Friday 4th December 2020 1.51pm GMT start
- Shared screen with speaker view
Karim Meeran
08:16
menti code 7239292
MUHAMMAD SHOAIB ZAIDI
13:40
Mentimeter is not proceeding forwards.
Rupa Ahluwalia
17:36
likely hypovol
Mussa Alfakhri
17:44
hypo
Hnin Yu Sanda
18:00
hypo
Asim shafique
18:03
likely hypovol
Myat Thida
18:20
likely hypo
Kasi Subbiah
18:23
Use urine Na (not serum Osm) if unsure clinically
GEETHA NATARAJAN
18:42
Hypovolemia
Mussa Alfakhri
19:26
adrenal insufficiency
May Thu Kyaw
22:27
hypo
amina khanam
22:38
do we have an ACTH?
Rupa Ahluwalia
22:44
have we got a repeat pre HC cortisol?
Saadia Saeed
23:14
did the hydrocortisone act as an anti-inflammatory agent
MUHAMMAD SHOAIB ZAIDI
23:16
What about the Short Synecthen test ?
Mohsin Sohail Siddiqui
23:37
Did he have repeat imaging?
Furat Wahab
23:37
could be the effect of opioids he's received ?
Hnin Yu Sanda
23:44
does abd pain due to Addisonian crisis or any other pathology
parez Namiq
24:27
how other hormones ilevel mproved only w steroid if panhypo ? thx
Rakshit Kumar
24:39
hypophysitis- responding to HC
Samsung Galaxy S7
24:43
how did the rest of axes recover with steroids? as mentioned was HC anti inflammatory
Dr Amel
25:14
it could be an inflamatory disease not a macroadenoma
Naik Haya
25:37
Was Pit imaging repeated? any CT ? any bleed? what was stalk thickness
parez Namiq
25:57
thanx
MUHAMMAD SHOAIB ZAIDI
26:04
SIADH can have the same biochemical picture ?
parez Namiq
27:32
but the dose was small ? my understanding if we want anti inflammatory effect of HC
parez Namiq
28:25
we have to give higher dose of hc
Rakshit Kumar
29:23
Loading dose was supra-physiological.. evidence is inconclusive on high dose vs normal dose steroids for hypophysitis remission
Alexandra Ward
32:06
please can you share the code again
christopher mcgettigan
32:19
Lymphoma - midline granuloma
Wui Hang Cheung
32:25
hypothesitis
Syed Bitat
32:26
ig4
Asim shafique
32:35
Localized metastasis / inflammatory
Abdul Lakhdar
32:45
Hypophysitis
neelam
32:47
IGf4
Abdul Lakhdar
33:23
High steroids
Dr Amel
33:37
steroides
Asim shafique
34:00
steroids and DDVAP
Zeenat Banu
34:29
steroids DDAVP
Zeenat Banu
34:39
rituximab is next step
Zeenat Banu
34:51
IgG4 MDT
Zeenat Banu
35:22
hi
Sanesh Pillai
35:59
do you consider biopsy?
MUHAMMAD SHOAIB ZAIDI
36:07
How common is this condition ?
Naik Haya
36:10
rituximab tried??
neelam
36:20
any other organs involvement? renal pancreas lung?
MIKE STACEY
36:41
Contrasting with our recent suspected case where we did biopsy...
Rupa Ahluwalia
36:53
I guess time will tell if the DI would relapse and remit as well
MIKE STACEY
36:55
… and it was only partially conclusive!
Furat Wahab
37:16
how do you explain having DI and hypog only affected rather than hypopit?
Rakshit Kumar
37:48
As per diagnostic scoring :IGG4 related Hypophysitis may be made without biopsy
Naik Haya
39:37
any family history?
Abdul Lakhdar
40:07
Idiopathic
Dr.Afsar Fatima
40:17
LCH
Asim shafique
40:24
IDIOPATHIC
GEETHA NATARAJAN
40:35
Langerhan Histocytosis
Narayan Kandel
40:36
B
IM
41:47
Did infundibulum looked slightly thickened? With bright spot present, shouldn't present as DI?
Naik Haya
44:09
Increased
Mussa Alfakhri
44:26
b
Rupa Ahluwalia
44:30
i guess it would also depend on the aetiology
Narayan Kandel
44:45
Can be increased
Naik Haya
45:21
did you think about gestational DI?
MIKE STACEY
45:59
Critically you need to target a lower plasma Osmo range in pregnancy to avoid IUGR, as I understand it
Stephen Robinson
46:23
On the scan make sure you look at Pineal, OK in this case
Elaine Soong
47:04
how much ddavp dose do you increase in pregnancy?
Kalyan Mansukhbhai Shekhda
47:05
do we need to increase the dose even if patients are managing well with their normal dosage? ( no dehydration bloods are normal?)
MUHAMMAD SHOAIB ZAIDI
47:17
1- So was the MRI normal ?
dmarshal
47:38
Out of interest-who uses copeptin measurement (analysed at Newcastle) instead of a 'regular' water deprivation test?
Furat Wahab
47:40
How often you see them in joint Endo - ANC.?
MUHAMMAD SHOAIB ZAIDI
47:50
How do you diagnose Idiopathic DI ?
parez Namiq
48:31
what about bright spot ?
Kasi Subbiah
48:46
Germinoma's - multiple lesions with pineal involvement
Naik Haya
50:11
mutations in the AVP gene considered??
Naik Haya
54:40
1,25 D level ? free:total 25 D ratio ?
Zeenat Banu
57:50
very interesting
Naik Haya
58:23
AVP gene was about previous case !!
Naik Haya
58:29
1,25 D level ? free:total 25 D ratio ?
Zeenat Banu
58:30
role of cinacalcet?
Hnin Yu Sanda
58:33
is it first pregnancy?
Eswari Chinnasamy
58:36
Whats the experience of others with calcitonin?
suhail
58:37
interesting
Abdul Lakhdar
58:44
Normally this is a benign condition in non pregnant, correct?
shanza akram
59:13
were the family members tested for this mutation as well?
Jeannie Todd
59:30
Excellent case
Eswari Chinnasamy
59:35
How long can you use calcitonin for?
Naik Haya
01:00:04
Tachyphylaxis to calcitonin developed???
neelam
01:01:07
excellent case, was 1,25 D levels very high in this patient?
Naik Haya
01:01:13
calcium binders considered??
hsiulye
01:01:33
Would you advise against further pregnancy?
Alexander Comninos
01:03:23
1,25 high yes as all 25 shunted down this pathway
Naik Haya
01:05:00
any results for PO4, Mg and ALP ?? please
Rohini Gunda
01:07:13
any features of acromegaly?
Abdul Lakhdar
01:07:43
4D CT neck/SPECT
Alexander Comninos
01:08:01
Naik- normal
parez Namiq
01:08:33
any role of us in hyperparathyroidism ? thx
Shadman Irshad
01:09:12
looks like Men based on family history
Ramjan Sanas Mohamed
01:10:09
is it MEN1 syndrome- acromegaly, Primary |HPT, Neuroendocrine tumour??
Eswari Chinnasamy
01:12:37
Was the PTH repeated?
MUHAMMAD SHOAIB ZAIDI
01:12:59
Thanks. Primary Hyper PTH has been reported to be associated with a primary malignancy ?
Eswari Chinnasamy
01:12:59
what was the biopsy result?
Naik Haya
01:13:12
GI bleed is one of rare complication of high calcium, also in this patient, could be MEN related
Duraisamy Ravichandran
01:13:33
why did he have parathyroid imaging if pth is not suppressed? or was it suppressed?
Eswari Chinnasamy
01:13:46
There was family hx of Acromegaly right, that would point to MEN1
Naik Haya
01:14:03
There was no tracer uptake in this scan
Mohsin Sohail Siddiqui
01:15:18
I think the presentation is not on share yet?
parez Namiq
01:18:00
show last slide
Abdul Lakhdar
01:18:14
B andC
Gautam Das
01:20:02
Can it be assay interference
Ahmed
01:20:20
could it be her inhaled sterids?
parez Namiq
01:20:45
what was the signs of adrenal insufiency in this case ?
Kagabo Hirwa
01:21:29
Could it be adrenal insufficiency and lipodystrophy in a patient on HAART?
Saadia Saeed
01:21:49
was the triamcinolone given as intra articular? or IM? indication?
IM
01:22:07
Awareness of Xenobiotics oxidising enzyme CYP3A4 inhibitor (Antifungals and protease inhibitors) delays steroid metabolism but in the presence of exogenous steroids identified in the recent NatPSA in August 2020
Kate Lazarus
01:22:39
Did she have a pred level whilst on the pred?
neelam
01:22:47
plasma life of Triamcinolone is 480 min max, could it be left alone to recover ?
Naik Haya
01:23:27
drug interaction with different steroids is slightly different, so here pred is good choice.
IM
01:23:28
Not to forget giving "RED Card" to AI patients
ALISON WREN
01:23:37
We give all patients going on to ritonavir or cobisistat (similar enzyme inhibitor) a card warning about this interaction. Also get them to check with pharmacist for interactions on HIV i-chart app
John Alexander
01:24:04
I guess the new term is tertiary adrenal insufficiency?
Neena Kamran
01:24:36
why we suspected AI
IM
01:24:39
I don't call it tertiary but actually It is reported as tertiary in the NatPSA
parez Namiq
01:24:48
will cushing not get worse with extra steroid ?
Naik Haya
01:25:11
No, this is replacement dose
parez Namiq
01:25:36
thanks
GEETHA NATARAJAN
01:30:33
Sarcodosis
Mussa Alfakhri
01:30:44
TB
Naik Haya
01:30:57
what is that lesion on scan in chest next to heart??
Shadman Irshad
01:31:38
was the necrosis caseous or histiocytic?
Naik Haya
01:31:52
IGRA level ?
Naik Haya
01:32:09
Montoux?
MUHAMMAD SHOAIB ZAIDI
01:32:16
What about the pt's CXR ?
Shawg Ganawa
01:32:41
very nice 👌
Sarah Roberts
01:32:53
interesting!
Shadman Irshad
01:33:01
unlikely to be sarcoid as it was non-necrtozing
Eswari Chinnasamy
01:33:17
Negative TB tissue culture?
Neena Kamran
01:33:19
it seems TB diagnosis was not in nitial differential and diagnosed only on histopathology
Shadman Irshad
01:33:19
sorry I mean it was necrotizing
Naik Haya
01:33:23
24 urine steroid profile ?
MUHAMMAD SHOAIB ZAIDI
01:33:57
What can be the differentials for the positive FD pET scan ?
Narayan Kandel
01:34:11
Interesting case , what would be his prognosis
MUHAMMAD SHOAIB ZAIDI
01:44:24
So was the initial MRU lumbar spine was wrongly reported ?
MUHAMMAD SHOAIB ZAIDI
01:44:48
Sorry MRI
Daniel Morganstein
01:45:26
Imaging will result in a differential diagnosis
Naik Haya
01:45:32
Cyclopos, vincrist, and dacarbazine regime considered??
Abdul Lakhdar
01:46:19
C
GEETHA NATARAJAN
01:46:31
Chemotherapy
GEETHA NATARAJAN
01:51:14
All of the above
Asim shafique
01:51:41
all of above
Narayan Kandel
01:51:44
I think we need to all of the above
Narayan Kandel
01:55:36
3
sara hussien abd allah
01:55:51
3
Narayan Kandel
01:58:34
Nice presentation
MUHAMMAD SHOAIB ZAIDI
01:58:58
why was FDG glucose PET ordered in the beginning ?
Tejhmal Rehman
01:59:09
How pressing was the need to do TSH receptor antibodies in this case given history? Could we have waited for USS?
MUHAMMAD SHOAIB ZAIDI
02:01:08
How frequent is painless S.acute thyroiditis ?
Ahmed
02:01:21
any role for FT4/Ft3 ratio
Ahmed
02:01:23
?
MUHAMMAD SHOAIB ZAIDI
02:01:36
How would you differentiate it with tHyroid storm ?
Naik Haya
02:02:49
Burch-Wartofsky score ?
Neena Kamran
02:02:59
hopefully we won’t get these rare presentations in our exam...;)
Carolyn Jack
02:03:31
Prevalence of 1 in a million happen 9 times out of 10 in the exams
GEETHA NATARAJAN
02:04:30
Thank you. Good cases.
MUHAMMAD SHOAIB ZAIDI
02:04:57
Thank-you for an excellent master class.
Bijal Patel
02:05:17
Can you share your screen please
Eswari Chinnasamy
02:05:18
could see poster
Dr Amel
02:05:18
amazing cases thanks you
Eswari Chinnasamy
02:05:31
couldn't see poster
Carolyn Jack
02:05:31
Great cases, thank you all
Dr Amel
02:05:43
me too
D2M Qnet
02:05:47
Can you please share the poster?
Dr Amel
02:06:51
yes
MUHAMMAD SHOAIB ZAIDI
02:06:53
Yes
Neena Kamran
02:13:46
can I get these posters link here
Hnin Yu Sanda
02:15:19
Very informative and good mixture of cases.Thank you Prof Meeran and the team-Dr Gideon Mlawa-Queens
Naik Haya
02:16:08
antibodies titre improved?
MUHAMMAD SHOAIB ZAIDI
02:16:16
how would you classify this type of diabetes ?
MUHAMMAD SHOAIB ZAIDI
02:16:51
Thanks
Trust Zaranyika
02:18:50
could it still be PCR negative COVID?
Elaine Soong
02:19:13
screen for TB?
Kate Lazarus
02:19:45
HIV?
MUHAMMAD SHOAIB ZAIDI
02:20:15
What's the relation of covid 19 e Addison's ?
Naik Haya
02:20:43
adrenalitis due to covid
parez Namiq
02:23:09
tsh low why TRH stimulation Done ?
Elaine Soong
02:24:53
screen for assay interference?
Hnin Yu Sanda
02:25:37
any infection including Covid19 can precipitate
Hnin Yu Sanda
02:26:37
any infection including Covid19 can precipitateaddisonian crisis @Zaranyika
Hnin Yu Sanda
02:27:15
any infection including Covid19 can precipitateaddisonian crisis @Zaranyika from Dr Mlawa
Naik Haya
02:27:40
thyroid uptake scan ?
Neena Kamran
02:28:14
could it be hypo or hyper?
MUHAMMAD SHOAIB ZAIDI
02:28:47
How can alemtuzumab provoke hyperthyroidism when it's an immunosuppressant ?
Ahmed
02:29:13
it causes immune reconstitution syndrome
Ahmed
02:29:34
can happen with HIv after treatment or BM transplant
MUHAMMAD SHOAIB ZAIDI
02:33:22
At what point in time should we consider malabsorption ?
Eswari Chinnasamy
02:36:43
what was the QTc
Naik Haya
02:39:04
APS---2 ?
MUHAMMAD SHOAIB ZAIDI
02:45:12
How can we contribute in future caes ?
MUHAMMAD SHOAIB ZAIDI
02:45:20
cases ?
Rochan Agha-Jaffar
02:45:50
Thank you for a great afternoon!
Trust Zaranyika
02:46:09
Have a Merry Xmas
Neena Kamran
02:46:10
Thank you
Dr Amel
02:46:14
thank you very much very interesting cases
sheenam
02:46:18
Thank you
John Alexander
02:46:22
thank you
Reena Kumari
02:46:25
Thank you
D2M Qnet
02:46:26
Thanks prof. Kareem!
Eswari Chinnasamy
02:46:29
Lovely, thank you for the very nice meeting
MUHAMMAD SHOAIB ZAIDI
02:46:36
Thank you ?
Almokhtar Otman
02:46:38
thank you
Becky Swain
02:46:44
Thank you for organising
Alamin Alkundi
02:46:48
thanks
Clara Limbaeck
02:46:49
Thank you!
hsiulye
02:46:52
Thank you prof
Hareesh Joshi
02:47:04
Many Thanks !
Saadia Saeed
02:47:34
thank you! great session