Sarah Tariq

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• Ebrahimi, N., Rivas Pajuelo, C. G., Habibi, R., Tariq, S., & Penquite, S. A. (2023). FRI218 Von Hippel-Lindau With Pheochromocytoma And Severe Orthostatic Hypotension. Journal of the Endocrine Society, 7(Supplement_1). doi:10.1210/jendso/bvad114.213
• Tariq, S. (2022). A case of Polyglandular Autoimmune Syndrome. Journal of the Endocrine Society, 4.
• Tariq, S. (2021). The Biggest Man in the Room. Journal of the Endocrine Society, 5(Supplement_1), A613-A614. doi:10.1210/jendso/bvab048.1251
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  Abstract A 42 year old gentleman who had been healthy all his life, began to develop new clinical symptoms including acid reflux. He was tested for H. Pylori by his PCP, and treatment was initiated. During this visit he was also noted to have elevated BP and was ultimately diagnosed with HTN, and started on anti-hypertensives. During these revelations he brought up the fact that he has also developed excessive joint pains over the years, and his shoe size has increased from the age of 30 to now by 3 sizes. When asked, he admitted to noticing an increase in his hands size, and also noted that his rings do not fit anymore. His fiancée works in medicine and requested he be screened for acromegaly, thus PCP checked IGF-1 and GH levels, which were noted to be significantly elevated at 887 and 20.9, respectively, leading to a referral to Endocrinology. Under Endocrinology care he underwent a GH suppression test resulting in a non-suppressed GH at 17.8. This was followed by a Pituitary MRI revealing an 18 x 19 x 18 mm solid/partially cystic hypoenhancing lesion consistent with a pituitary macroadenoma, with leftward deviations of the infundibulum, without involvement of the optic chiasm. He was treated with transsphenoidal resection of the pituitary tumor. On post-op day 4, the IGF level had fallen to 456. His thyroid and gonadal axes were assessed and did not show any evidence of deficiency post-operatively. He was however started on Prednisone post-operatively, and was switched to Hydrocortisone in the outpatient setting with plans to taper and re-assess his HPA axis. Overall he is doing well, and there are plans for repeat labs and imaging about 6 weeks post-operatively. When evaluating patients with a variety of newly developing symptoms, remember to consider a unified diagnosis that could explain the cluster of symptoms that they are experiencing. Although rare, pituitary disorders such as Acromegaly should be explored in patients with clinical features of growth hormone excess, such as macrognathia, enlargement of the hands and feet, and in addition development of other clinical symptoms such OSA, CVD, Type 2 DM, and arthropathies.
• Tariq, S. (2020). SAT-215 A Case of Polyglandular Autoimmune Syndrome. Journal of the Endocrine Society, 4(Supplement_1). doi:10.1210/jendso/bvaa046.1847
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  Abstract Background: Polyglandular autoimmune syndrome is defined by the presence of Addison’s disease, Autoimmune thyroid disease and Type 1 Diabetes Mellitus. Clinical Case: This is a case presentation of a 56 year old female with a multitude of endocrine disorders, classified as polyglandular autoimmune syndrome, type 2, persistently elevated ACTH levels. Over the years, the diagnoses of Primary Adrenal Insufficiency, Type 1 Diabetes, and Hypothyroidism, had revealed themselves, in this patient. Her initial diagnosis upon establishment into our clinic was Addison’s disease and hypothyroidism for which she was getting adequate treatment. Her clinical course had been complicated by multiple admissions for DKA, along with adrenal crises. Following the adrenal crisis, her ACTH levels had been noted to be persistently elevated, at 3362, despite hydrocortisone replacement at optimal dosing and normal AM cortisol levels. Her hyperpigmentation continued to worsen. A 1mg dexamethasone suppression test failed to lower the ACTH levels. Concern for a possible ectopic ACTH secretion prompted further investigation with imaging studies such as an abdominal Cat scan which showed no adrenal pathology. Pituitary MRI was ultimately performed which showed no evidence of pituitary lesions. These were following by an 8mg Dexamethasone suppression test which adequately decreased the ACTH level. However re-check of ACTH levels, after weeks of being on her physiological hydrocortisone dosing, showed that her ACTH levels had started to rise again. Given she had also had multiple admissions for adrenal crises, the concern was raised for possible malabsorption. Given her risk for auto-antibody development, there was concern for another autoimmune process such as Celiac disease, as a potential cause for malabsorption. Her TTG IgA antibodies were checked, however they were absent. At this point, the decision was made to use prednisone as a means of suppression of ACTH, and she was given three days of 40mg Prednisone daily, followed by ACTH level testing, which showed a decrease from 2009 to 708. These results prompted us to change her hydrocortisone to prednisone daily dosing instead, and we converted her to a slightly higher dose of Prednisone. In the setting of underlying DM, this may pose an additional challenge with glycemic control, but we plan for close clinic follow up and repeat ACTH levels a few weeks after she has been on the new prednisone regimen. Conclusion: This is a rare case of a patient with polyglandular autoimmune syndrome, type 2, with a persistently elevated ACTH level, requiring Prednisone, instead of hydrocortisone for treatment of primary adrenal insufficiency in efforts to reduce ACTH levels. References: Neufeld M, Maclaren NK, Blizzard RM, Two types of autoimmune Addison’s disease associated with different polyglandular autoimmune (PGA) syndromes. Medicine (Baltimore). 1981;60(5):355.