Biomedical subjects
Publications and source records attributed to A Bhansali.
We describe a case of follicular carcinoma in a functioning struma ovarii, which presented as an ovarian mass in a patient who had undergone a near-total thyroidectomy for a benign lesion. She underwent bilateral salpingo-oophorectomy and received radiotherapy and L-thyroxine treatment with no evidence of metastases in 4 years follow-up.
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Suprasellar arachnoid cysts (SSAC) are uncommon intracranial lesions. Two patients of SSAC presenting with precocious puberty are described. In both the cases partial excision of the cyst wall, through a pterional craniotomy, establishing communication with the basal subarachnoid spaces was carried out. The endocrinological symptoms regressed after surgery. The clinical presentations of SSAC and the treatment options available are reviewed.
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Timed cortisol responses to insulin-hypoglycemia (IH) and arginine-vasopressin (AVP) were compared in 16 patients with pituitary tumors and six healthy controls. Serum cortisol was estimated by a specific and sensitive radioimmunoassay as per the WHO protocol. The basal cortisol (AM) was normal (> 290 nmol/l) in 9 patients and low in seven. With IH peak cortisol response was normal (> 550 nmol/l) in 10 patients, 8 of whom had normal and 2 had low basal (AM) cortisol. In contrast AVP evoked normal cortisol responses in only 5 of these patients, all of whom had normal basal (AM) cortisol and none had low basal (AM) cortisol. The data indicate lower sensitivity for AVP stimulation test (50%) and favour IH as the standard cortisol stimulation test in patients with pituitary tumors awaiting surgery.
Pancreatic insulinomas are rare tumors and their association with polycystic disease of the liver is uncommon. We report here a patient with pancreatic insulinoma with hepatic metastasis and biliary obstruction presenting with neuroglycopenic symptoms and cholestasis on a background of polycystic liver disease.
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Corticotropin-dependent Cushing's syndrome was detected in a 32-year-old male suffering from membranous nephropathy and chronic renal failure. Cortisol dynamics revealed high basal cortisol, loss of circadian rhythm, and nonsuppressibility with low-dose dexamethasone. However, the latter was suppressible with high-dose dexamethasone. Treatment with ketoconazole led to a remarkable response both clinically and biochemically. The occurrence of Cushing's syndrome in a patient with chronic renal failure is extremely rare and poses significant diagnostic and therapeutic problems.
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A case of primary hemochromatosis with hypogonadotropic hypogonadism and decreased Leydig cell reserve is reported.
A case of pituitary acromegaly with multiple nonendocrine neoplasia is reported. The tumorogenic potential of growth hormone, prolactin and other growth factors is discussed.
Lithium carbonate was tried in 27 patients with Graves' disease to induce euthyroid state. Each patient received 1200 mg of lithium carbonate in three divided doses. The study protocol included monthly monitoring of serum lithium, total serum T3, T4 and T3/T4 ratio, and a repeat radioactive iodine uptake (RAIU) at the end of three months. Twenty three patients completed the study. Of these, only 9 (39.1%) achieved euthyroid state, with a significant reduction in serum T3 and T4 but not in T3/T4 ratio and RAIU, suggesting a major effect of lithium on thyroid hormone release. No significant correlation was observed between serum lithium and circulating T3 and T4.
Six patients with Cushing's disease received ketoconazole for 7-10 weeks following ketoconazole challenge test. Clinical and hormonal alterations in circulating cortisol, 17 OH progesterone, androstenedione and testosterone were assessed during the therapy. There was significant clinical improvement which corresponded to a fall in cortisol, androstenedione and testosterone. The rise in 17 OH progesterone and the fall in cortisol suggest a blockade at 17,20 desmolase and 11 B-hydroxylase in the cortisol bio-synthetic pathway.
Spontaneous rupture of the spleen in acute lymphoblastic leukaemia is rare and has only exceptionally been reported as the presenting manifestation. One such case is being reported to emphasize the importance of this potentially fatal complication.
Thalamic gliomas, because of their anatomical location, usually present with early and extensive neurologic signs. A case, which at initial presentation had subjective hemianaesthesia, but no objective neurologic deficit, is being reported, to emphasize the importance of proper investigations even in absence of clinical signs.
Circulating levels of cortisol, 17 alpha hydroxy progesterone and delta 4 androstenedione were analysed by specific radioimmunoassays in 11 patients with Cushing's disease before and at 2, 4, 6, 12 and 24# h following an oral dose of 400 mg ketoconazole. A significant fall in cortisol (26 - 79.6%, 59.8 +/- 18.7 SEM), delta 4 androstenedione (21.5 - 63.3%, 47.8 +/- 4.87) with a concomitant rise in 17 alpha hydroxy progesterone (113 - 218%, 116 +/- 11.43) were noted, suggesting inhibition of 17, 20 desmolase and 11 beta-hydroxylase enzymes in cortisol biosynthetic pathway.
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