We report the case of a 19-year old Filipino woman who presented with hard masses on the left upper arm and leg with multiple fractures on all extremities. Her serum calcium and intact parathyroid hormone (iPTH) levels were elevated, while serum phosphorus was low. Ultrasonography of the neck revealed a left inferior parathyroid mass. Ultrasound-guided fine needle aspiration of the mass revealed findings consistent with parathyroid carcinoma. After hydration and administration of diuretic and bisphosphonate to control the severe hypercalcemia, she subsequently underwent 3½ gland parathyroidectomy with en-bloc left thyroid lobectomy. There was immediate normalization of biochemical indices after surgery. Three months later, the fractures on all extremities were fully resolved.
Hypercalcemia ; Hyperparathyroidism ; Parathyroid Neoplasms

We report a case of severe gingival bleeding in a 15-year old, type 1 diabetic female. Examination revealed severe gingival inflammation with periodontal pockets (<6 mm), indicating mild-moderate periodontitis. Periodontal therapy resulted in reduction of fructosamine level (-72.98) after four weeks, but HbA1c level checked 3 months after treatmentincreased (+0.7). Reduction in gingival bleeding and periodontal pockets improved the patient’s quality of life. Insulin resistance is offered as a possible reason for non-improvement in HbA1c levels.
Periodontitis

We report a case of a 40-year-old multiparous woman who underwent total abdominal hysterectomy due to massivevaginal bleeding from partial molar pregnancy. Post-operatively, she developed high-grade fever, profuse sweating andshortness of breath. Examination revealed tachycardia, hypertension, elevated jugular venous pressure, and crackleson both lower lung fields, with no palpable thyroid mass. Free thyroxine (FT4) and human chorionic gonadotropinβ-subunit(β-hCG) were markedly elevated, while thyroid stimulating hormone (TSH) was significantly suppressed. With a Burch and Wartofskyscore of 55, thyroid storm from the molar pregnancy was considered. She was givenpropylthiouracil (PTU), propranolol and hydrocortisone. Resolution of her signs and symptoms were noted 2 to 3 daysfollowing treatment.
Thyroid Crisis ; Pregnancy ; Hydatidiform Mole ; Hyperthyroidism

The traditional binary classification of gender is repeatedly challenged throughout history with the presence of transgenders. Under the umbrella of transgenderism is transsexualism which pertains to individuals who identify with or desire to become the opposite sex. Transsexualism or Gender Dysphoria is classified as a medical condition under ICD 10 and DSM-5. The proposed treatment is sex reassignment that includes all treatments carried out to adapt to the desired sex. Sex reassignment involves a multidisciplinary approach wherein the psychiatrist or mental health practitioner, endocrinologist and surgeon play active roles. Certain legal and ethical issues exist in the treatment of transsexualism. This article provides a review of psychological, medical and surgical issues in the evaluation and treatment of Transgender individuals, with an Asian perspective, and in the context of an actual case.
Gender Dysphoria ; Transsexualism ; Transgender Persons