Uncommon Cause of Obesity Successfully Treated
You may be forgiven for thinking that the pictures on the right are from a slimming center or beauty salon. No they are not. This lady presented in January with excessive weight gain. Before coming to consult me, she had thought about going for liposuction. Other symptoms which include facial puffiness, weakness and elevated blood pressure made me suspect that there was an abnormality of her adrenal (a gland that sits on top of the kidney). Blood and urine tests confirmed the suspicion of excessive hormonal secretion from the adrenal. CT scan examination showed the left adrenal to be enlarged. This is indicated by the pink arrow on the X-ray film below the sequence of pictures.
After much deliberation, a decision to remove the tumorous adrenal was taken. Keyhole surgery was performed in February, and her recovery has been spectacular. She has lost 10 inches around the waist and at least 12 kg in weight. As the pictures show, her appearance has changed dramatically. Understandably she is delighted with her treatment, and has allowed her pictures to be published in the hope that her story will benefit others in a similar situation.
2 kg Thyroid Tumor Removed from Indonesian Boy
In October 2005, I was asked by my ENT colleague Dr Goh Yau Hong to assist in the care of this 13 year old Indonesian boy who was disadvantaged by a huge thyroid gland present shortly after birth. It grew to be embarrassingly large and was causal of his delayed growth and development. He came to Singapore through the charity of his local church, where we found him to be grossly hypothyroid. After extensive evaluation and nutritional support, it was decided to proceed with surgery to remove the growth. Dr Goh completed the surgery after a marathon session in the operating theatre. The picture on the right shows the excellent cosmetic result. This young man now is thriving but will require lifelong hormonal support with thyroxine, the latter a small price to pay for a new lease on life.
The Dangers of Porcupine Kidney Powder
In March 2007, this young man consulted me regarding weight gain of 9 kg (about 20 lbs) over a 2 week period. His mother had given him some pills obtained from a Chinese physician. He was told that the pills contained "porcupine kidney powder" and if taken, would significantly boost his immunity. He disliked the sudden increase in his girth, but was particularly distressed by the appearance of red striae (picture on right) on his abdomen and arms. It turns out that he was unknowingly given steroids, resulting in his frightful appearance typical of Cushing's syndrome. The lesson for all of us is not to unquestioningly accept treatments from anyone, no matter how well intentioned.
Tour de France Doping Controversy - July 29, 2006
The winner of this year's Tour de France was accused of having used anabolic agents to boost his performance. The basis of this accusation was an abnormal testosterone / epi-testosterone ratio. In 1982 the IOC ruled that a T/E ratio > 6 was evidence of illicit T use. The expected T / E ratio in healthy males is ~ 1.
In practice, there are many confounding factors. In the general male population, less than 0.8% of individuals not on T or anabolic steroids will show a T/E ratio of > 6. Therefore there is a false positive rate. The lowering of the T / E ratio to 4 by the Cycling Federation will result in significantly more false positive tests. It's also been shown that chronic use of androstenedione (an anabolic steroid) can be compatible with a T / E ratio of < 6. Without prior knowledge of an athlete's T / E ratio out of competition (where AS or T use is less likely), one would be foolish to level accusations regarding use of performance enhancing drugs.
The question now is how much over the mark Landis's T / E ratio is. If it's between 4 and 6, reasonable doubt can be cast about steroid use. If it is just over 6, doubt can still be cast about testosterone use. If it's exceedingly over 6, testosterone-assisted performance is highly likely. If you are interested in the science of dope testing, kindly view or download the 2 files T-E Ratio in Sport (143KB PDF) and Urinary Steroids after Chronic Androstenedione Ingestion (99KB PDF).
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