Journal of Pakistan Endocrine Society

Content

Musarrat Riaz — 2026-07-09

Vol. 3 | Issue No. 1 | January - June 2026 | J Pak Endo Society

Fahr’s Disease Presenting with Neuropsychiatric Symptoms: A Case Report

Soha Samreen — 2026-07-09

Introduction: Fahr’s disease is a rare neurological disorder characterized by idiopathic bilateral calcifications in the basal ganglia and other regions of the brain. This case highlights the diagnostic approach and management of a patient presenting with progressive neuropsychiatric symptoms.

Case Presentation: A 72-year-old male presented with tremors, memory impairment, and disorientation. Neurological examination revealed bradykinesia, reduced arm swing, and stooped posture. Computed Tomography (CT) of brain revealed extensive bilateral symmetrical calcifications in the basal ganglia. Secondary causes were excluded through normal biochemical investigations. The patient was treated with memantine, amantadine, ropinirole, and vitamin D supplementation.

Results: Over six weeks, cognitive function and sleep improved, with reduction in tremors and rigidity.

Conclusion: Fahr’s disease should be suspected in elderly patients presenting with progressive neuropsychiatric symptoms and characteristic imaging findings. Early recognition and symptomatic management improve quality of life.

Estrogen-Induced Severe Hypertriglyceridemia Presenting as Recurrent Acute Pancreatitis Successfully Managed with Intravenous Insulin Infusion

Salma Salman — 2026-07-09

Introduction: Hypertriglyceridemia is an underrecognized cause of acute pancreatitis, especially in reproductive-age females without obvious risk factors. Careful history taking is essential, particularly drug history. Estrogen use, often for menstrual irregularities, may be over looked but can significantly elevate triglyceride levels and precipitate pancreatitis, warranting targeted clinical inquiry.

Case Presentation: We report a 26-year-old female admitted to the Medical ICU with severe abdominal pain who was diagnosed with acute pancreatitis. Laboratory evaluation revealed markedly elevated triglyceride levels of 4694 mg/dL. She had a history of menstrual irregularities, hirsutism, and recent use of oral estradiol for menstrual period regulation, secondary to suspected underlying polyendocrine metabolic ovarian syndrome. The patient was managed in the intensive care unit with continuous intravenous insulin infusion, resulting in a rapid decline in triglyceride levels to 640 mg/dL within 24 hours, along with significant clinical improvement. She was simultaneously started on fibrates and high doses omega-3 fatty acids.

Conclusion: Estrogen triggered hypertriglyceridemia with metabolic predisposition can cause pancreatitis; intravenous insulin offers rapid, effective, and accessible treatment in resource-limited settings.

Hypokalemic Paralysis Revealing Subclinical Hyperthyroidism: A Case report of Thyrotoxic Periodic Paralysis

Arshad Hussain — 2026-07-09

Introduction: Thyrotoxic periodic paralysis is a rare, potentially life-threatening hyperthyroid complication causing transient muscle weakness due to intracellular potassium shift and hypokalemia.

Case Presentation: A 41-year-old man presented with a sudden onset of symmetrical weakness in all limbs. Laboratory evaluation revealed significant hypokalemia (serum potassium 2.3 mmol/L) and suppressed TSH, with low normal thyroid hormone levels, consistent with thyrotoxicosis. The patient also exhibited clinical signs of hyperthyroidism, including heat intolerance, tremors, diaphoresis, and sinus tachycardia.

Management: Intravenous potassium replacement led to rapid resolution of symptoms. He was subsequently treated with propranolol and carbimazole. At four-week follow-up, the patient remained asymptomatic with normalization of both serum potassium and thyroid function.

Conclusion: This case highlights the importance of considering TPP in patients with hypokalemic paralysis, even in the absence of classic hyperthyroid features or common triggers. Early diagnosis and appropriate treatment can reverse paralysis and prevent serious complications like cardiac arrhythmias.

Audit of Access to DEXA Scanning and Quality of DEXA Reporting in Patients at Risk of Osteoporosis

Mohammad Talha Tahir — 2026-07-09

Objective: To evaluate adherence to osteoporosis screening recommendations by assessing dual- energy X-ray absorptiometry (DEXA) referral practices and the quality of DEXA reporting among patients attending a specialized endocrine outpatient clinic.

Methodology: A retrospective clinical audit was conducted in a specialized diabetes, endocrine, and weight management outpatient clinic between November 1 and December 31, 2025. Medical records of patients attending the clinic during the audit period were reviewed. Patients meeting the National Institute for Health and Care Excellence (NICE) guideline NG56 criteria for DEXA referral were identified. Data were collected regarding referral practices, DEXA completion rates, and quality of DEXA report documentation. Compliance with predefined audit standards was assessed using descriptive statistics.

Results: A total of 227 patients were reviewed, of whom 56 (24.7%) met NICE criteria for DEXA referral. Only 28 (50.0%) eligible patients were advised to undergo DEXA scanning, which was substantially below the target standard of ≥90%. Among those advised, 17 (60.7%) completed the scan, failing to meet the predefined target of ≥80%. Assessment of completed DEXA reports demonstrated poor documentation quality. DEXA indication was documented in none of the reports (0%), formal interpretation in 4 (23.5%), FRAX assessment in 8 (47.1%), management plans in 14 (82.4%), and referring clinician details in 15 (88.2%). Among completed scans, 11.8% were normal, 64.7% showed osteopenia, and 23.5% demonstrated osteoporosis.

Conclusion: Significant deficiencies were identified in both DEXA referral practices and DEXA report documentation. Implementation of standardized referral pathways, reporting templates, and clinician education initiatives may improve adherence to osteoporosis assessment guidelines and facilitate timely identification and management of patients at risk of fragility fractures.

Knowledge, Attitude and Practice Regarding Insulin Pen Devices Among Nurses in Tertiary Hospital of Karachi

Zareen Kiran — 2026-07-09

Background: Limited data exist in Pakistan regarding nurses’ knowledge, attitudes, and practices related to insulin pen devices, despite their pivotal role in diabetes care.

Purpose: We aim to assess the knowledge, attitudes, and practices of insulin pen devices among nurses in a tertiary care hospital. The study findings can guide educators and administrators in developing targeted nurse training in Pakistan.

Methodology: This observational cross-sectional questionnaire-based study was conducted at Dow University of Health Sciences in Karachi. All registered nurses of either gender who consented to participate and had a minimum of one year of experience were included in the study. The knowledge and attitudes of the nurses were assessed on the basis of their personal encounters with patients diagnosed with diabetes mellitus and their use of insulin pen devices.

Results: A total of 246 nurses completed the survey. The majority were aged 30-40 years (n = 138, 56.09%), and most were female (51.2%), single (53.6%), and resided in urban areas (78%). Additionally, 75.6% held a bachelor's degree, and 12.19% were head nurses. Approximately 192 nurses (78%) reported personal connections with diabetes patients, with doctors being the primary information source (48.8%). Approximately 73.2% felt confident in teaching the technical skills required to use insulin pen devices to their colleagues. However, only 29.27% reported using these devices in practice, whereas 71.13% found it easier to measure insulin compared with vials and syringes. Nearly 97.56% believed that insulin pens are convenient for patients to carry while traveling.

Conclusions: The nurses demonstrated good knowledge, attitudes, and practices regarding diabetes mellitus and the use of insulin pen devices among diabetes mellitus patients. Improved nurse knowledge and skills in insulin pen use can reduce errors, enhance patient education, and improve glycemic control. Therefore, identified gaps in attitude and practice highlight the need for structured training to ensure safer insulin use and better diabetes outcomes.

Factors Associated with Delay from Diagnosis to Treatment Initiation among Patients with Head & Neck Cancer at a Tertiary Care Hospital in Karachi, Pakistan

Ali Hussain — 2026-07-09

Objective: Timely initiation of treatment is essential for improving outcomes among patients with head and neck cancer (HNC). Delays between diagnosis and treatment initiation may adversely affect disease progression, treatment efficacy, and survival. This study aimed to identify factors associated with delay from diagnosis to treatment initiation among patients with head and neck cancer presenting to a tertiary care hospital in Karachi, Pakistan.

Methodology: A prospective observational cross-sectional study was conducted at the Department of Otolaryngology–Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan, from July 2021 to July 2022. A total of 155 adult patients with histopathologically confirmed head and neck carcinoma were enrolled using a non-probability consecutive sampling technique. Of these, 142 patients were managed with surgery, while 13 patients were managed with chemoradiation as the definitive primary treatment modality. Data regarding sociodemographic characteristics, clinical variables, and potential factors contributing to treatment delay were collected. The diagnosis-to-treatment interval (DTI) was defined as the time from histopathological confirmation of head and neck cancer to the initiation of definitive primary treatment, either surgery or chemoradiation/Radiotherapy (CRT/RT). Descriptive statistics were computed, while Chi-square and independent sample t-tests were used for univariate analyses. Multivariable logistic regression analysis was performed to identify factors independently associated with treatment delay. A p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 50.8 ± 14.5 years, and 111 (71.6%) were male. Treatment delay was observed in 128 (82.6%) patients. The median diagnosis-to-treatment interval was 4 weeks (IQR: 2–12 weeks), while the mean interval was 11.2 ± 14.5 weeks. Univariate analysis demonstrated significant associations between treatment delay and quality of counselling (p=0.022), alcohol use (p=0.029), and seeking alternative treatment modalities (p=0.033). Among patients with treatment delay, inadequate quality of counselling was the most frequently reported reason in both surgical and concurrent chemoradiotherapy groups. Multivariable logistic regression revealed that adequate counselling was independently associated with lower odds of treatment delay (AOR=0.23, 95% CI: 0.06-0.86; p=0.029). Seeking alternative treatment modalities showed a borderline association with delayed treatment initiation (AOR=8.27, 95% CI: 0.99-69.29; p=0.051). No significant associations were observed for age, marital status, financial constraints, or alcohol use.

Conclusion: Treatment delay was highly prevalent among patients with head and neck cancer. Inadequate counselling emerged as the only independent associate of delayed treatment initiation. Strategies aimed at improving physician-patient communication and counselling may facilitate timely initiation of treatment and improve oncologic outcomes.

Clinical Profile of Patients with Type 2 Diabetes Mellitus Initiated on Insulin Therapy: A Single-Center Experience

Ehtasham Mehmood — 2026-07-09

Objective: The objectives of the present study was to describe the demographic and clinical characteristics of people with type 2 diabetes initiated on insulin therapy and to identify common comorbidities and complications present at insulin initiation.

Methodology: It was a retrospective observational study conducted at the Endocrinology clinics of the Shifa International Hospital, Islamabad. Adults (≥18 years) with a diagnosis of T2DM who are being started on insulin therapy for the first time were included in the study. Patients already on insulin or who have used insulin previously due to any reason were excluded. Patients with hyperglycemic emergencies, pregnancy, hospitalization were also excluded. Data was collected from Electronic Medical Records over a period of 3 years from 2022-2025.

Results: In the cohort of 270 patients, who were started on insulin for the first time, there were 150 males (55.6%) and 120 females (44.4%), with a mean age of 56.8 ± 10.1 years (range: 30–80 years). Their mean duration of diabetes was 11.07 ± 5.0 years (range: 2–25 years). The overall mean HbA1c was 10.73 ± 1.81 % (range: 7.3–15.2), while the mean fasting plasma glucose (FPG) was 208.8 ± 41.6 mg/dL (range: 145–400). Most patients (56.7%) were on triple-drug therapy, followed by four-drug therapy (23.3%), dual therapy (15.2%), monotherapy (3.3%), and five-drug therapy (1.5%). Most common microvascular complication was neuropathy (43%) while most common macrovascular complication was CAD (14.4%). The most frequent reason for insulin initiation was failure of oral drugs (81.9%). Basal insulin was the most commonly initiated insulin (67.8%), followed by premixed insulin (31.5%) and basal-bolus (0.7%). Mean HbA1c was significantly higher among those started on premixed insulin (12.19 ± 1.48 %) compared to basal insulin (10.05 ± 1.51 %).

Conclusions: Insulin therapy was most commonly initiated after failure of three or more oral glucose-lowering agents and at markedly elevated HbA1c levels, suggesting delayed treatment intensification. Longer duration of diabetes and poorer glycemic control were associated with a higher prevalence of diabetes-related complications, highlighting the need for earlier insulin initiation and timely optimization of glycemic management.

Association between Dietary Intake and Glycemic Control among Adults with Type 2 Diabetes Attending a Public Hospital in Karachi, Pakistan

Thamina Rashid — 2026-07-09

Background & Objective: Dietary management is considered a crucial part of managing diabetes that helps patients achieve effective blood glucose management. This study aimed at identifying frequency of food choices and determines its association with glycemic control among people with type 2 diabetes.

Methodology: This cross-sectional study was conducted among people with diabetes at the National Institute of Diabetes and Endocrinology, DUHS, in Karachi, Pakistan. Using convenience sampling, 300 people with diabetes were enrolled. Anthropometric measures, HbA1c, and a food frequency questionnaire were used to obtain the participants' dietary patterns.

Results: Participants were mostly females (54.5%), and the mean age was 51.66±10. More than half of the participants (78%) had HBAC levels more than 7%., obesity was highly prevalent among the study participants, with 74% classified as obese according to Asian BMI cut-offs. An additional 14% were overweight, indicating that 88% of the population had excess body weight. Chapati was the most commonly consumed food item, with a mean intake frequency of 9.46 times per week. In the multivariable logistic regression analysis, higher fruit intake was independently associated with lower odds of having HbA1c >7% (OR = 0.865, 95% CI: 0.764–0.979). Similarly, greater consumption of raw fresh vegetable salads was associated with lower odds of having HbA1c >7% (OR = 0.763, 95% CI: 0.681–0.855). Among participants with HbA1c ≤7%, the mean frequency of fruit consumption was 4.61 ± 2.59 times per week, while the mean frequency of salad consumption was 3.27 ± 2.74 times per week.

Conclusion: Dietary intake patterns among individuals with type 2 diabetes showed variability across food groups. Higher consumption of fruits and salads was associated with better glycemic control, whereas no significant differences were observed for most other food items. These findings highlight the importance of incorporating nutrition education and ongoing dietary counseling into routine diabetes care to promote healthier dietary practices and support glycemic management.

Predatory Journals – Menace to the Real Science and Academic Publishing

Tejhmal Rehman — 2026-07-09

SSRIs and the Spectrum of PMDD Care: Balancing Efficacy with Safety

Zara Sohail — 2026-07-09

From PCOS to PMOS: A Landmark Change in Nomenclature and an Opportunity to Transform Women's Healthcare

Musarrat Riaz — 2026-07-09

Endocrine dysfunction and complications in patients with post-operative Craniopharyngioma: A Narrative Review

Tayyaba Hidayat — 2026-07-09

Craniopharyngioma is a rare benign epithelial tumor arising in the sellar and suprasellar region that frequently involves the hypothalamic-pituitary axis. Although advances in neurosurgical techniques and adjuvant therapies have substantially improved survival, endocrine dysfunction remains one of the most important determinants of long-term morbidity and impaired quality of life. Endocrine abnormalities may be present at diagnosis due to tumor-related hypothalamic and pituitary compression or develop following surgery and radiotherapy.

Common postoperative complications include central diabetes insipidus, syndrome of inappropriate antidiuretic hormone secretion, cerebral salt wasting, hypothalamic obesity, and deficiencies of growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, and gonadotropins. These disorders contribute to impaired growth, delayed puberty, infertility, metabolic syndrome, cardiovascular disease, neurocognitive impairment, and reduced quality of life. Early recognition, systematic endocrine surveillance, and timely hormone replacement therapy are essential to minimize morbidity. Recent advances in hypothalamus-sparing surgery, endoscopic approaches, proton beam radiotherapy, and molecularly targeted therapy offer opportunities to improve functional outcomes while maintaining effective tumor control.This narrative review summarizes the current understanding of the mechanisms underlying endocrine dysfunction in craniopharyngioma, reviews the spectrum of postoperative endocrine complications and their long-term consequences, and discusses strategies for endocrine surveillance, hormone replacement, and multidisciplinary management.