Search

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.

Background Hypokalaemic paralysis is a rare group of disorders with concomitant muscle weakness and hypokalaemia. Thyrotoxicosis is a recognized and a common cause for hypokalaemic paralysis among Asians, in which intracellular shift of potassium is enhanced. Gitelman syndrome, an autosomal recessive renal salt loosing condition is characterized by hypokalaemia, hypocalciuria and hypomagnesaemia. Concurrence of these two conditions is very rarely reported.Case Presentation We report two genetically unrelated Sri Lankan patients who presented with concurrent thyrotoxicosis and Gitelman syndrome. Both of them presented with symptomatic hypokalaemia and detected to have thyrotoxicosis. One had Grave’s disease, while the other patient had toxic multinodular goiter. They were initially managed symptomatically for thyrotoxic hypokalaemic paralysis. Despite rendering euthyroidism with medical management, they persisted to have symtomatic hypokalaemia. On evaluation for a second pathology, we detected them to have Gitelman syndrome, which is a rare concurrence.Conclusion Elevated thyroid hormone levels can precipitate a paralytic episode in a patient with subclinical chronic hypokalaemia due to an additional underlying disease. Gitelman syndrome is such a disease which should be considered and actively looked for in a patient with persistent hypokalaemia following rendering euthyroidism.

No abstract available