Tumour-induced or oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by bone pain and muscle weakness. A biochemical profile consisting of normocalcaemia, hypophosphataemia, phosphaturia, increased serum alkaline phosphatase and inappropriately low serum levels of 1, 25-dihydroxyvitamin-D is diagnostic. OOM is usually caused by an osseous or soft-tissue tumour of mesenchymal origin that secretes phosphaturic substances leading to increased urinary phosphate wasting. These tumours are small and slow growing. The diagnosis continues to be easily missed and when eventually made, localization of the tumour can be difficult. We describe the case of a young man who presented with severe generalized pain associated with muscle weakness. He was extensively investigated and eventually diagnosed to have OOM 3 years after initial presentation. Specialized investigations were necessary to localize the offending tumour.
Introduction: Diabetes is associated with a high risk of cardiovascular disease. The management of blood glucose, dyslipidaemia and other modifiable risk factor, is a key element in the multifactorial approach to prevent complications of type 2 diabetes. Materials and Methods: A cross sectional study was conducted to determine the level of glycaemic control, lipid profile, blood pressure and body weight status among type 2 diabetics in rural Malaysia. A total of 237 diabetic subjects participated in this study. Physical examination was carried out, including measurements of height, weight, waist and hip circumferences, and systolic and diastolic blood pressure. Fasting venous blood samples were collected to determine the glucose level and lipid profile. Results: About 70% of the subjects had a high body mass index (BMI), equal to or above 25 kg/m2. More than 60% of the subjects had systolic blood pressure >= 140 mmHg and/or diastolic >=90 mmHg. Mean fasting blood glucose was 9.84±4.54 mmol/L. Mean total cholesterol was 5.18±1.35 mmol/L. High density lipoprotein cholesterol (HDLC) and triglyceride (TG) and glucose levels were higher in male than in female, but not statistically significant (p>0.05). However, low density lipoprotein cholesterol (LDLC) was higher in females than males (p
We report a 33-year-old Malay lady who presented with fever, tonsillitis and pharyngitis a month after initiation of antithyroid therapy (carbimazole 15 mg tds) for thyrotoxicosis by her general practitioner. She was still clinically and biochemically thyrotoxic but not in thyroid storm. At that time, she was also confirmed to be four weeks pregnant. Her full blood count revealed neutropaenia with an absolute neutrophil count of 0.036 × 109/L. Bone marrow aspirate and trephine were compatible with carbimazole-related agranulocytosis. Carbimazole was discontinued and she was given broad spectrum antibiotics and Granulocyte Colony Stimulating Factor (GCSF), to which she responded. Verapamil was used for symptomatic heart rate control instead of beta-blockers as she had a history of bronchial asthma. The patient subsequently opted for termination of pregnancy after which she was given radioactive iodine I131 (10 mCi) for definitive therapy of her thyrotoxicosis. In conclusion, carbimazole-related agranulocytosis is an important entity to recognise and treat early to prevent morbidity and mortality. Termination of pregnancy was carried out as the treatment given during the episode of agranulocytosis may have negative effects on foetal viability and growth.
This study assessed the effect of calcium supplementation towards the change in serum calcium,
phosphorus and magnesium level. We carried out a randomized controlled trial of calcium supplementation in 113 postmenopausal women for 24 months period study. Subjects were randomly assigned into two groups. Subjects in Calcium Supplemented Group (CSG) were to take calcium supplement (1200 mg/day) while the Control Group were not given any placebo and advised to continue with their regular diet. The study showed that calcium supplementation helps to increased daily intake of calcium amongst the subject which in results helping to maintain the serum calcium level within normal range. The serum magnesium and phosphorus level in this study were kept at a normal range although there is a slight decrease in serum phosphorus levels may be due to a reduction in the daily intake of the mineral.