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Das S, Rastogi A, Harikumar KVS, Dutta D, Sahay R, Kalra S, Ghosh S, Gupta SK, Pandit K, Jabbar PK, Damodaran S, Nagesh VS, Sheikh S, Madhu SV, Bantwal G. Diagnosis and Management Considerations in Steroid-Related Hyperglycemia in COVID-19: A Position Statement from the Endocrine Society of India. Indian J Endocrinol Metab 2021; 25:4-11. [PMID: 34386386 PMCID: PMC8323636 DOI: 10.4103/ijem.ijem_227_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
The current coronavirus disease (COVID-19) pandemic is showing no signs of abatement and result in significant morbidity and mortality in the infected patients. Many therapeutic agents ranging widely between antivirals and anti-inflammatory drugs have been used to mitigate the disease burden. In the deluge of the drugs being used for COVID-19 infection, glucocorticoids (GCs) stand out by reducing mortality amongst in-hospital severe-to-critically ill patients. Health-care practitioners have seen this as a glimmer of hope and started using these drugs more frequently than ever in clinical practice. The fear of mortality in the short term has overridden the concern of adverse long-term consequences with steroid use. The ease of availability, low cost, and apparent clinical improvement in the short term have led to the unscrupulous use of the steroids even in mild COVID-19 patients including self-medication with steroids. The use of GCs has led to the increasing incidence of hyperglycemia and consequent acute complications of diabetic ketoacidosis and mucormycosis in COVID-19 patients. There is an urgent need to dissipate information about optimum management of hyperglycemia during steroid use. In view of this, the Endocrine Society of India has formulated this position statement about the diagnosis and management of hyperglycemia due to the use of GCs in patients with COVID-19 infection.
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Affiliation(s)
- Sambit Das
- Professor of Endocrinology, Hi Tech Medical College and Hospitals, Bhubaneswar, Odisha, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - K. V. S. Harikumar
- Senior Consultant Endocrinologist, Magna Clinics, Hyderabad, Telangana, India
| | - Deep Dutta
- Department of Endocrinology, Cedar Superspecialty Clinics, Dwarka, New Delhi, India
| | - Rakesh Sahay
- Professor of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sanjay Kalra
- Endocrinologist, Bharti Hospital, Karnal, Haryana, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME and R, Kolkata, West Bengal, India
| | - Sushil K. Gupta
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Kaushik Pandit
- Consultant Endocrinologist and Diabetologist, Fortis Medical Centre, Kolkata, West Bengal, India
| | - P. K. Jabbar
- Department of Endocrinology, Medical College Trivandrum, Trivandrum, Kerala, India
| | - Suresh Damodaran
- Consultant Diabetologist and Endocrinologist, Ramakrishna Hospital and Harvey speciality clinic, Coimbatore, Tamil Nadu, India
| | - V. Sri Nagesh
- Endocrinologist, Srinagesh Diabetes, Thyroid and Endocrine Clinic, Hyderabad, Telangana, India
| | - Shehla Sheikh
- Consultant Endocrinologist, Nagpada-Mumbai Central, Mumbai, Maharashtra, India
| | - S. V. Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Ganapathi Bantwal
- Professor of Endocrinology, St Johns Medical College and Hospital, John Nagar, Koramangala, Bengaluru, Karnataka, India
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Garg BMK, Harikumar KVS. Growth Hormone Stimulation: An Achilles Heel in the Evaluation of Short Stature. Indian J Endocrinol Metab 2018; 22:439-440. [PMID: 30148084 PMCID: PMC6085959 DOI: 10.4103/ijem.ijem_255_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Brig M. K. Garg
- Dy Commandant & Consultant (Medicine and Endocrinology), Officer's Training College, AMC Centre and College, Lucknow, Uttar Pradesh, India
| | - K. V. S. Harikumar
- Senior Adviser (Medicine and Endocrinology), Army Hospital (Research and Referral), Delhi Cantt, India
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Jayaraman M, Verma A, Harikumar KVS, Ugale M, Modi K. Pregnancy outcomes with thyroxine replacement for subclinical hypothyroidism: Role of thyroid autoimmunity. Indian J Endocrinol Metab 2013; 17:294-297. [PMID: 23776906 PMCID: PMC3683208 DOI: 10.4103/2230-8210.109717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study pregnancy outcomes in relation to thyroid peroxidase antibody (TPOAb) status with optimum thyroxine replacement for subclinical hypothyroidism. MATERIALS AND METHODS Ninety-eight women with subclinical hypothyroidism were followed up until the end of their pregnancy. TPO antibody status was performed for 59 women (positive 20, negative 39). Levothyroxine was supplemented to maintain TSH between 0.3-3 mIU/l in all patients, irrespective of TPOAb status. Pregnancy outcomes were noted as pregnancy-induced hypertension (PIH), antepartum or postpartum hemorrhage, preterm delivery, and spontaneous abortion. Outcomes were compared between 3 groups as per TPO antibody status (positive, negative, and undetermined), which were matched for age and gestational period. RESULTS Thyroid autoimmunity was noted in 34% of women screened for TPO antibody. A total of 11 adverse pregnancy outcomes were recorded (4 spontaneous abortions, 4 preterm deliveries, 3 PIH) with no significant difference between the groups. CONCLUSION Adverse pregnancy outcomes were not different in the 3 groups with adequate thyroxine replacement for pregnant women with subclinical hypothyroidism targeting TSH in euthyroid range, irrespective of thyroid autoimmunity status.
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Affiliation(s)
| | - Abhyuday Verma
- Department of Endocrinology, Medwin Hospital, Hyderabad, India
| | | | - Meena Ugale
- Department of Obstetrics, Kirloskar Hospital, Hyderabad, India
| | - Kirtikumar Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, India
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Abstract
A 15-mth-old male child of consanguineous parents, presented with classical features of congenital hypothyroidism. Serum total thyroxine (T4), total triiodothyronine (T3) and TSH were low. There was no evidence of deficiency of other pituitary hormones. Magnetic resonance imaging of the pituitary was normal. TSHB gene sequencing revealed a homozygous missense mutation due to single base substitution G?A at codon 85 resulting in change from Glycine to Arginine. This mutation in TSHB gene has been reported earlier in three cases with similar phenotype from Japan.
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Muthukrishnan J, Harikumar KVS, Sangeeta J, Singh MK, Modi K. Nerve, muscle or bone disease? Look before you leap. Singapore Med J 2009; 50:e293-e294. [PMID: 19710962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Severe muscle weakness in osteomalacia may mimic a primary neuromuscular disorder like spinal muscular atrophy. A 32-year-old woman, initially diagnosed as a case of spinal muscular atrophy based on clinical presentation, electromyography and muscle biopsy, was later found to have osteomalacic myopathy due to primary hyperparathyroidism complicated by vitamin D deficiency. Before diagnosing a progressive, inevitably fatal degenerative condition like spinal muscular atrophy, one must rule out all possible treatable conditions with a similar presentation.
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Affiliation(s)
- J Muthukrishnan
- Department of Endocrinology, Medwin Hospital, Chirag Ali Lane, Nampally, Hyderabad 500001, India.
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Muthukrishnan J, Harikumar KVS, Abhyuday V, Modi KD. Visual vignette. Hypoxemic-ischemic brain injury. Endocr Pract 2008; 14:799. [PMID: 18996805 DOI: 10.4158/ep.14.6.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Muthukrishnan J, Jha S, Modi KD, Jha R, Kumar J, Verma A, Harikumar KVS, Patro K, Srinivas B, Kumaresan K, Ramasubba R. Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre. J Assoc Physicians India 2008; 56:503-507. [PMID: 18846900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Widely prevalent vitamin D deficiency and delayed diagnosis contributes to severe symptomatic primary hyperparathyroidism in India. We analysed fifty one consecutive patients of primary hyperparathyroidism managed at our centre. All of them were symptomatic. DESIGN Retrospective analysis. MATERIAL AND METHODS Fifty one consecutive cases of symptomatic primary hyperparathyroidism, presenting to our centre from January 1994 to May 2007 were retrospectively analyzed. Clinical presentation, biochemical, radiological and details of underlying parathyroid lesion were noted. RESULTS A total of 51 cases of primary hyperparathyroidism were studied. Mean age was 39.5 +/- 11.5 yrs (Range 13 to 70 years, Female: Male 2:1). Mean duration of symptoms was 35.8 + 29.1 months. Bone pains and painful proximal myopathy were the commonest presentation (24/51), followed by pathological fractures in 12 cases. Distal Renal tubular acidosis was diagnosed in 4 cases, 3 of whom normalized after surgery. At initial evaluation, twenty one patients had elevated alkaline phosphatase with normal calcium levels indirectly suggesting associated vitamin D deficiency. Low serum levels of 25-hydroxy vitamin D were documented in five of them. Parathyroid carcinoma was diagnosed in 3 patients. Ectopic parathyroid adenoma was seen in 7 cases (3 mediastinal, 3 intrathyroidal, 1 near left carotid sheath). All the cases responded well to surgical excision. CONCLUSION Lack of universal screening for hypercalcemia, normocalcemia contributed by associated vitamin D deficiency and lack of awareness about unusual presentations of primary hyperparathyroidism led to delayed diagnosis in our patients. Delayed diagnosis and associated vitamin D deficiency in our patients contributed to greater severity of symptomatic primary hyperparathyroidism.
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Affiliation(s)
- J Muthukrishnan
- Department of Endocrinology, Medwin Hospital, Hyderabad, India
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