Introduction: Autoimmune polyendocrine syndrome (APS) type 4 is a clustering of at least 2 or more organ-specific autoimmune diseases in a single patient, which do not fall into other categories of APS, in combination with at least one more endocrine or non-endocrine organs. The multitude of autoimmune comorbidities and their associated treatment may contribute to osteoporosis and fracture. Case Description: A 35-year-old female with bilateral distal femoral pathologic fracture from an inch fall underwent bilateral, minimally invasive plate osteosynthesis. Pathologic fracture from secondary osteoporosis resulted from rheumatoid arthritis, chronic steroid use from rheumatoid arthritis (prednisone 10 mg for 24 months), premature ovarian failure since 20 years old without hormone replacement therapy, and possible Turner syndrome. She had persistently elevated thyroid-stimulating hormone in spite of high levothyroxine (4.25 μg/kg/day) dose; hence, gastric malabsorption from possible atrophic gastritis was likewise considered. Benefits and risks associated with treatment were reviewed to manage the patient holistically. Conclusion APS is a rare complex syndrome which may lead to various complications. Presence of hypogonadism, rheumatoid arthritis, and chronic steroid use further predisposes the development of secondary osteoporosis. Early screening and treatment of osteoporosis would have decreased the risk of development of fracture.
Fractures, Spontaneous ; Primary Ovarian Insufficiency ; Arthritis, Rheumatoid

BACKGROUND: The objective of this study was to determine the efficacy of liraglutide in reducing cardiovascular complications. METHODOLOGY: Literature searches of electronic databases (PubMed and ScienceDirect) were performed to identify relevant studies. Relevant journals included were electronically searched for randomized controlled trials (RCTs) regarding the use of liraglutide versus placebo in reducing the rate of cardiovascular complications. Data extraction and quality assess- ment were done by independent reviewers. Statistical analysis of the study was accomplished using Cochrane Systematic Review Software Review Manager. Mean difference was used to analyze a data set which used mean and standard deviation from the studies. A p-value of less than 0.05 for the observed effect size was considered statistically significant. RESULTS: A total of two RCTs with 16,977 patients were included in this meta-analysis. The results showed that in the lirag- lutide group, there is a statistically lower rate of the major adverse cardiovascular events (risk ratio [RR] 0.86 [0.78, 0.95]), cardiovascular events (RR 0.75 [0.63, 0.89]), and all-cause mortality (RR 0.81 [0.70, 0.93), but it is not statistically significant when compared to the placebo group in terms of non-fatal myocardial infarction and non-fatal stroke. There is no significant difference in rates of severe adverse events in general (p > 0.05). However, liraglutide caused significant reduction in rates of severe hypoglycemia as an independent secondary outcome (p < 0.05). CONCLUSION Compared with placebo, liraglutide provided a significant reduction in MACE, cardiovascular events, all-cause mortality and severe hypoglycemia as an adverse event.
Human ; Liraglutide ; Diabetes Mellitus, Type 2

A 34-year-old Filipino with Graves' disease on methimazole came in due to fever, sore throat and jaundice. Patient was initially diagnosed with methimazole induced agranulocytosis and drug induced liver injury. She was treated with intravenous broad spectrum antibiotic and granulocyte colony stimulating factor. On day 4 of admission, patient had pancytopenia and was managed as methimazole induced aplastic anemia and was started on steroid therapy and 1 unit of packed red blood cell was transfused. The jaundice also increased hence she was given ursodeoxycholic acid. On day 9 of admission, with the consideration of "lineage steal phenomenon," biopsy was done and eltrompobag was started. Patient was discharged stable at 12th day of hospital admission. This case presents the 3 rarest, life threatening complication of methimazole: agranulocytosis, aplastic anemia and hepatitis. 

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Anemia ; Agranulocytosis ; Methimazole ; Antithyroid Agents

BACKGROUND: Endocrine malignancy in the Filipino population has not been well documented particularly on the incidence, prevalence, demographic profile and survival rate. It is the aim of this study to determine the prevalence rate and demographic profile of all endocrine malignancies diagnosed at a tertiary hospital.
MATERIALS AND METHODS: This is a retrospective study from March 2003 to March 2008. Data were obtained from the Tumour Registry of St. Luke's Medical Center Cancer Institute (SLMC-CI) and from the Annual Report of the Diabetes, Thyroid and Endocrinology Center (DTEC) Section of SLMC-Quezon City. Only individuals with retrievable histopathology at this institution were included in the study.
STATISTICAL ANALYSIS: Data were calculated using percentages and proportions.
RESULTS: There were a total of 855 cases of endocrine malignancies documented in five years of which, 833 were cases of thyroid malignancies (97.4%). Fourteen cases of adrenal cancer (1.60%), seven cases of neuroendocrine carcinoma (0.79%), and one case of parathyroid carcinoma (0.14%). There was no note of pituitary cancer. There were a total of 833 newly diagnosed thyroid cancer: 652 papillary carcinoma (78.2%), 157 follicular carcinoma (18.8%), 11 anaplastic carcinoma (1.32%); nine medullary thyroid cancer (1.08%); two thyroid lymphoma (0.28%), one poorly differentiated carcinoma (0.14%) and one metastatic to the thyroid (0.14%). Among the 14 adrenal cancers, seven cases were due to adrenal cortical carcinoma, one case was due to adrenal neuroblastoma and six cases were due to adrenal metastases. Among the neuroendocrine carcinomas, four were pancreatic neuroendocrine carcinoma which included two malignant insulinoma and three patients were extra pancreatic neuroendocrine carcinoma.

Human ; Male ; Female ; Aged ; Middle Aged ; Parathyroid Neoplasms ; Pituitary Neoplasms ; Thyroid Neoplasms ; Adenocarcinoma, Follicular ; Adrenal Gland Neoplasms ; Carcinoma, Neuroendocrine ; Diabetes Mellitus