Correlation between acne and insulin resistance; experience from central India

Introduction

Acne is a common dermatological condition primarily seen in teenage and adolescent patients and is a major concern for cosmological issues. Along with environmental factors, the proliferation of basal keratinocytes in the sebaceous-pilosebaceous unit, abnormal desquamation of follicular corneocytes, and metabolic abnormalities play a significant role in the pathogenesis of acne development.

Aim

To study the causal relation between acne vulgaris and insulin resistance by calculating Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and identify the relation between insulin resistance and the severity of acne.

Materials and Methods

This was a retrospective study, where the data of patients with persistent Acne Vulgaris who were referred to the Endocrine department for evaluation of the hormonal and metabolic causes for acne vulgaris were analysed. The patient's clinical records were evaluated in whom there was no significant hormonal or metabolic abnormality identified known to cause persistent acne were included after proper consent and HOMA-IR was calculated.

Results

Of several patients with persistent acne, 150 patients were included in our study with the male-to-female ratio was 23:27. The mean age of patients was 33.2 years. The mean HOMA-IR in our acne patients was 1.62 ranging from 0.9-3.7. Sixty four (42.67%) patients had HOMA-IR more than 2.0, thereby suggesting insulin resistance.

Conclusion

Our study suggests the prevalence of insulin resistance in 42.67% of patients with acne, thereby providing the possibility of use of insulin modifiers as an adjunct acne treatment and stratifying the possible risk of metabolic syndrome in patients with acne. Also recommended is the control of dietary factors and lifestyle modification for the management of acne with insulin resistance.

Sociocrinology: Impact of Social Media on Endocrine Health - A Review

Social media (SM) refers to social networking sites (SNSs), which are defined as online services that enable individuals to build a public or semi-public profile and give them the opportunity to create a network of contacts and interact. SM affects all aspects of life and may offer new opportunities to explore new experiences and perspectives of life because of its feasibility. But several times, because of feasibility, misinformation is generated intentionally or unintentionally, which spreads rapidly, and such misinformation can affect all aspects of life. However, health-related misinformation can be life-threatening to individuals. Endocrinology is the branch of medicine that deals with endocrine glands and hormones, which regulates mood, growth, development, metabolism and the way our organ works to maintain internal homeostasis. SM usage and endocrine health impact each other in both positive and negative ways. So, in this review, we will discuss about the effect of SM on Endocrine health.

Observational study on effect of lock down due to COVID 19 on HBA1c levels in patients with diabetes: Experience from Central India

BACKGROUND AND AIMS

Diabetes is a chronic metabolic condition characterized by hyperglycemia and is associated with several complications. Prevalence of Diabetes in adult population in India ranges from 10.9 to 14.2% in urban area and 3.0-7.8% in rural area. Glycemic control is an important factor in preventing the complications associated with diabetes. HBA1c is the indicator of long-term glycemic control and slight variation in it significantly alters the risk of diabetic complications. Thus, the aim of this study was to study the change in HBA1c levels due to lock down in patients with diabetes.

METHODS

307 patients with diabetes who had attended our endocrine OPD in last 3 months before nationwide 68 days lockdown from 24 March 2020 to 31 May 2020, and had recent HBA1c report in past and willing to participate were included in the study after informed consent from 2nd June 2020 to 14th June 2020 when first phase of Unlock started, to identify the change in HBA1c levels during the lockdown period in our patients with diabetes.

RESULTS

The patients were aged between 25-69 years and male to female ratio was 181:126 (1.44: 1). The mean age and mean duration of diabetes in our patients was 55.68 years and 7.95 years respectively. Increment of 0.51% was seen in mean HBA1c levels in our patient from 7.92% mean pre-lockdown HBA1c to mean of 8.43% after release of lock down.

CONCLUSION

Glycemic control got deranged during lockdown period with significant increase of mean HBA1c by 0.51% in immediate post lock down period which may significantly increase the annual incidence of complications related to diabetes.

Observational Study on Outcomes after Radioiodine Ablation in Hyperthyroid Patients

INTRODUCTION

Radio-active Iodine (RAI) is a safe, definitive, and cost-effective modality of treatment that is used as the first line of treatment for Graves' hyperthyroidism by most endocrinologists. Very few reports are available from India, observational follow-up data is needed to determine the meaningful prognostic outcomes of RAI ablation in the Indian population.

AIMS

To study the outcomes in hyperthyroid patients undergoing RAI ablation.

MATERIALS AND METHODS

This observational cohort study was conducted at Department of Endocrinology at Indraprastha Apollo Hospital, New Delhi. A total of 82 hyperthyroid patients who underwent RAI ablation between June 2014 to June 2018 were enrolled. RAI dose was calculated arbitrarily in most cases; often by an empirical fixed dose based on the goiter size and RAIU. The patients were reviewed at 1, 3 and 6 months post-RAI ablation. During follow-up, along with a detailed clinical examination, free T4, free T3 and TSH were checked.

RESULTS

The dose of I-131 varied from 6 mCi to 14 mCi. Most of the patients were given RAI in the dose of 7.1-10 mci. About 63.4% of patients achieved hypothyroidism in 6 months, 6.1% in 1 month, 37.8% in 3 months, and 19.5% in 6 months. Gender, age, etiology of hyperthyroidism, baseline thyroid function, goiter, and ophthalmopathy did not affect outcomes after RAI ablation. Those who were not treated with antithyroid drugs prior to RAI therapy were found to have higher rates of conversion to a hypothyroid state.

CONCLUSION

RAI can be given safely as the first line of treatment in Graves' disease and antithyroid drug naïve patients respond better to therapy.

Observational study on Effect of Lock Down due to COVID 19 on glycemic control in patients with Diabetes: Experience from Central India

BACKGROUND AND AIMS

Diabetes is a chronic metabolic condition characterized with hyperglycemia and associated with several complications. Glycemic control is important factor in preventing the complications associated with diabetes. Pillars for good glycemic control are good life style modification with proper medication under medical guidance. The aim of this study was to study the effect of lock down on glycemic control in diabetic patients and possible factor responsible for this.

MATERIAL AND METHODS

- Out of 407 only 143 diabetic patients who attended the our endocrine OPD in last 3 months who had good glycemic control in past without any chronic complication and willing to participate were included in study. They were advised for the self-monitoring of blood glucose for identifying the glycemic control and with questionnaire designed possible factor was identified during the lockdown period.

RESULTS

- The patients were aged between 18 and 65 years with mean age of 54.68 years and male to female ratio was 91:52.56 (39.16%) patients reported worsening of hyperglycemia and requiring addition of medications for control of blood glucose and 3 (2.09%) patients reported hypoglycemic events and medications were stepped down. Psychological stress was most common factor worsening of hyperglycemia followed by change in diet and exercise.

Ectopic adrenocorticotropic hormone syndrome in a case of duodenal neuroendocrine tumor presenting with liver metastasis

Ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon disorder and comprises about 15% of all patients with Cushing's syndrome (CS). Duodenal carcinoids are rare, indolent tumors usually associated with a benign progression. We hereby report a rare case of CS resulting from ectopic ACTH secretion from a duodenal neuroendocrine tumor (NET) presenting with liver metastasis. A 37-year-old female presented with abdominal discomfort and dyspepsia of 1-month duration. Ultrasound abdomen suggested a well-defined hypoechoic lesion in the left lobe of the liver, suggestive of neoplasia. On clinical examination, she had Cushingoid features and persistent hypokalemia. Midnight ACTH and cortisol levels were grossly elevated at 1027 pg/ml (n < 46 pg/ml) and 87.56 μg/dl (n < 7.5 μg/ml), respectively. Both overnight and high-dose dexamethasone suppression test confirmed nonsuppressed cortisol levels - 86.04 and 84.42 μg/dl (n < 1.8 μg/ml), respectively. Magnetic resonance imaging brain showed a structurally normal pituitary gland. Computed tomography scan of the abdomen revealed hepatic lesion with bilateral adrenal enlargement. A diagnosis of ectopic ACTH-dependent CS was made. Intraoperatively, a duodenal lesion of 0.5 cm × 0.5 cm was identified alongside an 8 cm × 6 cm exophytic lesion in segment IV of the liver. Frozen section of the duodenal lesion was positive for NET. She underwent a Whipple's surgery, cholecystectomy, and left hepatic lobectomy. Postoperatively, she showed clinical and biochemical remission. Herewith, we report the third case of duodenal carcinoid tumor presenting as ectopic ACTH syndrome and the first with liver metastasis.