Eating before 8:30 a.m. could reduce risk factors for type 2 diabetes.

A 46 year old woman presents with complaints of heart palpitations which begun few months back, but have more frequent recently. She is also feeling extremely anxious, sometimes for no reason at all and is concerned that she may be having hot flashes of menopause because she feels he and begins sweating even when no one else there feels hot. she has lost nearly 9kg in the last 2 months even without any major change in diet or exercise. O/E fine tremor of the extended hands

35 yr old male wid left sided hearing loss , headache n multiple episodes of vomiting.np other complaint..ct brain report s/o pituitary adenoma.kindly suggest further management?

CONGENITAL ADRENAL HYPERPLASIA. CONGENITAL ADRENAL HYPERPLASIA. ADRENOGENITAL SYNDROME. SUB DIVISIONS OF CAH. 11 - B - Hydroxylase deficiency. 17 a - Hydroxylase deficiency. 21 - Hydroxylase deficiency. 3 - beta - hydroxysteroid dehydrogenase deficiency. Congenital lipoid adrenal hyperplasia. CAH is a group of rare inherited autosomal recessive disorders characterised by a deficiency of one of the enzymes needed to make specific hormones. Adrenal glands produce three different hormones. Corticosteroids. Mineralocorticoids Androgens. The most common cause of CAH is absence of 21 -hydroxylase enzyme and constitutes 95 % of all cases of CAH. There are two types of CAH. 1) ClaSsical CAH salt loosing //simple virilizing. 2) Non - classical CAH. Deficiency of an enzyme leads to under production of that hormone and over production of another type of hormones. SIGNS AND SYMPTOMS. Females will have ambiguous genitilia masculinization and normal female internal reproductive organs and they are genetically female. Males will not have ambiguous genitilia. Both genders have early onset of puberty,fast body growth and premature completion of growth causing short stature. As they have associated aldosterone deficiency ,they have dehydration,hypovolemia,hypotension and shock. Untreated CAH leads to circulatory failure due to adrenal crisis in infancy. Non - classical CAH is not life threatening and is due to genetic mutation. CAUSES. Deletions and mutations of CYP 21 A2 gene accounts for all cases of 21 Hydroxylase deficiency. DIAGNOSIS. Screening of newborns for 21 Hydroxylase deficiency. Prenatal diagnosis by chorionic villus sampling. TREATMENT. CAH CANNOT BE CURED , BUT CAN BE EFFECTIVELY TREATED. Treatment of classical CAH begins after birth and continued through out life. PATIENTS WITH NON CLASSICAL CAH MAY NOT REQUIRE TREATMENT. PRIMARY GOAL OF TREATMENT OF CLASSICAL CAH IS REDUCE THE EXCESSIVE ANDROGEN PRODUCTION AND REPLACE THE DEFICIENT HORMONES.. PROPER TREATMENT WITH THE CORRECT DOSAGE OF THESE HORMONES IS CRUCIAL TO PREVENT ADRENAL CRISIS AND VIRILIZATION. Glucocorticoids - to replace cortisol. Mineralocorticoids - to replace aldosterone. CAH patients are closely monitored during stress and surgery to adjust the dosage of hormones. Female classical CAH patients undergo surgery for correction of ambiguous genitilia.

70 yr old female ,with history of diabetes for 20 yrs and history of trauma for 1 month

INDICATIONS FOR FETAL ECHOCARDIOGRAPHY : 1 ) FAMILY HISTORY OF CONGENITAL HEART DISEASE. 2 ) MATERNAL DIABETES. 3 ) MATERNAL DRUG EXPOSURE OR INFECTIONS DURING PREGNANCY. 4 ) MATERNAL SYSTEMIC LUPUS ERYTHEMATOSUS. 5 ) MATERNAL PHENYL KETONURIA. 6 ) POLYHYDRAMNIOS. 7 ) NON IMMUNE HYDROPS FETALIS... 8 ) FETAL DYSRHYTHMIAS. 9 ) FETAL EXTRA CARDIAC ABNORMALITIES. 10 ) FETAL CHROMOSOMAL ABNORMALITIES. 11 ) SYMMETRICAL INTRA UTERINE GROWTH RETARDATION.