1.Pancytopenia in a Patient with Grave's Disease.
Loh, Huai Heng ; Tan, Florence
The Medical Journal of Malaysia 2013;68(4):372-3
Pancytopenia can rarely complicate Grave's disease. It can be due to uncontrolled thyrotoxicosis or as a result of rare side effect of antithyroid medication. Pernicious anemia leading to Vitamin B12 deficiency is another rare associated cause. We report a case of a patient with Grave's disease and undiagnosed pernicious anemia whom was assumed to have antithyroid drug induced pancytopenia. Failure to recognize this rare association of pernicious anemia as a cause of pancytopenia had resulted in delay in treatment and neurological complication in our patient.
2.Hypercalcemic Crisis – A Fatal Case of Primary Hyperparathyroidism
Yueh Chien Kuan ; Florence Tan
The Medical Journal of Malaysia 2014;69(6):277-278
We describe the clinical presentation, investigation and
management of an eventually fatal case of hypercalcemic
crisis due to primary hyperparathyridism (PHPT).
A 60 year-old lady with history of urolithiasis presented with
worsening generalized bone pain, spinal scoliosis and a
limp. Laboratory data showed hypercalcemia and raised
alkaline phosphatase. Left hip x-ray revealed a subcapital
femoral neck fracture. Intact parathyroid hormone was
elevated, 187.6 pmol/L (1.6 – 6.9) and ultrasound showed an
enlarged right parathyroid gland. Despite initial reduction of
serum calcium with saline infusion and multiple doses of
intravenous pamidronate, her calcium increased to 4.14
mmol/L a week following application of Buck’s traction for
persistent left hip pain. She succumbed eventually with
serum calcium peaking at 6.28 mmol/L despite multiple
therapeutic interventions.
3.Drosophila melanogaster: Deciphering Alzheimer's Disease
Florence Hui Ping Tan ; Ghows Azzam
Malaysian Journal of Medical Sciences 2017;24(2):6-20
Alzheimer's disease (AD) is the most widespread neurodegenerative disorder worldwide.
Its pathogenesis involves two hallmarks: aggregation of amyloid beta (Aβ) and occurrence of
neurofibrillary tangles (NFTs). The mechanism behind the disease is still unknown. This has
prompted the use of animal models to mirror the disease. The fruit fly, Drosophila melanogaster
has garnered considerable attention as an organism to recapitulate human disorders. With
the ability to monopolise a multitude of traditional and novel genetic tools, Drosophila is ideal
for studying not only cellular aspects but also physiological and behavioural traits of human
neurodegenerative diseases. Here, we discuss the use of the Drosophila model in understanding
AD pathology and the insights gained in discovering drug therapies for AD.
4.A hyperthyroid patient with measurable thyroid-stimulating hormone concentration - a trap for the unwary.
Mary Jean TAN ; Florence TAN ; Robert HAWKINS ; Wei-Keat CHEAH ; J J MUKHERJEE
Annals of the Academy of Medicine, Singapore 2006;35(7):500-503
INTRODUCTIONIn a patient with hyperthyroidism, the detection of elevated thyroid hormone concentration with measurable thyroid-stimulating hormone (TSH) value poses considerable diagnostic difficulties.
CLINICAL PICTUREThis 38-year-old lady presented with clinical features of thyrotoxicosis. Her serum free thyroxine concentrations were unequivocally elevated [45 to 82 pmol/L (reference interval, 10 to 20 pmol/L)] but the serum TSH values were persistently within the reference interval [0.49 to 2.48 mIU/L (reference interval, 0.45 to 4.5 mIU/L)].
TREATMENTInvestigations excluded a TSH-secreting pituitary adenoma and a thyroid hormone resistance state and confirmed false elevation in serum TSH concentration due to assay interference from heterophile antibodies. The patient was treated with carbimazole for 18 months.
OUTCOMEThe heterophile antibody-mediated assay interference disappeared 10 months following the initiation of treatment with carbimazole, but returned when the patient relapsed. It disappeared again 2 months after the initiation of treatment.
CONCLUSIONSClinicians should be aware of the potential for interference in immunoassays, and suspect it whenever the test results seem inappropriate to the patient's clinical state. Misinterpretation of test values, arising as a result of assay interference, may lead to misdiagnosis, unnecessary and at times expensive investigations, delay in initiation of treatment and worst of all, the initiation of inappropriate treatment.
Adenoma ; diagnosis ; Adult ; Antibodies, Heterophile ; analysis ; immunology ; Diagnostic Errors ; Female ; Graves Disease ; diagnosis ; Humans ; Immunoassay ; Pituitary Neoplasms ; diagnosis ; Thyrotoxicosis ; blood ; diagnosis ; immunology ; Thyrotropin ; blood ; Thyroxine ; blood
5.Outbreak of novel influenza A (H1N1-2009) linked to a dance club.
Pei Pei CHAN ; Hariharan SUBRAMONY ; Florence Y L LAI ; Wee Siong TIEN ; Boon Hian TAN ; Suhana SOLHAN ; Hwi Kwang HAN ; Bok Huay FOONG ; Lyn JAMES ; Peng Lim OOI
Annals of the Academy of Medicine, Singapore 2010;39(4):299-294
INTRODUCTIONThis paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009.
MATERIALS AND METHODSCases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone.
RESULTSA total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modelling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries.
CONCLUSIONThis transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.
Adolescent ; Adult ; Commerce ; Contact Tracing ; methods ; Dancing ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Interviews as Topic ; Male ; Models, Statistical ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Travel ; Young Adult
6.Bone health among older persons in medical clinic: A clinical audit
Cheng Lay Teh ; Seow Lin Chuah ; Hong Khoh Lee ; Sharifah Aishah binti Wan Mohd Akbar ; Tze Shin Leong ; Florence Hui Sieng Tan ; Bik Kui Lau
The Medical Journal of Malaysia 2020;75(2):191-193
Osteoporosis is commonly underdiagnosed and
undertreated. We performed a clinical audit to assess the
risk factors and clinical care for osteoporosis among older
persons who attended medical clinic during a 4-week period
in August 2013. There was a total of 128 patients with a mean
age of 73.1±5.8 years, and 20.3%. had a history of fall.
Fracture Risk Assessment Tool (FRAX) scores assessment
showed 14.2% and 68.8% had a 10-year risk of major
osteoporotic and hip fractures respectively. Only 6.3%
underwent Dual-energy X-ray absorptiometry (DXA) and
73.4% did not receive any preventive treatment for
osteoporosis. Older persons attending medical clinic at high
risk of osteoporosis fractures did not receive appropriate
screening and treatment. There is a need to improve the
suboptimal care for bone health among older persons.
7.Collision of two tumors: A case report of a Lung Adenocarcinoma with metastasis to a Pituitary Adenoma
Marisa Khatijah Borhan ; Florence Hui Sieng Tan ; Nur Shazwaniza Awang Basry
Journal of the ASEAN Federation of Endocrine Societies 2022;37(2):89-94
A collision tumor involving metastasis to a pituitary adenoma is rare. We describe a case of a 68-year-old Bidayuh woman with underlying treatment-responsive lung adenocarcinoma, who presented with mass effect, panhypopituitarism and polyuria. Her initial imaging study reported pituitary macroadenoma, and she was treated with hormone replacement therapy. She then underwent transsphenoidal tumor debulking surgery with subsequent histopathological findings of a collision tumor of an adenocarcinoma with metastasis to a non-functioning pituitary adenoma.
Pituitary Neoplasms
8.Severe Pericardial Effusion due to autoimmune Hypothyroidism with Levothyroxine withdrawal and systemic Lupus Erythematosus
Sylvernon Israel ; Katherine Ann Tan ; Ma. Felisse Carmen Gomez ; Florence Rochelle Gan ; Jean Uy-Ho
Journal of the ASEAN Federation of Endocrine Societies 2022;37(2):83-88
The presence of autoantibodies is a common link between autoimmune hypothyroidism (AH) and Systemic Lupus Erythematosus (SLE). The coexistence of AH (Hashimoto’s Thyroiditis) and SLE is common; however, massive pericardial effusion (PEEF) with signs of tamponade is extremely rare and only a few cases have been reported in literature. We present a case of a 54-year-old female who came in with progressive dyspnea who was found out to have massive PEEF from overt AH and concurrent SLE, which was successfully managed medically. This gave us valuable insight that massive pericardial effusion occurring in overt hypothyroidism may be secondarily caused by other co-existing disease entities such as SLE. The importance of the correct diagnosis cannot be overemphasized, as this largely contributed to the successful management of this case.
Pericardial Effusion
;
Cardiac Tamponade
;
Lupus Erythematosus, Systemic
9.The Effect of DPP4 Inhibitor on Glycemic Variability in Patients with Type 2 Diabetes treated with twice-daily Premixed Human Insulin
Florence Hui Sieng Tan ; Chin Voon Tong ; Xun Ting Tiong ; Bik Kui Lau ; Yueh Chien Kuan ; Huai Heng Loh ; Saravanan A/L Vengadesa Pillai
Journal of the ASEAN Federation of Endocrine Societies 2021;36(2):167-171
Objective:
To evaluate the effect of adding DPP4 inhibitor (DPP4-i) on glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) treated with premixed human insulin (MHI).
Methodology:
We conducted a prospective study in patients with T2DM on twice-daily MHI with or without metformin therapy. Blinded continuous glucose monitoring was performed at baseline and following 6 weeks of Vildagliptin therapy.
Results:
Twelve patients with mean (SD) age of 55.8 (13.1) years and duration of disease of 14.0 (6.6) years were recruited. The addition of Vildagliptin significantly reduced GV indices (mmol/L): SD from 2.73 (IQR 2.12-3.66) to 2.11 (1.76-2.55), p=0.015; mean amplitude of glycemic excursions (MAGE) 6.94(2.61) to 5.72 (1.87), p=0.018 and CV 34.05 (8.76) to 28.19 (5.36), p=0.010. In addition, % time in range (3.9-10 mmol/l) improved from 61.17 (20.50) to 79.67 (15.33)%, p=0.001; % time above range reduced from 32.92 (23.99) to 18.50 (15.62)%, p=0.016; with reduction in AUC for hyperglycemia from 1.24 (1.31) to 0.47 (0.71) mmol/day, p=0.015. Hypoglycemic events were infrequent and the reduction in time below range and AUC for hypoglycemia did not reach statistical significance.
Conclusion
The addition of DPP4-I to commonly prescribed twice-daily MHI in patients with T2DM improves GV and warrants further exploration.
Diabetes Mellitus, Type 2
10.Patient characteristics, disease burden, treatment patterns and outcomes in patients with acromegaly: Real-world evidence from the Malaysian acromegaly registry
Mohamed Badrulnizam Long Bidin ; Abdul Mueed Khan ; Florence Hui Sieng Tan ; Nor Azizah Aziz ; Norhaliza Mohd Ali ; Nor Azmi Kamaruddin ; Shireene Vethakkan ; Balraj Sethi ; Zanariah Hussein
Journal of the ASEAN Federation of Endocrine Societies 2023;38(1):75-80
Objective:
This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia.
Methodology:
This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained.
Results:
Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%).
Conclusion
This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly
;
treatment outcomes