THYROID DISORDERS IN PATIENTS WITH MELASMA

Background and objectives: Melasma, a common pigmentary disorder is major cosmetic concernamong patients. The aim of our study was to determine the frequency of thyroid disorders in melasma cases. Methodology: Thisobservational study was conducted at RIHS DermatologyDepartment Islamabad from 20thFeb–20thMay 2021. Diagnosed cases of melasma (>18 years) were selected via consecutive sampling technique.Themedically/surgically treated cases of thyroid, melasma secondary to other dermatosis, organ failure, Addisons disease, pregnancy and subclinical thyroid disorders were excluded. After detailed clinical evaluation, thyroid status documented on the basis of thyroid function tests. Data analysed by SPSS with significant p-value<0.05. Results: Amongst 150 melasma cases 117(78%) females and 33(22%) males, mean age was 35.45+9.68 years. 36(24%) were euthyroid, 109(72.7%) hypothyroid and 5(3.3%) hyperthyroid. Mean TSH was 1.82+18.64 mIU/L. 75(50%) had epidermal, 38(25.3%) dermal and 37(24.7%) mixed melasma, hypothyroidism frequent in all three types. Dermal melasma frequent in 41-50 years, epidermal in 20-30 years and mixed in 31-40 years. Thyroid status had significant association with age group, hypothyroidism more common in 41-50 years and Euthyroid in <30 years. Obesity observed in 55(36.7%) having significant association with hypothyroidism. Mandibular melasma observed in 88%, malar 77.3%, centro-facial18.7% and neck melasma 9.3%. Conclusion: Thyroid disorders, particularly hypothyroidism is frequent among melasma cases.Authors recommend to screen all melasma cases regardless of age or gender for thyroid disorders, in particular obese cases. The diagnosis and management of thyroid disease in melasma cases may improve quality of life, prevent thyroid related complications and improve outcome of melasma treatment.

PATTERN OF ADDISONS DISEASE AND ADDISONION CRISIS IN PATIENTS PRESENTING TO TERTIARY HEALTH CARE HOSPITAL IN INDIA

BACKGROUND: Thomas Addison described a group of patients with diseased adrenal glands at autopsy, with similar signs and symptoms before death; a condition now known as primary adrenal insufciency i.e. Addison's disease. Secondary adrenal insufciency also causes similar symptoms and signs that are due to reduced ACTH secretion from the pituitary gland. Sometimes these symptoms and signs can be subtle and nonspecic. Patients may experience fatigue, weakness, weight loss, and gastrointestinal upset, hyperpigmentation of the skin and mucous membranes. These symptoms are gradual in progression and worsen over years, making early diagnosis difcult. The clinical presentation of adrenal insufciency in India may be underdiagnosed and not paid sufcient attention to. We, therefore, studied the clinical prole of adrenal insufciency. METHODS: We used a prospective study as a study design. We studied 26 patients with adrenal insufciency for their etiology, clinical features, and various laboratory prole including autoantibodies and cortisol levels. RESULTS: Drug-induced adrenal insufciency (steroid abuse) etiology was present in 46.15% of the patients. Tuberculosis was the cause in 26.92% of the patients. Septicemic shock with multiorgan dysfunction syndrome was the etiology in 23.07% of patients. Postural hypotension and salt craving and hyponatremia were noted in about 30.76% of patients with s/o mineralocorticoid deciency. CONCLUSION: Steroid abuse was the most common cause of adrenal insufciency followed by septicemic shock and tuberculosis. Thus, a high index of clinical suspicion is required for a diagnosis of adrenal insufciency in the early stages for diagnosis and prompt treatment.