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Background: Vitamin D level has profound clinical implications but there is dilemma of optimal vitamin D cut-off level among Bangladeshi population as well in many parts of the world. This study aimed to determine the sufficient level of vitamin D [25 hydroxyvitamin D, 25(OH)D] in relation to intact parathormone (iPTH) in apparently healthy adult volunteers. Materials and Methods: This cross-sectional study was carried out among 130 apparently healthy adult participants [age (years): 37.57±12.23, mean±SD; m/f: 67/63] in Bangabandhu Sheikh Mujib Medical University, Dhaka. Demographic profile, sunlight exposure and dietary history were taken, physical examinations were done and fasting blood was taken to measure 25(OH)D, iPTH, calcium, albumin and phosphate. Serum 25(OH)D was measured by high performance liquid chromatography whereas iPTH, serum calcium, albumin and phosphate were measured by chemiluminescent Method. Results: The mean serum 25(OH)D of apparently healthy Bangladeshi adults was 15.44 – 18.44 ng/ml. Vitamin D level was significantly affected by age group [p=0.002], sunlight exposure time [p=0.013] and body surface area [p=0.023] along with sunscreen use [p=0.026]. Serum 25(OH)D had negative predictive association with iPTH [β=-0.220, p=0.012] and positive predictive association with daily sunlight exposure time [β=0.235, p=0.007]. Serum 25(OH)D level above 30 ng/ml was sufficient to keep maximum suppression of iPTH at 54.56 pg/ml by using the quadratic model. Conclusion: The optimal level of 25(OH)D for apparently healthy adults in Bangladesh is above 30.0 ng/ml. J MEDICINE 2022; 23: 139-145

Introduction: Secondary hyperparathyroidism due to vitamin D deficiency (VDD) is thought to play a role in glucose homeostasis. The aim of this study was to determine the association of parathormone and vitamin D with prediabetes and its different cardiovascular risk factors. Methods: This crosssectional study was conducted among 117 adults with newly detected prediabetes. Participants were recruited consecutively from the Department of Endocrinology, BSMMU to measure serum 25- hydroxyvitamin D by high performance liquid chromatography, intact parathormone (iPTH) by chemiluminescent enzyme-labeled immunometric assay; fasting insulin by chemiluminescent microparticle immunoassay and glucose by glucose oxidase method to calculate homeostasis model assessment of insulin resistance (HOMA-IR). Results: Patients with hyperparathyroidism had significantly higher percentages of VDD than those with normal parathyroid status. Only percentages of impaired glucose tolerance (IGT) status had significant association with the combined iPTH and vitamin D groups. Serum iPTH significantly correlated with age, HbA1C, vitamin D and HOMA-IR. Hyperparathyroidism had significant predictive association with only IGT and hypovitaminosis D in adults with prediabetes. Conclusion: VDD combined with high PTH may be associated with glycemic dysregulation in adults with prediabetes especially in IGT without any significant associations with its cardiovascular risk factors. Bangladesh J Medicine 2022; 33: 154-160

Objectives: Data regarding vitamin D level and status among categories of prediabetes are scarce in the literature. This study is aimed to determine the level and status of vitamin D among adults with prediabetes and its different categories. Materials and methods: This crosssectional study was carried out in 111 newly detected adults with prediabetes according to American Diabetes Association 2018 criteria and 74 matched healthy control (normal glucose tolerance). People with prediabetes were categorized into impaired glucose tolerance, impaired fasting glucose and their combination group. Participants were recruited consecutively from the Department of Endocrinology, BSMMU to measure serum 25 hydroxyvitamin D by high performance liquid chromatography and serum intact parathormone, calcium, albumin and phosphate by chemiluminescent enzyme-labeled immunometric assay. Results: Vitamin D level and status were not significantly different between people with prediabetes & control and also in different categories of prediabetes. Severe vitamin D deficiency was significantly higher in people with prediabetes (27.5% vs 10%, p= 0.05). There were no associations between different blood glucose levels with vitamin D among adults with prediabetes. Conclusions:Vitamin D was not associated with prediabetes or its categories. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 120-128

Background: Vitamin D may play important role in the pathogenesis of several components of metabolic syndrome (MS). The aim of this study was to observe the association of vitamin D with MS and its components in Bangladeshi adults with prediabetes. Methods: This cross-sectional study was done among 117 newly detected nonpregnant adults with prediabetes [age (years): 36.30±9.99; BMI (kg/ m2): 28.89±4.35, mean±SD; M/F: 23/94] based on American Diabetes Association 2018 criteria. Metabolic syndrome was diagnosed by any three of five criteria: central obesity; elevated blood pressure, fasting blood glucose & triglyceride (TG) and lower HDL cholesterol. Glucose was measured by glucose oxidase, lipid by glycerol phosphate dehydrogenase-peroxidase and vitamin D by high performance liquid chromatography method. Vitamin D

Improved treatment has increased survival of patients with thalassemia. However, they still suffer from several endocrine complications mainly as a result of iron overload from multiple transfusions. Endocrinopathies manifest as early as the first decade of life, affecting growth, puberty, psychological development and quality of life. The presence of concomitant anemia, chronic liver disease and cardiomyopathy affect the development and treatment of endocrine disorders, making endocrinopathies in thalassemia a complex disorder. This review focuses on the pathogenesis, diagnosis and treatment of endocrinopathies in transfusion and non transfusion dependent thalassemia. The main points that should be considered in the management of endocrine disorders in a patient with thalassemia are highlighted in this review. IMC J Med Sci 2021; 15(1): 008. OPEN ACCESS *Correspondence: Tahniyah Haq, Department of Endocrinology, Room 1620, 15th Floor, Block D, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. Email: tahniyah81@gmail.com

Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the literature. This study is aimed to determine the association of visceral adiposity index (VAI) with insulin resistance in adults with prediabetes. This cross-sectional study was done among 117 adults with newly detected prediabetes [m/f; 23/94; mean ± SD: Age 36.30 ± 9.99 years, BMI 28.89 ± 4.35 kg/m2] based on American Diabetes Association 2018 criteria and 141 matched healthy controls [m/f: 28/113; mean ± SD: 35.30 ± 6.88 years, BMI 25.03 ± 4.58]. Waist circumference, body mass index, fasting triglyceride, HDL cholesterol, fasting blood glucose and insulin were measured in each group to calculate VAI and homeostatic model assessment of insulin resistance (HOMA-IR). People with prediabetes had significantly higher median value of VAI {3.08 (2.26) vs. 1.86 (2.31); p 1) (98.3% vs. 85.8%; p < 0.001) than the control population. HOMA-IR level was significantly higher in prediabetes with high VAI (cut-off of 2.64) than control with normal VAI [2.78 (2.22, 4.15) vs. 2.20 (1.53, 3.36); p = 0.002]. VAI was positively correlated with HOMA-IR in females with prediabetes (r = 0.299, p = 0.003). VAI had predictive association with prediabetes [OR (95% CI: 9.504 (2.173, 41.576); p = 0.03] and high insulin resistance (HOMA-IR ≥ 2.6) in females with prediabetes [OR (95% CI) = 3.50 (1.476, 8.297); p = 0.004] only. It could satisfactorily discriminate prediabetes in both sexes (male: AUC = 0.767, p = 0.001; female: AUC = 0.641, p < 0.001) and high insulin resistance in females with prediabetes (AUC = 0.641; p = 0.019) only. So, VAI was associated with prediabetes and insulin resistance only in females with prediabetes.

Background and objectives: Visceral adiposity is linked to excess morbidity and mortality and positively correlates with the risk of insulin resistance, type-2 diabetes mellitus, cardiovascular disease and premature death. The study was conducted to find out the relationship between visceral adiposity index (VAI) and homeostatic model assessment insulin resistance (HOMA-IR) in diabetes mellitus (DM). Materials and methods: This cross sectional study was carried out on adult population with and without DM. Waist circumference (WC) and body mass index (BMI) were measured. BMI of 25-29.9 kg/m2 and ≥30 kg/m2 was defined as overweight and obese respectively. HOMA-IR method was used to calculate insulin resistance (IR). Standard formula using BMI, WC, triglyceride (TG) and high density lipoprotein cholesterol (HDL-c) was used to calculate VAI. Blood was analyzed for fasting blood glucose (FBS), TG, HDL-c and insulin level. Results: A total of 439 individuals were included in the study of which 269 had DM and 170 were healthy volunteers and the mean age was 41.47±6.82 and 36.16±7.44 years respectively. Compared to healthy controls, a greater number of diabetics had high VAI (86.5% vs. 98.9%) and high IR (43.5% vs. 85.1%). We found the highest sensitivity and specificity at a cut-off of 2.23 of VAI while at 3.65 had the highest specificity. Insulin resistance was observed significantly higher in those with diabetes compared to control, both in case of normal and high VAI at all cut-offs of VAI. Among anthropometric parameters (WC, BMI and VAI), VAI had positive (r=0.21, p

Background and objectives: Metformin improves macrovascular complications in people with diabetes mellitus (DM). Although the exact mechanism is not known, metformin has beneficial effects on dyslipidaemia. The aim of the study was to find out if there was an effect of metformin on blood lipids in people with diabetes mellitus. Method: This was a cross-sectional study which included 80 patients with diabetes mellitus. They were divided into 2 groups – (a) Group 1: on metformin and (b) Group 2: without metformin medication. None of the patients were on any other anti-diabetic medication. All data were obtained from patients’ medical records. Individual blood lipids and lipid ratios were compared between two groups. Result: Group 1 included 42 patients with a mean HbA1c of 7.58 ± 0.24% taking an average dose of 820.83 ± 60.40 mg/day of metformin. Group 2 consisted of 38 patients with mean HbA1c of 7.58 ± 0.29%. There was no significant difference in individual plasma lipid levels, lipoprotein ratio or frequency of dyslipidaemia between patients taking and not taking metformin (p>0.05). Also, different doses of metformin had no significant effect on the plasma lipid levels. Conclusion: Metformin did not affect the lipid profile of patients with diabetes mellitus. IMC J Med Sci 2019; 13(2): 004. EPub date: 22 August 2019 Address for Correspondence: Dr. Tahniyah Haq, Assistant Professor, Department of Endocrinology, Room 1620, 15th Floor, Block D, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh. Email: tahniyah81@gmail.com

Background and aims: Hypothyroidism is a common global endocrine disorder. The magnitude of hypothyroidism at community level in Bangladesh is unknown except some clinic-based studies. The present study was undertaken to determine the prevalence of hypothyroidism in different occupational groups of Bangladeshi population and to assess the risks related to it. Study design: Three occupational groups (house-wives, college students, rickshaw-pullers) of native Bangladeshi population were purposively selected. Investigations included socio-demography, anthropometry, blood pressure and biochemistry [fasting blood glucose, lipids, thyroid stimulating hormone (TSH) and free thyroxin (FT4)]. Laboratory tests were done only on a randomized sample of participants. Results: Overall, 626 (M/F=123 / 503) participants with a mean age of 35.9 (34.75 – 37.02) years volunteered. The mean values of all participant for TSH and FT4 were 2.08 (95%CI: 1.72 – 2.45) μiu/ml and 13.04 (95CI:12.86 – 13.22) pmol/L respectively. The third percentile of TSH ranged from 0.42 to 0.46 μiu/ml and 97th percentile ranged from 5.16 to 5.24 μiu/ml. For FT4, the 3rd and the 97th percentile were 10.3 and 16.41 pmol/L, respectively. The prevalence of hypothyroidism in both sexes was 7.0% (M/F=4.1/8.3%). Occupational groups, sex and increasing age, obesity, blood pressure, and lipids showed no association with hypothyroidism. Hyperglycemia was proved to be a significant risk for hypothyroidism (prevalence in diabetic vs. non-diabetic was12.9% vs. 5.5%, p = 0.04; FBG was correlated with TSH, r = 0.138, p

Aims The aim was to see the frequency of CAN in type 2 diabetes mellitus patients with peripheral neuropathy, and its association with peripheral nerve conduction abnormalities. Methods A cross-sectional study at BIRDEM was conducted in 62 patients with type 2 diabetes mellitus having electrophysiologically diagnosed peripheral neuropathy. CAN was detected by four clinical tests - heart rate response to deep breathing and valsalva maneuver, blood pressure response to standing and sustained handgrip. Result The study showed that all patients had CAN – 14.52% had early, 26.67% had definitive and 59.68% had severe CAN. Patients with severe CAN had significantly reduced nerve conduction velocity and amplitude of peripheral nerves (sural 4.36 ± 12.77 vs 9.65 ± 17.77 m/s, p = 0.009; 2.23 ± 1.89 vs 3.01 ± 2.76 mV, p = 0.001; peroneal 7 ± 4.23 vs 8.53 ± 5.99 mV, p = 0.047; tibial 0.008 ± 0.03 vs 0.026 ± 0.05 mV, p = 0.009) and higher serum triglyceride levels (221.17 ± 120.61 vs 197.76 ± 68.43 mg/dl, p = 0.033). Conclusion Diabetic patients with peripheral neuropathy have CAN, the severity of which increases with worsening neuropathy.

Introduction: Childhood obesity is increasing dramatically and represents an important public health issue due to associated metabolic and cardiovascular comorbidities. Very limited data are available regarding cardiometabolic risk factors among this group in Bangladesh. Objective: To observe the cardiometabolic risk factors in overweight and obese children. Methods: This cross-sectional study was carried out in 88 overweight and obese children recruited consecutively by using CDC percentile chart for body mass index (BMI) in children between January 2017 and March 2018 in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. After completing a questionnaire and relevant clinical examination, blood was collected for fasting plasma glucose (FPG), insulin, HbA1c, lipid profile and C-reactive protein (CRP). Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to determine insulin resistance. Results: Central obesity (100%), dyslipidaemia (88.6%), raised CRP (81.8%) and metabolic syndrome (69.3%) were the most common cardiometabolic risk factors. Children with grade 3 obesity had significantly higher systolic blood pressure (115.57 ± 11.60 vs 105.71 ± 8.84 mmHg, p = 0.043) and insulin resistance (7.15 ± 4.97 vs 3.53 ± 2.04, p = 0.017) than grade 1 obesity. Blood pressure, insulin resistance and CRP increased while high density lipoprotein (HDL) decreased with increasing severity of obesity. BMI z score was a significant predictor of systolic blood pressure; waist circumference was an independent predictor of diastolic blood pressure and HDL; waist height ratio best predicted insulin resistance, CRP and total cholesterol in overweight/obese children. Conclusions: We have observed a high frequency of cardiometabolic risk factors in overweight and obese children and they increased worsened with increasing grade of obesity.

IntroductionVitamin D level has profound clinical implications but there is dilemma of optimal vitamin D cut off level among Bangladeshi population as well in many parts of the world. This study aimed to determine the optimal level of vitamin D in relation to intact parathyroid hormone (iPTH) and serum calcium in apparently healthy adult volunteer.MethodsThis observational cross-sectional study was carried out in 130 apparently healthy adult participants of BSMMU. All the subjects were taken their demographic profile and investigated for vitamin D level, iPTH, corrected calcium and phosphate. Serum 25(OH)D was measured by high performance liquid chromatography (HPLC) whereas iPTH, corrected serum calcium and serum phosphate were measured by chemiluminescent method.ResultsThe mean 25(OH)D level was found to be 16.78(SD8.47) ng/ml and extensively distinct by age distribution and adequacy of sun exposure. There was substantially inverse correlation between serum iPTH and serum 25(OH)D (r = - 0.22, p = 0.01). Serum 25(OH)D levels < 27.5ng/ml were associated with a steep increase in serum iPTH levels. Serum iPTH was stabilized at level 54.5pg/ml by using the quadratic fit with plateau model.ConclusionsFrom this study the optimal level of 25(OH)D for apparently healthy adult in Bangladesh is 27.5 ng/ml.

We present a 16-year girl, second issue of a consanguineous couple presented with painless symmetrical bony swellings around hips for 3 years. She lost 25 kg weight due to profound anorexia in the first year of illness and developed secondary amenorrhea. Last 7 months she had repeated generalized tonic clonic seizure due to hypocalcaemia. The bony swellings were located in both gluteal regions and were 30x35 cm2, hard and non tender. Mobility of hip joints were restricted. Except for severe wasting as a part of generalized cachexia other systemic examination was unremarkable. Investigations revealed anaemia (Hb-E trait), low albumin, low corrected calcium (during convulsions) otherwise normal, persistently high phosphate & vitamin-D level, normal iPTH & alkaline phosphatase (ALP), low serum ascorbic acid, normal ESR & CRP. X-ray & CT scan of pelvis showed large calcified mass in periarticular soft tissues. Biopsy confirmed presence of dystrophic calcification. Diagnosis of tumoral calcinosis was based on biochemical parameters, imaging and biopsy findings. A homozygous novel mutation in FGF homology domain: B-21 mutated from G to A at 232 in exon 2. As a result glutamic acid is replaced by lysine. Phosphate restricted diet and phosphate lowering agent improved biochemical paramaters. Surgical excision has been withheld. Contemporary manifestation of hFTC and Hb E trait; two disease of autosomal recessive inheritance in an individual makes it extremely rare. High index of suspicion is needed for early diagnosis and treatment.

The discovery of brown adipose tissue (BAT) in adults has sparked interest in its role as a therapeutic target in metabolic disorders. Infrared thermography is a promising way to quantify BAT; however, a standardized methodology has not been established. This study aims to establish a standardized and reproducible protocol to measure thermal response to cold in the supraclavicular area using thermographic imaging. In Phase 1, we compared the thermal response to 12 °C cold after acclimation at either 32 °C or room temperature using thermographic imaging. Repeatability of the 32 °C acclimation trial was studied in a second group in Phase 2. Phase 1 included 28 men (mean age 23.9 ± 5.9 y; mean BMI 25.2 ± 3.9 kg/m2) and Phase 2 included 14 men (mean age 20.9 ± 2.4 y; mean BMI 23.6 ± 3.1 kg/m2). The thermal response was greater after 32 °C than after room temperature acclimation (0.22 ± 0.19 vs 0.13 ± 0.17 °C, p = 0.05), was not related to outdoor temperature (r = −0.35, p = 0.07), did not correlate with supraclavicular fat (r = −0.26, p = 0.21) measured with dual-energy x-ray absorptiometry and was repeatable [ICC 0.69 (0.14–0.72)]. Acclimation at 32 °C followed by cold generates a reproducible change in supraclavicular skin temperature measurable by thermal imaging that may be indicative of BAT metabolic activity.

Background and aims: Although vitamin D deficiency (VDD) is inversely associated with glucose intolerance, very limited data are available in Bangladesh. Thus, the study aimed to determine vitamin D status of Bangladeshi adults based on the glucose intolerance status. Materials & Methods: This cross-sectional study was carried out among 70 newly detected DM, age-group & sex-matched 76 newly detected pre-diabetes and 74 healthy control with normal glucose tolerance (NGT) based on American Diabetes Association, 2018 criteria. Participants were included consecutively from the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of 1 year by convenient sampling to see serum 25(OH)D which was measured by high performance liquid chromatography (HPLC) method. Results: Vitamin D levels decreased with increasing degrees of glucose intolerance [NGT: 16.82±6.57; prediabetes: 15.54±8.58; T2DM: 11.01±6.03 ng/ml, p

not availableBangladesh Med J. 2016 Sep; 45 (3): 175-177

We describe a case of a 26 years old man who presented with adrenocortical insufficiency followed by hypoparathyroidism and subsequently mucocutaneous candidiasis. He also had nail dystrophy, cataract and alopecia, but no other endocrinopathies. He was diagnosed as a case of autoimmune polyendocrine syndrome type 1(APS 1). APS1 is a rare endocrine disorder and only a few cases have been reported from Bangladesh. IMC J Med Sci 2016; 10(1): 33-35

Aim: Diabetes mellitus is a metabolic disorder that causes disturbances in the electrolyte regulating mechanisms of our body. The purpose of the study was to determine the pattern of electrolyte imbalance in patients with diabetes mellitus and compare with healthy individuals; and to correlate the degree of electrolyte imbalance with control and duration of diabetes. Methods: This cross-sectional study was conducted over a period of 6 months. It included 90 cases with diabetes mellitus and 50 cases without diabetes mellitus. All subjects had normal serum creatinine level. Serum electrolytes (sodium, potassium, chloride and bicarbonate) were measured in each subject by automated methods. The normal levels of sodium, potassium, chloride and bicarbonate were taken as 136-146, 3.5-5, 102-109 and 22-30 mmol/L respectively. Levels above or below this reference were taken as abnormal. Control of diabetes was determined by measuring HbA1c using high-performance liquid chromatography. Result: The most common abnormalities in patients with diabetes mellitus were hypochloraemia (48.89%), low serum bicarbonate (23.33%) and hyponatraemia (11.11%), though the mean values of serum electrolytes were within the normal reference range. Serum bicarbonate level was significantly lower in the group with diabetes mellitus (p = 0.010). There were a significantly greater number of cases with hyponatraemia and hypochloraemia among cases with diabetes mellitus (p < 0.016). Serum sodium was negatively correlated with glycaemic control (r = -0.39; p

Objective: Medullary thyroid carcinomas (MTCs) originate from parafollicular C cells and produce the hormone calcitonin, which is primarily responsible for the biochemical dysfunction in calcium metabolism seen in MTC. MTCs constitute only about 5 to 7% of thyroid neoplasms. In rare cases, serum calcitonin can be normal or undetectable.Methods: We present the clinical examination and laboratory findings of a patient with MTC and a review of the literature.Results: A female of 65 years was suspected to have MTC after fine-needle aspiration cytology but serum calcitonin was normal. A total thyroidectomy was performed. Histopathology confirmed MTC. During the 9-year follow-up period, she had persistently normal serum calcitonin level despite lymph node metastasis.Conclusion: Raised serum calcitonin is a biochemical hallmark of diagnosis and recurrence of MTC in the post-surgical period. Our patient, however, is a case of MTC with postsurgical recurrence and metastasis but persistently normal calcitonin. Such cases are challenging in management. We have not found another report in the literature with the combination of normal calcitonin, MTC, and postsurgical recurrence with metastasis in lymph nodes.Abbreviations: CEA = carcinoembryonic antigen; CT = calcitonin; CT-NEG-MTC = calcitonin-negative medullary thyroid cancer; FNAC = fine-needle aspiration cytology; MTC = medullary thyroid carcinoma

The activation of brown adipose tissue (BAT) is associated with reductions in circulating lipids and glucose in rodents and contributes to energy expenditure in humans indicating the potential therapeutic importance of targetting this tissue for the treatment of a variety of metabolic disorders. In order to evaluate the therapeutic potential of human BAT, a variety of methodologies for assessing the volume and metabolic activity of BAT are utilized. Cold exposure is often utilized to increase BAT activity but inconsistencies in the characteristics of the exposure protocols make it challenging to compare findings. The metabolic activity of BAT in response to cold exposure has most commonly been measured by static positron emission tomography of 18F-fluorodeoxyglucose in combination with computed tomography (18F-FDG PET-CT) imaging, but recent studies suggest that under some conditions this may not always reflect BAT thermogenic activity. Therefore, recent studies have used alternative positron emission tomography and computed tomography (PET-CT) imaging strategies and radiotracers that may offer important insights. In addition to PET-CT, there are numerous emerging techniques that may have utility for assessing BAT metabolic activity including magnetic resonance imaging (MRI), skin temperature measurements, near-infrared spectroscopy (NIRS) and contrast ultrasound (CU). In this review, we discuss and critically evaluate the various methodologies used to measure BAT metabolic activity in humans and provide a contemporary assessment of protocols which may be useful in interpreting research findings and guiding the development of future studies.

Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue. IMC J Med Sci 2019; 13(1): 002. EPub date: 03 February 2019 Address for Correspondence: Dr. Tahniyah Haq, Assistant Professor, Department of Endocrinology, Room 1620, 15th Floor, Block D, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Banglades

We present a case of Cushing’s syndrome and virilization in a 15 year old girl which was suspected to be due to an adrenal carcinoma. She presented with features of virilization in addition to those of hypercortisilism. Her high androgen levels especially dehydroepiandrosterone sulfate (DHEAS) were also in favor of an adrenal carcinoma. An unenhanced computerized tomography (CT) scan showed a mass (size: 5.3 cm) in the right adrenal gland with a soft tissue intensity of more than 10 HU which was suggestive of adrenal carcinoma. But, histopathology of the resected mass revealed a benign adrenocortical adenoma. DOI: http://dx.doi.org/10.3329/imcj.v6i2.14736 Ibrahim Med. Coll. J. 2012; 6(2): 70-72

Background Primary renal aspergillosis is rare in diabetic patients. Diagnosis of localized primary renal Aspergillus infection in diabetic patients requires careful investigations due to its benign presentation and lack of associated systemic clinical features. There is also paucity of information on the role of conservative treatment of such localized infection with antifungal agents only. Here, we describe a case of localized renal aspergillosis in a type 2 diabetic patient with a brief review of literature. Case presentation We describe a case of unilateral renal aspergillosis following intracorporeal pneumatic lithotripsy (ICPL) in a type 2 diabetic man. The patient presented with mild pain in the left lumbar region and periodic expulsion of whitish soft masses per urethra, which yielded growth of Aspergillus fumigatus. He was treated initially with amphotericin B; however, it was stopped after 2 weeks, as he could not tolerate the drug. Subsequently, he was successfully treated with oral itraconazole. Conclusion Localized renal aspergillosis may be suspected in diabetic patients having history of urinary tract instrumentation, mild lumbar pain, passage of suspicious masses in urine and persistent pyuria. Examination of the suspicious substances expelled per urethra is essential for diagnosis as routine multiple urine analysis may yield negative results. Conservative treatment with oral itraconazole alone is effective in cases with incomplete obstruction.