To describe a case of propylthiouracilinduced lupus, complicated with antiphospholipid syndrome and acute ischemic stroke.
Introduction Pseudohypoparathyroidism (PHP) encompasses five metabolic disorders characterized by target organ PTH resistance. The focus of this paper is PHP Type 1B (PHP1B), a disease that typically presents in children with symptomatic hypocalcemia. Only 15-20% of cases are genetic, making our case of Familial PHP1B even rarer. Case Presentation A 23-year-old African-American female with hypothyroidism and PHP1B diagnosed in 2005 presented to the emergency department with symptomatic hypocalcemia. As a child, she was evaluated for progressive femur, tibia, radius, and ulna bowing in the setting of short stature without phenotypic features of Albright's Hereditary Osteodystrophy. Her biochemical profile was consistent with pseudohypoparathyroidism and imaging showed costochondral junction enlargement. Genetic testing revealed STX mutation confirming PHP1B diagnosis. Extensive studies of her family revealed several affected members, including one of her two children.Patient has history of multiple hospitalizations for symptomatic hypocalcemia. During this admission, her laboratories demonstrated: calcium 4.4 mg/dL (8.6-10.3 mg/dL), phosphorus 7.3 mg/dL (2.5-4.5 mg/dL), PTH 574 pg/mL (16-65 pg/mL), 1,25-dihyroxyvitamin D < 8 ng/mL (18-78 ng/mL), and 25-hydroxyvitamin D 7.6 ng/mL (30-100 ng/mL).She has an extensive history of non-compliance with medications and endocrinology appointments. During the last visit, she complained of ostealgia, particularly in long bones. While discussing the importance of maintaining adequate calcium levels, the patient expressed feeling overwhelmed by her regimen (calcitriol 1 mcg QAM and 0.5 mcg QHS, calcium carbonate 1,200 mg TID). After a lengthy conversation regarding the need for long-term medical therapy, she became increasingly distraught. Conclusion When normocalcemia is achieved with high doses of calcium and calcitriol, patients with PHP1B have an average life expectancy. Given that patients are typically diagnosed in childhood, taking several medications multiple times a day can be challenging and lead to poor compliance. When this occurs, PHP1B becomes a life-altering disease with a significant decrease in quality of life.In 2018 Wierenga et al. reported that being emotionally overwhelmed by chronic disease prevents a patient from appropriately caring for themselves. Their research shows that older males with higher levels of education have better emotional regulation than young females with low educational levels. Providing patients at high risk of psychological stress with a multidisciplinary team including cognitive-behavioral therapists can improve their quality of life and compliance while decreasing the healthcare costs associated with poorly controlled chronic diseases. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Introduction : Despite having a broad range of services available at the Veterans Affairs Healthcare System (VAHS), veterans struggle to control their chronic diseases. At the Miami VAHS, 30% of veterans have diabetes, and of those, 30% are poorly controlled. Women represent a growing number of veterans at the Miami VAHS who face many of the challenges posed by having a diabetes diagnosis. Objective: To improve HbA1c measurements in women veterans (WV) with poorly controlled diabetes following a phone encounter with an endocrinologist addressing diabetes management. Method: This was a prospective intervention study of WV with HbA1c levels ≥ 9%. An endocrinologist attempted up to three telephone calls to reach WV. The phone intervention involved a chart review of co-morbidities to establish a HbA1c target, and management included lifestyle modification counseling, insulin dose adjustment, introduction and/or discontinuation of diabetes medications, and a plan for follow-up. During the following 3-4 months, results of follow-up HbA1c were collected regardless of having had an initial telephone encounter. WV who did not have follow-up HbA1c were excluded from the study. The remaining WV were further divided into 1) those that answered the phone and participated in the assessment (intervention group) and 2) those who did not answer the phone to have an initial encounter (control group). Other variables included BMI, eGFR, type of diabetes, diabetes medication, presence of hypertension, dyslipidemia, coronary artery disease (CAD), smoking, and psychiatric illness. Results: Of 77 WV who were called, 36 WV were assessed by the endocrinologist; 41 did not answer the phone and were regarded as the control. 8 WV from the intervention group and 16 WV from the control group did not have a follow-up HbA1c, and were excluded. 28 intervention and 25 control WV were included in the final analysis. In the intervention group: mean age 55.0 ± 10.3 years, BMI 29.8 ± 5.5, eGFR 57.9 ± 4.5, 86% type 2 diabetes, 61% on basal bolus insulin therapy, 68% HTN, 93% dyslipidemia, 71% smokers, 4% CAD, and 68% psychiatric diagnosis. In the control group: mean age 55.6 ± 9.9 years, BMI 32.5 ± 6.1, eGFR 58.9 ± 4.5, 96% type 2 diabetes, 44% on basal bolus insulin therapy, 80% HTN, 84% dyslipidemia, 16% smokers, 4% CAD, and 68% psychiatric diagnosis. Mean baseline HbA1c was 10.9 ± 1.5 for the intervention and 10.8 ± 1.8 for the control group. After 3-4 months, mean HbA1c was 9.9 ± 2.3 in the intervention group, and 10.6 ± 1.7 in the control group. HbA1c decrease in the intervention group was statistically significant (p = 0.03). Conclusion: This preliminary study demonstrates that a telephone intervention from a diabetes specialist has a positive impact on decreasing HbA1c in WV with poorly controlled diabetes. Findings from this study suggest that this approach should be considered in management of other chronic diseas...
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