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Background: Incidentalomas of endocrine glands are a common problem in endocrine practice. Data on their prevalence are limited from South Asian settings. Objective: We aimed to describe incidentalomas and other histopathological abnormalities in an autopsy series of Sri Lankans. Methods: Consecutive autopsies performed at Judicial Medical Office, Colombo from December 2014 to December 2016 were screened and the deceased without a diagnosed endocrinopathy (except diabetes) were included in the study. Pituitary, thyroid, adrenal, pancreas and ovarian specimens were sampled and examined both macroscopically and under light microscopy with Haemotoxylin Eosin stain. Results: Among 441 autopsies (mean age 52.5 years, male 77.8%) examined, pituitary, thyroid, adrenal, pancreatic and ovarian nodules were detected in 0.8%, 37.2%, 1.8%, 1.3% and 18.4% respectively. Thyroid neoplasms were present in 6.4%, of which 87.5% were papillary carcinoma or papillary microcarcinoma and it was associated with background thyroiditis (χ2 = 4.05, p = 0.04) or nodular thyroid enlargement (χ2 = 32.68, p Conclusions: In this population of Sri Lankan adults, prevalence of thyroid incidentalomas, neoplasms and thyroiditis are comparable to published studies from the West. Papillary carcinoma or microcarcinoma was the commonest type and it showed a predilection to affect thyroid glands with background thyroiditis. Pituitary, pancreatic and adrenal incidentalomas and neoplasms were less prevalent.

Introduction Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis. Objective To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults. Methods A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants. Results The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age. Conclusion CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

Introduction: Congenital adrenal hyperplasia (CAH) requires lifelong glucocorticoid therapy (GCT). Long- term use of GCT is known to adversely affect bone metabolism. Vitamin D synthesis in the skin can be impaired by the hyperpigmentation seen in CAH patients. Objectives: To describe the effects of glucocorticoid therapy and vitamin D status on the bones in children with CAH. Method: Children with CAH followed up in the University Unit at the Lady Ridgeway Hospital, Colombo were studied. Mean values of the daily dose of hydrocortisone received, serum calcium, intact parathormone (iPTH) and 25-hydroxy vitamin D levels were compared with the duration of therapy categorized into 3 groups. Skin pigmentation was graded using the Fitzpatrick scale and was described with the biochemical parameters according to vitamin D status (sufficiency >50nmol/L). Results: Thirty eight children were studied. Mean daily dose of hydrocortisone of children treated for less than 4 years (n=6), 4 to 7 years (n=6) and more than 7 years (n=26) were 14.0, 13.4, and 14.0 mg/m2/day respectively (recommended dose 10-15 mg/m2/day). Mean serum calcium levels (2.53, 2.41, 2.28mmol/L) and iPTH levels (3.59, 4.46, 6.30pmol/L) were in the normal range and vitamin D levels (47.55, 47.97, 44.44nmol/L) were in the insufficient range. The differences between the groups were not significant. However, the difference seen in alkaline phosphatase (ALP) was significant (p=0.026). There was also an apparent inverse association of ALP with the total average daily dose of glucocorticoids (R2=0.077, F=3.0, p=0.092). Vitamin D deficiency (≤37.5nmol/L) was seen in 8 (21.1%) patients. Degree of pigmentation and biochemical parameters assessed were not significant according to vitamin D status. Conclusions: Serum ALP levels show an inverse relationship with the duration of glucocorticoid therapy indicating possible adverse outcome on bones. The apparent inverse relationship of total average daily dose of glucocorticoids with ALP failed to reach statistical significance. No relationship was found with vitamin D status and other parameters assessed.