Publications by authors named "Nitin Kapoor"

124 Publications

Contemporary Classification of Glucagon-Like Peptide 1 Receptor Agonists (GLP1RAs).

Diabetes Ther 2021 Jul 15. Epub 2021 Jul 15.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.

This communication provides a contemporary classification of glucagon-like peptide 1 receptor agonists (GLP1RAs) based on indication, route, and frequency of administration, which could support a person-centric approach to treatment choice. It includes all recently developed GLP1RAs as well as those in advanced stages of clinical study. Keeping pace with current trends in pharmacology and metabolic medicine, it attempts to bring clarity and simplicity to a complex spread of information.
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http://dx.doi.org/10.1007/s13300-021-01113-yDOI Listing
July 2021

Bone Mineral Density and Body Composition in Males with Motor Neuron Disease: A Study from Teaching Hospital in Southern Part of India.

Ann Indian Acad Neurol 2021 Mar-Apr;24(2):211-216. Epub 2020 Aug 28.

Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India.

Background: Osteoporosis and sarcopenia are important aspects of motor neuron disease (MND). Individuals with amyotrophic lateral sclerosis (MND-ALS) have an increased risk of falls and fractures. Currently, the standard of care does not involve a routine assessment of bone mineral density (BMD) and body composition in these patients. We aimed to assess BMD, bone mineral parameters and body composition in men with MND and compared them with healthy controls.

Methods: Consecutive males between 50 and 80 years of age diagnosed as MND-ALS by revised El Escorial criteria and able to walk unassisted attending Neurology outpatient clinic were recruited into the study. Age, gender and body mass index (BMI) matched healthy controls were recruited from the local community. BMD and body composition were assessed by dual-energy x-ray absorptiometry (DXA). Bone mineral parameters and bone turnover markers (BTMs) were also assessed in them.

Results: A total of 30 subjects with MND-ALS and 33 controls were recruited. The mean age (years) was 59.2 in cases and 61.2 in controls. The mean BMD (g/cm) between the two groups was similar; however, BTMs were significantly higher in the MND group ( < 0.05). Subjects with MND-ALS had significantly lower mean appendicular lean mass (ALM) (19.9 versus 22.4 kg; = 0.007) and ALM corrected for BMI than the healthy control group (0.858 versus 0.934 kg/kg/m; = 0.034). Sarcopenic obesity (Percentage fat mass >27% + ALM/BMI <0.786 kg/kg/m) was more prevalent in MND-ALS compared to controls (44.5% versus 16.7%; = 0.03).

Conclusion: Although BMD was not significantly different between subjects with MND-ALS and healthy controls, BTMs were significantly higher in the MND group indicating a high bone turnover state. Sarcopenia and sarcopenic obesity were also more in MND-ALS group than controls. Routine assessment for bone health parameters and body composition indices may be included in management of the patients with MND.
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http://dx.doi.org/10.4103/aian.AIAN_293_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232495PMC
August 2020

Epidemiology of overweight and obesity in Indian adults - A secondary data analysis of the National Family Health Surveys.

Diabetes Metab Syndr 2021 Jun 11;15(4):102166. Epub 2021 Jun 11.

Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India. Electronic address:

Aims: National Family Health Survey (NFHS) conducted in India provide nationally comparable data on socio-demographic characteristics and anthropometric estimates. Present study was conducted to examine the prevalence of Indian adults who are living with overweight/obesity, their correlates, and trends observed between the last two rounds of the NFHS 2005-06 to 2015-16).

Methods: Socio-demographic characteristics and anthropometric estimates of respondents from NFHS round III & IV were analysed. Asian cut-offs were used for obesity classification. Of the total 198,754 and 811,808 eligible respondents, adults ≥18 years of age were included in the analysis. Prevalence and correlates were presented after taking into account stratification, clustering and sampling weights. GIS mapping was done to depict regional variations.

Results: Prevalence of men and women living with overweight/obesity were observed to be 38.4% and 36.2% respectively. Wide variations were observed in prevalence across the regions of India. Results of multivariate analysis showed that the strongest predictors for being overweight or obese were older age, currently in union, higher education, richest wealth quintile, and living in urban areas.

Conclusion: The present study highlights the rising prevalence across the urban and rural locations and has implications for policy change based on the prevalence estimates.
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http://dx.doi.org/10.1016/j.dsx.2021.06.003DOI Listing
June 2021

A clinicoradiological analysis of silent corticotroph adenomas after the introduction of pituitary-specific transcription factors.

Acta Neurochir (Wien) 2021 Jun 28. Epub 2021 Jun 28.

Department of Neurosurgery, Christian Medical College, Vellore, 632004, India.

Background: Silent corticotroph adenomas (SCAs) are a rare subtype of non-functional pituitary adenoma. While it has been suggested that they are more aggressive and recur more frequently following excision, there is limited literature on the optimum treatment strategy for these tumors, especially regarding the role of radiation therapy in incompletely resected tumors.

Method: We assimilated data from 62 SCAs and 238 other non-functional adenomas (ONAs), defined according to the WHO 2017 criteria that incorporates transcription factor analysis. We compared their clinicoradiological characteristics, such as hormonal levels, tumor configuration, size, and invasiveness. For 52 SCAs and 205 ONAs with serial follow-up imaging, we studied outcomes for progression after subtotal resection with or without radiation therapy or recurrence after gross total resection. Kaplan Meier analysis for recurrence or progression was used to determine the need for a differential treatment strategy for SCAs compared with other non-functional adenomas specifically concerning the role of radiotherapy.

Results: Patients with SCAs present at a younger age than ONAs (43.9 years vs. 48.2 years, p = 0.014), with larger (14.9 cc vs. 9.7 cc, p = 0.006) and more invasive adenomas (61.2% vs. 45.8%, p = 0.021). Overall, SCAs are more likely to recur or progress (48.7 vs. 15.7%, p < 0.001) following excision than ONAs, with significantly poorer event-free survival (Log rank test p < 0.001). Early adjuvant radiotherapy provides favorable outcomes among SCAs with postoperative residual tumor, on par with ONAs. Multivariate analysis identified male gender (HR: 2.217; p = 0.017), MIB index ≥ 3% (HR: 2.116; p = 0.012), and SCA tumor pathology (HR: 3.787; p < 0.001) as factors predicting recurrence.

Conclusions: Based on the results of this retrospective, single-center review of 300 non-functional adenomas, we conclude that silent corticotroph adenomas are an aggressive subtype of non-functional pituitary adenomas that are larger, more likely to be invasive, and tend to recur more frequently after a subtotal excision compared with other non-functional adenomas. A gross total resection must be attempted whenever possible and earlier adjuvant radiation is recommended when re-surgery for residual tumor is difficult.
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http://dx.doi.org/10.1007/s00701-021-04911-2DOI Listing
June 2021

The Indian Society for Bone and Mineral Research (ISBMR) position statement for the diagnosis and treatment of osteoporosis in adults.

Arch Osteoporos 2021 Jun 26;16(1):102. Epub 2021 Jun 26.

Endocrinology and Diabetes Division, Max Healthcare, New Delhi, 110017, India.

The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.

Purpose: In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country.

Methods: The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India.

Results: Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy.

Conclusions: Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India.
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http://dx.doi.org/10.1007/s11657-021-00954-1DOI Listing
June 2021

Impact of Experience on Outcomes After Endoscopic Transsphenoidal Surgery for Acromegaly.

World Neurosurg 2021 Jul 21;151:e1007-e1015. Epub 2021 May 21.

Department of Neurosurgery, Christian Medical College, Vellore, Tamil Nadu, India. Electronic address:

Objective: Acromegaly is a syndrome of metabolic alterations secondary to increased growth hormone levels from a somatotroph pituitary adenoma. A multidisciplinary approach beginning with surgery, followed by adjuvant radiation or medical therapy for residual disease, is considered standard of care. Several factors affect the likelihood of remission after surgery, but the impact of surgical experience on remission rates has not been adequately assessed.

Methods: Retrospective review of 203 patients, divided into 2 eras (era 1, 102 patients; era 2, 101 patients) of patients who underwent transsphenoidal surgery for acromegaly by a single surgeon over 11 years, was performed, determining the effect of surgical experience on rates of remission and various complications. Remission was defined according to the 2014 Endocrine Society Clinical Practice Guideline.

Results: The rate of surgical remission was 40.6% (62.9% among noninvasive adenomas). Rates of surgical remission significantly improved in the latter half of this cohort (31.2% in the first half vs. 50% in the second half), despite other factors being comparable. On multivariate analysis, surgeon experience, cavernous sinus invasion, and preoperative growth hormone levels affected the rates of surgical remission. Rates of cerebrospinal fluid leak and hypopituitarism were lower in the second half, whereas resolution of acromegaly-associated comorbidities was increased.

Conclusions: We report, in this large single-surgeon review of endoscopically operated acromegaly cases, increased rates of surgical remission and reduced complications with increasing surgeon experience. The overall experience of the treating team in dealing with perioperative and intraoperative factors also contributes to improved outcomes.
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http://dx.doi.org/10.1016/j.wneu.2021.05.030DOI Listing
July 2021

Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective.

Diabetes Metab Syndr Obes 2021 16;14:1703-1728. Epub 2021 Apr 16.

Department of Medicine, JIPMER, Puducherry, India.

Diabetes and obesity are both increasing at a fast pace and giving rise to a new epidemic called diabesity. Lifestyle interventions including diet play a major role in the treatment of diabetes, obesity and diabesity. There are many guidelines on dietary management of diabetes or obesity globally and also from South Asia. However, there are no global or South Asian guidelines on the non-pharmacological management of diabesity. South Asia differs from the rest of the world as South Asians have different phenotype, cooking practices, food resources and exposure, medical nutrition therapy (MNT) practices, and availability of trained specialists. Therefore, South Asia needs its own guidelines for non-pharmacological management of diabesity in adults. The aim of the Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective is to recommend therapeutic and preventive MNT in the South-Asians with diabesity.
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http://dx.doi.org/10.2147/DMSO.S278928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057793PMC
April 2021

Management of late-onset hypogonadism: person-centred thresholds, targets, techniques and tools.

J R Coll Physicians Edinb 2021 03;51(1):79-84

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; Non communicable disease unit, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Australia.

Late-onset hypogonadism (LOH) is a complex and highly debatable syndrome in ageing men, which is characterised by reduced testosterone levels associated with classical symptoms of androgen deficiency. This article discusses the complex issues surrounding its management related to patient-centric thresholds and therapeutic targets. It specifically highlights the need to consider symptoms as the starting point, the key milestones in the management and the target of treatment, while ensuring safety at all times. The diagnosis of LOH requires a high index of suspicion and early identification of symptoms followed by appropriate investigations. The threshold for initiation of treatment has to be person centric and requires individualised decisions. The dose, preparation, route and follow up after testosterone initiation also may vary among different people. A person-centred approach is key to the successful management of this complex, nebulous yet debilitating disease.
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http://dx.doi.org/10.4997/JRCPE.2021.121DOI Listing
March 2021

Clinical Profile and Mutations Associated with Multiple Endocrine Neoplasia-Type1 (MEN1) and Their First-Degree Relatives at Risk of Developing MEN1: A Prospective Study.

Horm Metab Res 2021 Apr 14;53(4):245-256. Epub 2021 Apr 14.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.

Multiple Endocrine Neoplasia type-1 (MEN1) is an autosomal dominant disorder with a combined occurrence of tumours of parathyroid glands, pancreatic islets, and anterior pituitary. About 90% of these patients carry mutations in the MEN1 gene, though the spectrum is not well defined in India. Forty clinically suspected cases of MEN1 were enrolled prospectively over six years; 32 patients (23 index-cases and nine affected relatives) with≥2 classical endocrine tumours of MEN1 were considered definite, and eight were categorised as 'MEN1-like'. Details of their clinical presentation, treatment and mutational analysis including MEN1 gene, 3' and 5' untranslated regions (UTR) of MEN1, CDKN1B, and CaSR genes were collated. Asymptomatic first-degree relatives were also screened. Among the 32 definite MEN1 patients, all had primary hyperparathyroidism, 22 (68.7%) had gastroentero-pancreatic neuroendocrine tumours, and 21 (66%) had pituitary adenoma. Of the 23 definite index-cases, 13 (56.5%) carried mutations in the MEN1 gene. Five of nine affected first-degree relatives (55.5%), and four of 10 asymptomatic relatives (40%) also had MEN1 mutations. Seven of 10 MEN1 mutation-negative definite index-cases harboured p.V109G polymorphism in the CDKN1B gene. All eight MEN1-like cases were negative for mutations and large deletions in MEN1, mutations in 3' and 5' UTR of MEN1, CaSR and CDKN1B genes. The study has helped to clearly document the pattern of mutations among Indian MEN1 patients. However, the absence of MEN1 mutation in ~44% of cases and the presence of p.V109G polymorphism in CDKN1B gene raise the question whether such polymorphisms could independently contribute to pathogenesis.
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http://dx.doi.org/10.1055/a-1402-0183DOI Listing
April 2021

Myelofibrosis and Pancytopenia Associated With Primary Hyperparathyroidism.

AACE Clin Case Rep 2021 Jan-Feb;7(1):69-71. Epub 2020 Dec 28.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India.

Objective: Primary hyperparathyroidism (PHPT) has varied clinical presentations. Hematologic abnormalities secondary to PHPT have been described before. However, pancytopenia as the initial presentation has rarely been reported. We report a patient with PHPT who presented for evaluation of pancytopenia.

Methods: Histopathology of the bone marrow at presentation is described. Bone biochemistry results and the hematologic profile before and after curative parathyroidectomy are presented.

Results: A 48-year-old woman presented with pancytopenia (hemoglobin, 6.3 g/dL; total leucocyte count, 3000 cells/mm; and platelet count, 60 000 cells/mm), and her bone marrow study showed marrow fibrosis. Biochemical evaluation revealed hypercalcemia (15.5 mg/dL), hypophosphatemia (2.2 mg/dL), and elevated total alkaline phosphatase (4132 U/L). Bone mineral density assessment by dual-energy X-ray absorptiometry scan revealed osteoporosis at all 3 sites, which was more severe in the distal one third of the forearm. Further investigations confirmed the diagnosis of PHPT (serum parathyroid hormone, 2082 pg/mL). Following curative parathyroidectomy, in addition to normalization of calcium, there was restoration of all 3 hematologic cell lines at 3 months.

Conclusion: Pancytopenia may be a rare manifestation of PHPT. Thus, it may be prudent to evaluate the calcium profile in patients with chronic refractory anemia and pancytopenia.
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http://dx.doi.org/10.1016/j.aace.2020.11.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924162PMC
December 2020

Proximal Hip Geometry, Trabecular Bone Score, Bone Mineral Density and Bone Mineral Parameters in Patients With Cryptogenic and Hepatitis B Related Cirrhosis- A Study From the Indian Subcontinent.

J Clin Densitom 2021 Mar 4. Epub 2021 Mar 4.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.

The impact of cryptogenic cirrhosis on skeleton has not been studied in Indian context. So this study investigated bone health in male patients with early cryptogenic cirrhosis as defined by Child-Turcot-Pugh A (CTP-A) categorization and compared it with patients diagnosed to have hepatitis B related chronic liver disease (CLD) on treatment and age, sex-matched healthy controls. It was a cross-sectional study, in which thirty male subjects were recruited in each group. Bone mineral density (BMD), trabecular bone score (TBS), hip structural analysis (HSA) and bone mineral parameters were assessed. The mean ±SD age of the study subjects was 39.3 ± 9.2 years. The mean 25-hydroxy vitamin D was significantly lower in subjects with cryptogenic cirrhosis as compared to controls (p = 0.001). Subjects with cryptogenic cirrhosis had significantly lower (1.297 ± 0.099) TBS as compared to hepatitis-B related CLD (1.350 ± 0.094) control subjects (1.351 ± 0.088) (p = 0.04). BMD at the hip and lumbar spine was also significantly lower in subjects with cryptogenic cirrhosis as compared to hepatitis-B related CLD and healthy age matched controls (p < 0.05). Most components of HSA were significantly affected in subjects with cryptogenic cirrhosis as compared to control subjects (p < 0.05). Patients with cryptogenic cirrhosis had significantly low TBS and BMD lumbar spine and hip as well as poor proximal hip geometry which may be good predictor of future fragility fractures.
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http://dx.doi.org/10.1016/j.jocd.2021.03.001DOI Listing
March 2021

Severe Idiopathic Osteoporosis in a Premenopausal Woman: A Case for Dual Therapy.

J Midlife Health 2020 Oct-Dec;11(4):260-263. Epub 2021 Jan 21.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Currently available agents improve bone mineral density (BMD) values on their own in monotherapy but may not completely restore microarchitecture and the patient may continue to sustain fragility fractures. Current monotherapies can only address either increased bone resorption or decreased bone formation. In this setting, combination therapy with antiresorptive and anabolic agents appears to be a promising option. A 49-year-old premenopausal woman presented with severe low backache associated with significant height loss. Evaluation elsewhere revealed severe osteoporosis, which prompted treatment with three doses of parenteral zoledronate 4 mg annually, followed by oral alendronate 70 mg once weekly for 7 years. However, her symptoms persisted despite treatment, and investigations done at our center confirmed severe osteoporosis, with multiple vertebral compression fractures. She was initiated on teriparatide therapy but despite 1 year of treatment, there was persistent height loss. In addition, there was a marked elevation of bone resorption, which prompted us to add denosumab which was administered subcutaneously every 6 months. On follow-up, there was marked relief from pain, no further decrease in height, and progressive improvement in BMD, and bone turnover markers were noted. A dual therapy with anabolic agent teriparatide and antiresorptive agent denosumab for osteoporosis may be a viable option in individuals with severe osteoporosis who do not respond well to a single agent.
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http://dx.doi.org/10.4103/jmh.JMH_168_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978054PMC
January 2021

Body composition and metabolic parameters in men with chronic traumatic paraplegia - A pilot study from India.

J Spinal Cord Med 2021 Mar 11:1-8. Epub 2021 Mar 11.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.

Objective: To study body composition, measures of insulin resistance and dyslipidemia in Indian men with paraplegia as compared to age and body mass index (BMI) matched able-bodied men.

Design: Cross sectional study.

Setting: Departments of Physical Medicine and Rehabilitation and Endocrinology.

Participants: Males aged 18-45 years with chronic traumatic paraplegia versus age and BMI-matched able-bodied men.

Interventions: None.

Main Outcome Measures: Measures of body composition such as total body fat, lean mass, regional adiposity using dual energy x-ray absorptiometry (DXA), metabolic profile and insulin resistance.

Results: Subjects with paraplegia ( = 43), compared to controls ( = 36), had higher %Fat mass (FM) (25.5 (21.2-28.9) vs 20.2 (15.9-22.2); P < 0.01), lower trunk to leg ratio (0.66 (0.51-0.73) vs 0.87 (0.72-0.94); P < 0.01), lower lean mass index (14.38 (2.57) vs 17.80 (2.34); P < 0.01) and lower appendicular lean mass index (5.81 ± 1.26 vs 8.17 ± 1.12; P < 0.01). Fasting blood glucose (mg/dl) was higher (89.0(81.5-96.5) vs 80.0 (74.5-88.2); P < 0.01), Homeostasis model assessment of insulin resistance was higher (1.33 (1.03-2.12) vs 0.94 (0.52-1.78); P = 0.02), Quantitative insulin sensitivity check index (QUICKI) was lower (0.36 ± 0.04 vs 0.38 ± 0.05; P = 0.02) and HDL-C was lower (33.00 (30.00-42.75) vs 38.50 (33.00-43.25); P < 0.02) in cases compared to controls. QUICKI correlated positively with HDL-C and negatively with %FM, estimated VAT volume and TG. Trunk to leg ratio correlated positively with TG even after controlling for %FM.

Conclusion: Men with chronic paraplegia had lower lean mass, higher total and regional fat mass, increased insulin resistance and low HDL-C when compared with BMI-matched able-bodied controls. Both total and regional adiposity correlated with poor metabolic profile.
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http://dx.doi.org/10.1080/10790268.2021.1888021DOI Listing
March 2021

Barocrinology.

J Pak Med Assoc 2021 Jan;71(1(A)):170-171

Department of Endocrinology, Christian Medical College, Vellore, india.

The authors propose "Barocrinology", a novel terminology in medical literature, to comprehensively describe the rapidly expanding field of obesity medicine. This new term highlights the need to appreciate the role of endocrine physiology in the evolution of obesity, insights into its complications and changes in the hormonal milieu following weight loss therapies, including bariatric surgery. This term would not only reduce the stigma associated with obesity in affected individuals but also give them a better appreciation of its biological origin rather than self-criticism. This paper also undermines the importance of a multi-disciplinary approach needed in this field for achieving practical and sustainable goals, individualized to each person.
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January 2021

Does Baseline PTH Influence Recovery of Bone Mineral Density, Trabecular Bone Score and Bone Turnover Markers? A Prospective Study Following Curative PArathyroidectomy in Primary Hyperparathyroidism.

Endocr Pract 2020 Dec;26(12):1442-1450

From the (1)Departments of Endocrinology. Electronic address:

Objective: This prospective study was carried out to assess trabecular bone score, bone mineral density (BMD), and bone biochemistry in Indian subjects with symptomatic primary hyperparathyroidism (PHPT), and to study the influence of baseline parathyroid hormone (PTH) on recovery of these parameters following curative surgery.

Methods: This was a 2-year prospective study conducted at a tertiary care centre in southern India. Baseline assessment included demographic details, mode of presentation, bone mineral biochemistry, BMD, trabecular bone score (TBS), and bone turnover markers (BTMs). These parameters were reassessed at the end of the first and second years following curative parathyroid surgery.

Results: Fifty-one subjects (32 men and 19 women) with PHPT who had undergone curative parathyroidectomy were included in this study. The mean (SD) age was 44.6 (13.7) years. The TBS, BTMs, and BMD at lumbar spine and forearm were significantly worse at baseline in subjects with higher baseline PTH (≥250 pg/mL) when compared to the group with lower baseline PTH (<250 pg/mL). At the end of 2 years, the difference between high versus low PTH groups (mean ± SD) persisted only for forearm BMD (0.638±0.093 versus 0.698±0.041 g/cm; P =.01). However, on follow-up visits in the first and second year after curative parathyroidectomy, there was no significant difference in BTMs, BMD at the femoral neck, lumbar spine, and TBS between the 2 groups stratified by baseline PTH.

Conclusion: The BMD at the forearm remained significantly worse in individuals with high baseline PTH even at 2 years after surgery, while other parameters including TBS improved significantly from baseline.

Abbreviations: 25(OH)D = 25-hydroxyvitamin D; BMD = bone mineral density; BMI = body mass index; BTMs = Bone turnover markers; CTX = C-terminal telopeptide of type 1 collagen; DXA = dual energy X-ray absorptiometry; P1NP = N-terminal propeptide of type 1 procollagen; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; TBS = trabecular bone score.
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http://dx.doi.org/10.4158/EP-2020-0148DOI Listing
December 2020

Visual Vignette.

Endocr Pract 2020 Aug;26(8):932

From the Department of Endocrinology, Christian Medical College, Vellore, India.. Electronic address:

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http://dx.doi.org/10.4158/EP-2019-0578DOI Listing
August 2020

Parathyroid lipohyperplasia - a rare and difficult to localize entity.

Indian J Pathol Microbiol 2021 Jan-Mar;64(1):200-201

Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_551_20DOI Listing
July 2021

Barocrinology: The Endocrinology of Obesity from Bench to Bedside.

Med Sci (Basel) 2020 Dec 21;8(4). Epub 2020 Dec 21.

Division of Endocrinology, Stellenbosch University, Cape Town 8000, South Africa.

Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose "Barocrinology", a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of "baro" (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.
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http://dx.doi.org/10.3390/medsci8040051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768467PMC
December 2020

Idiopathic systemic capillary leak syndrome - An often missed diagnosis.

Trop Doct 2021 Apr 22;51(2):246-248. Epub 2020 Dec 22.

Professor, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India.

Idiopathic systemic capillary leak syndrome (ISCLS) is a potentially fatal disorder characterised by 'attacks' of varying intensity of hypovolemic shock in association with haemoconcentration and hypoalbuminaemia. It is a disease of exclusion, and the severity of attacks may mimic sepsis at presentation. We report a case of a lady with recurrent attacks of ISCLS with at least two life-threatening episodes, having been treated elsewhere as a case of steroid insufficiency. The diagnosis is often challenging, and treatment of an acute episode involves the judicious use of fluids and vasopressors, as required. Prophylaxis to prevent further attacks is of varied success.
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http://dx.doi.org/10.1177/0049475520979299DOI Listing
April 2021

Commentary on Indian Menopause Society Guidelines.

J Midlife Health 2020 Apr-Jun;11(2):115-116. Epub 2020 Aug 10.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.4103/jmh.JMH_153_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688021PMC
August 2020

Proportion of newly diagnosed diabetes in COVID-19 patients: A systematic review and meta-analysis.

Diabetes Obes Metab 2021 03 29;23(3):870-874. Epub 2020 Dec 29.

Central Clinical School, The Alfred Centre, Monash University, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/dom.14269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753574PMC
March 2021

The Prevalence and Predictors of Non-alcoholic Fatty Liver Disease in Morbidly Obese Women - A Cross-sectional Study from Southern India.

Eur Endocrinol 2020 Oct 6;16(2):152-155. Epub 2020 Oct 6.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Background: The prevalence of obesity is increasing rapidly in India and so are its associated comorbidities. Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is commonly associated with obesity. However, limited data are available on its prevalence and clinical indicators among morbidly obese Indian women. The aim of our study was to find the prevalence of NAFLD in morbidly obese Indian women and study the clinically measurable obesity indicators that would best predict NAFLD.

Methods: This was a cross-sectional study, conducted in the Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore. Women were enrolled who were diagnosed to have NAFLD on sonography. Anthropometric variables, such as body mass index, waist circumference, hip circumference, waist-hip ratio and waist-height ratio were measured and compared between the two groups. SPSS Statistics 21.0 software was used for analysing the data.

Results: One hundred and six consecutive, morbidly obese women were recruited in this study. Nearly three-quarters (73.6%) of the 106 morbidly obese participants were found to have NAFLD. We found waist circumference, body mass index and waist-height ratio to be most useful in distinguishing between patients with and without NAFLD, and found waist-height ratio was the best screening tool for diagnosing NAFLD.

Conclusion: NAFLD is present in a large proportion of morbidly obese women. Waist-height ratio could be used a surrogate screening tool to detect NAFLD in resource-constrained settings.
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http://dx.doi.org/10.17925/EE.2020.16.2.152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572172PMC
October 2020

Obesity Indicators and Health-related Quality of Life - Insights from a Cohort of Morbidly Obese, Middle-aged South Indian Women.

Eur Endocrinol 2020 Oct 6;16(2):148-151. Epub 2020 Oct 6.

Department of Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Objective: The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients.

Methods: Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life.

Results: The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles.

Conclusion: In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient.
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http://dx.doi.org/10.17925/EE.2020.16.2.148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572161PMC
October 2020

Exogenous recombinant human insulin-induced severe hypersensitivity reaction precipitating hyperglycemic crisis: A clinical conundrum.

J Family Med Prim Care 2020 Aug 25;9(8):4470-4472. Epub 2020 Aug 25.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College (CMC) Vellore, Tamil Nadu, India.

Hypersensitivity reactions against exogenous insulin are a rare clinical entity after the advent of recombinant human insulin; however, there are still case reports wherein patients develop hypersensitivity reactions against insulin. We present the case of a type 1 diabetes mellitus patient who developed type 1 hypersensitivity reaction against subcutaneous insulin. He had recurrent episodes of diabetic ketoacidosis after developing hypersensitivity reactions against insulin, requiring multiple hospital admissions. When he presented to us, he was on both insulin infusion and subcutaneous insulin, requiring a daily insulin dose of about 800 units and having severe insulin hypersensitivity reactions and hyperglycemia. He had multiple subcutaneous erythematous nodules at the insulin injection sites, however, had no evidence of systemic allergy. Investigations revealed eosinophilic leukocytosis, and high IgE levels and skin biopsy showing evidence of insulin hypersensitivity. He was desensitized to insulin according to Heinzerling . insulin desensitization protocol and subsequently with immunomodulation therapy using steroids (pulse methylprednisolone) and mycophenolate mofetil as well as by installation of insulin pump.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_148_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586586PMC
August 2020

Familial hypercholesterolemia: The skin speaks.

J Family Med Prim Care 2020 Aug 25;9(8):4451-4453. Epub 2020 Aug 25.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Familial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipoprotein metabolism caused by defects in the low-density lipoprotein receptor (LDLR) gene. It is characterized by high low-density lipoprotein (LDL) cholesterol levels, premature cardiovascular disease (CVD), and tendon xanthomas. We present the case of a 26-year-old gentleman who presented with multiple nodular eruptions over the extensor aspects of upper and lower limbs and was diagnosed as FH on the basis of positive family history, typical lipid profile abnormalities, and biopsy of the nodule consistent with tendon xanthomas. The diagnosis and management of this case is deftly feasible at the primary care level.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_819_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586528PMC
August 2020

A case of infection presenting as refractory hypothyroidism.

J Family Med Prim Care 2020 Jul 30;9(7):3770-3772. Epub 2020 Jul 30.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

We present the case of a 45-year-old lady with long standing hypothyroidism who was euthyroid on replacement for many years, but stopped responding even to supraphysiological doses of LT4 since the last five years. She complained of abdominal discomfort, bloating, and nausea. She did not have diarrhea or weight loss. Levothyroxine absorption test was done which was suggestive of malabsorption and she was started on triple therapy for H. pylori eradication after confirmation of diagnosis. After 10 days of treatment initiation, she developed symptoms of thyrotoxicosis with her supraphysiological dose of LT4, which was then tapered to a lower dose. Euthyroid state was ultimately achieved with lower doses of LT4 replacement.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_729_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567260PMC
July 2020

Normal weight obesity and COVID-19 severity: A poorly recognized link.

Diabetes Res Clin Pract 2020 11 21;169:108521. Epub 2020 Oct 21.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, Tamil Nadu, India; Non Communicable Disease Unit, Melbourne School of Population and Global Health, University of Melbourne, VIC 3053, Australia.

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http://dx.doi.org/10.1016/j.diabres.2020.108521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575588PMC
November 2020

Paget's Disease of Bone Revisited: The Changing Indian Scenario.

Indian J Endocrinol Metab 2020 Jul-Aug;24(4):293-294. Epub 2020 Aug 27.

Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijem.IJEM_480_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540821PMC
August 2020