Overweight and obesity are rapidly increasing globally, and Bardet–Biedl syndrome (BBS) is a rare genetic disorder that can cause obesity. We report a case of a 27-year-old unmarried man with morbid obesity, retinal dystrophy, polydactyly, mental retardation, hypogonadism, and poor scholastic performance diagnosed as BBS who was admitted to our care.

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Obstructive sleep apnea (OSA) and the various components of metabolic syndrome are closely interrelated. We propose the term somnometabolic syndrome to define the condition where OSA coexists with one or more components of metabolic syndrome. Such a definition reinforces the strong association between OSA and metabolic syndrome and will urge the clinician to screen and diagnose OSA in individuals with metabolic syndrome and vice versa. It is hoped that the usage of this new term will not only address the lacunae in screening and treatment of OSA in individuals with metabolic syndrome but will also foster collaboration and research among specialties managing OSA.

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Objective: The correlation between bone mineral density (BMD) and bone markers is well studied in postmenopausal women and elderly men. However, related literature on healthy adults is scarce. This study determined the correlation between parathyroid hormone (PTH), BMD of the left distal radius, and other biochemical markers in apparently healthy Nigerian adults. Methods: This research included 80 (28 males/52 females) healthy participants between 22 and 50 years of age (32.10 ± 5.8 years) who met the inclusion criteria. All the participants were recruited by a systematic random sampling. Interview questionnaires were used to supplement clinical data and anthropometric measures. Fasting samples were analyzed for calcium, inorganic phosphorus, 25-hydroxyvitamin D (25[OH]D), PTH, osteocalcin (OC), alkaline phosphatase, and 24-h calcium excretion. The left distal radius BMD was examined using dual-energy X-ray absorptiometry. The data were statistically analyzed, and the significance level was set at <0.05. Results: It was found that PTH was inversely correlated with left distal radius BMD/z-score (P = 0.004). It showed positive and negative trends with serum-adjusted calcium and inorganic phosphorus (P = 0.09 and P = 0.07, respectively). Neither the OC nor 24-h calcium excretion correlated with PTH (P > 0.05). The OC was inversely correlated with BMD (P = 0.003), but not with 24-h urinary calcium excretion (P > 0.05). None of the participants had osteoporosis. Regression analysis showed that PTH and OC predict radial bone density in participants (P < 0.05). Conclusion: Higher PTH levels correlate with lower left distal radius BMD in apparently healthy participants.

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Introduction: Hypogonadism in males is characterized by low serum testosterone (T) levels together with clinical symptoms and is more common in diabetes mellitus (DM). Association between DM and hypogonadism has been studied in different populations but is not clearly known in Bangladeshi population. Objectives: The objective of this study was to find out the frequency and determinants of hypogonadism and erectile dysfunction (ED) in men with newly detected type 2 DM diabetes (T2DM). Materials and Methods: A cross-sectional study encompassing 1940 newly T2DM male patients (age: 42.57 ± 7.4 years; body mass index [kg/m²]: 26 ± 5.1; mean ± standard deviation) was carried out in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, to see hypogonadism. Measurement of serum total testosterone (TT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle stimulation hormone (FSH) was measured by chemiluminescent technology. Results: Among hypogonadal subjects, according to calculated Free Testosterone (cFT) and Androgen Deficiency in the Aging Male (ADAM) criteria, the frequency of hypogonadotropic hypogonadism was 80% which, on the basis of TT and ADAM criteria, was 92.5%. There was no significant difference for hypogonadism among either the hemoglobin A1c (HbA1c) categories (P = 0.23) or age groups (P = 0.9). Hypogonadal and eugonadal groups significantly differed both according to TT and ADAM (81.5% vs. 43.4%, P = 0.01) and cFT and ADAM (93.3% vs. 47.7%, P ≤ 0.001) criteria for ED. There was a significant difference between the groups for SHBG (21.7 ± 11.6 vs. 30.71 ± 22, P = 0.05) by TT and ADAM criteria. Similarly, cFT and ADAM criteria also revealed a statistically significant difference for SHBG (38.04 ± 19.90 vs. 25.28 ± 19.37 nmol/l, P = 0.03) and total cholesterol (211.40 ± 44.7 vs. 191.3 ± 32.64 mg/dl, P = 0.04). However, in both the groups, LH, follicle-stimulating hormone (FSH), HbA1c, fasting blood sugar, 2 h after 75 g glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein did not differ significantly. cFT significantly correlated with age (r = ‒0.3503, P = 001) and SHBG (r = ‒0.37, P ≤ 0.01) whereas TT with SHBG (r = 0.58, P = 0.01). By multiple regression, ED and SHBG were significant predictors for hypogonadism (P = 0.01 and 0.03, respectively). Conclusion: It was concluded that a significant number of newly detected male T2DM subjects have symptoms of hypogonadism judged on the basis of TT, cFT, and ADAM scores. Poor glycemic control may affect gonadal and erectile functions. This aspect should be considered while diagnosing male subjects as T2DM.

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Polyostotic fibrous dysplasia is a disorder that features the replacement of multiple areas of bone with fibrous tissue, which may cause fractures and deformity. It begins in childhood and progresses onward, affecting both sexes equally. A 23-year-old male presented with recurrent fractures of all long bones and multiple vertebrae with low trauma. X-ray showed extensive multilocular cystic lesions with ground-glass diffuse refractions throughout all long bones, multiple fracture lines and dislocation of joints, scoliosis, and compression of multiple vertebrae. Severe cortical thinning is also seen in all bones. He was managed with bisphosphonate, and significant improvement was observed.

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Background: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. The aim of this study is to observe and compare the effect of commonly used regimens of insulin on body mass index (BMI) among Type 2 diabetes patients. Methods: An observational study was conducted in two diabetic centers in Dhaka starting from July 2018 to June 2019. During the 12 weeks of the data collection period, a total of 100 patients were included according to selection criteria and then divided into two equal groups. Patients who were prescribed with premixed (conventional or analog) 30/70 insulin twice daily with or without oral Antidiabetic drugs were included in Group I (n = 50) and the patients who were prescribed with insulin glargine once daily with a bolus insulin (conventional or analog) three times before large meals with or without oral Antidiabetic drugs were included in Group II (n = 50). BMI was calculated from the height and weight of the patients initially as baseline data and again after 12 weeks of treatment in both groups. Fiber Bragg grating, 2 h ABF, and hemoglobin A1C (HbA1c) change were also observed among the patients of both insulin groups from diagnostic reports during the study period. Results: After 12 weeks of treatment, mean body weight (±standard deviation [SD]) was increased significantly from 59.82 ± 12.33 kg to 60.40 ± 13.38 kg in Group I (P = 0.01) and from 59.00 ± 12.36 kg to 60.33 ± 12.97 kg in Group II (P = 0.02). Mean BMI (±SD) increased significantly from 23.71 ± 4.69 kg/m² to 24.10 ± 4.17 kg/m² in Group I (P = 0.01) and from 24.00 ± 4.30 kg/m² to 24.43 ± 4.59 kg/m² in Group II (P = 0.02) during the study period. The mean BMI compared between two study groups (24.10 ± 4.17 vs. 24.43 ± 4.59) kg/m² m+ after 12 weeks of treatment was not statistically significant (P = 0.816). About 64.0% of patients in Group I and 68.0% in Group II have shown weight gain and BMI change after 12 weeks. Mean HbA1c (±standard deviation [SD]) reduced significantly from 10.40% ± 2.17% to 7.76% ± 1.41% in Group I and from 10.41% ± 1.80% to 7.63% ± 1.37% in Group II. About 48.0% of patients in Group I and 56.0% of patients in Group II achieved glycemic target <7%. About 28.0% of patients in Group I and 20.0% of patients in Group II had hypoglycemia. Conclusion: From the current study, it can be concluded that both insulin regimens significantly cause weight gain, BMI change and also significantly effective in glycemic control. However, in comparison between the two groups, there was no significant difference. Hence, both premixed and glargine-based basal-bolus regimen can be prescribed as per patient need. This result may provide some preliminary information for further investigation

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Background: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype and severity at presentation are different in patients with and without diabetes. Objective: The objective of the study was to identify the subtype and severity of stroke at presentation in diabetic versus nondiabetic subjects in our population. Methods: This cross-sectional comparative study was conducted in the Departments of Neurology and Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, from July 2011 to December 2011. Forty-seven stroke patients with diabetes and 47 nondiabetic patients with stroke were included in the study. Results: The mean age of the patients of the diabetic group was lower than the nondiabetic group (60.4 [standard deviation (SD) ± 10.5] vs. 65.4 [SD ± 10.3], P< 0.05), but there was no sex difference between the two groups. Hypertension and stroke severity was more in diabetics (Scandinavian Stroke Scale: 21.2 vs. 28.1, P< 0.001). Ischemic stroke was significantly more in the diabetic group than that of the nondiabetic group (83.0% vs. 59.6%, P< 0.01). Subtypes of hemorrhagic stroke and ischemic stroke were almost similar in both the diabetic and nondiabetic groups. Conclusion: Stroke in diabetic patients is different from stroke in nondiabetic patients in several aspects. The diabetic stroke patient is younger, ischemic stroke and stroke severity is more, but hemorrhagic stroke is less in diabetic individuals.

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Background: In Bangladesh, patients with thyroid disorders are managed in accordance with the recognized guidelines and based on expert experience, as comprehensive national guidelines are currently lacking. The Bangladesh Endocrine Society (BES), as a professional body, has been working to develop guidelines for the last couple of years. Most recently, BES formulated practical recommendations for the management of thyroid disorders during pregnancy, which will be termed the “Guideline on Thyroid Disorders in Pregnancy in Bangladesh 2022,” Methods: The BES formed a task force comprising experts in this field to formulate the practical recommendations for the management of thyroid disorders during pregnancy under several sections. The members of this task force comprehensively reviewed the available evidence for the specific conditions. Three well-known databases (Google Scholar, PubMed, and Scopus) were searched to determine the evidence. The task force members were well trained on reviewing the documents and methods of evidence synthesis. Each section of the recommendation was drafted by one member and subsequently reviewed. There was no barrier to the date or type of article published in the aforementioned databases except for articles published other than English. Due to the scarcity of intervention studies, ideas and findings of observational studies, case studies and expert recommendations were considered during the formulation of the guidelines. All members and affiliated persons declared no competing interest, and it was managed and communicated by the President of the BES. Results: The current guidelines for the management of thyroid disease in pregnancy include recommendations about the screening of thyroid function in pregnancy, planning pregnancy in women with thyroid disorders, interpretation of thyroid function tests, management of hypothyroidism and hyperthyroidism in pregnancy, management of thyroid nodules and thyroid emergencies throughout pregnancy, postpartum care, and directions of future research. Conclusions: Our utmost efforts were centered on developing evidence-based recommendations to inform all the levels of clinicians of Bangladesh for the easy understanding and decision-making processes in the management of thyroid disorders in pregnancy and afterward. While we care most to prepare the guideline, all recommendations are the opinion of society and admit the scope of making individualized decisions for the optimal care of patients.

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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women. PCOS is not a homogeneous disease and can manifest as a range of multifaceted problems, including various reproductive, cosmetic, cardiometabolic, and psychiatric conditions. In Bangladesh, research defining the prevalence and characteristics of PCOS is not ample. This review summarizes the findings from published studies that provide consistent evidence on the prevalence and characteristics of women with PCOS in the country. The small-scale studies conducted among different subgroups of women indicate a high prevalence of the condition. Clinical presentations of PCOS in Bangladeshi women are also highly variable. A substantial portion has obesity, insulin resistance, abnormal glucose tolerance, dyslipidemia, and metabolic syndrome, which significantly threaten their cardiovascular health. Many of them have co-existent other endocrinopathies, including thyroid abnormalities. Moreover, highly prevalent psychiatric comorbidities among these women warrant routine screening for these conditions.

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Background and Objectives: Vitamin D deficiency (VDD) is highly prevalent in both healthy population and patients with type 2 diabetes mellitus (T2DM) in Bangladesh. Data on Vitamin D status in nonresident Bangladeshi (NRB) individuals with T2DM are scarce. We conducted this study to compare the Vitamin D status between resident and NRBs. Materials and Methods: This cross-sectional study evaluated 234 patients with T2DM (109 resident Bangladeshis [RBs] and 125 NRBs) attending a specialized diabetes hospital in Cumilla city, Bangladesh, from July 2021 to February 2022. Serum 25(OH)D <20 ng/mL defined VDD. Results: The mean age of the study participants was 42.5 ± 9.4 years; the frequencies of obesity, hypertension, dyslipidemia, and uncontrolled diabetes (HbA1c ≥7%) were 79.1%, 45.7%, 93.6%, and 88.9%, respectively. The Middle East countries were the residing countries of most (92.8%) of the NRBs. Higher frequencies of smokers and dyslipidemia were observed among RBs. The body mass index and HbA1c were higher, and low-density lipoprotein cholesterol was lower among NRBs than RBs. In the study participants, the mean 25(OH)D level was 25.7 ± 10.2 ng/mL; 30.3%, 38.5%, and 31.2% of the study participants were sufficient, insufficient, and deficient in Vitamin D, respectively. RBs and NRBs had similar 25(OH)D levels (25.7 ± 11.9 vs. 25.8 ± 8.5 ng/mL, P = 0.948) and VDD status (36.7% vs. 26.4%, P = 0.124). Conclusion: Low Vitamin D is highly prevalent in both RBs and NRBs with T2DM though they have similar Vitamin D levels and comparable rates of VDD. Further studies are needed to determine the factors that influence Vitamin D status in our people.

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Introduction: Diabetic neuropathy (DN) is most commonly associated with diabetic peripheral neuropathy (DPN). About 66% of diabetic patients have either clinical or subclinical neuropathy. Materials and Methods: One hundred and twenty patients were enrolled in our study, 60 patients are of Type 2 diabetes mellitus (T2DM) with neuropathy (DPN), and 60 were of T2DM without neuropathy. They were assessed for neuropathy. Serum fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin A1C (HbA1_C), and duration of disease were obtained from the patients. Forced expiratory volume at the 1^st s (FEV₁) and forced vital capacity were recorded and % FEV₁ was calculated. Results: The mean age of T2DM with neuropathy was 49.17 ± 7.1 and in patients of T2DM without neuropathy was 46.63 ± 8.028. The mean value of % FEV₁ in T2DM with neuropathy is 95.45 ± 7.16, while in T2DM without neuropathy, it is 83.53 ± 6.22, and the difference was statistically significant. Linear correlation of % FEV₁ with fasting plasma glucose (FPG) (r = 0.474, P = 0.008) and HbA1_C (r = 0.588, P = 0.001) shows a statistically significant association in diabetic peripheral neuropathy. The standardized β weights of FPG, postprandial plasma glucose, and HbA1_C show significant values in patients of DPN. Conclusion: Diabetic peripheral neuropathy (DPN) is associated with decreased pulmonary function as compared to patients of diabetes without neuropathy, the glycemic status of patients may also adversely affect % FEV₁. Thus, proper control of hyperglycemia will decrease the further progression of the disease. We also suggest performing pulmonary function test in patients of diabetes mellitus with DN in the preoperative period so as to optimize the perioperative care.

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Background: Diabetes mellitus is one of the most common noncommunicable diseases worldwide, which requires management of the symptoms through lifestyle modification and antidiabetic pharmacotherapies. The purpose of this study was to observe the effects on glycemic control by combination therapy of gliclazide-metformin and insulin in type 2 diabetes mellitus patients according to baseline HbA1c, fasting blood glucose (FBG), and blood glucose 2 h after breakfast. Methods: An observational study was conducted at Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, and Outpatient Department of Ibrahim General Hospital, Mirpur, Dhaka, for 1 year (July 2018–June 2019). In total, 110 type 2 diabetic patients were selected purposively. The patients were divided into two groups. In Group I, 55 patients treated with gliclazide (80 mg) and metformin (500 mg) combination therapy twice daily for consecutive 12 weeks, and in Group II, 55 patients treated with insulin (premixed 30/70) twice daily for consecutive 12 weeks. Results: After 12 weeks of treatment, HbA1c level reduced from (mean ± standard deviation) 8.94 ± 0.91 to 7.82 ± 1.86 in Group I and 10.07 ± 1.28 to 7.90 ± 1.01 in Group II. FBG level reduced from 10.05 ± 1.57 to 7.96 ± 1.62 in Group I and 11.61 ± 2.62 to 7.60 ± 1.23 in Group II. Blood glucose 2 h ABF level reduced from 14.00 ± 2.04 to 10.99 ± 1.41 in Group I and 16.70 ± 3.61 to 10.71 ± 1.52 in Group II. In Group I, 36.4% of patients achieved HbA1c target level, 40% of patients achieved FBG target level, and 25.5% of patients achieved blood glucose 2 h ABF target level. In Group II, 29.1% of patients achieved HbA1c target level, 56.4% of patients achieved FBG target level, and 29.1% of patients achieved blood glucose 2 h ABF target level. Conclusions: On the basis of the study findings, patients of both study groups showed an improvement in the overall glycemic control (HbA1c, FBG, and blood sugar 2 h ABF) during the study. Both groups of drugs are effective in controlling blood glucose, but individual group has a unique beneficial effect.

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A 21-year-old male presented with the features of thyrotoxicosis, and his thyroid function tests revealed primary hyperthyroidism. He also had mild bilateral exophthalmos with lid lag, lid retraction, and a clinical activity score of 1, suggestive of mild Graves' ophthalmopathy. Neck ultrasonography revealed mild diffuse goiter with bilateral fairly large nodules predominantly at the right lobe and bilateral multiple cervical lymphadenopathies. Tc-99m pertechnetate scan demonstrated diffuse goiter with homogeneously increased radiotracer concentration. He had an elevated titer of thyroid-stimulating hormone receptor autoantibody level. Fine-needle aspiration cytology from the largest nodule of the right lobe reported a Bethesda Category-VI lesion compatible with papillary thyroid carcinoma. Graves' disease and papillary thyroid cancer carcinoma might be present concomitantly in the same patient. Although links between these entities have long been investigated, a clear correlation is not established yet.

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Background and Objectives: The triglyceride glucose (TyG) index has emerged as a cheaper alternative to hemoglobin A1c (HbA1c) and Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) for diagnosing prediabetes and insulin resistance (IR), respectively. This study evaluated the utility of the TyG index as a marker of prediabetes and IR compared to HbA1c and HOMA-IR in Bangladeshi adults. Materials and Methods: This cross-sectional comparative study evaluated 100 prediabetics and 100 age-sex-matched normoglycemic subjects attending the outpatient department of Chittagong Diabetic General Hospital between October 2021 to September 2022. Anthropometric data were collected; laboratory data included oral glucose tolerance test, HbA1c, fasting triglyceride, serum insulin, and HOMA-IR. Comparative analyses were done between the TyG Index and HbA1c and HOMA-IR with the receiver operator characteristics (ROC) curves. Results: The areas under the curves (AUC) for diagnosing prediabetes for HbA1c and TyG Index were 0.923 (P < 0.001) and 0.874 (P < 0.001), respectively; TyG Index is comparable to HbA1c (P = 0.062). TyG Index >4.762 had 84.5% sensitivity and 80.5% specificity for diagnosing prediabetes. The AUC for the TyG index for IR was 0.792 (P < 0.001); TyG Index >4.762 had 84.5% sensitivity and 46.8% specificity for diagnosing IR. The Pearson correlation coefficients between the various anthropometric measurements related to IR with TyG Index and HOMA-IR demonstrate a highly significant difference in weight (0.186 vs. 0.154) in favor of the TyG index (P < 0.01). It also shows a significant difference (P < 0.05) in body mass index (0.421 vs. 0.372), waist circumference (0.286 vs. 0.253), and waist-to-height ratio (0.392 vs. 0.333) in favor of the TyG index. Conclusion: The TyG index is a reliable surrogate marker for IR and comparable to HbA1c for identifying prediabetes. Hence, it can be used as an alternative screening tool for diagnosing prediabetes and IR.

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Introduction: Fine-needle aspiration (FNA) cytology is a reliable method to diagnose thyroid lesions. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is universally followed for thyroid cytology reporting. Out of the six categories described, Category III, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous one. Materials and Methods: In this study conducted in a tertiary health care center in Eastern India over 2 ½-year period, 868 thyroid FNAs were performed and the cytology smears were interpreted using the TBSRTC. There were 32 FNAs in Category III. Histopathology report was available in nine cases. Results: The risk of malignancy (ROM) considering noninvasive follicular thyroid carcinoma with papillary nuclear features (NIFTP) as benign was 9.3% and by considering NIFTP as malignant was 21.8%. Conclusion: The ROM for AUS/FLUS in our study was within the revised ROM criteria. In Category III, surgery is preferable in nodules which harbor suspicious features either clinically or according to ultrasound findings.

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Both diabetes mellitus (DM) and male infertility are widely prevalent, and their prevalence has increasing trends. Diabetes is known to have negative impacts on almost all aspects of male reproductive functions. Such pathophysiology is more widely studied in animal models, and in men with type 2 DM (T2DM), similar reproductive dysfunctions are also described in type 1 DM (T1DM). T1DM and T2DM may have different underlying mechanisms contributing to the changes seen in their sperm parameters. At the pretesticular level, DM causes hypogonadotropic hypogonadism. DM affects many aspects of testicular function. Increased oxidative stress and inflammation, increased reactive oxygen species, lipid peroxidation, advanced glycation end products, disrupted energy metabolism, and nuclear and mitochondrial deoxyribonucleic acid damage alter sperm count and quality. The structure and function of the epididymis, vas deferens, seminal vesicles, and prostate are also affected, changing sperm quality and viability. Genitourinary infections are common in DM and might alter reproductive homeostasis. Erectile and ejaculatory dysfunction frequently affects men with DM. Retrograde ejaculation and anejaculation may lead to infertility. Glucose-lowering drugs may also influence the male reproductive process; insulin, metformin, pioglitazone, sodium-glucose cotransporters, and glucagon-like peptide 1 agonist drugs may have favorable impacts. The pathophysiology of reproductive dysfunction and fertility in men with DM is yet to be completely elucidated. Many factors, including duration of diabetes, glycemic control, and associated comorbidities, may obscure the real impact of DM-related male infertility. The ongoing molecular studies generating new insights are expected to better clarify DM-induced alterations in male reproductive function.

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Background: Obesity is a harbinger of cardiovascular disease. It is affecting individuals from an early age. Aim: The aim of the study was to compare cardiometabolic risk factors (CRFs) in obese children and adults; and to see their relationship with obesity. Materials and Methods: Two hundred and thirty-nine overweight and obese individuals (189 ≤20 and 50 >20 years) without secondary causes of obesity were included and data on their CRFs (blood pressure, plasma glucose, glycated hemoglobin, and lipid profile) were obtained from clinic records. Results: Mean age and body mass index (BMI) of ≤20 years of group were 13.77 ± 2.32 years and 33.29 ± 8.45 kg/m², respectively. The mean age and BMI of >20-year group were 39 ± 1.41 years and 36.81 ± 2.40 kg/m², respectively. Participants in the ≤20-year group had a lower rate of abnormal glucose tolerance (28.9% vs. 61.9%, P < 0.001) and hypertension (3.6% vs. 15.4%, P < 0.001), but a higher rate of dyslipidemia (98.8% vs. 97.5%, P < 0.001) than the ≤20 years of group. After adjusting for all cardiovascular risk factors, diastolic blood pressure was significantly related to obesity (BMI β = 0.380, P = 0.001; waist circumference β = 0.499, P < 0.001; fat mass index β = 0.407, P = 0.001; waist height ratio β = 0.356, P = 0.004) in the ≤20-year group, while fasting plasma glucose was related to BMI (β = 1.086, P = 0.001) in the >20-year group. Conclusion: There is a high rate of dyslipidemia in young obese individuals. Blood pressure is associated with obesity at a younger age, while dysglycemia is associated with increasing BMI in adults.

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Pheochromocytoma is one of the causes of endocrine hypertension leading to stroke in young patients. The tumor secretes not only catecholamines but also other hormones in rare occasions. Besides, symptomatic tumors may come with normal catecholamine metabolite levels. Here is a case of a 28-year-old male featuring these exceptions who was managed at Dhaka Medical College Hospital.

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Background and Objectives: Nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are two prevalent metabolic disorders characterized by insulin resistance. A bidirectional relationship exists between NAFLD and PCOS. NAFLD prevalence is significantly higher and more severe in women with PCOS. This study was conducted to generate data regarding the frequency of NAFLD among Bangladeshi women with PCOS. Materials and Methods: This cross-sectional study was conducted at the endocrinology and gynecology outpatient department of a tertiary hospital in Bangladesh from October 2020 to December 2021. All adult women diagnosed with PCOS by the revised Rotterdam criteria underwent ultrasonographic evaluation for hepatic steatosis. Relevant sociodemographic and clinical data were obtained from all; all underwent hormonal and metabolic assessment. Results: Among 120 women (age 33.67 ± 10.15 years) with PCOS studied, 32 (26.7%) had NAFLD. NAFLD frequency was higher in rural than urban areas. Clinical hyperandrogenism (HA) was less frequent in the NAFLD group than in the non-NAFLD group. Two groups did not vary in the frequencies of overweight, obesity, abdominal obesity, and hypertension. Hormonal parameters were indifferent in the two groups; both groups had a similar frequency of biochemical HA. Both groups had similar plasma glucose levels and glycemic status. NAFLD patients had lower high-density lipoprotein cholesterol and higher triglyceride than the non-NAFLD patients; total and low-density lipoprotein cholesterol were similar in the two groups. Although metabolic syndrome frequency was higher (43.8% vs. 33.0%) in the NAFLD group, the difference was insignificant (P = 0.290). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were more elevated in the NAFLD group; AST: ALT ratios were identical in the two groups. In binary logistic regression analysis, only clinical HA was associated with a lower risk of NAFLD among the study participants. Conclusion: More than one-fourth of women with PCOS have NAFLD in this study. A large-scale, multicenter study may better explain NAFLD's association and risk factors in women with PCOS.

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Background: Thyroid status influences weight and thyroid function is altered in obese individuals. Objective: This study aimed to see the levels of free thyroxine (FT4) and thyroid-stimulating hormone (TSH) and their relationship with the parameters of obesity in obese children and adults with primary exogenous obesity without thyroid disorders. Materials and Methods: This retrospective cross-sectional study was done in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, from May 2019 to March 2020 in 238 children and adults with primary exogenous obesity. Individuals with thyroid disorders were excluded from the study. Data were taken from hospital records to assess the thyroid function (FT4 and TSH) in obesity. Results: Two hundred and thirty-eight individuals with a mean age of 16.42 ± 9.72 years (range 3–62 years) and mean body mass index of 31.09 ± 7.64 kg/m² were included in the study. The distribution of FT4 was normal and that of TSH was skewed to the right. Ninety-five percent confidence interval (CI) of FT4 and TSH was within the normal reference range. Ninety-five percent CI of FT4 was in the upper end of normal (1.176–1.251 mIU/L in ≤20 years and 1.094–1.306 mIU/L in >20 years) and that of TSH was in the lower end of normal (2.619–3.207 mIU/L in ≤20 years and 2.616–4.141 mIU/L in >20 years). About 13.4% had low FT4 and 15.4% had raised TSH. Waist circumference (WC) had a negative linear association with FT4 (r = −0.229, P = 0.003, R² = 5.24%), which was not present in the multivariate analysis. WC was significantly higher in the first versus third quartile of FT4 (103.974 ± 17.211 vs. 94.818 ± 14.544 cm). Conclusion: FT4 and TSH levels were in the lower and upper end of normal, respectively, in obese patients without thyroid disorders. Central obesity was negatively associated with FT4 in obese individuals.

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Van Wyk–Grumbach syndrome is a rare presentation of long-standing prepubertal hypothyroidism in a female characterized by bilateral polycystic ovaries, delayed skeletal growth, and isosexual precocious puberty. We report a case of juvenile primary hypothyroidism presenting as an abdominal mass due to huge bilateral ovarian cysts which responded to the thyroid hormone replacement therapy. This case report highlights that hypothyroidism and other endocrinopathies should be considered in the differential diagnosis of girls with short stature and ovarian masses to avoid unnecessary surgery in young women.

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