1.Occult primary spontaneous pneumothorax
Yong-Ting Tai ; Chin-Voon Tong
International e-Journal of Science, Medicine and Education 2017;11(2):30-33
We report a case of occult primary spontaneous
pneumothorax in a 30 years-old woman. She
developed symptoms and signs that were suggestive of
pneumothorax. However, chest radiograph failed to
reveal pneumothorax. Therefore, we proceeded with
computed tomography (CT) thorax which revealed
significantly moderate right pneumothorax. The
diagnostic approach and the management of this case
are discussed.
2.Primary hyperparathyroidism with vitamin D deficiency in third trimester of pregnancy
Chin Voon Tong ; Mohamad Rafie bin Md Kaslan
International e-Journal of Science, Medicine and Education 2015;9(3):47-51
In pregnancy, the diagnosis of primary
hyperparathyroidism (PHP) may be delayed due to
physiological changes that occur during this period.
The maternal related complications of PHP during
pregnancy has been reported to be as high as 67%, whilst
fetal complications up to 80% of cases.1
The therapeutic
gold standard and definitive treatment for PHP in
pregnancy is minimally invasive parathyroidectomy
in the second trimester. We report a case of a 22-year
old primidgravida who underwent parathyroidectomy
in the third trimester of her pregnancy for PHP with
persistent hypercalcemia. She was also found to have
Vitamin D deficiency which probably led to secondary
hyperparathyroidism and made her hypercalcemia more
apparent during pregnancy.
Hyperparathyroidism
;
Pregnancy
3.Case Report: Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion
Chin Voon Tong ; Shanty Velaiutham ; Nor Azizah Aziz ; Shueh Lin Lim ; Chong Hui Khaw
The Medical Journal of Malaysia 2015;70(4):249-250
We report a case of a 54-year-old man with severe HTG
which did not respond to conventional anti lipid therapies.
He was treated with intravenous insulin and concurrent
dextrose infusions which led to a dramatic reduction in
serum triglyceride levels.
Hypertriglyceridemia
4.Ectopic ACTH Syndrome - Experience with etomidate
Chin Voon Tong ; Zanariah Hussein
Journal of the ASEAN Federation of Endocrine Societies 2017;32(1):54-56
For ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS), when surgery is not feasible, or in cases of severe biochemical disturbances, immunosuppression or mental instability, medical therapy with agents such as etomidate is indicated. We present our experience in using etomidate for a 41-year old female with EAS secondary to a malignant mediastinal paraganglioma. We were able to demonstrate that etomidate can be used effectively to control severe hypercortisolism in a lower dose than previously described.
Etomidate
;
ACTH Syndrome, Ectopic
5.Ectopic ACTH Syndrome – Experience with Etomidate
Chin Voon Tong ; Zanariah Hussein
Journal of the ASEAN Federation of Endocrine Societies 2016;31(11):54-56
For ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS), when surgery is not feasible, or in cases of severe biochemical disturbances, immunosuppression or mental instability, medical therapy with agents such as etomidate is indicated. We present our experience in using etomidate for a 41-year old female with EAS secondary to a malignant mediastinal paraganglioma. We were able to demonstrate that etomidate can be used effectively to control severe hypercortisolism in a lower dose than previously described.
Etomidate
;
ACTH Syndrome, Ectopic
;
Cushing Syndrome
6.Use of combination of Oral Levothyroxine and Liothyronine in severe Hypothyroidism with Massive Pericardial Effusion
Poh Shean Wong ; Sue Wen Lim ; Chin Voon Tong ; Masni Mohamad ; Zanariah Hussein
Journal of the ASEAN Federation of Endocrine Societies 2022;37(2):106-112
Thyroid hormone plays an important role in cardiovascular function. Pericardial effusions are commonly seen in cases of severe hypothyroidism. However, large to massive pericardial effusions with cardiac tamponade are exceptionally rare. Herein, we present two cases of severe hypothyroidism with massive pericardial effusion. Our first case demonstrates that a patient with large pericardial effusion can be managed conservatively with aggressive thyroid hormone replacement therapy. In our second case, pericardiocentesis was performed in addition to thyroid hormone replacement therapy as the underlying aetiology of effusion could not be reasonably limited to hypothyroidism. These two cases served to highlight and demonstrate rapid normalisation of thyroid function test by using aggressive oral thyroid hormone replacement therapy using liothyronine, in combination with levothyroxine, which led to resolution of pericardial effusion and prevent its re-accumulation.
Pericardial Effusion
;
Thyroxine
;
Triiodothyronine
7.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