Journal of Association of Clinical Endocrinologist and Diabetologist of Bangladesh
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Association of Clinical Endocrinologist and Diabetologist of Bangladesh
Navigating GIP/ GLP-1 pathophysiology and compounding impacts on T2DM care
Incretin hormones—glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)—are central to glucose regulation and insulin secretion. Their discovery and characterization revolutionized type 2 diabetes mellitus (T2DM) and obesity management, inspiring novel therapies such as the dual GIP/GLP-1 receptor agonist tirzepatide, which demonstrates superior glycemic, weight, and cardiovascular outcomes. However, growing use of compounded GLP-1 receptor agonists raises serious safety and regulatory concerns. These formulations, often produced from unapproved bulk substances, may contain impurities, lack bioequivalence, and pose risks of immunogenicity and adverse events, including hospitalizations and deaths. Regulatory authorities and professional bodies such as the ADA and EASD strongly discourage their use. Approved agents like Trulicity® (dulaglutide)—an FDA-regulated GLP-1 receptor agonist—remain the standard of care, offering proven benefits in glycemic control, weight reduction, cardiovascular protection, renal safety, and hepatic improvement in NAFLD. Understanding incretin biology thus continues to guide safe, evidence-based innovation in T2DM and obesity treatment. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S28]
Copyright (c) 2025 Tania Tofail https://creativecommons.org/licenses/by-nc/4.0
Beyond glycemic control: The role of Tirzepatide in MASLD and OSA management
Tirzepatide, a dual GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist, represents a breakthrough in the treatment of metabolic disorders. While primarily developed for type 2 diabetes and weight management, its benefits extend beyond glycemic control to conditions like Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Obstructive Sleep Apnea (OSA). Similarly, OSA—a condition characterized by recurrent upper airway obstruction during sleep—is worsened by excess visceral fat and inflammation. Clinical studies, including the SURPASS and SURMOUNT trials, indicate that Tirzepatide leads to substantial weight loss and improved apnea-hypopnea index (AHI), suggesting a direct role in mitigating OSA severity. By targeting core mechanisms such as obesity, insulin resistance, and inflammation, Tirzepatide offers a comprehensive therapeutic strategy for patients with coexisting metabolic diseases. Ongoing research aims to determine whether its effects on MASLD and OSA are independent of weight loss. Tirzepatide is emerging as a multifaceted agent capable of transforming the management of obesity-related complications, offering new hope for patients with MASLD and OSA. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S29]
Copyright (c) 2025 MD. Masud Un Nabi https://creativecommons.org/licenses/by-nc/4.0
Clinical obesity in the new era: Evidence-based therapeutics and improved patient outcomes
Obesity is a chronic, relapsing disease associated with significant morbidity, mortality, and rising healthcare costs. It represents one of the most urgent global health challenges of the 21st century. With the continued surge of obesity among children and adolescents, the burden in adulthood is projected to escalate further, fueling an epidemic of non-communicable diseases (NCDs) such as type 2 diabetes, cardiovascular disease, and cancer. Once regarded as a problem confined to Western nations, obesity is now rising sharply across the globe, including in South Asia and Bangladesh, where it threatens to derail public health progress. Advances in our understanding of weight regulation and the gut–brain axis have paved the way for a new generation of safe and effective pharmacotherapies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide 2.4 mg once weekly, approved in 2021, deliver unprecedented results, achieving an average weight reduction of 15–17% by targeting appetite and satiety pathways. The dual incretin agent tirzepatide (GLP-1/GIP RA) has further expanded therapeutic possibilities, initially approved for type 2 diabetes and now established as an option for obesity care. Additional entero-pancreatic and non-entero-pancreatic hormone-based agents are under active investigation. This emerging therapeutic landscape signals a paradigm shift: obesity management is shifting toward individualized treatment strategies, similar to those used in diabetes or dyslipidemia care. Treatment selection could be tailored not only to weight reduction goals but also to obesity-related complications. Ectopic fat accumulation drives organ-specific dysfunctions—including type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD)/ metabolic dysfunction-associated steatohepatitis (MASH), and heart failure with preserved ejection fraction (HFpEF). Some agents, such as GLP-1/glucagon combinations, demonstrate weight-independent effects on liver fat reduction, suggesting opportunities for tailored therapy. Moreover, robust cardiovascular and renal outcome data are already available for several newer anti-obesity agents, reinforcing their potential to improve survival as well as quality of life. The new era of obesity care is therefore defined not merely by greater weight loss, but by improved, patient-centered outcomes across metabolic, cardiovascular, hepatic, and renal domains. The challenge for clinicians is to translate this evidence into practice—ensuring equitable access, long-term adherence, and individualized therapeutic decisions to reduce the global burden of obesity and its complications. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S30]
Copyright (c) 2025 Iqbal Munir https://creativecommons.org/licenses/by-nc/4.0
The new era of diabetes management: Comprehensive benefits of Ozempic in diabetes and co-morbidities
The global health landscape is increasingly burdened by the rising prevalence of chronic conditions such as Type 2 Diabetes (T2D), obesity, cardiovascular disease (CVD), and chronic kidney disease (CKD), which are often interlinked through underlying metabolic dysfunction. This presentation provides an in-depth exploration of the multifaceted benefits of Ozempic (Semaglutide), a glucagon-like peptide-1 receptor agonist (GLP-1RA), as a cornerstone treatment for managing T2D and its associated comorbidities. Comorbidities like metabolic dysfunction-associated steatohepatitis (MASH) and cardiovascular complications are prevalent, underscoring the necessity of integrated treatment approaches. Clinical trial data from pivotal studies, such as the SUSTAIN and FLOW trials, evidenced remarkable outcomes, including up to 80% of patients achieving their HbA1c target of <7% and significant reductions in body weight with Ozempic. Furthermore, improvements in functional capacity, quantified as a mean increase in maximum walking distance (MWD) and substantial reductions in major adverse cardiovascular events (MACE), demonstrate the medication's impact not just on metabolic markers but also on overall health-related quality of life. The FLOW trial, specifically, revealed that semaglutide significantly reduces the risk of kidney disease progression, making it the only GLP-1RA with established protective effects on renal health. In conclusion, this presentation advocates for the recognition of semaglutide as an essential therapeutic agent in the holistic management of T2D. By addressing key risk factors and comorbidities through its diverse pharmacological effects, Ozempic represents a novel approach that not only targets hyperglycemia but also contributes significantly to the reduction of associated cardiovascular and renal complications, ultimately enhancing patient outcomes and quality of life. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S31]
Copyright (c) 2025 Yasmin Aktar https://creativecommons.org/licenses/by-nc/4.0
Changing paradigms in diabetes: Scientific breakthroughs of the past 15 years
Over the past 15 years, the landscape of diabetes care has been transformed by remarkable scientific and clinical advances. Breakthroughs in genetics, epigenetics, and gut microbiome research have provided deeper insights into disease pathophysiology, while progress in beta-cell biology has opened novel therapeutic avenues. Pharmacological innovation has been central to this transformation: GLP-1 receptor agonists have redefined standards of care by demonstrating not only effective glycemic control but also significant cardiovascular and renal protection. A major milestone has been the development of SGLT2 inhibitors, particularly empagliflozin, which has shown robust benefits in reducing heart failure, slowing chronic kidney disease progression, and lowering cardiovascular mortality, thereby shifting treatment goals beyond glucose lowering toward organ protection. More recently, dual and triple agonists such as tirzepatide have delivered unprecedented outcomes in glucose lowering and weight reduction. Perhaps the most significant paradigm shift has been the transition from a glucose-centric model to a comprehensive cardio-renal-metabolic approach, with empagliflozin and related agents at the forefront of this revolution. In parallel, the integration of artificial intelligence, big data, and evolving global health policies has advanced patient-centred care and improved access to life-saving therapies. Looking ahead, the advent of oral insulin, immunotherapies, and fully automated artificial pancreas systems promises to reshape diabetes management, offering improved outcomes and quality of life for patients worldwide. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S32]
Copyright (c) 2025 M A Halim Khan https://creativecommons.org/licenses/by-nc/4.0
Redefining diabesity management: Tirzepatide's role in improving cardiovascular outcomes
Diabesity, the convergence of type 2 diabetes mellitus (T2DM) and obesity—constitutes a major global health challenge, driving disproportionate cardiovascular morbidity and mortality. In Bangladesh alone, an estimated 14 million individuals live with diabetes (prevalence 13.2%), while 31% of adults have elevated BMI (≥25 kg/m²), including 6% with obesity. Conventional antidiabetic therapies emphasize glycemic control; however, persistent residual cardiovascular risk underscores the necessity for interventions targeting the intertwined mechanisms of adiposity, insulin resistance, and cardiometabolic dysfunction. Tirzepatide, a first-in-class dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, represents a paradigm shift in diabesity management. Data from the SURPASS program demonstrate unprecedented reductions in HbA1c (up to –2.5%) and body weight (15–20%), surpassing outcomes achieved with established GLP-1 receptor agonists and insulin. Beyond glycemic and weight control, tirzepatide improves cardiometabolic health through reductions in blood pressure, favorable modulation of lipid profiles, and attenuation of systemic inflammation. Preliminary cardiovascular outcomes further suggest a protective role against major adverse cardiovascular events (MACE), reinforcing its potential as a cardiometabolic disease modifier rather than a glucose-lowering agent alone. By simultaneously addressing T2DM and obesity, tirzepatide exemplifies an integrated therapeutic strategy aligned with contemporary priorities that emphasize cardiovascular risk reduction alongside glycemic targets. Ongoing large-scale outcome trials, including SURPASS-CVOT, will elucidate its definitive impact on morbidity and mortality. Collectively, tirzepatide advances the therapeutic frontier, offering a transformative approach for patients at the nexus of diabetes, obesity, and cardiovascular disease. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S33]
Copyright (c) 2025 Mohammad Atiqur-Rahman https://creativecommons.org/licenses/by-nc/4.0
Modern care for congenital adrenal hyperplasia: New horizons in management
Congenital adrenal hyperplasia (CAH), most commonly caused by 21-hydroxylase deficiency, is an autosomal recessive disorder characterized by impaired cortisol and aldosterone synthesis with androgen excess. Conventional management with lifelong glucocorticoid and mineralocorticoid replacement often fails to prevent adrenal crises and long-term complications while exposing patients to adverse effects of supraphysiologic steroid doses. Recent advances are reshaping management strategies. Modified-release and continuous subcutaneous hydrocortisone formulations provide more physiologic cortisol replacement, improving hormonal control and quality of life. Novel pharmacologic agents such as crinecerfont, a corticotropin-releasing factor receptor antagonist and the first FDA-approved therapy for classic CAH, and investigational tildacerfont reduce ACTH-driven androgen production, thereby lowering glucocorticoid requirements. Future approaches include melanocortin 2 receptor (MC2R) antagonists, which block ACTH action directly at the adrenal cortex, offering a targeted means of suppressing androgen excess. Additional innovations include micro-dosed pediatric hydrocortisone granules, androgen receptor antagonists, and experimental gene and cell therapies with curative potential. Beyond pharmacological treatment, modern care emphasizes fertility preservation, cardiometabolic health, psychological support, and shared decision-making regarding genital surgery. These evolving strategies represent a paradigm shift from traditional hormone replacement toward individualized, outcome-focused care, offering renewed prospects for improved growth, fertility, and quality of life in patients with CAH. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S21]
Copyright (c) 2025 Choman Abdullah Mohana https://creativecommons.org/licenses/by-nc/4.0
Recent controversial issues in testosterone replacement therapy
Testosterone replacement therapy (TRT) remains controversial despite its established role in symptomatic hypogonadism. Cardiovascular (CV) safety is debated: while the TRAVERSE trial found no excess of major CV events, observational data remain conflicting. Glycemic outcomes add further complexity: real-world studies suggest HbA1c reductions in men with type 2 diabetes, but evidence is heterogeneous. In obesity-related metabolic hypogonadism, substantial weight loss from GLP-1/GIP receptor agonists such as Tirzepatide has been shown to restore testosterone levels, prompting discussion on whether metabolic therapy should precede TRT. Safety monitoring also remains critical-prostate health surveillance is essential despite no proven increase in cancer risk, and polycythemia continues to be a leading hematologic complication requiring vigilant hematocrit monitoring. Testosterone replacement therapy sits at the intersection of endocrinology and metabolism, cardiology and urology. Recent data support careful, individualized use, but controversies persist, and novel metabolic agents may redefine treatment algorithms. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S22]
Copyright (c) 2025 Md. Mahmud Hasan https://creativecommons.org/licenses/by-nc/4.0
Beyond the fingerstick – Empowering pregnancy with continuous glucose monitoring
The optimized control of diabetes during pregnancy is both challenging and essential. The risks associated with uncontrolled diabetes in pregnancy include congenital anomalies, stillbirth and miscarriage, macrosomia. CGM devices utilize waterproof, self-administered subcutaneous sensors to measure interstitial fluid glucose levels continuously. Its emergence has revolutionized the management of diabetes in pregnancy; its use has demonstrated improvements in glycemic control with respect to both hyperglycemic and hypoglycemic events, as well as reported benefits to quality of life. This article focuses on the role of continuous glucose monitoring (CGM) in pregnancy, assessing the evidence available and providing an update on current guidance. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S23]
Copyright (c) 2025 Anjana Saha https://creativecommons.org/licenses/by-nc/4.0
Updates in LDL-cholesterol management – the lower, the better – for longer
Low-density lipoprotein cholesterol (LDL-C) is a validated marker for the amount of plasma LDL and a primary driver of atherosclerosis. At least 25% of ASCVD-related deaths are directly attributed to elevated LDL-C as the primary marker of dyslipidemia. LDL-C is the primary target of lipid-lowering therapies. Targets of LDL-C depend on CV risk categorization. For primary prevention desirable level of LDL-C should be less than 100mg/dl (2.6mmol/L) for the patient with moderate risk; less than 70mg/dl(1.8mmol/L) for high risk patients; and less than 55mg/dl(1.4mmol/L) for very high risk patients. The goal of drug treatment for any patient with LDL-C greater than 190mg/dl (4.9mmol/L). Dietary intervention, moderate exercise, and weight loss are first-line therapies. Statins are the cornerstone of therapy to lower LDL-C and reduce LDL-C by 20% to 60%, and increase HDL-C by 2% to 16%. Statins are safe and generally well tolerated. Subtle adverse events are more frequent due to the nocebo effect. Rhabdomyolysis is rare. Ezetimibe inhibits cholesterol absorption from the ileum and lowers LDL by 14% to 25% when used alone or in combination with statins and reduces CVD events. Uncommon side effects are diarrhea and abnormal liver function. Bile acid sequestrants (Cholestyramine, colestipol, and colesevelam) were the first LDL-C lowering drug class shown to reduce CVD. As monotherapy, sequestrants lower LDL-C by 5% to 30%. GI disturbances are common. Bempedoic acid reduces cholesterol synthesis by inhibiting ATP citrate lyase and is especially useful in statin-intolerant patients and reducing LDL-C by 18% to 30%, either alone or in combination with other LDL-lowering agents, with very limited musculoskeletal-related side effects. PCSK9 inhibitors (alirocumab and evolocumab), alone or in conjunction with statins, further reduce 60% of circulating LDL-C beyond that achieved by statins alone. Administered alongside high-intensity statin therapy (with or without ezetimibe), PCSK9 inhibitors significantly reduce MACE in patients with DM with ASCVD. It is especially useful in FH. Side effects are injection site reactions. Inclisiran, a small interfering RNA (siRNA), inhibit hepatic synthesis of PCSK9, decreases LDL-C levels by 51% and is associated with a 24% lower risk of MACE. ANGPTL3 Inhibitors, Evinacumab is a monoclonal antibody against ANGPTL3166 and reduces up to a 50% LDL-C in patients with HoFH, with good safety and tolerability. LDL apheresis cornerstone of therapy in HoFH and produces an acute decrease in LDL-C by 50% to 60%. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S24]
Copyright (c) 2025 Md. Rezaul Karim https://creativecommons.org/licenses/by-nc/4.0
Pregnancy and preexisting diabetes: Bridging evidence, technology, and care in 2025
The risk of maternal and neonatal death and morbidity is elevated in individuals with preexisting diabetic mellitus (PDM). These hazards can be decreased by lowering maternal hyperglycemia both before and during pregnancy. Preconception care (PCC), which involves meeting stringent glycaemic targets, has been shown to significantly lower the risk of congenital defects and other unfavourable pregnancy outcomes. However, only a small proportion of people are given PCC. Real-world evidence showing suboptimal pregnancy outcomes emphasises the necessity of further optimising prenatal glucose levels. Emerging technologies have the potential to aid in achieving that objective. More factors besides dysglycemia contribute to poor pregnancy outcomes in PDM. The significance of managing insulin-sensitive drugs and maintaining optimum nutrition during prenatal care for PDM is highlighted by the growing influence of obesity on pregnancy outcomes. In individuals with T2DM, recent guidelines suggest discontinuation of glucagon-like peptide-1 receptor agonist (GLP-1RA) before conception rather than discontinuation between the start of pregnancy and the end of the first trimester. This suggestion was based on limited data regarding the risk of exposure to GLP-1RA receptor agonists during pregnancy. We advise against routinely adding metformin to pregnant people with type 2 diabetes who are already taking insulin. This was proposed in light of the Guideline Development Panel (GDP) ruling that the possible harm of raising the risk of small for gestational age infants or unfavourable childhood outcomes associated with large for gestational age infants was not outweighed by the benefit of adding metformin to insulin to reduce rates of large for gestational age infants. As such, the evidence was insufficient to support a recommendation either for or against a carbohydrate intake cutoff of 175 g/day. To avoid serious mortality and morbidity for people with PDM and their offspring, investments in implementation science for PCC are essential. Further defining glycaemic targets during pregnancy through RCTs and improving new technologies to meet those targets can significantly lessen harm and the burden of diabetic treatment. There is a lack of data on managing obesity and proper nutrition during pregnancy. There is also a need for more research on when women with PDM should deliver their babies. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S25]
Copyright (c) 2025 Tahmina Ferdousi https://creativecommons.org/licenses/by-nc/4.0
The fifth face of Diabetes: Hidden player in dysglycemia
Type 5 Diabetes Mellitus (T5DM), also known as malnutrition-related diabetes, is a largely neglected and under-recognized form of dysglycemia, predominantly affecting tropical and subtropical regions. Unlike type 1 and type 2 diabetes, T5DM often develops in the context of chronic undernutrition, early-life malnutrition, and socio-economic deprivation, leading to a unique clinical and metabolic profile. Its diagnosis remains challenging due to overlapping features with other diabetes types, heterogeneous presentations, and the lack of standardized diagnostic criteria, often resulting in underdiagnosis or mismanagement. The pathophysiology of T5DM is multifactorial. Chronic nutritional deficiencies lead to impaired pancreatic beta-cell development and long-term insulin secretory defects. Concurrently, patients exhibit variable degrees of insulin resistance, altered glucose metabolism, and enhanced susceptibility to oxidative stress and inflammatory pathways. Emerging evidence suggests a role of micronutrient deficiencies (e.g., zinc, vitamin D, thiamine) and persistent metabolic programming from early-life malnutrition, which together exacerbate dysglycemia. Developing countries, particularly in South Asia—including Bangladesh—bear a disproportionate burden of T5DM, making awareness, early diagnosis, and context-specific interventions critical. Recent advances in biomarkers, metabolic imaging, and therapeutic strategies offer promise for better characterization and individualized management. Recognizing and addressing this hidden face of diabetes is essential for improving patient outcomes, guiding public health strategies, and mitigating the growing impact of dysglycemia in vulnerable populations. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S26]
Copyright (c) 2025 Kishore Kumar Shil https://creativecommons.org/licenses/by-nc/4.0
Comparing effectiveness of anthropometric and biochemical markers as predictors of cardiometabolic risk among Bangladeshi doctors
Background: “Cardiometabolic risk,” in simple terms, refers to the higher chances of developing Type 2 DM, cardiovascular, and cerebrovascular events in an adult. Obesity, insulin resistance, and dyslipidemia are the major contributing factors for this risk. The risk increases two to threefold with long-term stress, smoking, and a sedentary lifestyle. Objectives: Doctors, all over the world in general and in Bangladesh in particular, lead very stressful lives due to their immense professional pressure. Most of them succumb to unhealthy lifestyles while trying to cope with the academic and work-life burden. This study aimed to compare the effectiveness of the Anthropometric marker Waist-to-height ratio (WHtR) and the Biochemical marker Triglyceride-to-High-density lipoprotein cholesterol (TG/HDL-C) ratio as predictors of cardiometabolic risk among Bangladeshi doctors. Methods: This cross-sectional study was conducted on 200 doctors of Bangladesh Medical University (BMU), aged 30−50 years, from March 2019 to February 2020, selected through purposive sampling. Anthropometric measurements (waist circumference and height, both in cm) of the study subjects were recorded in preformed data sheets. Then their fasting serum Triglyceride & fasting serum HDL-C concentrations were estimated. All the data were then entered and processed by SPSS. Results: Sensitivity, Specificity, Positive Predictive value, and Negative Predictive value of WHtR, as a diagnostic marker, were 88.1%, 23.2%, 53.9% and 66.7% respectively. Sensitivity, Specificity, Positive Predictive value, and Negative Predictive value of TG/HDL-C ratio, as a diagnostic marker, were 72.3%, 75.8%, 53.9% and 66.7% respectively. According to the cut-off value of WHtR, 85.6% of the study subjects were found to have cardiometabolic risk. Cardiometabolic risk was present in 51.5% of the male study subjects and 32% of the female study subjects, based on the cut-off value of WHtR. According to the cut-off value of the TG/HDL-C ratio, 63.5% of the study subjects were found to have cardiometabolic risk. Cardiometabolic risk was present in 66.3% of the male study subjects and 57.5% of the female study subjects, based on the cut-off value of the TG/HDL-C ratio. Conclusion: The Biochemical marker (TG/HDL-C ratio) was found to be a better predictor than the Anthropometric marker (WHtR) in predicting cardiometabolic risk among Bangladeshi doctors. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S35]
Copyright (c) 2025 Mariya Tabassum, Miliva Mozaffor https://creativecommons.org/licenses/by-nc/4.0
Intestinal alkaline phosphatase: A novel enteric biomarker and potential mediator in the pathogenesis of gestational diabetes mellitus
Background: Gestational diabetes mellitus (GDM) represents a complex condition where the interplay between insulin resistance and β-cell dysfunction is central to its pathophysiology. Emerging evidence implicates intestinal alkaline phosphatase (IAP), a crucial gut barrier enzyme that detoxifies bacterial lipopolysaccharides (LPS), as a key contributor to insulin resistance. However, its role in the unique metabolic milieu of pregnancy and GDM remains largely unexplored. Objective: This study aims to determine the frequency of intestinal alkaline phosphatase deficiency in pregnancy and its association with abnormal glucose tolerance, and to evaluate the predictive utility of fecal IAP for GDM. Method: This observational cross-sectional study involved 198 pregnant women, comprising 55 with GDM and 143 with normal glucose tolerance (NGT), diagnosed according to WHO 2013 criteria by a 75g OGTT. Stool sample collection was done, and the IAP assay was performed using a pNPP/DEA protocol with L‑phenylalanine inhibition to ensure isoform specificity. Logistic regression was used to identify independent predictors of GDM, and the ROC curve analysis was performed to assess the diagnostic utility of IAP. Result: Women with GDM demonstrated significantly reduced median stool IAP levels compared to controls (23.59 vs 46.48 U/g, p < 0.001). Severe IAPD (≤18 U/g) was nearly twice as prevalent in GDM cases (43.6% vs 24.5%, p<0.001). After adjustment for BMI and previous history of GDM, a 10 U/g decrease in stool IAP corresponds to about 22% higher odds of having GDM (p<0.001). ROC analysis revealed a diagnostic threshold of 29.19 U/g with 61.8% sensitivity, 65.7% specificity, and a remarkable 81.7% negative predictive value. Conclusion: Fecal IAP emerges as a non-invasive biomarker for risk stratification besides OGTT, rather than replacing it. The high negative predictive value suggests particular utility for ruling out GDM risk, while the mechanistic link through bacterial endotoxin detoxification opens promising preventive and therapeutic avenues. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S36]
Copyright (c) 2025 Prodipta Chowdhury, Tania Tofail, Nazia Akter, Smeeta Poddar, Md. Hasanul Islam, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Prevalence of polycystic ovary syndrome by the international evidence-based guidelines: A nationwide cross-sectional survey
Background: Data regarding the nationwide prevalence of polycystic ovary syndrome (PCOS) in Bangladeshi women is scarce. Additionally, a prevalence study using the stepwise decision-making approach, incorporating antimüllerian hormone (AMH), was also not reported. Objectives: To determine the prevalence and characteristics of PCOS and its isolated diagnostic features among Bangladeshi women aged 10-45 years, using the 2023 International Evidence-based Guidelines, including AMH. Methods: From April to September 2024, 1201 females were sampled across eight divisions of Bangladesh by history, physical examinations, and blood collection. Total testosterone (TT) and AMH levels were assessed, with specific cut-offs established from a healthy control group. Thyroid dysfunction and hyperprolactinemia were excluded. Results: Of 1201 participants, 403 were excluded. Among 798 eligible women, 38 (4.8%) had both irregular cycles and significant hirsutism, 75 (9.4%) had only significant hirsutism, 141 (17.7%) had only irregular cycles, and 544 (68.2%) had neither. After TT and AMH evaluation and excluding two hyperprolactinemia cases, a 6.9% (55/798) prevalence was found among 57 women with probable PCOS. Familial predisposition, unhealthy sleep behaviour, and higher androgenic and metabolic features were observed in women with PCOS versus controls. Metabolic syndrome frequency was higher among adult PCOS (33.3% vs. 4.0%) than adolescent PCOS. Conclusions: The prevalence of PCOS among Bangladeshi women was 6.9%, with distinctive features compared to controls. Women with isolated diagnostic criteria require further evaluation and long-term follow-up. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S37]
Copyright (c) 2025 Samirah Binte Illiyas, Md. Shahed Morshed, Mashfiqul Hasan, Tania Tofail, Hurjahan Banu, Nusrat Sultana, Munira Afroz Siddika, Md. Rafayel Islam, Hafsa Mahrukh, Tahmina Ferdousi, Indira Roy, Yasmin Aktar, Hilary Yasmin, Farhana Rahman, Nazia Akter, Abdullah Al Noman Bhuiyan, Krishna Airi, Rifat Hossain Ratul, Prodipta Chowdhury, Koushik Ashraf, Rayhan Ali Mollah, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Evaluation of thyroid status in primary obese adults
Background: Obesity and hypothyroidism are two common clinical conditions that have been linked closely. Objective: To determine the status of thyroid function in primary obese adults. Methods: This cross-sectional study was conducted in the Department of Endocrinology, BMU from September 2022 to March 2025, enrolling 100 adults (aged 18-60 years) with obesity (BMI ≥25 kg/m²) and 50 adults (aged 18-60 years) with normal weight (BMI 18.5-22.9 kg/m²), all without known thyroid disorders. Secondary causes of obesity and conditions affecting thyroid function were excluded. Obesity parameters (body mass index, waist circumference, hip circumference, waist-hip ratio, waist-height ratio) were measured. Thyroid function tests, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase antibody, were measured by chemiluminescent immunoassay. Results: The mean age of the obese and normal weight groups was 28.6 (8.5) years and 28.1 (8.8) years, respectively. Serum FT3 [3.2 (0.5) vs. 3.6 (0.4), pg/ml, p<0.001] and FT4 [1.1 (0.2) vs. 1.2 (0.2), ng/dl, p<0.001] levels were significantly lower while TSH [3.9 (3.3) vs. 1.6 (1.1), µIU/mL, p<0.001] levels were significantly higher in obese individuals compared to those of normal weight individuals. There was a significantly higher frequency of hypothyroidism (24% vs. 2% Total, 17% vs. 2% subclinical, and 7% vs. 0% overt, p=0.001) and anti-thyroid peroxidase antibody positivity (27% vs. 12%, p=0.037) in obese adults compared with normal weight adults. None of the participants had subclinical or overt thyrotoxicosis. Multiple linear regression revealed a significant negative correlation between FT4 and hip circumference (β = -2.266, 95% CI = -0.050 to -0.001). Conclusions: We found a significant association of hypothyroidism with obesity, irrespective of anti-thyroid peroxidase antibody status. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S38]
Copyright (c) 2025 Nilufar Yeasmin, Hilary Yasmin, Rehnuma Tasnin, Tonmoy Reza Masum, Tahniyah Haq, Md. Fariduddin https://creativecommons.org/licenses/by-nc/4.0
Dysglycemia under the lens: Comparative diagnostic performance of hemoglobin A1c and oral glucose tolerance test
Background: Dysglycemia, encompassing prediabetes and diabetes (DM), is linked to increased complications and cardiovascular risk. Since 2010, HbA1c has been recommended as a practical and stable diagnostic tool, though its accuracy may differ from glucose-based criteria. Objectives: To assess the diagnostic accuracy of HbA1c against OGTT and determine optimal HbA1c cut-offs for DM and prediabetes. Methods: This cross-sectional study was conducted in the endocrinology department of BMU from September 2022 to March 2025. We evaluated HbA1c thresholds against OGTT in 376 non-diabetic participants, using ROC analysis to determine diagnostic accuracy and optimal cut-off values. Results: Out of the 376 people who took part, 174 (46.3%) had normal glucose tolerance (NGT), 108 (28.7%) had been diagnosed with diabetes mellitus (DM), and 94 (25%) had prediabetes based on the criteria of the oral glucose tolerance test (OGTT). The median age was 35 years, with a range of 28 to 43.8 years. At an HbA1c level of 6.5%, the sensitivity and specificity for DM were 75.9% and 96.3%, respectively. In the case of prediabetes, at 5.7%, the sensitivity was 53.2%, and the specificity was 63.2%. The optimal cut-off value for diagnosing DM and prediabetes was determined to be 6.1% ((AUC (95% CI) = 0.956 (0.935 to 0.977), p < 0.001)) and 5.6% ((AUC (95% CI) = 0.617 (0.546 to 0.688), p < 0.01)), respectively. There was a strong concordance between HbA1c and OGTT for DM diagnosis (kappa, κ= 0.76, p< 0.001) but a poor concordance for prediabetes identification (kappa, κ= 0.13, p<0.033). Conclusions: The HbA1c standards for diabetes and prediabetes were 6.1% and 5.6%, respectively, lower than the ADA recommendation. Changing prediabetes and diabetes thresholds based on HbA1c values may enhance accuracy. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S39]
Copyright (c) 2025 Ahmad Monirul Hoque, Marufa Mustari, Md. Fariduddin, Shahjada Selim https://creativecommons.org/licenses/by-nc/4.0
Outcome pattern of mycophenolate mofetil in combination with low dose steroid in Graves’ orbitopathy
Background: Graves' orbitopathy (GO) is a debilitating autoimmune condition associated with thyroid disease. Despite corticosteroids being the primary treatment, many patients show inadequate responses or relapse. Aim: To evaluate the outcome of mycophenolate mofetil combined with low-dose steroids in treating active moderate to severe GO. Methods: In this hospital-based prospective observational longitudinal study, a total of 40 patients with GO were included. Three follow-ups were conducted during the study period. Data were collected using case-record forms and analyzed with SPSS-26. Results: Comparing CAS at 6 months with treatment and baseline CAS shows significant improvement in both eyes (right eye's P value is 0.001 and left eye's P value is 0.025). Spontaneous retro-orbital pain, pain on eye movement, redness, and swelling of the caruncle and conjunctiva significantly reduced over the treatment period, while eyelid swelling showed a slight decrease. Lid retraction and soft tissue involvement improved in both eyes, although changes in diplopia and ocular motility are not statistically significant. Regarding outcome pattern, the majority of participants (68.8%) demonstrated significant improvement, while 31.3% showed unchanged/static. Conclusion: MMF combined with low-dose prednisolone may be considered for the treatment of moderate to severe GO as a steroid-sparing agent. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S40]
Copyright (c) 2025 Mazharul Islam, Partha Pulak Aich, Shawkat Kabir, Murshed Ahamed Khan, Marufa Mustari, Shahjada Selim, Md. Fariduddin https://creativecommons.org/licenses/by-nc/4.0
Obesity and its determinants among adolescents and young adults in Bangladesh: Evidence from a nationwide study
Background: Limited studies explored the determinants of obesity among Bangladeshi youth. Aims: To estimate the prevalence of obesity and identify socio-demographic, lifestyle, and metabolic risk factors among Bangladeshi adolescents and young adults. Method: This is a post-hoc analysis of a nationwide study that included 2300 young [adolescents: 10-18 years, n=1118 and young adults: 19-34 years, n=1182] by multistage random sampling during March-August 2024. Obesity among adolescents was defined by BMI percentiles (overweight 85th–94th, obesity ≥95th), while in adults by BMI cut-offs (overweight 23–24.9 kg/m², obesity ≥25 kg/m²). Data on lifestyle, family, and socioeconomic history were collected. Blood pressure (BP), plasma glucose, and lipid profile were measured. Results: The prevalence of overweight/obesity was 29.2% (overweight 11.6%, obesity 17.6%), higher among young adults (43.8%) vs. adolescents (13.6%), and in urban areas (38.2%) vs. rural areas (21.1%). In both adolescents and young adults, overweight/obesity was associated with higher wealth index (OR 3.3, 95% CI 2.4–4.8 and 1.9, 95% CI 1.5–2.4 respectively), urban residence (OR 2.9, 95% CI 2.1–4.2 and 1.5, 95% CI 1.2–1.9 respectively), and late bedtime (OR 3.0, 95% CI 2.1–4.3 and 1.3, 95% CI 1.0–1.6 respectively). In addition, overweight/obesity was associated with increased screen time (OR 2.1, 95% CI 1.5–2.9) and short sleep duration (OR 2.2, 95% CI 1.5–3.2) in adolescents while frequent meals outside home (OR 1.3, 95% CI 1.0–1.7) and female gender (OR 1.4, 95% CI 1.1–1.8) in young adults. Elevated BP, acanthosis, and dyslipidemia were associated with overweight/obesity in both groups and diabetes in young adults (all p<0.01). Conclusion: Obesity is highly prevalent among Bangladeshi youth, with distinct risk profiles in adolescents and young adults. Lifestyle factors such as late bedtime, short sleep, poor diet, and inactivity, together with urbanization and metabolic disorders, contribute significantly. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S41]
Copyright (c) 2025 Rifat Hossain Ratul, Mashfiqul Hasan, Koushik Ashraf, Abdullah Al Noman Bhuiyan, Nusrat Sultana, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Genetic insights: TCF7L2 polymorphisms in young Bangladeshi with type 2 diabetes mellitus
Background: The prevalence of youth-onset type 2 diabetes mellitus (T2D) is increasing worldwide, including in Bangladesh. Variants in the transcription factor 7-like 2 (TCF7L2) gene are strongly associated with T2D, but their role in young individuals remains uncertain. Objectives: To examine the frequency and association of TCF7L2 polymorphisms—rs7903146 (C>T) and rs12255372 (G>T)—in Bangladeshi youth with phenotypic T2D. Methods: In this cross-sectional study, 163 youth-onset phenotypic T2D patients and 149 age-group-matched controls with normal glucose tolerance (NGT) were recruited at BMU (March 2022–September 2024). Demographic, clinical, and biochemical data were recorded. Genotyping was performed by Sanger sequencing, though sequencing failed in 67 (rs7903146) and 44 (rs12255372) samples due to insufficient DNA. Genotype and allele frequencies were compared; Hardy-Weinberg equilibrium, linkage disequilibrium, and genetic models were analyzed. Results: For rs12255372, polymorphic genotypes were more frequent in NGT (GT 59.5%, TT 17.1%) than T2D (GT 47.8%, TT 11.2%), while the wild genotype (GG) was higher in T2D (41.0% vs. 23.4%, p=0.012). Significant associations were observed under co-dominant (p=0.011) and dominant (p=0.003) models. The minor allele frequency of rs12255372 was higher in NGT (46.8% vs. 35.1%, p=0.008). By contrast, rs7903146 showed no significant differences in genotype (p=0.334) or allele frequencies (p=0.142). Haplotype analysis indicated that the T–C haplotype (rs12255372-T, rs7903146-C) was significantly less common in T2D (OR 0.24, 95% CI 0.12–0.48, p<0.001). Logistic regression confirmed rs12255372 polymorphism (GT+TT) as protective [OR 0.48, 95% CI 0.27–0.85, p=0.012], while rs7903146 showed no association. Conclusion: TCF7L2 polymorphisms are present in Bangladeshi youth; rs12255372 confers protection against T2D, whereas rs7903146 shows no significant association. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S42]
Copyright (c) 2025 Sayad Bin Abdus Salam, Mashfiqul Hasan, Nusrat Sultana, Kishore Kumar Shil, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Insulin secretory status and insulin indices after 5 years of index pregnancy with gestational diabetes mellitus
Background: Women with a previous history of Gestational Diabetes Mellitus (GDM) have a higher risk of developing adverse metabolic outcomes in comparison to women without GDM. Although after delivery dysglycemia usually subsides, insulin resistance and β-cell defects may not disappear completely postpartum, eventually leading to type-2 diabetes mellitus. So, it is meaningful to investigate the long-term changes in insulin secretion and resistance after delivery. Aim: The aim of this study is to assess the insulin resistance and insulin secretory status of mothers with a history of GDM ≥ 5 years of index pregnancy. Method: In this hospital-based cross-sectional study,107 women with a history of GDM and 101 women without GDM participated. Fasting insulin and C-peptide were measured by the chemiluminescence method. Homeostatic Model Assessment (HOMA) was used to estimate β-cell secretory function (HOMA-B), insulin resistance (HOMA-IR), and insulin sensitivity (HOMA-%S). Data were analyzed by SPSS (version 25). Results: Median time elapsed after index pregnancy was 9 years for the GDM group and 7 years for the NGT group (p=0.004). C-peptide was significantly higher in the GDM group compared to the NGT group [3 (2.34-3.74) vs. 2.52(2.16-3.35); p=0.011]. Fasting insulin and HOMA-IR had similar trends [15.3 (10.6-19.2) vs. 13.3 (10.0-17.25); p=0.044 and 4.06 (2.71-6.25) vs. 3.11 (2.25-4.34); p<0.001, respectively]. On the other hand, HOMA-B was lower among GDM compared to the NGT [117.13 (74.39-185.28) vs. 159.45 (121.91-206.43); p<0.001]. Fasting insulin level (p<0.001), C-peptide (p<0.001), and HOMA-IR (p<0.001) increased progressively with the change of current glycemic status across the NGT, prediabetes (PDM), and diabetes (DM) groups. There was a gradual decline in β-cell function from the NGT to the DM group based on the current glycemic status (p<0.001). Conclusion: Women with GDM also had substantial β-cell dysfunction and insulin resistance after ≥ 5 years of index pregnancy. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S43]
Copyright (c) 2025 Md. Hasanul Islam, Krishna Airi, Tania Tofail, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Vitamin D status and relation with thyroid antibodies in patients with autoimmune thyroid disease
Background: The most common cause of thyroid dysfunction is autoimmune thyroid disease (AITD), which includes Hashimoto's thyroiditis (HT) and Graves' disease (GD). Vitamin D insufficiency has been linked to autoimmune disorders, but the data are inconclusive. Objective: This study aimed to evaluate vitamin D status and its relation with thyroid autoantibodies (Anti-TPO-Ab, Anti-Tg-Ab, TRAb) in Bangladeshi patients with AITD. Material and methods: This case-control study was conducted in the department of Endocrinology in BIRDEM General Hospital from March 2022 to February 2024. Eighty newly diagnosed untreated AITD patients (40 HT, 40 GD), aged >18 years, were enrolled. Eighty subjects with normal thyroid function were recruited as controls. Serum 25(OH)D was checked by CMIA, and Anti-TPO-Ab, Anti-Tg-Ab, and TRAb were noted. The status of vitamin D was defined on serum 25(OH)D levels: sufficiency if ≥30ng/ml, insufficiency if 21-29ng/ml, and deficiency if ≤20 ng/ml. Results: It was observed that 67.5% of AITD cases (70.0% with HT, 65.0% with GD) had vitamin D deficiency, compared with 51.2% in controls (p=0.039). The mean 25(OH)D was significantly lower in patients with HT (13.22±8.89 ng/ml) and GD (14.46±9.73 ng/ml) than in controls (19.14±7.59 ng/ml) (p 0.001). Correlation analysis revealed that vitamin D was inversely related to Anti-TPO-Ab (r=-0.501, p=0.001 in HT and r=-0.431, p=0.006 in GD), Anti-Tg-Ab (r=-0.296, p=0.064 in HT; r=-0.299, p=0.061 in GD), and TR-Ab (r=-0.447, p=0.004), indicating that as vitamin D levels decrease, antibody titres tend to increase. Conclusion: Our findings indicate that patients with AITD have lower vitamin D levels. Since we found an inverse correlation between vitamin D and thyroid antibody levels, we may speculate that vitamin D deficiency can be one of the potential factors in the pathogenesis of AITD. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S44]
Copyright (c) 2025 Hafsa Hassan Khan, Md Feroz Amin, Faria Afsana, Nazmul Hossain, Rushda Sharmin Binte-Rouf https://creativecommons.org/licenses/by-nc/4.0
Body fat distribution in women with polycystic ovary syndrome
Background: Evaluating the difference in body fat distribution between polycystic ovary syndrome (PCOS) and healthy controls may help to understand their roles in the pathogenesis of PCOS. Objectives: To compare the body fat distribution of women with PCOS with that of healthy controls, and to investigate the association of these measurements with anthropometric, metabolic, and hormonal profiles among PCOS patients. Methods: This case-control study was carried out in 50 reproductive-aged women with PCOS and 50 age-matched healthy controls in the Department of Endocrinology, Bangladesh Medical University (BMU). Anthropometry, blood pressure, biochemical tests, and USG of the ovaries were done. Body fat distribution was measured by DEXA scan in Nuclear Medicine, BMU campus. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Results: The frequency of obese participants was higher in the PCOS group than in the control group based on the fat mass index. Though the total body fat percentage was higher in women with PCOS, both groups were obese based on the cutoff point (total body fat% ≥35). PCOS patients showed higher android fat percentage and android-gynoid ratio (AGR). Both visceral and subcutaneous adipose tissue were higher in PCOS patients than in the controls. Almost all body fat indices were positively correlated with anthropometric parameters. AGR had a significant correlation with total cholesterol and triglyceride levels. HOMA-IR was positively correlated with nearly all body fat metrics. Multivariate logistic regression analyses showed no significant association between PCOS and body fat distribution after adjustment for age, modified Ferriman-Gallwey score, free androgen index, and HOMA-IR. Conclusion: Body fat distributions had no independent associations with PCOS. Body fat distributions correlated with anthropometric measurements and insulin resistance in women with PCOS. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S45]
Copyright (c) 2025 Munira Afroz Siddika, Md. Shahed Morshed, Samirah Binte Illiyas, Jasmine Ferdous, Hurjahan Banu, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Correlation of urinary nephrin with albuminuria as early marker of diabetic nephropathy in type 2 diabetes mellitus
Background: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease and a public health concern nowadays. Early detection is imperative to halt the progression. Albuminuria has been considered a gold standard for early detection of DN, but it has several limitations. Nephrin is a podocyte-specific protein and a key structural element of the glomerular filtration barrier, which has been considered a promising early marker of DN. Objectives: To determine the correlation of urinary nephrin with albuminuria as an early marker of diabetic nephropathy in type 2 DM. Methods: This case-control study was performed from July 2023 to December 2024. A total of 86 participants were recruited purposively and allocated into four groups. Group A comprised non-diabetic healthy individuals, while the other three groups consisted of people with type 2 DM, categorized into Group B (normoalbuminuria), Group C (microalbuminuria), and Group D (macroalbuminuria). Informed written consent was taken. History, clinical evaluation, and laboratory investigations, including UACR, urinary nephrin, s. creatinine, urine R/M/E, HbA1C, FPG, and PPG were done. SPSS version 26.0 was used for statistical analysis. P-value <0.05 was considered significant. Result: Urinary nephrin increased progressively and significantly across the group and showed significant positive correlations with HbA1C & UACR and a negative correlation with eGFR. It has a very high and significant odds ratio of 116.83. ROC curve of urinary nephrin revealed AUC 0.977 (≥0.75 ng/ml) with 92.16% sensitivity and 90.91% specificity for predicting DN. It was 100% positive among diabetes with micro or macroalbuminuria, and 76.19% positive in those with normoalbuminuria. Conclusion: Urinary nephrin revealed a significant positive correlation with UACR in people with type 2 DM. Even in the normoalbuminuria stage, its significant positivity suggests that it could be a more reliable early predictive marker of diabetic nephropathy than UACR. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S46]
Copyright (c) 2025 Md. Amiruzzaman, Moinul Islam, Indrajit Prasad https://creativecommons.org/licenses/by-nc/4.0
Pharmacogenomics: Way forward to personalised medicine
Pharmacogenomics is the study of how genetic variations influence an individual’s response to drugs. By integrating genomics with pharmacology, pharmacogenomics aims to optimize drug therapy, minimize adverse drug reactions, and enhance therapeutic efficacy. Genetic differences, particularly in genes encoding drug-metabolising enzymes, transporters, and targets, can significantly affect drug absorption, distribution, metabolism, and excretion. The identification of these genetic variants allows for personalised treatment strategies—often termed precision medicine—that tailor drug selection and dosage to each patient’s genetic profile. Advances in genotyping technologies, such as next-generation sequencing (NGS), have accelerated the discovery of pharmacogenomic markers and facilitated their clinical application. Despite its promise, challenges remain in integrating pharmacogenomics into routine clinical practice due to issues of cost, limited awareness, and the need for robust clinical validation. Nevertheless, pharmacogenomics represents a transformative approach in modern medicine, promoting safer and more effective treatments. J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S2
Copyright (c) 2025 Sharif Akhteruzzaman https://creativecommons.org/licenses/by-nc/4.0
Artificial intelligence in Endocrinology and Diabetes: Challenges, opportunities and future directions
Artificial Intelligence (AI) is reshaping healthcare by enabling algorithms to learn from complex medical data and assist in clinical decision-making. In endocrinology and diabetes, AI holds promise for predicting disease risk, optimizing glucose control, automating insulin delivery, and screening for complications using patients’ clinical data and physiological signals. However, the use of AI also raises concerns about risks such as demographic bias, domain variability, explainability and fairness—particularly when models trained on Western populations are applied to diverse LMIC settings. This talk will outline key applications and future directions of AI in diabetes and endocrine care, highlighting the integration of multimodal data, emerging foundation models, and ethical challenges. Drawing from the mHealth Lab’s work at BUET, examples will demonstrate how locally developed AI tools—such as smartphone-based clinical decision systems and low-cost physiological monitoring platforms—can bridge the gap between cutting-edge algorithms and equitable, real-world healthcare delivery in Bangladesh. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S3]
Copyright (c) 2025 Taufiq Hasan https://creativecommons.org/licenses/by-nc/4.0
Primary aldosteronism (PA) is the most common endocrine cause of hypertension, affecting 10% of hypertensive patients in the community and up to 30% of patients with resistant hypertension. Compared to patients with primary hypertension matched for age, sex, and blood pressure, those with undiagnosed and untreated PA have worse cardiovascular outcomes. Effective treatment is available for PA with either mineralocorticoid receptor antagonists or unilateral adrenalectomy, which are effective in treating PA if instituted in a timely manner. However, PA is currently underdiagnosed with a detection rate of <0.1%. In recognition of the importance of PA in the pathophysiology of hypertension, recent hypertension and endocrine guidelines recommended screening for PA in all adults with hypertension. We will discuss updates in PA diagnosis and management with a focus on increasing screening, the role of aldosterone-suppression testing, laboratory method considerations, and emerging treatment options. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S4]
Copyright (c) 2025 Renata Libianto https://creativecommons.org/licenses/by-nc/4.0
Mineralocorticoid receptor signalling in hypertension
The actions of the mineralocorticoid, aldosterone, are mediated by the mineralocorticoid receptor (MR), a member of the nuclear receptor superfamily of ligand-dependent transcription factors. The MR appears in vertebrate evolution before aldosterone and indeed responds to two physiological ligands, aldosterone and cortisol (and also perhaps a third, progesterone). In epithelial tissues, aldosterone selectivity is determined by 11β-hydroxysteroid dehydrogenase type II. In other tissues, cortisol is the primary ligand with multiple roles in cardiovascular function, immune cell signalling, neuronal function and adipocyte differentiation. These actions, beyond simply sodium homeostasis and hypertension, contribute to the disproportionate morbidity associated with hyperaldosteronism and the benefit observed more broadly in cardiovascular disease with the use of MR antagonists. This diversity of responses at the MR, including ligand- and tissue-specificity, is achieved through critical interactions involved in MR-mediated signal transduction. Signalling is initiated by ligand-binding, which confers a ligand-specific, agonist or antagonist conformation upon the receptor. This conformation then determines subsequent interactions within the receptor, with other transcription factors independent of DNA-binding, and with coregulatory molecules. Relatively few coregulators have, however, been described for the MR, although our recent studies have demonstrated both ligand and/or tissue-selectivity for MR-coregulator interactions. The successful identification of the structural basis of antagonism at the MR and of ligand-specific interactions of the MR may provide the basis for the development of novel ligands with the ability to modulate the MR response and provide tissue specificity. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S5]
Copyright (c) 2025 Peter J. Fuller https://creativecommons.org/licenses/by-nc/4.0
Update on gut hormone-based diabesity treatment
Gut hormones are peptide hormones produced by the digestive tract that regulate digestion, nutrient absorption and metabolism eg. GLP-1, GIP, Glucagon, Amylin. The earliest gut hormone-based therapy for diabetes is the DPP-4 inhibitors eg. Vildagliptin, Sitagliptin, Linagliptin, which inhibit the DPP-4 enzyme that breaks down the incretin hormones (GLP-1 and GIP). The increase in circulating GLP-1 and GIP results in improved glycemia. The next class is the GLP-1 receptor agonist (GLP-1RA), which is based either on the exendin molecule (eg. Exenatide, Lixisenatide) or the human GLP-1 molecule (eg. Liraglutide, Dulaglutide, Semaglutide). The advantage of these GLP-1RAs is the benefit of weight reduction in addition to glucose lowering, and Liraglutide and Semaglutide have also been approved as obesity management medications in people with obesity without diabetes. GLP-1RAs (Liraglutide, Dulaglutide, Semaglutide) have also been shown to reduce the risk of major CV events in people with diabetes and more recently, Semaglutide has also been shown to reduce the risk of major CV events in people with obesity without diabetes. The newest class of gut hormone-based therapy is the dual incretin (GLP-1 and GIP) receptor agonist, Tirzepatide, which can result in more glucose lowering and weight reduction. This agent has also been approved as an obesity management medication in people with obesity without diabetes. There are now a number of agents being developed for the treatment of diabetes and obesity. Glucagon receptor (GCGR) agonism has been shown to increase energy expenditure. Hence, the development of GLP-1RA and GCGR agonists is expected to provide superior body weight reduction versus GLP-1RA alone. Mazdutide and Survodutide are two such agents being developed. Triple receptor agonist (GLP-1/GIP/GCGR agonist), Retatrutide, has been developed and shown to result in more glucose and body weight reduction. Other agents being studied are GLP-1 and Amylin receptor agonist (CagriSema, Amycretin) and GLP-1RA and GIP-R inhibitor (MariTide). In the oral formulation, small molecule GLP-1RA, Orforglipron and oral Amycretin are in development. In summary, gut hormone-based therapy has shown remarkable success not only for diabetes but also for obesity management. It also has the potential to reduce long-term diabetes and obesity complications, such as CV and CKD events. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S6]
Copyright (c) 2025 Mafauzy Mohamed https://creativecommons.org/licenses/by-nc/4.0
Radiofrequency ablation: A modern solution for thyroid nodule in Bangladesh
Thyroid nodules are common and often require intervention when symptomatic, cosmetically concerning, or hormonally active. Surgery remains the standard treatment but carries risks of hypothyroidism, nerve injury, scarring, and prolonged recovery. Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative with demonstrated safety and efficacy. RFA achieves substantial nodule volume reduction (50–80% within 6 months; sustained in >85% after 3 years) and provides symptom relief in over 80% of patients, with high cosmetic satisfaction. Thyroid function is largely preserved, minimizing the need for lifelong hormone therapy. Complications are uncommon (<1% major; 2–3% minor), most frequently transient pain or voice changes. Compared with surgery, RFA offers shorter recovery, reduced costs, and fewer long-term sequelae. International guidelines from the Korean Society of Thyroid Radiology, European Thyroid Association, and AACE/ACE/AME endorse RFA as a first-line treatment for benign symptomatic nodules. In Bangladesh, where thyroid disease is highly prevalent and surgical access is limited, RFA provides a cost-effective, outpatient-based alternative that may reduce surgical burden and expand treatment options. RFA represents a paradigm shift in thyroid nodule management, offering a safe, effective, and affordable alternative to surgery. Its integration in Bangladesh could improve outcomes, preserve thyroid function, and enhance patient quality of life. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S7]
Copyright (c) 2025 Md Kamrul Azad https://creativecommons.org/licenses/by-nc/4.0
Updated management of differentiated thyroid carcinoma
Differentiated thyroid cancer (DTC) is the most common type of thyroid cancer and one of the most frequently diagnosed endocrine cancers. The American Thyroid Association (ATA) initially published guidelines for DTC management in 1996, with subsequent revisions reflecting advancements in the field. The most recent update aims to provide clinicians, patients, researchers, and policymakers with comprehensive, evidence-based recommendations for managing adult DTC patients, emphasizing the patient’s journey from diagnosis through treatment and long-term care. The updated guidelines were developed by a diverse panel of experts, including specialists in thyroid cancer care, a patient advocate, and experts in systematic reviews and guidelines. Systematic literature reviews were conducted, and two additional reviews were commissioned, with evidence drawn from English-language articles published up until July 1, 2024. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of the evidence. The revised guidelines cover various aspects of DTC management, starting with diagnosis and extending to staging, treatment, response assessment, monitoring strategies, diagnostic testing, and subsequent therapies. Emphasis is placed on patient-reported outcomes and areas identified for further research. By incorporating the latest evidence, the guidelines aim to optimize clinical decision-making and improve patient care throughout their treatment journey. This presentation will highlight the key aspects of these updated guidelines, providing an overview of the current standards in DTC management. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S8]
Copyright (c) 2025 Farhana Akter https://creativecommons.org/licenses/by-nc/4.0
Decoding the mystery of young-onset diabetes in Bangladesh: How to translate observations into clinical practice?
Diabetes in young, especially in South Asia, often does not fit into conventional categories, leading to diagnostic and therapeutic challenges. The scarcity of evidence and limited healthcare resources compel physicians to adopt an empirical approach, which, at least in some cases, may not be appropriate for an individual patient. Over the past decade, the ‘Study on Obesity and Diabetes in Young’ (SODY) group has investigated various aspects of this phenomenon. With our findings now available, we aim to synthesize the results and translate them into clinical practice. Our research indicates that the majority of young adults (aged 25-34 years) with diabetes exhibit characteristics consistent with obesity-related type 2 diabetes (T2D), albeit with distinct disease trajectories and varying complication rates in comparison to older adults. These individuals tend to benefit more from therapies targeting insulin resistance and metabolic dysfunction. However, in adolescents (aged 10-18 years) and early adults (aged 19-24 years), it is critical to assess for potential autoimmune factors, pancreatic pathology, and, in selected cases, monogenic forms of diabetes. Notably, our findings show several rare variants in MODY-related genes that have not been frequently reported in the literature, alongside a relative absence of more commonly documented variants. An exceptional subset exists in young people with diabetes, which can be called ‘non-autoimmune, non-obese, lean youth-onset diabetes’. This group has no secondary causes of diabetes, such as pancreatic or endocrine pathology. It is characterized by more prominent beta-cell dysfunction and only a modest increase in insulin resistance. It remains unclear whether this variety is related to malnutrition, low birth weight, genetic predisposition, or other as-yet unidentified factors. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S9]
Copyright (c) 2025 Mashfiqul Hasan https://creativecommons.org/licenses/by-nc/4.0
Finerenone in DKD: Could it be a game-changer?
Type 2 diabetes is the leading cause of chronic kidney disease (CKD) worldwide. International guidelines for the management of CKD in patients with type 2 diabetes recommend control of hypertension and hyperglycemia, as well as the use of a renin–angiotensin system (RAS) blocker (an angiotensin-converting–enzyme [ACE] inhibitor or angiotensin-receptor blocker [ARB]). The sodium–glucose cotransporter 2 (SGLT2) inhibitors have also shown some promise. But despite recommended treatment, a risk of CKD progression persists, and newer therapies are always in search. Overactivation of the mineralocorticoid receptor causes inflammation and fibrosis that lead to progressive kidney and cardiovascular dysfunction. So there is always a scope of mineralocorticoid receptor antagonists (MRA) to retard the progression of DKD. Finerenone has potent antiinflammatory and antifibrotic effects and has lesser adverse events like hyperkalemia & gynecomastia than steroidal mineralocorticoid receptor antagonists due to its greater affinity and selectivity to mineralocorticoid receptor. Finerenone has been shown to reduce the urinary albumin-to-creatinine ratio in patients with CKD. Finerenone was able to reduce renal and cardiac endpoints compared to placebo with less hyperkalemia than non-selective MRA in people with DKD and proteinuria, as revealed by several studies. The mechanism of action of SGLT2i and finerenone are complimentary as SGLT2i induce reno-protection related to reduced hyperfiltration while finerenone uses to work via inhibiting the MRA pathway for inflammation and fibrosis. SGLT2i have also been shown to reduce the incidence of hyperkalemia associated with finerenone in the FIDELIO-DKD trial. Study like CONFIDENCE showed the clinical evidence that simultaneous initiation of finerenone and empagliflozin led to an early and additive reduction in UACR of 52% in patients with chronic kidney disease and type 2 diabetes, which was significantly greater than with either treatment alone. With all this promising findings, finerenone is definitely going to be game-changer as far as DKD is concerned. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S10]
Copyright (c) 2025 AKM Aminul Islam https://creativecommons.org/licenses/by-nc/4.0
When the sella is empty: Navigating empty sella syndrome
Empty sella syndrome (ESS) is a condition characterized by the herniation of the subarachnoid space into the sella turcica, resulting in a partially or completely empty sella on imaging. It is often discovered incidentally during brain imaging for unrelated symptoms. ESS is classified as primary, occurring without prior pituitary surgery or radiation, or secondary, following such interventions. Primary ESS is associated with congenital defects or increased intracranial pressure, while secondary ESS results from pituitary gland atrophy or iatrogenic causes. Symptoms, if present, include headache, hormonal imbalances (e.g. hypopituitarism), and rarely, visual disturbances due to optic chiasma compression. Diagnosis relies on magnetic resonance imaging (MRI) or computed tomography (CT), revealing a flattened or absent pituitary gland. Management is typically conservative for asymptomatic cases, focusing on monitoring and addressing hormonal deficiencies with replacement therapy. Symptomatic cases may require surgical intervention to relieve pressure or correct cerebrospinal fluid leaks. The prognosis is generally favourable, with most patients experiencing minimal complications. Understanding ESS is crucial for distinguishing it from other pituitary disorders, ensuring appropriate management, and improving patient outcomes through targeted hormonal and symptomatic treatment. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S11]
Copyright (c) 2025 Debasish Kumar Ghosh https://creativecommons.org/licenses/by-nc/4.0
Rewriting the growth trajectory: Innovations in growth hormone therapy
Growth hormone (GH) therapy has evolved far beyond its original indication of isolated GH deficiency. Over the last decade, advances in molecular biology, long-acting GH formulations, and individualized dosing algorithms have redefined therapeutic goals from mere height augmentation to holistic metabolic benefits. Novel delivery systems—weekly depot preparations, sustained-release microspheres, and transdermal options—aim to improve adherence and patient quality of life while maintaining physiological insulin-like growth factor-1 (IGF-1) profiles. Real-world data highlight the importance of early diagnosis, precision dosing guided by pharmacogenomics, and comprehensive monitoring to maximize adult height and minimize adverse effects. This presentation reviews recent clinical trials, emerging biomarkers for treatment tailoring, and practical strategies for integrating these innovations into routine endocrine practice, with special focus on transitioning pediatric patients to adult care. These developments collectively “rewrite the growth trajectory,” offering new hope for children with growth disorders and adults with GH deficiency. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S12]
Copyright (c) 2025 Indrajit Prasad https://creativecommons.org/licenses/by-nc/4.0
Osteoporosis in the young: A Diagnostic and therapeutic challenge
Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, which increases the risk of fractures. It is commonly observed in menopause and among older adults. Although less common in younger people, it can still pose a significant health risk. In younger individuals, the relationship between BMD and fracture risk is less direct than in postmenopausal individuals. Therefore, the diagnostic guidelines and treatment practices based on BMD measurements in postmenopausal women do not apply to this younger group. Similarly, the Fracture Risk Assessment (FRAX) tool cannot be used to evaluate fracture risk based on BMD in people under 40 years of age. In younger people, osteoporosis refers to those with fragility fractures from low trauma or low bone density caused by a secondary condition. Early-onset osteoporosis can result from genetic conditions, chronic diseases, hormonal imbalances, nutritional gaps, long-term use of glucocorticoids, or lifestyle choices such as low activity levels, smoking, and poor diet. Detecting it early is often challenging because the disease is typically silent until a fracture occurs. Dual-energy X-ray absorptiometry (DXA) remains the primary diagnostic method; however, thoroughly assessing risk factors through clinical and laboratory evaluation is essential. Treatment emphasizes lifestyle modifications, including a sufficient intake of calcium and vitamin D, consistent weight-bearing exercise, and avoidance of smoking. Case-based treatment is appropriate when a secondary cause is identified. Osteoporosis-specific pharmacotherapy is recommended for severe osteoporosis with ongoing bone loss. Raising awareness about osteoporosis in young people is crucial, as early prevention and intervention can significantly enhance long-term bone health and quality of life. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S13]
Copyright (c) 2025 Nusrat Sultana https://creativecommons.org/licenses/by-nc/4.0
Recurrent primary hyperparathyroidism: Management challenges
Recurrent primary hyperparathyroidism (recHPT) is defined as the return of hypercalcemia more than six months after an initially successful parathyroidectomy. Despite advancements in surgical techniques and imaging modalities, recHPT continues to pose significant management challenges, with recurrence rates reported between 2.5% and 10%. This review aims to discuss the etiology, diagnostic evaluation, and management strategies for recHPT, emphasizing the importance of a multidisciplinary approach in optimizing outcomes. The most common causes include missed or ectopic parathyroid glands, multiglandular disease, and surgeon inexperience. Rare etiologies such as parathyromatosis and parathyroid carcinoma should also be considered. Diagnosis requires exclusion of secondary hyperparathyroidism and familial hypocalciuric hypercalcemia through comprehensive biochemical assessment and appropriate imaging. Advanced preoperative localization studies—including high-resolution neck ultrasonography, 99mTc-sestamibi SPECT-CT, 4D-CT or MRI, and newer modalities such as 18F-fluorocholine PET/CT or PET/MRI—play a pivotal role in identifying abnormal glands. Reoperative parathyroid surgery remains the definitive treatment; however, it is technically demanding and carries increased operative risks. Therefore, surgical indications should be carefully reviewed in a multidisciplinary setting, balancing potential benefits against procedural risks. For patients who are unsuitable for surgery, medical management with calcimimetics, bisphosphonates, or denosumab may be considered as alternative therapeutic options. Recurrent primary hyperparathyroidism continues to present diagnostic and therapeutic challenges despite technological advances. A systematic, multidisciplinary approach—combining precise localization, expert surgical planning, and individualized medical therapy—is essential for optimal long-term outcomes. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S14]
Copyright (c) 2025 Moinul Islam https://creativecommons.org/licenses/by-nc/4.0
Individualized management of polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a common endocrinopathy that remains mysterious. The heterogeneous presentations underscore the limitations of a standardized, ‘one size fits all’ management strategy. Hence, the management of PCOS is essentially symptomatic and individualized. Lifestyle management always remains central. The patient’s stages of life, fertility issues, as well as metabolic factors are principal factors in determining individual management. Besides the patient’s comorbidity, the availability of drugs and tolerability also affect the choice of treatment. The individualization is now exploring the pharmacogenomics of individual drugs. In this presentation, a few cases will be discussed to demonstrate the individualized approach. By moving beyond a singular treatment algorithm, we can provide more effective, compassionate, and holistic care for individuals with PCOS. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S15]
Copyright (c) 2025 Md. Shahed Morshed https://creativecommons.org/licenses/by-nc/4.0
Management of perimenopause and menopause: New insights
The current approach to managing menopause and perimenopause is based on an individual basis. Menopausal hormone therapy (MHT) is still the best treatment for symptoms, but its use depends on a thorough evaluation of the patient's medical background. Clinical guidelines support MHT for healthy people under 60 or in the first ten years after menopause, as long as the therapeutic advantages are thought to outweigh any possible risks. Furthermore, there are numerous effective lifestyle-based and non-hormonal interventions available as substitutes, such as pharmaceuticals and therapeutic approaches. The main goal is still to work together to develop a treatment plan for managing symptoms and fostering long-term physiological health. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S16]
Copyright (c) 2025 Hurjahan Banu https://creativecommons.org/licenses/by-nc/4.0
Spectrum of DSD cases presenting at a tertiary care hospital in Bangladesh
Disorder of sexual development (DSD) is defined as a diverse group of congenital conditions in which the development of chromosomal, gonadal and anatomic sex is different or incongruent. It has replaced older terminology like intersex, pseudo hermaphroditism or ambiguous genitalia. These conditions, affecting approximately 1 in 4500 newborns, arise from variations in the complex genetic and hormonal pathways that govern sexual development. The exact data on the incidence or prevalence of DSD in Bangladesh is limited. Bangladesh Medical University (BMU) is the largest tertiary care hospital in Bangladesh, which is considered as the ultimate referral center for such complex cases as DSD. The DSD cases that are commonly encountered in the department of Endocrinology, BMU, include congenital adrenal hyperplasia (CAH), complete androgen insensitivity syndrome (CAIS), gonadal dysgenesis, Leydig cell hypoplasia, etc. However, there are no adequately designed studies to observe the frequency or pattern of DSD at our institute. In this scientific paper, we try to enumerate the approach to a patient with DSD presented at our institute and the common barriers that we encounter. We envision an internationally concerted collaboration among the endocrinologists and biochemists/pathologists involved in this field of patient management at home and abroad in the upcoming days. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S17]
Copyright (c) 2025 Sharmin Jahan https://creativecommons.org/licenses/by-nc/4.0
Nourishment, not restrictions - Managing obesity with food
Obesity is a multifaceted and complex condition that requires holistic management. Abnormal weight gain can occur in conjunction with a variety of physical, metabolic, and psychological health issues. Preventing obesity has received a lot of attention since it can help avoid conditions like type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, osteoarthritis, obstructive sleep apnea, reproductive issues, depression, and cancer. Obesity is often associated with weight stigma, impacting psychological well-being and quality of life. It is well documented how nutrition can impact our health and is important for all, regardless of body weight. However, eating patterns and macronutrient composition, as well as physical activity levels, have changed significantly. Urbanization and globalization have led to a trend toward greater portion sizes, increased consumption of fat and sugar, and rising prices for fresh produce and falling prices for processed foods. A calorie deficit of 500–600 kcal per day from the existing diet is recommended by conventional guidelines in a number of nations in order to lose 0.5–1 kg of weight per week. However, weight loss is not a direct linear trajectory and fluctuations can occur. It has been suggested that illnesses linked to obesity can be improved by losing 5–10% of body weight. In order to develop more effective strategies, it is important to understand the efficacy, health effects, and long-term sustainability of current dietary approaches to weight control. Improvements in diabetes and CVD risk factors have been observed with diets ranging from 10% fat to 45% fat. For weight loss, there is no "one-size-fits-all" diet; maintaining dietary modifications is the primary goal. It is essential to tailor the diet to each person's demands. The mix of dietary changes and physical exercise should be taken into account for both medication approaches and the weight maintenance phase. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S18]
Shaping mind, body and metabolism: From burden to breakthrough
Regular physical activity is a cornerstone of obesity management due to its profound endocrine and metabolic effects. Exercise enhances insulin sensitivity, lowering circulating insulin and improving glucose uptake, which facilitates weight reduction and metabolic control. Aerobic and resistance training stimulate catecholamine release, promoting lipolysis and mobilization of free fatty acids as energy substrates. Exercise also modifies adipokine secretion: leptin levels decrease, improving appetite regulation, while adiponectin increases, enhancing lipid oxidation and insulin sensitivity. These changes collectively establish a biochemical environment favorable for sustained fat loss. Moreover, transient rises in growth hormone and cortisol during exercise support lipolysis and gluconeogenesis, while increased thyroid hormone activity elevates basal metabolic rate. From a clinical perspective, a minimum of 150 minutes per week of moderate-intensity aerobic activity combined with 2–3 sessions of resistance training is recommended. Early weight-loss efforts benefit from low-impact, continuous exercise to maximize fat oxidation, progressing to higher intensities as tolerance improves. Dietary modification enhances these hormonal effects, particularly when paired with protein-rich meals post-exercise to support muscle adaptation and metabolic health. Monitoring metabolic markers—such as fasting glucose, insulin, and leptin—can guide therapy and track endocrine responses. By viewing exercise not merely as calorie expenditure but as a targeted hormonal intervention, clinicians can design more effective, personalized strategies for weight reduction and long-term metabolic disease prevention. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S19]
Copyright (c) 2025 Indira Roy https://creativecommons.org/licenses/by-nc/4.0
A double challenge: Managing precocious puberty in congenital adrenal hyperplasia with gonadotropin releasing hormone agonist
Congenital adrenal hyperplasia is the most common cause of peripheral precocious puberty in boys. Treatment with hydrocortisone usually halts the progression of peripheral precocity. However, being on this treatment, a few cases may be complicated by central precocious puberty. In such cases, treatment with a Gonadotropin-Releasing Hormone agonist (GnRHa) usually prevents further pubertal development and the acceleration of bone age. Here, we present a case of an 8-year-old boy who was diagnosed with peripheral precocious puberty due to congenital adrenal hyperplasia. He had a history of the appearance of pubic hair and phallic enlargement at 6 years of age, aggressive behavior, and hyperpigmentation. Notably, he had bilateral testicular microlithiasis and a varicocele. Despite treatment with hydrocortisone and fludrocortisone, his pubertal progression and advancement of bone age continued. Clinical and hormonal evaluation subsequently confirmed conversion to central precocious puberty. Addition of a GnRHa to his glucocorticoid and mineralocorticoid regimen successfully arrested further pubertal progression. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S48]
Copyright (c) 2025 Md. Ashraful Hossain, Tania Tofail, Hurjahan Banu, Nusrat Sultana, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Clinical spectrum of Bardet-Biedl Syndrome: A case series
Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy characterized by a wide spectrum of clinical manifestations, including retinal dystrophy, obesity, post-axial polydactyly, learning disabilities, hypogonadism, and renal abnormalities. Early recognition is often challenging due to its gradual progression and overlapping features with other conditions, particularly in resource-limited settings where genetic testing is not readily available. We report a series of four Bangladeshi cases with variable phenotypic expressions of BBS. All patients presented with progressive visual impairment, obesity, and polydactyly, accompanied by additional features such as diabetes mellitus, dyslipidemia, hypogonadism, renal impairment, developmental delay, and behavioral disturbances. Diagnosis was established based on Beales’ clinical criteria, with patients meeting multiple primary and secondary features. Renal involvement was observed in two cases, including diabetic nephropathy and focal segmental glomerulosclerosis, underscoring its role as a major determinant of morbidity and mortality. Management required a multidisciplinary approach involving endocrinology, ophthalmology, nephrology, and mental health services, alongside lifestyle modification, pharmacotherapy, and family counseling. This case series highlights the clinical heterogeneity of BBS, the importance of heightened clinical suspicion for early detection, and the need for comprehensive multidisciplinary care to improve long-term outcomes in affected individuals. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S49]
Copyright (c) 2025 Monzur Elahi, Ahmad Monirul Haq, Md. Hasanul Islam, Md. Ashiqur Rahman, Md. Fariduddin https://creativecommons.org/licenses/by-nc/4.0
Insulin indices and metabolic characteristics of young adults with prediabetes: An emerging threat
Background: Prediabetes is often overlooked in young adults, although early insulin resistance and metabolic abnormalities can accelerate the onset of type 2 diabetes. Ethnic and environmental differences necessitate population-specific data to guide preventive strategies. Aims: To compare insulin indices, anthropometric markers, and metabolic profiles between young adults with prediabetes and normoglycemia. Method: This cross-sectional study included 58 participants with prediabetes and 143 with normoglycemia, aged 18–34 years, recruited from the Young Diabetes Clinic at Bangladesh Medical University (September 2023–February 2024). Prediabetes was defined by the ADA OGTT criteria. Anthropometric measurements, lipid profiles, fasting insulin, C-peptide, and insulin indices (HOMA-IR, HOMA-β) were assessed. Statistical comparisons were made between prediabetic and normoglycemic groups. Results: Prediabetes was associated with older age, male sex, and smoking (p<0.05 for all). Obesity was more prevalent in prediabetes, with higher mean BMI (25.9 vs. 23.3 kg/m²), central obesity (72.4% vs. 52.4%), and abnormal waist–height ratio (91.4% vs. 77.6%) in comparison to normoglycemic (p<0.05 for all). Prediabetic participants had higher mean systolic (112 vs. 106 mm Hg) and diastolic (78 vs. 74 mm Hg) blood pressure, increased triglycerides (168 vs. 111 mg/dL), and elevated TG/HDL ratio (4.1 vs. 2.6) (p<0.05 for all). Fasting insulin (18.3 vs. 10.3 μIU/mL) and C-peptide (3.6 vs. 2.3 ng/mL) were significantly higher, with increased HOMA-IR (3.4 vs. 2.1) (p<0.05 for all). However, although reduced in prediabetes, HOMA-β (117 vs. 140) was not significantly different between the two groups. Conclusion: Young Bangladeshi adults with prediabetes demonstrate early-onset obesity, dyslipidemia, hypertension, and insulin resistance, underscoring a trajectory toward type 2 diabetes. Early identification and lifestyle interventions are critical to mitigate this emerging threat. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S50]
Copyright (c) 2025 Koushik Ashraf, Mashfiqul Hasan, Abdullah Al Noman Bhuiyan, Rifat Hossain Ratul, Nusrat Sultana, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Suspected primary distal renal tubular acidosis in a young male with seronegative spondyloarthropathy, severe osteoporosis, osteomalacia, and hypothyroidism: A case report
A 22-year-old normotensive, non-diabetic male presented with recurrent episodes of hypokalemic paralysis since adolescence, followed by progressive inflammatory back pain, height loss, and proximal muscle weakness. Examination revealed severe kyphosis, restricted spinal mobility, proximal myopathy, and waddling gait. Laboratory investigations showed persistent hypokalemia (2.25–2.7 mmol/L), hyperchloraemic metabolic acidosis with normal anion gap, hypercalciuria, and elevated urinary magnesium excretion. Arterial blood gas analysis demonstrated low bicarbonate (12.5 mmol/L) with pH 7.34. Imaging confirmed bilateral sacroiliitis, medullary nephrocalcinosis, severe osteoporosis (Z score –5.5), and osteomalacia. Autoimmune screening, including HLA-B27, was negative. A diagnosis of distal renal tubular acidosis (dRTA) with seronegative spondyloarthropathy, severe osteoporosis, osteomalacia, and hypothyroidism was established. The patient was managed with potassium citrate, sodium bicarbonate, sulfasalazine, teriparatide, calcium carbonate, vitamin D3, and levothyroxine. Distal RTA is an uncommon association with seronegative spondyloarthropathy, particularly in the absence of conventional autoimmune markers. Given the adolescent onset, differentiation between primary and secondary dRTA remains a concern. Primary dRTA has been linked to mutations in ATP6V1B1, ATP6V0A4, SLC4A1, CA2, and recently FOXI1, WDR72, and ATP6V1C2. Genetic analysis is planned for this patient. This case underscores the importance of evaluating renal tubular function in young patients with recurrent hypokalemia and musculoskeletal deformities to enable early diagnosis and targeted therapy. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S51]
Copyright (c) 2025 Tasnim Nusrat, Shahjada Selim, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
A rare case of subclinical hyperthyroidism due to Graves’ disease with papillary thyroid carcinoma in a young female
A 36-year-old lady presented with convincing symptoms of hyperthyroidism with a swelling in front of her neck for the last 3 months, but she denied any fever, flu-like illness, or pain over it. On examination, there was a non-tender (2 X 2) cm2 nodule in the left lobe of the thyroid, firm in consistency, not fixed to the surrounding structure, and no cervical lymphadenopathy. Investigations showed suppressed TSH, normal FT4 and FT3, and positive TRAb. USG of the thyroid showed a nodule (2.2 x 1.3 x 2 cm3) with a TIRADS score of 4 in the lower pole of the left lobe of the thyroid; thyroid scan revealed a warm nodule in the left lobe. FNAC showed Bethesda category VI. Total thyroidectomy was safely performed. Histopathology confirmed the case as a well-differentiated, classical variety of papillary thyroid cancer. One month later, she visited the endocrinologist with TSH 73.3 mU/L, thyroglobulin 3.52 ng/mL, negative anti-thyroglobulin antibody, USG of the neck showing no remnant, thyroid scan showing a small remnant in the thyroid bed. So, the patient was categorized into the American Thyroid Association-defined “indeterminate response” category. Levothyroxine was started again, and she was kept under regular follow-up. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S52]
Copyright (c) 2025 Mita Datta, Mohammad Aminul Islam, Nusrat Sultana, Md. Fariduddin https://creativecommons.org/licenses/by-nc/4.0
Mitochondrial myopathy presenting with recurrent lactic acidosis and diabetes mellitus: A diagnostic challenge
Mitochondrial myopathies are rare disorders of oxidative phosphorylation that may manifest with muscle weakness, lactic acidosis, and multi-organ involvement. Endocrine dysfunction, particularly diabetes mellitus, is a recognized association. We report a 28-year-old male with recurrent episodes of vomiting, myalgia, and altered sensorium, each associated with severe lactic acidosis. He had been diagnosed with diabetes mellitus at age 23, with poor glycemic control despite therapy. Examination revealed bilateral ptosis, proximal muscle weakness, and fatigability. Investigations showed persistent hyperlactatemia, elevated creatine kinase, and basal ganglia calcification. Muscle biopsy could not be performed locally, and the patient was referred to the National Institute of Neurosciences & Hospital, Dhaka, for further evaluation. He was managed with insulin, supportive care, avoidance of metformin, and physiotherapy. This case highlights the diagnostic challenge when mitochondrial myopathy presents with endocrine manifestations such as diabetes. Awareness is crucial to avoid mismanagement and delayed recognition, particularly in resource-limited settings. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S53]
Copyright (c) 2025 Tanvir Ahmed, Eshrat Jahan Eshita https://creativecommons.org/licenses/by-nc/4.0
Not all refractory seizures are epilepsy: A case of insulinoma
Hypoglycemia can present with diverse neurological manifestations ranging from altered cognition, impaired consciousness, seizures, and psychosis to chronic complications such as dementia and neuropathy. Insulinoma, though rare, is a potentially reversible cause of recurrent hypoglycemia that can mimic seizure disorders, leading to diagnostic delays. We report the case of a 29-year-old man with a one-year history of recurrent stereotyped seizures, resistant to multiple antiepileptic drugs. The episodes predominantly occurred in the early morning or several hours post-meal and were occasionally shortened with food intake. Despite extensive neurological evaluation, including MRI and video EEG, no epileptiform activity was detected. During one admission, he was found to be hypoglycemic (48 mg/dl) with rapid recovery following glucose administration. Endocrine workup confirmed hyperinsulinaemic hypoglycemia, and contrast-enhanced CT revealed a solitary insulinoma in the pancreatic head. He underwent Whipple’s resection, and histopathology confirmed a benign insulinoma. Postoperatively, the patient has remained seizure-free and asymptomatic for six months. This case highlights the importance of considering hypoglycemia, particularly insulinoma, in refractory or atypical seizure disorders. Early recognition based on clinical clues and biochemical testing is vital, as surgical resection can provide a complete cure and prevent irreversible neurological damage. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S54]
Copyright (c) 2025 Pavel Chowdhury, Mourin Binte Zaman, Tarin Binte Zaman https://creativecommons.org/licenses/by-nc/4.0
Bilateral pheochromocytoma and medullary thyroid carcinoma in a middle-aged female: A case of Multiple endocrine neoplasia Type 2A
Multiple endocrine neoplasia type 2A (MEN 2A) is a rare autosomal dominant disorder characterized by the co-existence of medullary thyroid carcinoma (MTC), pheochromocytoma, and, less commonly, primary hyperparathyroidism. Here we present a case of a 43-year-old female who presented with recurrent hyperadrenergic spells along with sustained hypertension, bilateral loin pain, and unintentional weight loss for 1 year. Physical examination revealed thyromegaly and hyperpigmented patches in the interscapular region. Laboratory investigations showed elevated 24-hour urinary fractionated metanephrine, raised serum calcitonin and carcinoembryonic antigen, along with a normal serum calcium profile. A CT scan of the adrenal gland was suggestive of bilateral adrenal pheochromocytoma. Ultrasound of the thyroid gland demonstrated bilateral neoplastic nodules in both lobes of the thyroid gland. A provisional diagnosis of MEN 2A was made. Bilateral adrenalectomy was done, followed by total thyroidectomy with prophylactic central lymph node dissection. Her postoperative evolution was favourable. She is currently maintained on appropriate hormone replacement therapy. Genetic counseling was done, and family screening was advised. This case highlights the importance of early detection and timely surgical intervention in MEN 2A, which are pivotal for improving outcomes and enabling preventive family screening. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S55]
Copyright (c) 2025 Nazia Akter, Abdullah Al Noman Bhuiyan, Md. Saddam Hossain, Tahniyah Haq, Md. Fariduddin https://creativecommons.org/licenses/by-nc/4.0
When mild hypercalcemia isn’t harmless: Recurrent pancreatitis in familial hypocalciuric hypercalcemia
Familial hypocalciuric hypercalcemia (FHH) is a rare, usually benign, autosomal dominant disorder caused by mutations in the calcium-sensing receptor (CaSR) gene. It is typically characterized by mild, lifelong hypercalcemia, relative hypocalciuria, and normal or mildly elevated parathyroid hormone levels. Here we present a case of a 38-year-old male with newly diagnosed diabetes mellitus for 3 months who had recurrent episodes of acute pancreatitis for the last 1 year. Recurrent pancreatitis, a recognized complication of primary hyperparathyroidism, has rarely been reported on FHH, which made our case a unique one. Studying the case might help to develop insight into the diagnosis and management of this rare entity. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S56]
Copyright (c) 2025 Ruhul Kuddul, Nabila Mehnaz, Saki Md. Jakiul-Alam https://creativecommons.org/licenses/by-nc/4.0
A case study on the interplay between thyroid storm and hepatic impairment
A 40-year-old lady presented with complaints of fever, jaundice, anorexia, weight loss, nausea, and vomiting. She had experienced palpitations, heat intolerance, and about 10kg weight loss within a year. But she ignored and did not seek any medical advice. Her presenting vitals were: heart rate: 124 beats per minute, regular; respiratory rate: 24 breaths per minute; blood pressure: 90/60 mmHg; and temperature: 1010F. The woman looked emaciated with the prominence of her zygomatic bones, had a mild diffuse goiter, and was severely icteric. However, there was no evidence of proptosis. Laboratory workup on admission showed significantly raised bilirubin and aspartate aminotransferase, along with biochemical evidence of hyperthyroidism. The diagnosis of Graves’ Disease was further approved by a high level of thyroid receptor antibody and diffuse enlargement of the thyroid on ultrasound. Hepatitis was also evident on ultrasound, with reduced parenchymal echogenicity and increased periportal echoes. According to the Burch-Wartofsky Point Scale, the score was 45 to categorize her as a case of thyroid storm. All relevant etiologies of hepatitis (Anti-HEV IgM, Anti-HAV IgM, Anti-HCV, HBsAg, including Anti-Nuclear Antibody (ANA), Anti-Smooth Muscle Ab, and Anti-Mitochondrial IgG) were excluded. Initially, the patient was resuscitated with fluids, and symptomatic treatment was provided. Later, she was managed with intravenous corticosteroid, carbimazole, and ß-blocker. She was discharged after two weeks with significant improvement in her clinical and biochemical profiles. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S57]
Copyright (c) 2025 Kazi Golum Kibria, Yasmin Aktar, Shahinul Alam https://creativecommons.org/licenses/by-nc/4.0
When PCOS isn’t the answer: Müllerian para-ovarian cyst presenting with hyperandrogenism
Hyperandrogenism in women is most commonly caused by polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), or androgen-secreting ovarian/adrenal tumors. Para-ovarian (para-tubal) cysts are generally benign and hormonally silent. A 42-year-old obese (BMI 35Kg/m2) woman presented with progressive hirsutism and amenorrhea for 5 years. Biochemistry revealed elevated total testosterone 4.66 nmol/L [normal: 0.38-1.97 nmol/L]. Adrenal imaging, 17-hydroxyprogesterone, and DHEA-S were normal. Trans vaginal USG reported polycystic ovaries along with a right adnexal cyst [9.3x6.5cm]. MRI revealed a right adnexal ovarian cyst along with bilateral ovarian hyperplasia. The patient underwent laparoscopic cystectomy. Post-operatively, serum testosterone dropped markedly to 1.13 nmol/L without any anti-androgen medication, and clinical symptoms improved, evidenced by resumption of menstruation and improvement of hirsutism. Histopathology confirmed a Müllerian cyst with no evidence of neoplasia. Although para-ovarian cysts are typically non-functional, rare reports suggest possible androgen production or paracrine ovarian stromal stimulation due to cystic lesions. In our case, normalization of testosterone following cystectomy strongly supports a causal relationship. Potential mechanisms include stromal luteinization within the cyst wall or stimulation of adjacent ovarian tissue. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S58]
Copyright (c) 2025 Israt Rezwana, Mahmudul Hasan, AKM Aminul Islam https://creativecommons.org/licenses/by-nc/4.0
A young girl presented with short stature with Sprengel deformity: A case report
Klippel-Fiel syndrome (KFS) is a rare congenital disorder characterized by the presence of a triad of short neck, limited neck mobility, and low posterior hairline. A 5-year-old girl of consanguineous parents had limited neck movement and poor growth for three years. Her height was 87cm (SDS -4.6), and her weight was 11kg (SDS-2.8), indicating significant growth retardation. Intelligence was normal for age, but a clinical examination revealed a short neck, limited neck movement, and Sprengel deformity. Although her thyroid function was normal, the growth hormone stimulation test (using clonidine) was borderline low. By karyotyping, a normal female pattern (46, XX) was identified. While the echocardiogram was normal, the ultrasound revealed that the left kidney was absent, along with an infantile uterus. An X-ray of the cervical spine revealed a Sprengel deformity and cervical ribs. Her radiological bone age was delayed. The diagnosis of Klippel-Feil Syndrome was made by using clinical presentation, physical examination, and laboratory investigations. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S59]
Copyright (c) 2025 Abdullah Al Ragib, Md. Anowar Hossain, Ershad Mondal, ABM Kamrul Hasan https://creativecommons.org/licenses/by-nc/4.0
Tetrasomy X (48,XXXX): A rare chromosomal aneuploidy with reproductive impact
Tetrasomy X (48, XXXX) is an exceptionally rare sex chromosome aneuploidy, with fewer than a few hundred cases documented worldwide. Clinical features vary widely, from mild developmental delay to pronounced dysmorphism, gonadal dysfunction, and tall stature. We report a young female who presented with menstrual irregularities and delayed pubertal development. On physical examination, she was unusually tall (height 182 cm, arm span 194 cm) with a low upper-to-lower segment ratio (0.91), consistent with eunuchoid body proportions. Tanner staging revealed discordant pubertal progression, with breast development at stage B4 but pubic hair at stage P1. Laboratory evaluation demonstrated hypergonadotropic hypogonadism, evidenced by elevated follicle-stimulating hormone (37.93 mIU/ml), elevated luteinizing hormone (16.61 mIU/ml), and low estradiol (17.21 pg/ml). Other biochemical and systemic evaluations, including thyroid, renal, hepatic, and cardiac assessments, were within normal limits. Karyotyping confirmed 48, XXXX, establishing the diagnosis of tetrasomy X. This case emphasizes the diagnostic challenge posed by such rare aneuploidies, particularly in individuals presenting with tall stature and reproductive dysfunction but without overt dysmorphic features. Early recognition is crucial for initiating hormonal replacement, addressing fertility concerns, and ensuring multidisciplinary long-term care. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S60]
Copyright (c) 2025 Md. Saddam Hossain, Md. Hasanul Islam, Hurjahan Banu, Nusrat Sultana, Mashfiqul Hasan, Md. Shahed Morshed, Tania Tofail, Sharmin Jahan, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Berardinelli–Seip congenital lipodystrophy: A rare case report
Berardinelli-Seip Congenital Lipodystrophy (BSCL) is a rare autosomal recessive disorder characterized by near total absence of adipose tissue, severe insulin resistance, dyslipidemia, and hepatic involvement. We report a prepubertal child presenting with thin build, generalized loss of subcutaneous fat, prominent bones, distended abdomen, hepatomegaly, and delayed secondary sexual characteristics. Anthropometry revealed severe wasting with a BMI of 11.96 kg/m² and MUAC 13 cm. Laboratory evaluation revealed markedly elevated fasting and postprandial blood glucose (19.2 and 20.8 mmol/L), HbA1c 11.8%, glycosuria, hypertriglyceridemia (388 mg/dl), and mild transaminitis, consistent with poorly controlled diabetes and hepatic steatosis. C-peptide level was low normal, with fasting insulin level low normal for the degree of hyperglycemia, indicating insulin resistance and partial β-cell dysfunction. Other routine parameters, including renal function, thyroid profile, and electrolytes, were normal. Echocardiogram revealed atrial septal defect (ASD) secundum. Based on the constellation of generalized lipodystrophy, hepatomegaly, insulin-resistant diabetes, and dyslipidemia, a diagnosis of Berardinelli-Seip Congenital Lipodystrophy was made. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S61]
Copyright (c) 2025 Joy Datta Banik, Md. Anowar Hossain, Ershad Mondal, ABM Kamrul Hasan https://creativecommons.org/licenses/by-nc/4.0
Kallmann syndrome with preserved olfactory bulb morphology: A rare diagnostic challenge in a young male
Kallmann syndrome (KS) is a rare genetic disorder (1:4,000–10,000, predominantly in males) marked by hypogonadotropic hypogonadism and anosmia due to defective GnRH neuron migration. Mutations in KAL1, FGFR1, and other genes are implicated. A 20-year-old male presented with absent puberty and lifelong anosmia. He had eunuchoid habitus, micropenis, gynecomastia, small bilateral testes, Tanner stage I genitalia, and absent axillary/facial hair. Hormonal profile confirmed hypogonadotropic hypogonadism (testosterone 30.2 ng/dL, LH 0.24 mIU/mL, FSH 1.68 mIU/mL) with normal prolactin and thyroid function. Semen analysis showed azoospermia, and the karyotype was 46, XY. Scrotal USG demonstrated bilateral testicular atrophy (R: 2.2 × 1.0 cm; L: 1.7 × 0.9 cm). Abdominal USG was normal. Brain MRI revealed a normal hypothalamic–pituitary axis with structurally preserved olfactory bulbs. The patient received intramuscular testosterone decanoate (250 mg/mL) every 21 days, gradually increased from half to one ampoule. After four months, testosterone rose to 289 ng/dL, FSH increased slightly (2.03 mIU/mL), and LH remained suppressed (0.40 mIU/mL). This case highlights the diagnostic challenge of KS, with the classic triad present despite normal MRI findings of the olfactory bulbs. Diagnosis was confirmed through clinical, hormonal, cytogenetic, and radiological evaluation, and testosterone therapy promoted endocrine recovery and initiation of secondary sexual characteristics. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S62]
Copyright (c) 2025 Sakib Abrar, Aiman Talukder, Muhammad Minhaj Fahim , Fabiha Rahman Spriha, Jamini Tamanna, Shah Tanvir Ahmed https://creativecommons.org/licenses/by-nc/4.0
Ambiguous genitalia in a 3-year-old: A case highlighting 5α-reductase deficiency
5α-reductase deficiency is a rare autosomal recessive disorder of sex development resulting from mutations in the SRD5A2 gene, which impairs the conversion of testosterone to dihydrotestosterone (DHT). We report a case of a 3-year-old child, firstborn of consanguineous parents, who presented with severe pallor, growth failure, and ambiguous genitalia since birth. He was born preterm with low birth weight and required NICU admission for delayed crying. Initially reared as female due to apparently female genitalia, parental concern arose at 6 months when progressive phallic enlargement and bilateral inguinal swellings were noted. Cytogenetic analysis confirmed a normal 46, XY male karyotype. Bilateral orchidopexy was performed at 1.5 years. Despite three intramuscular testosterone injections, microphallus persisted. Examination revealed moderate anemia, growth retardation, bifid scrotum with pea-sized testes, phallus length 2.5 cm, and penoscrotal hypospadias (EMS 3). Hematological evaluation suggested iron deficiency anemia, necessitating four blood transfusions. The β-hCG stimulation test showed elevated testosterone (250.34 ng/dl) with disproportionately low dihydrotestosterone (2.88 ng/dl) and raised T/DHT ratio(86.92:1), indicating 5α-reductase deficiency as the likely etiology of 46,XY DSD. Molecular genetic testing has been advised. This case highlights the complexity of managing 46,XY DSD with suspected 5α-reductase deficiency, particularly when compounded by systemic comorbidities such as chronic anemia and growth failure. Early diagnosis is crucial for gender assignment decisions, counselling of parents, and planning future surgical and hormonal interventions. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S63]
Copyright (c) 2025 Muhtarima Sifat, Koushik Ashraf, Hurjahan Banu, Nusrat Sultana, Mashfiqul Hasan, Md. Shahed Morshed, Tania Tofail, Sharmin Jahan, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Addition of central obesity criteria increases the prevalence of clinical obesity in women with polycystic ovary syndrome
Background: The Lancet Diabetes & Endocrinology Commission 2025 has recommended a newer definition and diagnostic criteria for clinical obesity. The impact of this newer definition has not been evaluated among women with polycystic ovary syndrome (PCOS). Objectives: To determine and compare the frequency of obesity with previous and newer definitions among women with PCOS Methods: This cross-sectional study included 765 adult women [age (years): 23.8 ±4.5; BMI (kg/m2): 27.7 ± 5.3; mean ± SD] with (newly diagnosed/ untreated for at least three months) PCOS based on the Rotterdam criteria from a University hospital in South Asia. Participants’ height, weight, waist circumference (WC), and hip circumference were measured. Body mass index (BMI), waist/hip ratio (WHR), and waist/height (WHtR) were calculated. Three BMI cut-offs of 23.0, 25.0, and 27.5 kg/m2 were considered. The cut-off of WC, WHR, and WHtR were 80 cm, 0.85, and 0.5, respectively. The following two criteria were used to define obesity: i) BMI + WC/WHR/WHtR, and ii) any two from WC, WHR, & WHtR regardless of BMI. Additionally, blood pressure (BP), glycemic status (fasting & OGTT glucose, HbA1C), and lipid profile (triglyceride & HDL-cholesterol) were considered for clinical obesity. Results: Using the BMI cut-offs of 23, 25, and 27.5 kg/m2, the prevalence of obesity was 82.1%, 67.5%, and 47.1%, respectively. Using the current definition, the prevalence of obesity was 80.5%, 81.4%, and 79.4%, respectively, for the three BMI cut-offs, resulting in increases in prevalence of 1.8%, 20.7%, and 68.6%, respectively. All participants with obesity had clinical obesity, as the presence of PCOS indicates an ongoing illness. Besides, a significant portion had arterial hypertension, dysglycemia, and lipid abnormalities. Conclusions: The Presence of higher central obesity (WC, WHR, WHtR) than generalized obesity (BMI) paradoxically increased the diagnosis of clinical obesity among South-Asian women with PCOS. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2024;3(Suppl 1): S64]
Copyright (c) 2025 Md. Rafayel Islam, Md. Shahed Morshed, Hurjahan Banu, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Normocalcemic primary hyperparathyroidism associated with fibrocalculous pancreatic disease & vitamin D deficiency: A case report
Normo-calcemic primary hyperparathyroidism (NHPT) is a disorder in which elevated parathyroid hormone (PTH) is the result of autonomic hypersecretion of parathyroid hormone from 1 or more parathyroid glands, and the serum calcium levels are consistently within the normal range. A 65-year-old diabetic woman presented with recurrent upper abdominal pain for 5 months, progressively increasing in severity, and was diagnosed with chronic pancreatitis with FCPD, depending on biochemical and radiological findings. Investigations revealed a normal serum calcium level (9.5 mg/dl), low phosphate level (2.3 mg/dl), persistently high parathyroid hormone (PTH) level (785.8 pg/ml), normal serum creatinine (0.93 mg/dl), severely low serum vitamin D (9.37 ng/ml), high alkaline phosphatase (206 U/L), elevated blood glucose (RBS-12.9), normal liver and thyroid functions. Ultrasonogram and CT scan of the abdomen revealed an atrophic pancreas, dilated major pancreatic duct (MPD) with multiple calculi in the lumen, pancreatic calculi & lipomatosis. SPECT Tc99m-MIBI scan was positive for a hyperactive parathyroid adenoma (left-inferior), suggesting PHPT from a hyperactive single parathyroid adenoma. The presence of normocalcemia in the case of PHPT with parathyroid adenoma raises a diagnostic dilemma. A severely low serum vitamin D level may explain the normal serum calcium level despite a very high PTH stimulation. FCPD also contributed to a normal calcium level despite high PTH. After exclusion of secondary causes, the diagnosis of PHPT was confirmed. After several literature reviews, vitamin D therapy was given as the serum calcium level was just in the normal range with no risk of hypercalcemia. A minimally invasive parathyroid surgery is planned to remove the parathyroid adenoma with preservation of other parathyroid glands to avoid any incidence of hungry bone syndrome. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S65]
Copyright (c) 2025 Shazia Afrin https://creativecommons.org/licenses/by-nc/4.0
Bilateral medullary nephrocalcinosis and macular dystrophy: Unmasking a rare tubulopathy
Early onset bilateral nephrocalcinosis often raises suspicion for inherited tubulopathies. Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) represents one such entity. It is a rare autosomal recessive renal tubular disorder characterized by excessive urinary magnesium and calcium wasting, nephrocalcinosis, nephrolithiasis, and progressive renal dysfunction. Extra-renal features such as ocular abnormalities may also occur, particularly in type 2 disease. Herein, we present an 8-year-old girl who was referred to us for evaluation of bilateral nephrocalcinosis detected over the preceding 3 years. Clinical history revealed polyuria and polydipsia since early childhood. Ophthalmologic evaluation showed bilateral horizontal nystagmus, severe myopia, and bilateral macular dystrophy. Laboratory investigations demonstrated hypocalcemia, hypomagnesemia, hypercalciuria, hypermagnesuria, secondary hyperparathyroidism, and elevated serum creatinine. Imaging revealed bilateral medullary nephrocalcinosis in addition to bilateral renal and ureteric calculi. A provisional diagnosis of FHHNC type 2 was made. The patient was managed with oral magnesium supplementation, potassium citrate, and thiazide diuretics. This case highlights the importance of considering rare renal tubular disorders such as FHHNC in children presenting with bilateral nephrocalcinosis along with ocular abnormalities. Early recognition and supportive management are crucial to delaying the progression of end-stage renal disease, which is the major cause of mortality in these patients. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S66]
Copyright (c) 2025 Abdullah Al Noman Bhuiyan, Samirah Binte Iliyas, Hurjahan Banu, Nusrat Sultana, Sharmin Jahan, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
From growth failure to gait failure: Arnold-Chiari 1 malformation in a teenager
Arnold-Chiari 1 malformation is a congenital anomaly of the craniovertebral junction, often presenting with diverse neurological, endocrine, and musculoskeletal manifestations. Growth and pubertal delay may coexist with neurological deficits, making early recognition essential. Here we report a 17-year-old male, 3rd issue of non-consanguineous parents, admitted to BMU with growth failure for 6-8 years and progressive difficulty in walking along with gait abnormality for 4 years. He experienced chronic occipital headaches, blurring of vision, and occasional dizziness. Pubertal delay was evident by underdeveloped secondary sexual characteristics, notably scanty facial hair and an underpitched voice. Examination reveals short stature (H-147 cm, SDS -2.6) and delayed puberty (Tanner-P2, left testis 10 ml, right undescended testis palpable in the inguinal region). Neurological signs included dysarthria, tongue fasciculation with wasting, exaggerated deep tendon reflex, plantar extensor, positive ankle clonus, wide-based gait, and other cerebellar dysfunctions. Biochemically, GH deficiency was found. MRI of the spine showed dysplastic occipital condyle with foramen magnum stenosis, cervico-medullary compression indicating Arnold-Chiari 1 malformation. This case illustrates an unusual presentation of chairi-1 malformation with growth retardation and delayed puberty, emphasizing the importance of a multidisciplinary approach for timely diagnosis and management. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S67]
Copyright (c) 2025 Satya Prasad Koirala, Md. Rafayel Islam, Hurjahan Banu, Nusrat Sultana, Sharmin Jahan, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Bone mineral density among women with polycystic ovary syndrome
Background: Polycystic ovary syndrome is a prevalent reproductive endocrinopathy with hyperandrogenism and insulin resistance. The combined effects of these two opposing factors on bone make the association between bone mineral density (BMD) and PCOS controversial. Objectives: To assess the association of BMD among women with PCOS Methods: This cross-sectional study was done among 50 reproductive-aged women with PCOS and an equal number of controls [23.0 (21.0, 26.0) vs. 26.0 (20.0, 29.0), median (IQR), p=0.227] enrolled conveniently from the PCOS clinic, Dept. of Endocrinology of a University hospital over one year. History was taken, physical examinations were done, and blood was drawn in a fasting and 2-hour OGTT to measure glucose, lipids, and hormones. BMD was measured by dual energy X-ray absorptiometry, and a whole body Z-score ≤-2 was considered osteoporosis. Result: Despite having higher androgen and metabolic features, women with PCOS had similar levels of BMD Z-scores (-0.8 ± 0.8 vs. 0.6 ± 0.6, p = 0.817) and a similar frequency of osteoporosis (4% vs. 4%, p = 1.00). None of the clinical and biochemical variables showed a significant association or correlation with BMD Z-scores in either group. Under subgroups of different metabolic features, women with PCOS had higher BMD Z-score than controls [-0.6 (-1.0, -0.1) vs. -0.9 (-1.6, -0.8), p=0.038] only in those with optimal waist circumference. Conclusion: PCOS, per se, does not appear to confer an increased risk of low bone mass or osteoporosis in young women. The single association with waist circumference subgroups requires further validation. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S68]
Copyright (c) 2025 Tazkia Nur, Md. Shahed Morshed, Munira Afroz Siddika, Hurjahan Banu, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0
Precocious puberty in a severely virilized 46, XX child: Diagnostic and therapeutic challenges
The most common cause of peripheral precocious puberty (PPP) is congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, resulting in excess androgen production independent of activation of the hypothalamic-pituitary-gonadal axis. A 6 year and 6 month old child, 2nd issue of non-consanguineous parents, presented to us with the appearance of pubic hair and gradual enlargement of the penis for the last 6 months. The child was born at term and raised as male, but had an absent gonad in the scrotum since birth. Physical examination revealed normal vitals, height between the 75th and 90th centiles. Examination of external genitalia revealed pubic hair stage-3, stretched penile length- 5 cm with urethral orifice at the tip of penis (Prader stage 5) and no palpable gonad in scrotum. Investigations revealed elevated testosterone and 17-hydroxyprogesterone. Karyotyping revealed a 46, XX genotype. Bone age was markedly advanced. MRI of the abdomen revealed a rudimentary uterus, but the ovaries were not clearly visualised. Based on the clinical manifestations, laboratory findings, and radiology imaging, the patient was diagnosed with PPP due to CAH. The condition was well explained to the parents of the patient. However, they were unwilling for our patient to change gender, and treatment was started using hydrocortisone at a dose of 10 mg/m2 body surface area. The most common form of CAH is 21-Hydroxylase deficiency, accounting for approximately 95% of cases. Androgen excess in CAH in 46, XX individuals leads to a range of clinical manifestations, including ambiguous genitalia at birth, enlarged clitoris, heterosexual precocious puberty, etc., and even the external genitalia may appear fully male (Prader 5). Early recognition is crucial to prevent compromised adult height and long-term complications. This case highlights the importance of considering CAH in children presenting with precocious puberty, particularly when the testis is absent or prepubertal despite virilization. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S69]
Copyright (c) 2025 Abida Yasmin, Md Momonul Islam Fakir, Md Rezaul Karim, Md. Shamim Hossan, Md. Lutful Kabir, Samir Kumar Talukder, Md. Qamrul Hassan https://creativecommons.org/licenses/by-nc/4.0
Comparative efficacy and safety of Tirzepatide versus Semaglutide for obesity management
Background: Incretin-based therapies have emerged as effective strategies for obesity and type 2 DM(T2DM) management. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), and tirzepatide, a dual gastric inhibitory polypeptide (GIP) and GLP-1R agonist, are among the most promising agents. Comparative real-world data on their efficacy, lifestyle interactions, and safety profiles remain limited. Objective: This study aimed to compare the efficacy and safety of tirzepatide with those of semaglutide in adults with obesity, and to assess the impact of lifestyle factors on weight reduction outcomes. Methods: In this retrospective, comparative, observational study, 100 participants (aged 18 years or older) with obesity received either tirzepatide (n = 58) or semaglutide (n = 42). Baseline demographics, comorbidities, lifestyle factors, and concomitant medications were recorded, and anthropometric outcomes, including BMI and weight change, were assessed. Safety was evaluated through reported adverse events, and the impact of diet, exercise, and antidiabetic medication on weight loss was analyzed. Results: Both treatment groups achieved significant weight reduction, with tirzepatide resulting in greater mean weight loss than semaglutide (8.5 ± 4.1 vs. 6.9 ± 3.4 kg; p = 0.033). Lifestyle modification further enhanced outcomes, with participants practicing both diet and exercise showing the largest improvements (p < 0.001). Adverse events were predominantly gastrointestinal, with higher rates of nausea, vomiting, and diarrhea in the tirzepatide group; serious events were rare. Baseline characteristics were generally comparable, though BMI was higher in the tirzepatide group (36.6 ± 4.8 vs. 32.3 ± 3.6 kg/m²; p < 0.001). Conclusion: Tirzepatide and semaglutide are both effective for weight reduction in obesity, with tirzepatide providing greater efficacy but increased gastrointestinal side effects. The integration of lifestyle interventions with pharmacotherapy further optimizes treatment outcomes, underscoring the importance of combining behavioral and pharmacological strategies. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S70]
Copyright (c) 2025 Kishore Kumar Shil, Debasish Kumar Ghosh https://creativecommons.org/licenses/by-nc/4.0
Reasons for insulin refusal among patients with uncontrolled type 2 diabetes and impact of patient-centered education on insulin acceptance
Background: Reasons for insulin refusal among uncontrolled type 2 diabetes (T2D) are well studied; however, the impact of patient-centered education (PCE) on insulin acceptance is still scarce in the literature. Objectives: To see the reasons for insulin refusal among patients with uncontrolled T2D, and the impact of PCE on subsequent insulin acceptance and its related factors. Method: This cross-sectional study was carried out from April 2024 to September 2025 in an outpatient setting of three hospitals. Patients with uncontrolled T2D who initially refused to take insulin despite having an appropriate indication according to standard guidelines were included in the study. Reasons for insulin refusal were evaluated by face-to-face interview. A group of patients was counselled by treating physicians conveniently. The impact of PCE on insulin acceptance was noted. Factors associated with insulin refusal after PCE were analysed by logistic regression. Result: Total 202 patients included in the study [(Age: 48.4±11.5 years, mean ± SD, Female: 134(66.3%), BMI: median 25.25 (IQR: 23.2-28.1), HbA1C%: mean 10.90±1.93, Duration of DM <10 years: 148(73.3%)]. We observed that the majority of the participants refused insulin due to needle phobia (153, 75.7%). Lack of knowledge of insulin injection technique 45 (22.3%), no caregiver to inject insulin 47(23.3%) contribute a significant proportion. A total of 113 patients were given PCE, out of whom 69 (61.1%) agreed to initiate insulin. Univariate analysis showed age ≥60 years, female sex, and duration of DM ≥10 years had higher odds, and graduate and living in urban areas had lower odds for insulin refusal after counselling (P <0.05). However, multivariate analysis showed that only female sex (AOR:3.97; 95% CI 1.27-12.43, p=0.018) had a predictive association. Conclusion: PCE ensured insulin initiation in ≥60% of the study participants who initially refused insulin. Females are more likely to refuse insulin even after counselling. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S71]
Copyright (c) 2025 Md. Rakibul Hasan, Md. Abdul Hannan, Mohammad Fakhrul Alam, Mashrura Quraishi https://creativecommons.org/licenses/by-nc/4.0
The silent storm within a young woman’s journey through hormonal havoc
A 32-year-old female presented with progressive weight gain, hirsutism, and generalized hyperpigmentation. She reported irregular menstruation followed by amenorrhea for two years, recurrent dull frontal headaches with visual disturbance, and episodes of convulsion. She also experienced back pain, a gradual loss of height, and proximal muscle weakness. History revealed diabetes for 7 years, hypertension for 4 years, and homeopathic medicine use for 1 year. On examination, she was obese (BMI 27 kg/m²) with cushingoid features: a rounded plethoric face, a dorsocervical fat pad, supraclavicular fullness, truncal obesity, purple striae, thin bruised skin, and acne. Hirsutism was moderate (Ferriman-Gallwey score 17). Generalized hyperpigmentation, including the oral mucosa, was evident. Neurological examination revealed a right temporal visual field defect and proximal limb weakness (MRC 3/5). Musculoskeletal evaluation showed positive Gowers’ sign, low MMT-8 score, and thoracic kyphosis. Biochemical evaluation confirmed hypercortisolism with elevated ACTH. Pituitary MRI revealed an adenoma, but HDDST was not suppressed. Right lateralization during IPSS confirmed a diagnosis of Cushing’s disease due to pituitary adenoma. She underwent transsphenoidal pituitary surgery, after which pigmentation regressed and weight declined. Postoperatively, she was managed with hydrocortisone, antiepileptics, metformin, antihypertensive, and supportive therapy. Long-term follow-up was planned with biochemical surveillance and bone health monitoring. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S72]
Copyright (c) 2025 Md. Rakibur Rahman Sourav, Tanjina Zannat, Md Mohiuddin Sarker, Md. Mahmud Hasan, Anaya Saha Banna, Soma Sarker https://creativecommons.org/licenses/by-nc/4.0
The McAuley Index is a better marker of insulin resistance among adult reproductive-aged women, irrespective of body mass index
Background: Age, sex, and BMI have significant impacts on insulin resistance (IR), requiring individual cut-offs of different insulin indices. Aim: To assess the cut-off levels of IR using several insulin-derived indices in adult reproductive-aged females and compare their utility Method: This cross-sectional study included 196 eumenorrheic women aged 18–40 years, conveniently as a control group of a study after excluding pregnancy, lactation, h/o smoking/alcohol intake, hormonal contraceptive use, features of hyperandrogenism, and advanced systemic diseases. Fasting glucose, insulin, and lipid profiles were used to calculate different insulin indices by different formulas and metabolic syndrome by the International Harmonization Criteria. To determine the cut-off levels for IR, we took two different approaches. The 1st was the percentile method: the 75th percentile of fasting insulin, homeostasis model assessment of IR (HOMA-IR), fasting insulin resistance index (FIRI), and the 25th percentile of fasting glucose insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), and McAuley index. The 2nd one was the cut-off obtained from the highest Youden’s index of a receiver operating characteristic (ROC) curve for predicting metabolic syndrome defined by International Harmonization criteria. Results: The cut-off points of the fasting insulin, HOMA-IR, FIRI, McAuley index, FGIR, and QUICKI were 11.2 μIU/mL, 2.3, 2.0, 6.8, 8.2, and 0.3, respectively, based on the IQR method, and 10.1 μIU/mL, 2.6, 2.4, 6.8, 9.2, and 0.3 based on the ROC curve method. The McAuley index had the highest AUC (0.86) irrespective of BMI status and was better than fasting insulin and FGIR as a marker of IR. It also had the highest agreement (κ0.45) with metabolic syndrome. Conclusion: The McAuley index might be a better insulin-derived index of IR among adult reproductive-aged females. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S73]
Copyright (c) 2025 Mahjabin Islam, Hurjahan Banu, Md. Shahed Morshed, Muhammad Abul Hasanat https://creativecommons.org/licenses/by-nc/4.0