According to common perception, hypothyroidism is held responsible for obesity. However, linking them causally is controversial. Overt hypothyroidism is associated with modest weight gain, but there is a lack of clarity regarding subclinical hypothyroidism. Novel view indicates that changes in thyroid-stimulating hormone (TSH) could well be secondary to obesity. The increasing prevalence of obesity further confounds definition of normal TSH range in population studies. Thyroid autoantibody status may help in establishing the diagnosis of subclinical hypothyroidism in obesity. High leptin levels may play a role in the hyperthyrotropinemia of obesity and also increase susceptibility to thyroid autoimmunity and subsequent hypothyroidism. There is at most a modest effect of L-T4 treatment in overt hypothyroidism in inducing weight loss; benefit in subclinical hypothyroidism is not established with no data supporting thyroid hormone use in euthyroid obese patients.

Context: The perception of non-alcoholic fatty liver disease (NAFLD) as an uncommon and benign condition is rapidly changing. Approximately, 70% type 2 diabetes mellitus (T2DM) patients have a fatty liver, which may follow an aggressive course with necroinflammation and fibrosis. Aims: To assess the profile of liver enzymes in subjects with impaired glucose tolerance (IGT), new onset treatment naive T2DM and normal glucose tolerance (NGT) with and without NAFLD. Settings and Design: Cross-sectional clinic-based study. Subjects and Methods: 152 IGT and 158 recently detected T2DM subjects aged between 30 and 69 years, along with 160 age and gender matched controls with NGT. An ultrasonography scan of the upper abdomen was done in all patients in order to examine presence of fatty liver. Anthropometry, lipid profile, liver enzymes were also analyzed in all patients. Statistical Analysis Used: Unpaired t-test, Chi-square/Fisher Exact test (for categorical variables), Pearson/Spearmen correlation test to find significant difference, association and correlation between two or more groups respectively. Results: NAFLD was significantly associated with higher alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) but not ALP levels in IGT and T2DM patients. ALT, GGT significant correlated with waist circumference, body mass index, fasting insulin, homeostatic model assessment- insulin resistance, fasting blood glucose, high density lipoprotein cholesterol, triglyceride. 57% of NAFLD patients had normal ALT between 25 and 40 U/L, 53% of NAFLD subjects had normal GGT between 15 and 30 U/L. ALT <25 U/L and GGT 40 U/L and GGT > 30 U/L had highest positive predictivity for presence of NAFLD in our study sample. Conclusions: Mild elevations of liver enzymes in the upper normal range are associated with features of metabolic syndrome and NAFLD even in IGT and recently detected T2DM patients. Novel cut-offs for liver enzymes are warranted in order to prevent unnecessary diagnostic work-ups and early detection of NAFLD to reduce the risk of cirrhosis, hepatocellular carcinoma and classical cardiovascular disease in T2DM and IGT patients.

New-onset diabetes after transplantation (NODAT) is frequently encountered after kidney transplant. In the present study, we retrospectively evaluated the safety and efficacy of linagliptin monotherapy in 21 renal transplant recipients in a real world setting. We found linagliptin monotherapy is effective for glycemic control in NODAT, even on glucocorticoids and standard dose of tacrolimus. There was no alteration of tacrolimus drug levels or estimated glomerular filtration rate (eGFR) and minimal side effects, including weight gain and hypoglycemia. Well-designed, powered randomized controlled of antiglycemic agents in NODAT are needed.

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction‐associated steatotic liver disease (MASLD), formerly known as non‐alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high‐risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high‐risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non‐invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well‐planned study design that could enhance the scientific value of these statements.

Hypocalcemia is a rare reversible cause of dilated cardiomyopathy (DCM) and congestive heart failure; however, there are few reported cases, especially in infants. We describe 12 infants presenting with DCM and congestive cardiac failure who were found to have hypocalcemia. Vitamin D deficiency was the cause of hypocalcemia in all cases. The infants improved on supplementation with vitamin D and calcium.

Context: There is paucity of scientific data from India on gender identity disorders (GIDs) or gender dysphoria (GD). Aims: To study the clinical, biochemical profile, personality characteristics and family support of GID subjects. Settings and Design: A retrospective and cross-sectional study at an endocrine referral center in Kolkata in Eastern India between 2010 and 2015. Subjects and Methods: Seventy-three GID subjects who presented to the center were included in the study. Clinical, biochemical profile, personality characteristics (cross-dressing), and family support were investigated. The protocol was presented to the Ethics Committee who felt that given the retrospective nature of the study, informed consent could be dispensed with. GD was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Statistical Analysis Used: Unpaired t-test has been used to find the significance of study parameters between two groups of patients. Chi-square/Fisher Exact test has been used to find the significance of study parameters on categorical scale between two groups. Results: Out of the total 73 patients, 55 (75.34%) patients were male-to-female and remaining 18 (24.66%) were female-to-male. Around 11% of GD subjects practiced cross-dressing. In spite of median age of onset of GD was 9 years, the mean age of GD at presentation was quite late at 25.77 ± 6.25 years due to lack of social and informative support. It is difficult for transgender to express their sexual identity in family or in society as only 10.96% of our GD subjects had family support, leading to delayed presentation and delayed endocrine consultation. This delayed endocrine consultation have accounted for a significant proportion of GD subjects having unplanned and ill-timed castration (16.36%) or mastectomy (16.67%) even by nonmedically qualified person (66.7% of castrated subjects). All GD subjects had normal thyroid stimulating hormone, testosterone, estradiol, and karyotype concordant with their biological sex. No significant differences were demonstrated between any of the studied parameters namely age at presentation, onset-age of GD, hormone profile, family support, and cross-dressing preferences. Conclusions: Social taboo and lack of informative, family support leads to delayed medical consultation and have accounted for complexities in presentation indicating a huge need of awareness programs in our country. Social and informative support can be improved by awareness programs, which might lead to an early endocrine evaluation and proper treatment with improved outcomes.