β = −1.015, p = 0.017). Conclusion: IGF1 and IGFBP-1 seems to be negatively associated with fasting glucose in IGT subjects and insulin sensitivity (HOMA S) may also be negatively associated with IGFBP-1 in IGT subjects.