Glucocorticoid use audits Jacob, Jubbin; Kalra, Sanjay
Indian journal of endocrinology and metabolism,
05/2022, Letnik:
26, Številka:
3
Journal Article
Background The diagnosis of syndrome of inappropriate anti-diuresis requires the exclusion of secondary adrenal insufficiency (AI) among patients with euvolemic hyponatremia (EuVHNa). Studies have ...suggested that about 2.7–3.8% of unselected patients presenting to the emergency room with EuVHNa have undiagnosed AI and it is as high as 15% among patients admitted to specialized units for evaluation of hyponatremia. Objective To study the prevalence of AI among in-patients with EuVHNa in a general medical ward setting. Methods This was a prospective, single-center observational study conducted among general medical in-patients with EuVHNa, defined as patients with a serum sodium <135 mmol/L, clinical euvolemia and urine spot sodium >30 mmol/L. Additionally, patients with recent vomiting, current renal failure, diuretic use and those with uncontrolled hyperglycemia were excluded. Adrenal functions were assessed by a modified adrenocorticotropic hormone (ACTH) stimulation test called the Acton Prolongatum™ stimulation test (APST). A cut-off cortisol value of <18 mg/dL after 60 min of ACTH injection was used to diagnose AI. Results One hundred forty-one patients were included and underwent an APST. APST suggested 20/141 (14.2%) had undiagnosed AI. The commonest cause of AI (9/20) was secondary AI because of the use of steroids including inhaled steroids and indigenous medicines contaminated with steroids. In 5 (3.5%) patients hypopituitarism was newly diagnosed. Despite primary AI (PAI) not commonly presenting as EuVHNa, 2/20 patients had PAI. Conclusions AI is much commoner in our country, among in-patients with EuVHNa primarily driven by exogenous steroid use and undiagnosed hypopituitarism.
•This study aimed to determine the impact of newly diagnosed subclinical hypothyroidism on cognition by a case-control study design.•We found no association between mild subclinical hypothyroidism ...and cognitive decline among elderly using the pre-specified TSH cut off >4mIU/L.•There was no significant association between severe subclinical hypothyroidism (TSH> 10mIU/L) and cognitive decline. However the sample size was small to make a definitive association.
The association of thyroid dysfunction with alterations in mood and cognition has been recognized since some of the earliest descriptions of the disease. Most recent cross-sectional and longitudinal studies have failed to find an association between cognitive dysfunction and subclinical hypothyroidism (SCH). A recent paper from our country however suggested a significant association.
This study was undertaken to determine the prevalence and risk of cognitive impairment among educated, elderly Indian patients (>60 years) with SCH.
This study was conducted among educated, elderly patients admitted to Christian Medical College and Hospital, Ludhiana, Punjab, India. Patients with SCH and an equal number of controls were interviewed after taking informed consent. SCH was defined as serum thyroid stimulating hormone (TSH) level more than 4.0 mIU/L with serum free triiodothyronine (FT3) and free thyroxine (FT4) in the normal reference range. Cognitive function was assessed by Hindi mini mental status examination (HMSE) and clock drawing test (CDT).
The cases (n=100) had a mean age of 68.2 years, there were 59% males, and had a mean body mass index of 25.5kg/m2 compared to controls (n=100) who had a mean age of 69.9 years (p=0.09), there were 64% males (p=0.5), and had a mean BMI of 25.3 kg/m2 (p=0.7) which were all comparable. All other baseline variables including co-morbidities, family history of dementia, head injury, smoking, alcohol use, fruit and vegetable intake, daily newspaper reading, education and exercise regularity were comparable in both groups. The cases and controls had mean HMSE of 26.1 and 25.9 (p=0.68) respectively, and the cases and controls had mean CDT of 2.19 and 2.18 (p=0.95) respectively.
There is no difference in cognitive function in older patients with SCH in comparison with those without SCH
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