Hyperparathyroidism

Management Team

Hyperparathyroidism

Overview

Hyperparathyroidism occurs when the parathyroid glands tend to produce high levels of parathyroid hormone, which result in high calcium levels in the blood. It can be primary (due to gland abnormalities) or secondary (often related to chronic kidney disease).

Kidney stones, bone pain, fatigue, and depression.

Blood tests to assess calcium and parathyroid hormone levels, as well as imaging studies to identify gland abnormalities.

Depends on the cause and severity and includes monitoring, medications, and/or surgery to remove overactive glands. Managing hyperparathyroidism helps prevent complications like osteoporosis and kidney damage.

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Hirsutism

Management Team

Hirsutism

Overview

Hirsutism refers to excessive growth of hair in women presenting in areas where hair is usually sparse or absent, including the face and chest.

Hormonal imbalances, particularly elevated levels of androgens. Conditions like PCOS and certain medications can cause hirsutism. If you notice excessive facial or body hair growth, it may indicate an underlying medical issue. Thus, it is advisable to consult an endocrinologist if you experience significant or sudden hair growth on your face or body persisting for a few months.

Evaluation of medical history, symptoms, and hormone levels through blood tests.

Medications to reduce androgen levels or inhibit hair growth as well as cosmetic treatments like laser hair removal or electrolysis. Managing underlying conditions contributing to hirsutism is important for effective treatment and improving the patient’s quality of life.

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Hypothyroidism

Management Team

Hypothyroidism

Overview

Hypothyroidism occurs when the is inadequate production of thyroid hormones in the thyroid gland, leading to a slow metabolism.

Autoimmune diseases like Hashimoto’s thyroiditis, thyroid surgery, or certain medications.

Fatigue, weight gain, cold intolerance, and depression

Blood tests to assess thyroid hormone and TSH levels.

Taking synthetic thyroid hormones (levothyroxine) to restore normal levels. Early diagnosis and treatment can improve symptoms and prevent complications like heart disease and mental health issues, so please contact your doctor if you are feeling tired for no reason or if you have any of the above-mentioned symptoms.

If you are taking thyroid hormone medications for hypothyroidism, adhere to your healthcare provider's guidance on the frequency of medical visits. Initially, you may require regular appointments to ensure that you are receiving the correct medication dosage. As time progresses, periodic follow-up check-ups will be necessary for your healthcare provider to oversee your health status and medication effectiveness.

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Hypoglycaemia

Management Team

Hypoglycaemia

Overview

Hypoglycaemia is a condition manifested by abnormally low levels of blood sugar. It frequently occurs in people having diabetes who use insulin or any specific medications.

Skipping meals, excessive physical activity, or too much insulin.

Confusion, shakiness, sweating, and even loss of consciousness in severe cases.

Measuring blood sugar levels during an episode.

Rapid consumption of fast-acting carbohydrates like glucose tablets or fruit juice can elevate blood sugar levels. Preventing hypoglycaemia involves regular monitoring, adjusting medications, and eating balanced meals. Education on recognising and treating hypoglycaemia is essential for the management of diabetes in diagnosed individuals.

If someone with diabetes or a history of low blood sugar levels experiences severe symptoms or loses consciousness and is not responding to treatments such as drinking juice, eating candy, or taking glucose tablets, it's crucial to seek immediate emergency assistance.

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HbA1c Testing

Management Team

HbA1c Testing

Overview

HbA1c testing assesses the average levels of blood glucose over the previous 2–3 months, providing a picture of long-term glucose control. It is used to diagnose and monitor diabetes.

Elevated HbA1c levels suggest poor blood sugar management and a heightened risk of diabetes-related complications. The test is simple and doesn’t require fasting.

Managing HbA1c includes lifestyle changes like healthy eating habits, regular exercise, and medications to control blood sugar levels. Regular HbA1c testing helps patients and healthcare providers adjust treatment plans to achieve and maintain optimal blood sugar control.

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Hypersensitivity Pneumonitis

Management Team

Hypersensitivity Pneumonitis

Overview

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is an inflammatory lung disease that is caused by repeated inhalation of organic dusts or other antigens to which an individual is sensitised. These antigens can include mould spores, bacteria, animal proteins, or chemicals found in workplaces or home environments.

HP develops when the immune system exhibits an exaggerated response to these inhaled antigens. Initially, exposure leads to an immune reaction in the small airways and air sacs (alveoli) of the lungs, causing inflammation. With repeated exposure over time, chronic inflammation can lead to scarring of the lung tissue.

Symptoms of HP can vary depending on the frequency and intensity of antigen exposure. Common symptoms include dry cough, shortness of breath, fatigue and weight loss and flu-like symptoms, particularly after exposure to the antigen.

Diagnosis involves a combination of clinical evaluation, imaging-based techniques (e.g., chest X-ray or high-resolution CT scan), pulmonary function tests (PFTs), and sometimes bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy to confirm the presence of inflammation and rule out other lung diseases.

Treatment includes avoiding further exposure to the offending antigen, which is crucial in managing symptoms and preventing disease progression. In some cases, corticosteroids may be prescribed to reduce inflammation. Severe cases may require immunosuppressive therapy, and in rare instances, lung transplantation.

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Huntington’s Disease

Management Team

Huntington’s Disease

Overview

Huntington’s disease is an untreatable, autosomal dominant genetic movement disorder. The disease shows anticipation, meaning subsequent generations are affected at an earlier age. It usually starts at 40–50 years of age.

CAG nucleotide repeats expansion in the huntingtin gene HTT

  • Hereditary
  • Child has a 50% chance of developing if parent has it
  • If the child does not develop the disease, it will not be passed on
  • No family history identified for 1-3% of people with Huntington disease

  • Altered body postures
  • Uncontrollable dance-like movements (chorea)
  • Issues with behaviour, sentiments, and thoughts
  • Parkinsonism (associated with juvenile onset Westphal variant)
  • Psychiatric features (personality changes, aggressive behaviour)
  • Dystonia
  • Dementia
  • Progressive weight loss

Neurologist

  • Family history and clinical evaluation of symptoms
  • Genetic testing
  • MRI Brain to determine caudate head atrophy

  • Symptomatic treatment for chorea and dystonia
  • Antipsychotics for behaviour management
  • Prevention of repetitive falls due to chorea
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Horner’s Syndrome

Management Team

Horner’s Syndrome

Overview

Horner’s syndrome is a rare type of oculosympathetic nerve palsy wherein the sympathetic nerves that control the eyes and face are damaged.

  • Lesion of the primary neuron
  • Lesion of the postganglionic neuron
  • Trauma to the brachial plexus
  • Brainstem tumour, stroke, syrinx of the preganglionic neuron
  • Carotid artery ischemia
  • Tumours (e.g. Pancoast) or infection of the lung apex
  • Dissecting carotid aneurysm
  • Internal jugular vein catheterization
  • Middle cranial fossa neoplasm
  • Migraine

  • Trauma to the neck or head, or damage to the nerves or carotid artery during birth or surgery
  • Benign or malignant tumours in the lungs, thyroid, hypothalamus, or cervical nerves 
  • Middle ear infections or other infections 
  • Stroke, aneurysm, embolism, or carotid artery dissection
  • Migraines or cluster headaches
  • Family history
  • Multiple sclerosis or other diseases that affect the protective covering of neurons

  • Small sized pupil
  • Eye retraction
  • Drooping of eye lid or elevation of lower eyelid
  • Decreased sweating over side of face affected
  • Pallor of side of face affected

Neurologist

  • Treatment of underlying condition
  • No specific cure
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H

HIV-associated Neurocognitive Disorders (HAND)

Management Team

HIV-associated Neurocognitive Disorders (HAND)

Overview

HAND, previously termed HIV-associated neurological disorders, encompasses a range of neurocognitive impairments linked to HIV infection.

  • HIV-associated dementia (HAD)
    Occurs in advanced stages of HIV and is characterized by difficulties in attention, memory loss, and apathy. Early signs include jerky eye movements, hyperreflexia, and cerebellar dysfunction.

    Diagnosis

    • Investigations to rule out alternative conditions
    • MRI shows atrophy and diffuse white matter changes
    • CSF examination to check non-specific cytochemical abnormalities
    • Neuropsychological assessment —to investigate abnormal information processing, psychomotor speed, and recall memory
  • Vascular myelopathy (VM)
    Typically co-occurs with HIV dementia, presenting as spastic paraparesis without a distinct sensory level. Resembles subacute combined degeneration seen in vitamin B12 deficiency.

    Diagnosis

    • MRI for imaging changes
    • Vitamin B12 and homocysteine levels.
    • HTLV-1 serology to detect co-infection
  • Distal sensory peripheral neuropathy (DSPN)
    Appears in late-stage AIDS approximately 25% of patients, with paraesthesia, burning pain, and dysesthesia. Weakness is minimal, ankle reflexes are diminished or absent, pain temperature sensations impaired.

    Diagnosis

    • Assess vitamin B12 and glucose levels
    • Nerve conduction studies may indicate an axonal neuropathy.
    • Nerve biopsy (rarely needed)
  • Other peripheral nerve syndromes including
    • Mononeuritis multiplex: Associated with HIV vasculitis and CMV.
    • Demyelinating polyneuropathy
    • Diffuse inflammatory lymphocytosis syndrome (DILS): mimics Sjögren’s syndrome, occurs during immunocompetent stages, and is linked to elevated CD8+ cell counts
    • Polyradiculopathy
  • Myopathy
    • Polymyositis: Seen in early HIV stages.
    • Zidovudine-Induced Myopathy: Linked to mitochondrial dysfunction.
  • Opportunistic infections
    Causes, symptoms, and diagnosis
    • Toxoplasmosis: Results in multiple ring-enhancing brain lesions, leading to increased intracranial pressure and headaches.
    • Cryptococcal meningitis causes headache, altered mental status, and meningism. MRI reveals meningeal enhancement and hydrocephalous. CSF may reveal pleocytosis.
    • Progressive multifocal leukoencephalopathy (PML): caused by JC virus reactivation. Symptoms include headache and focal signs. MRI presents white matter abnormalities, while CSF investigations detect presence of JC virus.
    • CMV infection: causes meningoencephalitis, polyradiculopathy. CSF testing confirms presence of CMV virus.

  • Older age
  • A low count of CD4+ cells
  • Advanced stage of HIV infection
  • Substance use
  • Comorbid conditions such as depression and anxiety
  • Low educational level
  • Other medical conditions such as hypertension, hyperlipidaemia, diabetes, and CVD
  • Traumatic brain injury
  • Antiretroviral therapy

Neurologist/ Infectious disease specialist

  • Symptomatic
  • Management of underlying infections
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Herpes Simplex Encephalitis

Management Team

Herpes Simplex Encephalitis

Overview

Herpes simplex encephalitis refers to a brain parenchyma infection caused due to herpes simplex viral infection. It leads to inflammation and swelling of brain parenchyma and covering of the brain (meninges).

Herpes simplex virus infection

  • Genetic defects in the Toll-like receptor (TLR3)-interferon (IFN) and IFN-responsive pathways
  • Chemotherapy and chronic alcoholism
  • History of substance abuse
  • A past medical history of sinusitis or psychotic disorders

  • Fever
  • Headache
  • Altered sensorium- confusion, disorientation, coma
  • Neck stiffness
  • Seizures
  • Weakness, nausea, vomiting
  • If not treated timely and adequately, may prove to be life threatening

Neurologist

  • CSF examination to determine pleocytosis
  • MRI brain to determine contrast enhancement in temporal areas, or vasculitic infarcts
  • EEG to check periodic lateralized discharges.
  • Blood tests for HIV antibodies

  • Antiviral therapy (acyclovir)
  • Supportive care- management of seizures, fluid replenishment, hydration and calory supplementation
  • ICU care may be required
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