Letters to the Editor
8. 9.
management: Consensus statement. Indian J Endocrinol Metab 2013;17:548-62. Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129-36. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339-48. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122654
normal range was taken as criteria for SCH. This essentially confuses a reader looking for quality research work in your journal. In the same issue of the journal, a better methodology has been adopted by the authors of the article “High prevalence of SCH during the first trimester of pregnancy in North India.”[2] Further, we would like to draw your attention to an article on SCH published in Jounal of American Medical Association JAMA.[3] It defines SCH as a serum TSH above the defined upper limit of the reference range, with a T4 within the reference range. Other causes of a raised TSH, a past history of thyroid disease and patients on T4 hormone treatment need to be excluded. Sunil Kumar Raina, Sujeet Raina1 Departments of Community Medicine and 1Medicine, Dr. RPGMC, Tanda, Himachal Pradesh, India
Research methodology and publications: Are we following the correct science? Sir, This is regarding an article entitled “Increased prevalence of subclinical hypothyroidism (SCH) in females in the mountainous valley of Kashmir” published in your journal.[1] We went through the contents of this article in hope to find a pure epidemiological study reflecting on the increase in prevalence of SCH in females in Kashmir valley. However, we were disappointed to note that the study based on pure laboratory investigations on patients probably referred from clinical departments for evaluation of hypothyroidism could yield prevalence, leave alone increased prevalence. Even if, we accept that prevalence estimates could be arrived at by this methodology, there is no way we can arrive at increased prevalence unless we have comparative statistics to prove this. We hardly find that. Further, the authors mention this as a retrospective study, but go on to write that the patients were re-evaluated with repeat thyroid profile after 3 months again. In fact, this forms the basis of their diagnosis for SCH. In materials and methods section the authors mention that patients with thyroid hormone evaluation picture of elevated serum thyroid stimulating hormone (TSH) levels (>4.3 to ≥10 mIU/ml) with normal levels of serum thyroxine (T4) and tri-iodothyronine (T3) were categorized as SCH if similar levels were observed in repeated thyroid profile after a lapse of three months. However, in the results section the authors mention that the TSH value above 4.3-10 mU/l and free T4 within
Corresponding Author: Dr. Sunil Kumar Riana, Department of Community Medicine, Dr. RPGMC, Tanda, Himachal Pradesh, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
Bashir H, Farooq R, Bhat MH, Majid S. Increased prevalence of SCH in females in mountainous valley of Kashmir. Indian J Endocrinol Metab 2013;17:276-80. Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab 2013;17:281-4. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-38. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122655
Prevalence of metabolic syndrome in adolescents: Reason to worry Sir, We read with interest the article ‘Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K’ by Singh et al.,[1] and would like to make some important comments.
Indian Journal of Endocrinology and Metabolism / Nov-Dec 2013 / Vol 17 | Issue 6
1135
Letters to the Editor
The metabolic syndrome (MS) in adolescents is a largely unrecognized health problem and it’s exact prevalence in developing countries particularly in India is unknown until recently when few studies were conducted in this field including that by Singh et al.[1] Kapil et al.,[2] found that the prevalence of MS in children (6-18 years) from high income group in Delhi was 6.5% (males 6.9% and females 5.9%), which was higher than that reported by Singh et al.[1] Recently, Tandon et al.,[3] studied the prevalence of MS in urban Indian adolescents (695 out of 15,101 adolescents, 10-18 years) and found that the calculated prevalence of MS in total population was 4.3% and 3.0% using Adult Treatment Panel (ATP) and international diabetes federation criteria, respectively, which was slightly higher than that reported by Singh et al.[1] MS was significantly higher in girls than boys and the most common component of MS was central obesity followed by hypertriglyceridemia, low high density lipoprotein (HDL)-cholesterol, hypertension and dysglycemia; which were in contrast to that reported by Singh et al.,[1] where males had higher prevalence; and low HDL-cholesterol was most common and high blood pressure was least common constituent of MS. Moraes et al.,[4] conducted a systematic review by including 8 studies in adolescents (10-19 years) undertaken in low to medium-income countries and found that the prevalence of MS ranged from 4.2-15.4 in studies using the NCEP-ATP III criteria; and 4.5-38.7 in studies using the WHO criteria.
and interventions with lifestyle changes are needed to prevent disease progression into adulthood. Suresh Kumar Angurana, Renu Suthar Angurana1 1
Departments of Pediatrics, Chaitanya Hospital, Chandigarh, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Corresponding Author: Dr. Suresh Kumar Angurana, Department of Pediatrics, Chaitanya Hospital, Sector 44, Chandigarh, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
Singh N, Parihar RK, Saini G, Mohan SK, Sharma N, Razaq M, et al. Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K. Indian J Endocrinol Metab 2013;17:133-7. Kapil U, Kaur S. Prevalence of pediatrics metabolic syndrome (PMS) amongst children in the age group of 6-18 years belonging to high income group residing in national capital territory (NCT) of Delhi. Indian J Pediatr 2010;77:1041. Tandon N, Garg MK, Singh Y, Marwaha RK. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR). J Pediatr Endocrinol Metab 2013;8:1-8. Moraes AC, Fulaz CS, Netto-Oliveira ER, Reichert FF. Prevalence of metabolic syndrome in adolescents: A systematic review. Cad Saude Publica 2009;25:1195-202. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr. Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-8. Access this article online
WHO criteria for MS include Insulin resistance (defined as 1 of the following: Type 2 diabetes; impaired fasting glucose; impaired glucose tolerance; or for those with normal fasting glucose values (0.85 in women; and urinary albumin excretion rate ≥20 g/min or albumin: creatinine ratio ≥30 mg/g.[5] The WHO criteria is more objective than ATP III criteria, but it requires special testing of glucose status beyond routine clinical assessment,[5] which makes it less preferred tool for epidemiological studies.
Temozolomide: Antitumor effect on giant, invasive and resistant pediatric prolactinoma
The difference in prevalence of MS and varied prevalence of different components of MS in different studies may be due to differences in populations studied and different criteria used. MS in adolescents is an under recognized and is a forerunner of diabetes mellitus and cardiovascular diseases in adulthood. Therefore, its urgent identification
Sir, Prolactinomas are more common in women than in men. They are usually well-controlled by dopamine agonists that normalize prolactin (PRL) and reduced the pituitary tumor. Resistant forms are relatively rare and their treatment is challenging. Pediatric forms are rarer and usually respond
1136
Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122656
Indian Journal of Endocrinology and Metabolism / Nov-Dec 2013 / Vol 17 | Issue 6
Copyright of Indian Journal of Endocrinology & Metabolism is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
8. 9.
management: Consensus statement. Indian J Endocrinol Metab 2013;17:548-62. Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129-36. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339-48. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122654
normal range was taken as criteria for SCH. This essentially confuses a reader looking for quality research work in your journal. In the same issue of the journal, a better methodology has been adopted by the authors of the article “High prevalence of SCH during the first trimester of pregnancy in North India.”[2] Further, we would like to draw your attention to an article on SCH published in Jounal of American Medical Association JAMA.[3] It defines SCH as a serum TSH above the defined upper limit of the reference range, with a T4 within the reference range. Other causes of a raised TSH, a past history of thyroid disease and patients on T4 hormone treatment need to be excluded. Sunil Kumar Raina, Sujeet Raina1 Departments of Community Medicine and 1Medicine, Dr. RPGMC, Tanda, Himachal Pradesh, India
Research methodology and publications: Are we following the correct science? Sir, This is regarding an article entitled “Increased prevalence of subclinical hypothyroidism (SCH) in females in the mountainous valley of Kashmir” published in your journal.[1] We went through the contents of this article in hope to find a pure epidemiological study reflecting on the increase in prevalence of SCH in females in Kashmir valley. However, we were disappointed to note that the study based on pure laboratory investigations on patients probably referred from clinical departments for evaluation of hypothyroidism could yield prevalence, leave alone increased prevalence. Even if, we accept that prevalence estimates could be arrived at by this methodology, there is no way we can arrive at increased prevalence unless we have comparative statistics to prove this. We hardly find that. Further, the authors mention this as a retrospective study, but go on to write that the patients were re-evaluated with repeat thyroid profile after 3 months again. In fact, this forms the basis of their diagnosis for SCH. In materials and methods section the authors mention that patients with thyroid hormone evaluation picture of elevated serum thyroid stimulating hormone (TSH) levels (>4.3 to ≥10 mIU/ml) with normal levels of serum thyroxine (T4) and tri-iodothyronine (T3) were categorized as SCH if similar levels were observed in repeated thyroid profile after a lapse of three months. However, in the results section the authors mention that the TSH value above 4.3-10 mU/l and free T4 within
Corresponding Author: Dr. Sunil Kumar Riana, Department of Community Medicine, Dr. RPGMC, Tanda, Himachal Pradesh, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
Bashir H, Farooq R, Bhat MH, Majid S. Increased prevalence of SCH in females in mountainous valley of Kashmir. Indian J Endocrinol Metab 2013;17:276-80. Dhanwal DK, Prasad S, Agarwal AK, Dixit V, Banerjee AK. High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab 2013;17:281-4. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-38. Access this article online Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122655
Prevalence of metabolic syndrome in adolescents: Reason to worry Sir, We read with interest the article ‘Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K’ by Singh et al.,[1] and would like to make some important comments.
Indian Journal of Endocrinology and Metabolism / Nov-Dec 2013 / Vol 17 | Issue 6
1135
Letters to the Editor
The metabolic syndrome (MS) in adolescents is a largely unrecognized health problem and it’s exact prevalence in developing countries particularly in India is unknown until recently when few studies were conducted in this field including that by Singh et al.[1] Kapil et al.,[2] found that the prevalence of MS in children (6-18 years) from high income group in Delhi was 6.5% (males 6.9% and females 5.9%), which was higher than that reported by Singh et al.[1] Recently, Tandon et al.,[3] studied the prevalence of MS in urban Indian adolescents (695 out of 15,101 adolescents, 10-18 years) and found that the calculated prevalence of MS in total population was 4.3% and 3.0% using Adult Treatment Panel (ATP) and international diabetes federation criteria, respectively, which was slightly higher than that reported by Singh et al.[1] MS was significantly higher in girls than boys and the most common component of MS was central obesity followed by hypertriglyceridemia, low high density lipoprotein (HDL)-cholesterol, hypertension and dysglycemia; which were in contrast to that reported by Singh et al.,[1] where males had higher prevalence; and low HDL-cholesterol was most common and high blood pressure was least common constituent of MS. Moraes et al.,[4] conducted a systematic review by including 8 studies in adolescents (10-19 years) undertaken in low to medium-income countries and found that the prevalence of MS ranged from 4.2-15.4 in studies using the NCEP-ATP III criteria; and 4.5-38.7 in studies using the WHO criteria.
and interventions with lifestyle changes are needed to prevent disease progression into adulthood. Suresh Kumar Angurana, Renu Suthar Angurana1 1
Departments of Pediatrics, Chaitanya Hospital, Chandigarh, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Corresponding Author: Dr. Suresh Kumar Angurana, Department of Pediatrics, Chaitanya Hospital, Sector 44, Chandigarh, India. E-mail: [email protected]
REFERENCES 1.
2.
3.
4.
5.
Singh N, Parihar RK, Saini G, Mohan SK, Sharma N, Razaq M, et al. Prevalence of metabolic syndrome in adolescents aged 10-18 years in Jammu, J and K. Indian J Endocrinol Metab 2013;17:133-7. Kapil U, Kaur S. Prevalence of pediatrics metabolic syndrome (PMS) amongst children in the age group of 6-18 years belonging to high income group residing in national capital territory (NCT) of Delhi. Indian J Pediatr 2010;77:1041. Tandon N, Garg MK, Singh Y, Marwaha RK. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR). J Pediatr Endocrinol Metab 2013;8:1-8. Moraes AC, Fulaz CS, Netto-Oliveira ER, Reichert FF. Prevalence of metabolic syndrome in adolescents: A systematic review. Cad Saude Publica 2009;25:1195-202. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr. Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-8. Access this article online
WHO criteria for MS include Insulin resistance (defined as 1 of the following: Type 2 diabetes; impaired fasting glucose; impaired glucose tolerance; or for those with normal fasting glucose values (0.85 in women; and urinary albumin excretion rate ≥20 g/min or albumin: creatinine ratio ≥30 mg/g.[5] The WHO criteria is more objective than ATP III criteria, but it requires special testing of glucose status beyond routine clinical assessment,[5] which makes it less preferred tool for epidemiological studies.
Temozolomide: Antitumor effect on giant, invasive and resistant pediatric prolactinoma
The difference in prevalence of MS and varied prevalence of different components of MS in different studies may be due to differences in populations studied and different criteria used. MS in adolescents is an under recognized and is a forerunner of diabetes mellitus and cardiovascular diseases in adulthood. Therefore, its urgent identification
Sir, Prolactinomas are more common in women than in men. They are usually well-controlled by dopamine agonists that normalize prolactin (PRL) and reduced the pituitary tumor. Resistant forms are relatively rare and their treatment is challenging. Pediatric forms are rarer and usually respond
1136
Quick Response Code: Website: www.ijem.in DOI: 10.4103/2230-8210.122656
Indian Journal of Endocrinology and Metabolism / Nov-Dec 2013 / Vol 17 | Issue 6
Copyright of Indian Journal of Endocrinology & Metabolism is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
