AYURVED MANAGEMENT OF SECONDARY INFERTILITY - A CASE STUDY

Infertility due to anovulatory cycles over recent years, has emerged as one of the most common health issues that many young women have been facing. Sedentary lifestyles with minimum physical activity, rising stress level and irregular sleep pattern are few of the reasons, according to many clinicians and health experts. PCOD is a common Endocrine disturbance affecting females of age group between 15-30 years. The disorder accounts for delayed periods, Infertility, obesity hirsutism and acne. According to modern science exact cause of disease is unknown. In Ayurveda all diseases of female reproductive system are classified under Yonivyapada, according to Ashtanga Hridayam 20 diseases of Vagina arises because of faulty food habits. PCOD is a kapha predominant disorder; kapha gets aggravated by consuming more sleshmika and sneha containing food items and by lethargic lifestyle. The line of treatment in modern medicine is Harmonal therapy. In Ayurveda the line of treatment is according to dosha predominance, here it is kaphahara, Strotoshodhaka and Anulomana. So, in the present study – Classical Virechana, Pushpadhanwa rasa, KanchanaraGugglu, Triphalvati, are selected. The result is outstanding, and symptoms subsided. Further clinical trials can be conducted to prove the efficacy of the drugs statistically.

GCT-75. ISOLATED PITUITARY STALK THICKENING

OBJECTIVES Only few studies have examined the predictive factors and outcome of isolated pituitary stalk thickening (PST) in children. We aim to describe our institutional cohort to determine predictors of future malignancy. METHODS A search of the radiology, endocrinology and neuro-oncology databases was performed to identify patients with isolated PST diagnosed between January 2000 and June 2019. Clinical data was collected. A detailed radiology review of baseline and follow up magnetic resonance imaging (MRI) was undertaken in a blinded fashion by two examiners. RESULTS Forty-four patients were identified, with 37 meeting criteria for isolated PST and adequate imaging. Median age of baseline MRI was 9.9 years (range 0.9–17.5). Twenty-three were female (62%). Median follow up time was 5 (0.31–18.6) years. Indication for MRI was symptoms of diabetes insipidus (DI) in 28 patients with the remainder having other concerns for endocrine disturbance (7), headache (1) or visual impairment (1). Thirty-five subjects had pituitary dysfunction (95%), including 30 with diabetes insipidus (81%). Nine patients developed a malignancy (24%), with germinoma (5), Langerhans cell histiocytosis (3) and lymphoma (1) at a median of 0.36 years, 0.63 years and 1.1 years respectively. Elevated white blood cell count (>5 x 106/L) in initial cerebrospinal fluid analysis was predictive of future diagnosis of germinoma or lymphoma (p=0.027). CONCLUSION In this cohort 24% of children with PST were eventually diagnosed with a neoplasia after a median of 0.63 years. Pleocytosis in initial CSF samples was predictive for future development of germinoma or lymphoma.

Increased TSH-producing cells in the pituitary gland of Pax6 haploinsufficient mice

Aniridia is a congenital condition characterized by absence of iris and is caused by a semidominant mutation in the transcription factor encoded by the PAX6 gene. Although ocular phenotypes of this disorder are well characterized, recent studies report that individuals with aniridia have a higher propensity for obesity, infertility, polycystic ovarian disease, and severe eczema compared to their Pax6-normal siblings. These symptoms collectively suggest an underlying endocrine disturbance related to haploinsufficient levels of Pax6. In mice, during development, Pax6 expression in the pituitary gland begins at E9.0 in the primordial anterior pituitary gland (Rathke’s Pouch). This expression becomes restricted to the dorsal anterior pituitary by E11.5, but is expressed throughout the anterior lobe by E14.5, and remains through adulthood. It is possible that a reduction in Pax6 could result in a change in pituitary hormone levels or cell numbers, which may explain symptoms experienced by aniridics. Using the Small eye mouse model, we find that Pax6 reduction results in a decrease in GH-producing cells and an increase in TSH-producing cells in neonate mice, with the TSH increase continuing into adulthood. Adult Pax6 haploinsufficient mice also have an increase in anterior pituitary volume and weigh significantly less than their wild-type littermates. Furthermore, we show that the increase in TSH-producing cells leads to an increase in thyroxin (T4) in mutant mice, although tri-iodothyronine (T3) levels remain unchanged. These findings present a new role for Pax6 in the endocrine system, which serves to refine our current understanding of Pax6 in endocrine development and maintenance and provides new avenues for investigating endocrine-related symptomatology in aniridia.

Raynaud Phenomenon: Diagnosis and Management

ABSTRACT Raynaud’s phenomenon (RP) is a chronic episodic attack of digital ischemia provoked by exposure to cold or emotional stres. This phenomenon affects 3-5% of the population, with female ratio more than men and is categorized into a primary and secondary form. Primary form of RP is idiopathic, meanwhile the secondary form is associated with underlying diseases and other condition such as connective tissue disease, obstructive arterial disease, neurologic disorders, drugs and toxin, hyperviscosity disorders, infections, endocrine disturbance, neoplasms, and occupation or environmental exposure. Until today, to classified and build the diagnosis of RP is still a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy are mandatory. A combination of conservative measures and medications can help in the management of RP. The approach to the RP patients requires therefore a coordinated care of specialists including dermatology.