Collective Intellect Clinical Case Discussion Platform (CICCDP)
APCO CICCDP Videos
APCO CICCDP Session 6 on 14 January 2025 - Case Updates
Case 1:
- Presented by Dr Tran Ha Uyên, a Resident Physician in the Department of Internal Medicine at the University of Medicine Pham Ngoc Thach, Vietnam.
- The case involved a 51-year-old male who had osteomalacia and Fanconis Syndrome. Dr Uyên sought guidance on managing the patient and requested advice on elucidating the cause of the patient’s protracted hypophosphatemia that was associated with renal phosphate wasting. This case was thoroughly discussed by our expert panel, with each panelist offering unique perspectives on the findings and recommendations for the patient’s management. The discussion also included suggestions for additional tests to obtain a more conclusive understanding of the patient’s condition.
Case 2:
- Presented by Dr Dinithi Ruwanga, a Senior Registrar in Endocrinology at the Sri Jayewardenapura General Hospital, Sri Lanka.
- This case involved a 37-year-old female with lactation-associated osteoporosis with worsening BMD on anti-resorptive treatment. Prof Manju Chandran highlighted an important point in interpretation of DXA scan namely the regions of interest that are included in serial scans. The panelists addressed the issue of the patient’s elevated parathyroid hormone (PTH) levels, fluctuating calcium levels, and low urinary calcium excretion as well as explored the potential options for treatment of pregnancy and lactation associated osteoporosis.
APCO CICCDP Session 5 on 12 November 2024 - Case Updates
Case 1:
- Presented by Dr Marjorie Faye Nierra, a 2nd year Rheumatology Fellow at the University of Santo Tomas Hospital in Manila, Philippines.
- The case involved a 63-year-old female with Systemic Lupus Erythematosus (SLE) and Glucocorticoid-Induced Osteoporosis (GIOP). The expert panel engaged in a dynamic discussion addressing Dr Marjorie’s concern about the multiple fractures the patient had been experiencing and provided strategies to mitigate the risk of further fractures.
Case 2:
- Presented by Dr Rasha Amin, a Pediatric Endocrinology Fellow at the Division of Pediatric Endocrinology and Diabetes at Sidra Medicine in Doha, Qatar.
- The case involved a 7-year-old boy with hypocalcemia secondary to Autosomal Recessive Vitamin D Resistant Rickets. Faced with the patient's poor response to oral medication and infusions, Dr Rasha sought guidance on how to manage the patient. Prof Manju Chandran provided the participants with insights into Vitamin D Resistant Rickets, while experienced Pediatric Endocrinologist Dr Ganesh Jevalikar provided his expert opinion on tailoring treatment for such complex cases.
APCO CICCDP Session 4 on 9 September 2024 - Case Updates
Case 1:
- Presented by Dr Caroline Hoong, Consultant at the Department of Endocrinology, Woodlands Health, Singapore.
- The case involved a 56 year old woman on Heamodialysis with severe osteoporosis. The issue of management of osteoporosis in the setting of end stage renal disease is a complex one. The expert panel had a lively discussion, offering valuable insights on treatment while addressing Dr. Hoong's concerns about medication interactions with the patient's other conditions and treatments as well as the role of bone turnover markers in CKDMBD.
- As of Nov 2024, the patient has recovered from post-denosumab hypocalcaemia. As the patient only received her first dose of denosumab in June 2024, a repeat BMD has not been performed yet. A repeat BMD in has been planned for June 2025. As the patient's iPTH level continues to rise, Dr Hoong is considering liaising with the renal department to explore if the patient will benefit from parathyroidectomy procedure or calcimimetics drugs.
Case 2:
- Presented by Dr Anish Kar, Senior Resident at the Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata.
- The case involved a 34 year old Male with a history of Transfusion Dependent Thalassemia. Another complex area which has many interlocking and interconnected issues within it and that involves close collaboration between Endocrinologists and Haematologists. The panelists addressed Dr Anish’s concerns and offered Dr. Anish a new approach to managing his patient from conversion of BMD values to treating the bone loss peculiar to patients with transfusion dependent thalessemia.
APCO CICCDP Session 3 on 9 July 2024 - Case Updates
Case 1:
- Presented by Dr Rashi Agrawal, Consultant Endocrinologist, Apollo Hospital, Navi Mumbai, India
- The case involved a 29 year old woman with premature ovarian failure seeking fertility options. The panelists addressed Dr Agrawal’s questions on the recommended management of her low bone density while addressing the patient's fertility options. Dr Lisa Webber and the other expert panelists provided their valuable insights on the case while engaging in a vibrant discussion ranging from Karyotyping to rule out Turner’s syndrome to the type of hormone replacement that was required in this patient.
- As of Nov 2024, the patient has started getting HRT-induced menses and her metabolic health has improved. Regarding further evaluation, Dr Agrawal has suggested a Karyotype test (as discussed in the CICCDP session), but the patient is yet to do it due to financial constraints. Dr Agrawal plans to follow up with the patient's osteoporosis only a year later after initiating HET.
Case 2:
- Presented by Dr Shiga Rappai Chirayath, Endocrinologist at the Division of Pediatric Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
- The case involved a 13 year old boy with autosomal dominant hypocalcemia and bilateral medullary nephrocalcinosis. The fruitful discussion and the panelists' advice provided Dr Shiga with a new direction in the management of hypocalcemia in her patient, including discussions on the role of Parathyroid hormone replacement as well as the exciting frontiers of Calcilytic use in this rare and challenging disorder.
- As of 8 Nov 2024, the patient's condition is status quo. Patient is on the same regimen of Calcium Vitamin D, Magnesium, and Calcium. Dr Shiga is currently in conversation with relevant parties on getting the patient on the trial with Encaleret.
APCO CICCDP Session 2 on 19 May 2024 - Case Updates
Case 1:
- Presented by Dr Charlotte Choo, Senior Resident, Department of Endocrinology, Singapore General Hospital
Case 2:
- Presented by Dr Kashish Gupta, Senior Resident at the Department of Endocrinology in SMS Medical College, Jaipur, India
- Post the case discussion on 19 may 2024, Dr Gupta initiated the patient on denosumab injection and instructed the patient to take the tests recommended by the panel.
- As of 25 Nov 2024, Dr Gupta is awaiting for the patient to return for a repeat visit.
APCO CICCDP Session 1 on 12 March 2024 - Case Updates
Case 1 :
- Presented by Dr Lưu Ngọc Linh, Resident at Pham Ngoc Thach University of Medicine in Vietnam
- The case involved a 20-year-old Male with pain in bilateral femurs for 4-5 months and an unknown family history who was found to have Primary Hyperparathyroidism. The panelists addressed Dr Linh’s questions on recommended screening tests for surveillance for MEN 1 and post-surgery actions. The fruitful discussion provided Dr Linh with a new direction in management of her clinical case.
- As of Sept 2024, the patient is doing well. Post-surgery, the patient is getting better, and regular follow-ups are being done with lab tests, including PTH, Ca, P, and DXA.
Case 2:
- Presented by Prof Moe Wint Aung and Dr Zar Chi Pyone, Department of Endocrinology, Yangon General Hospital in Myanmar
- At the CICCDP session, it was opined by the expert panelists that the diagnosis was more likely to be Camurati-Engelmann disease rather than Fibrous dysplasia or Paget's disease.
- After the case was presented in March 2024, a follow-up was conducted. A family member screening was done, and nothing was found in his brother. As the patient's IGF1 was normal, acromegaly was excluded. The patient was given Alandronate 70 mg per week for 6 months till September. His pain is controlled with simple analgesics. ALP and renal function will be checked during the patient's next follow-up.
- In the Sept 2024 follow-up, the patient's bone pain has reduced, cardiac status (small VSD) is stable, and biochemical profile ALP is slightly decreased. Patient appearance is the same, and his skull and long bones X-rays are the same as previous scans. The patient is now given ARB (Telmisartan ) 20 mg OD for 2 months.
APCO CICCDP Pilot Session on 27 November 2023 - Case Updates
Case 1:
- Presented by Dr Charlotte Choo, Senior Resident, Department of Endocrinology, Singapore General Hospital
Case 2:
- Presented by Dr. Muhammad Umer Effendi, Resident-III, Chemical Pathology, Pathology & Laboratory Medicine, The Aga Khan University