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Case Report: An Unusual Etiology of Hypokalemia in a Patient With an Eating Disorder
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Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 167e187
pregnant (25%); broke a condom on purpose so that I would get pregnant (13%); made me have sex without a condom so I would get pregnant (13%).” Girls reporting reproductive coercion were less likely than those not reporting coercion to have used a condom at last sex [3/12 (25%) vs. 41/ 65 (63%), p <0.05] and more likely to report ever having chlamydia [4/11 (36%) vs. 7/65 (11%), p<0.05], respectively. Girls who experienced reproductive coercion were more likely than those not reporting coercion to also report physical IPV, i.e. being hit, pushed, slapped or physically hurt by a romantic/sexual partner [6/12 (50%) vs. 10/65 (16%), p < 0.01], respectively. A higher proportion of girls reporting reproductive coercion had ever been pregnant [2/12 (17%) vs. 5/65 (8%), p¼0.3], a difference that is clinically meaningful but not statistically significant. Conclusion: We found a prevalence of reproductive coercion in our sample of urban high-school-aged girls similar to that found in adult women. Also consistent with adult women, reproductive coercion in 14-17 year-old girls is associated with unprotected sex, sexually transmitted infection, and intimate partner violence. Awareness of the high prevalence and health risks associated with reproductive coercion in this young age group may allow for identification of high-school-aged girls most at risk of contraceptive failure and intimate partner violence and provide opportunities for intervention. 23. Case Report: An Unusual Etiology of Hypokalemia in a Patient With an Eating Disorder Kelly A. Curran MD, MA, Amy B. Middleman MD, MSEd, MPH* Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
Background: Patients with eating disorders are at risk for electrolyte imbalances that can lead to life-threatening medical complications including heart failure, arrhythmia, muscular weakness and paralysis, respiratory failure and death. Timely recognition of electrolyte abnormalities and identification of their etiology is essential to prevent complications and place appropriate safety measures to prevent ongoing dangerous behavior. Case: An adolescent with known past history of familial prolonged QT syndrome, with recurrent weakness with syncopal episodes thought to be secondary to postural orthostatic tachycardia syndrome, was admitted to the adolescent medicine service for treatment of disordered eating behaviors. On admission, she endorsed fear of gaining weight and becoming fat, restricted food intake, hyper-exercise and weight loss prior to admission. She also related a three-week history of purposefully inducing vomiting twice daily, though her family suspected that the vomiting began several months prior. Laboratory evaluation revealed hypokalemia and mild hypochloremia. She was placed on the disordered eating protocol, which included strict monitoring. Despite these measures, her potassium trended down during early hospitalization. On in-depth review on her past medical and family history, the family disclosed that the patient had a long-standing history of episodic hypokalemia of unclear etiology and other maternal family members had experienced similar episodic hypokalemia requiring chronic potassium supplementation. During hospitalization, potassium slowly trended back to normal. The adolescent medicine team was suspicious of genetic causes of hypokalemia in addition to disordered eating behaviors. Laboratory evaluation of hypokalemia was pursued and genetics was consulted. Genetic testing revealed a novel splice site variant in CACNA1S, which encodes for voltage-dependent L-type calcium channel alpha1S subunit, expressed in skeletal muscle, which is associated with hypokalemic periodic paralysis. This mutation, which is predicted to cause disease, is currently labeled as a variant of uncertain significance. The patient’s family members are currently undergoing further genetic evaluation to assess causative nature of this gene mutation. Comments: When evaluating a patient with an eating disorder who has electrolyte abnormalities, it is important to consider the cause. While typically from disordered behaviors, electrolyte abnormalities should be thoroughly evaluated with careful thought to other more unusual causes, especially when patients fail to respond to typical treatment. This patient had a prior history of weakness with syncope associated with episodes of low to low-normal serum potassium levels, consistent with hypokalemic periodic paralysis. Identifying suspected familial hypokalemic periodic
paralysis in this case had significant diagnostic and treatment implications for this patient, but also for her family members, and changed our management. 24. A Unique Opportunity: Aplication of Subdermic Implant to Adolescents in a Low Resource Area ~ a-Santoven ~ a MD 1,2, Godinez- LI T. Arroyo-Lemarroy MD 1,2, V. Santoven zquez-Martin del Campo 2, MD 1, E. Bermeo- Villarreal 2, P. Va ndez-Escobar MD*2 C.E. Herna n, Hospital Metropolitano “Dr. Bernardo Sepulveda”, Monterrey, Nuevo Leo M exico 2 gico de Monterrey Tecnolo 1
Background: In Mexico, 53.8% of the population between 0-17 years old lives in poverty. In year 2005, 144,6770 women between 12 and 18 years old had not concluded basic education, and they were in their first pregnancy or have had a child already. Introduction of Long-Acting Reversible Contraception (LARC) Methods in developing countries is not only a health problem, but also a social concern that involves improvement on education and economy status for future generations. Methods: A descriptive study of 146 women between 13 and 19 years old, who had a subdermic implant inserted between 2013 and 2015. Clinical records were reviewed to evaluate characteristics of the population and attendance for follow-up visits. A telephone interview was performed to evaluate satisfaction and continuity of the method. Results: The median age of subdermic implant insertion was 18 years old, the follow-up at one week, 1 month and 6 months was evaluated, rate of attendance was 24.6 %, 20.4% and 13.3% respectively. A total of 106 phone calls were done; only 23 patients answered the questionnaire. Survey yield the following results 21.7% of patients had the implant removed, 60% of them secondary to headache, none of the patients in this group desired pregnancy, therefore they initiated another contraception method immediately, OCP’s in 40.0 % of cases. 50% of this group got pregnant after removal of the implant even with the use of another contraception method. 23 patients were interviewed about satisfaction, 95.0% would recommend this method and 60% reported maximum satisfaction in a scale of 0 to 5. Conclusions: In a second level hospital of a low resource area, rate of attendance to follow-up visits is low, lack of home ownership and local migration makes difficult to look for the adolescents in this area. Women under 19 years old are a pregnancy high-risk population, each visit to the hospital may be the only chance to avoid a future non-planned pregnancy, LARC Methods need to be strongly offered. 25. Effects of Cross-Sex Hormone Treatment on Adolescents With Gender Dysphoria J. Jarin MD 1, G. Trotman MD 2, E. Pine-Twaddell MD 3, L.A. Conard DO 2, J. Stevens MD 3, V. Gomez-Lobo MD*1 1
Washington Hospital Center and Children’s National Medical Center, Washington, DC Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 3 University of Maryland, Baltimore, MD 2
Background: Gender Dysphoria (GD) is the condition encountered in individuals experiencing significant distress due to persistent crossgender identification and discomfort with one’s assigned sex. The Endocrine Society Guidelines recommend that adolescents with a diagnosis of GD may start cross-sex hormones. The aim of this study is to identify patterns in metabolic and cardiovascular parameters in transgender adolescents receiving cross-sex hormone treatment. Methods: This study analyzed databases maintained for the care of patients with GD at Medstar Washington Hospital Center, Children’s National Medical Center, Cincinnati Children’s Hospital Medical Center and University of Maryland. Data from adolescents age 14-21 receiving cross-sex hormone therapy from 2008 to 2014 were included in this study. Subjects were divided into 2 separate groups: Female to Male (FTM) patients on
Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 167e187
pregnant (25%); broke a condom on purpose so that I would get pregnant (13%); made me have sex without a condom so I would get pregnant (13%).” Girls reporting reproductive coercion were less likely than those not reporting coercion to have used a condom at last sex [3/12 (25%) vs. 41/ 65 (63%), p <0.05] and more likely to report ever having chlamydia [4/11 (36%) vs. 7/65 (11%), p<0.05], respectively. Girls who experienced reproductive coercion were more likely than those not reporting coercion to also report physical IPV, i.e. being hit, pushed, slapped or physically hurt by a romantic/sexual partner [6/12 (50%) vs. 10/65 (16%), p < 0.01], respectively. A higher proportion of girls reporting reproductive coercion had ever been pregnant [2/12 (17%) vs. 5/65 (8%), p¼0.3], a difference that is clinically meaningful but not statistically significant. Conclusion: We found a prevalence of reproductive coercion in our sample of urban high-school-aged girls similar to that found in adult women. Also consistent with adult women, reproductive coercion in 14-17 year-old girls is associated with unprotected sex, sexually transmitted infection, and intimate partner violence. Awareness of the high prevalence and health risks associated with reproductive coercion in this young age group may allow for identification of high-school-aged girls most at risk of contraceptive failure and intimate partner violence and provide opportunities for intervention. 23. Case Report: An Unusual Etiology of Hypokalemia in a Patient With an Eating Disorder Kelly A. Curran MD, MA, Amy B. Middleman MD, MSEd, MPH* Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
Background: Patients with eating disorders are at risk for electrolyte imbalances that can lead to life-threatening medical complications including heart failure, arrhythmia, muscular weakness and paralysis, respiratory failure and death. Timely recognition of electrolyte abnormalities and identification of their etiology is essential to prevent complications and place appropriate safety measures to prevent ongoing dangerous behavior. Case: An adolescent with known past history of familial prolonged QT syndrome, with recurrent weakness with syncopal episodes thought to be secondary to postural orthostatic tachycardia syndrome, was admitted to the adolescent medicine service for treatment of disordered eating behaviors. On admission, she endorsed fear of gaining weight and becoming fat, restricted food intake, hyper-exercise and weight loss prior to admission. She also related a three-week history of purposefully inducing vomiting twice daily, though her family suspected that the vomiting began several months prior. Laboratory evaluation revealed hypokalemia and mild hypochloremia. She was placed on the disordered eating protocol, which included strict monitoring. Despite these measures, her potassium trended down during early hospitalization. On in-depth review on her past medical and family history, the family disclosed that the patient had a long-standing history of episodic hypokalemia of unclear etiology and other maternal family members had experienced similar episodic hypokalemia requiring chronic potassium supplementation. During hospitalization, potassium slowly trended back to normal. The adolescent medicine team was suspicious of genetic causes of hypokalemia in addition to disordered eating behaviors. Laboratory evaluation of hypokalemia was pursued and genetics was consulted. Genetic testing revealed a novel splice site variant in CACNA1S, which encodes for voltage-dependent L-type calcium channel alpha1S subunit, expressed in skeletal muscle, which is associated with hypokalemic periodic paralysis. This mutation, which is predicted to cause disease, is currently labeled as a variant of uncertain significance. The patient’s family members are currently undergoing further genetic evaluation to assess causative nature of this gene mutation. Comments: When evaluating a patient with an eating disorder who has electrolyte abnormalities, it is important to consider the cause. While typically from disordered behaviors, electrolyte abnormalities should be thoroughly evaluated with careful thought to other more unusual causes, especially when patients fail to respond to typical treatment. This patient had a prior history of weakness with syncope associated with episodes of low to low-normal serum potassium levels, consistent with hypokalemic periodic paralysis. Identifying suspected familial hypokalemic periodic
paralysis in this case had significant diagnostic and treatment implications for this patient, but also for her family members, and changed our management. 24. A Unique Opportunity: Aplication of Subdermic Implant to Adolescents in a Low Resource Area ~ a-Santoven ~ a MD 1,2, Godinez- LI T. Arroyo-Lemarroy MD 1,2, V. Santoven zquez-Martin del Campo 2, MD 1, E. Bermeo- Villarreal 2, P. Va ndez-Escobar MD*2 C.E. Herna n, Hospital Metropolitano “Dr. Bernardo Sepulveda”, Monterrey, Nuevo Leo M exico 2 gico de Monterrey Tecnolo 1
Background: In Mexico, 53.8% of the population between 0-17 years old lives in poverty. In year 2005, 144,6770 women between 12 and 18 years old had not concluded basic education, and they were in their first pregnancy or have had a child already. Introduction of Long-Acting Reversible Contraception (LARC) Methods in developing countries is not only a health problem, but also a social concern that involves improvement on education and economy status for future generations. Methods: A descriptive study of 146 women between 13 and 19 years old, who had a subdermic implant inserted between 2013 and 2015. Clinical records were reviewed to evaluate characteristics of the population and attendance for follow-up visits. A telephone interview was performed to evaluate satisfaction and continuity of the method. Results: The median age of subdermic implant insertion was 18 years old, the follow-up at one week, 1 month and 6 months was evaluated, rate of attendance was 24.6 %, 20.4% and 13.3% respectively. A total of 106 phone calls were done; only 23 patients answered the questionnaire. Survey yield the following results 21.7% of patients had the implant removed, 60% of them secondary to headache, none of the patients in this group desired pregnancy, therefore they initiated another contraception method immediately, OCP’s in 40.0 % of cases. 50% of this group got pregnant after removal of the implant even with the use of another contraception method. 23 patients were interviewed about satisfaction, 95.0% would recommend this method and 60% reported maximum satisfaction in a scale of 0 to 5. Conclusions: In a second level hospital of a low resource area, rate of attendance to follow-up visits is low, lack of home ownership and local migration makes difficult to look for the adolescents in this area. Women under 19 years old are a pregnancy high-risk population, each visit to the hospital may be the only chance to avoid a future non-planned pregnancy, LARC Methods need to be strongly offered. 25. Effects of Cross-Sex Hormone Treatment on Adolescents With Gender Dysphoria J. Jarin MD 1, G. Trotman MD 2, E. Pine-Twaddell MD 3, L.A. Conard DO 2, J. Stevens MD 3, V. Gomez-Lobo MD*1 1
Washington Hospital Center and Children’s National Medical Center, Washington, DC Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 3 University of Maryland, Baltimore, MD 2
Background: Gender Dysphoria (GD) is the condition encountered in individuals experiencing significant distress due to persistent crossgender identification and discomfort with one’s assigned sex. The Endocrine Society Guidelines recommend that adolescents with a diagnosis of GD may start cross-sex hormones. The aim of this study is to identify patterns in metabolic and cardiovascular parameters in transgender adolescents receiving cross-sex hormone treatment. Methods: This study analyzed databases maintained for the care of patients with GD at Medstar Washington Hospital Center, Children’s National Medical Center, Cincinnati Children’s Hospital Medical Center and University of Maryland. Data from adolescents age 14-21 receiving cross-sex hormone therapy from 2008 to 2014 were included in this study. Subjects were divided into 2 separate groups: Female to Male (FTM) patients on