ORCID Profile
0000-0001-8451-2385
Current Organisations
Royal Brisbane and Women's Hospital
,
The Wesley Hospital
,
Queensland Physician Care
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Publisher: Wiley
Date: 2022
DOI: 10.1111/IMJ.15655
Abstract: A 35‐year‐old man with known human immunodeficiency virus experienced chronic diarrhoea for 18 months. He presented to multiple hospitals with profuse secretory diarrhoea and life‐threatening electrolyte disturbances. Infectious and non‐infectious aetiologies were considered, with focussed history and investigations ultimately leading to a diagnosis of VIPoma. Initiation of somatostatin analogue therapy followed by surgical resection led to complete resolution of symptoms and markedly improved quality of life.
Publisher: Mary Ann Liebert Inc
Date: 07-2021
Publisher: Wiley
Date: 04-10-2023
DOI: 10.1111/IMJ.16247
Publisher: Mary Ann Liebert Inc
Date: 06-2021
Publisher: Mary Ann Liebert Inc
Date: 04-01-2022
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.IJANTIMICAG.2022.106587
Abstract: Azoles are among the most effective and widely used class of antifungals for prophylaxis as well as empirical and directed therapy against yeast and mould infections. Their use appears to be increasing worldwide. All triazoles cause hepatotoxicity, drug-drug interactions, and QTc prolongation (except isavuconazole) however, there are growing concerns following increasing reports of off-target endocrinologic adverse events. Skeletal fluorosis, pseudohyperaldosteronism, adrenal insufficiency, hyponatraemia and hypogonadism have all been documented in relation to azole use, causing considerable morbidity. The following review provides new insights into the clinical incidence and underlying pathophysiology of azole-associated endocrinopathies. Routine clinical and biochemical monitoring (including therapeutic drug monitoring) of endocrinologic adverse events may play a role in their prevention and progression. Novel azoles in preclinical and clinical stages of development may offer therapeutic advantages due to their greater selectivity of binding to fungal CYP51. The integration of pharmacogenomics into routine clinical practice holds future promise in guiding antifungal drug and dose selection to reduce the risk of off-target phenomena, including endocrinologic adverse events.
Publisher: Frontiers Media SA
Date: 13-07-2021
DOI: 10.3389/FENDO.2021.667403
Abstract: The safety and efficacy of feminizing hormone therapy in aging transgender (trans) in iduals is unclear. Current recommendations suggest transdermal estradiol beyond the age of 45 years, especially if cardiometabolic risk factors are present. To evaluate feminizing hormone therapy regimens and cardiovascular risk factors in aging trans in iduals. Retrospective cross-sectional analysis. Primary care and endocrine specialist clinic in Melbourne, Australia. Trans in iduals on feminizing therapy for ≥6 months. Feminizing hormone regimens and serum estradiol concentrations by age group: (a) ≥45 years, (b) & years, and prevalence of cardiometabolic risk factors in in iduals ≥45 years. 296 in iduals were stratified by age group: ≥45 years ( n =55) and & years ( n =241). There was no difference in median estradiol concentration between groups (328 nmol/L vs . 300 nmol/L, p=0.22). However, there was a higher proportion of in iduals ≥45 years treated with transdermal estradiol (31% vs. 8%, p& .00001). Of those treated with oral estradiol, the median dose was lower in the ≥45 years group (4mg vs. 6mg, p=0.01). The most prevalent cardiometabolic risk factor in the ≥45 years group was hypertension (29%), followed by current smoking (24%), obesity (20%), dyslipidaemia (16%) and diabetes (9%). A greater proportion of trans in iduals ≥45 years of age were treated with transdermal estradiol. Of those who received oral estradiol, the median dose was lower. This is important given the high prevalence of cardiometabolic risk factors in this age group, however cardiovascular risk management guidelines in this demographic are lacking.
Publisher: The Endocrine Society
Date: 05-2021
DOI: 10.1210/JENDSO/BVAB048.431
Abstract: Background: Heterotopic ossification (HO) is a rare disease characterised by abnormal bone growth in non-osseous tissues, causing pain, immobility and impaired quality of life. Although still being elucidated, the underlying pathophysiology may relate to local macrophage-driven inflammation in response to trauma1. Case: A 35-year-old man involved in a motor vehicle accident (MVA) fractured over twenty bones (multiple vertebrae, ribs and complex open book pelvic fracture with shattered left acetabulum) with extensive soft tissue injuries requiring multiple surgeries. Past medical history included a renal calculus three years earlier. His serum corrected calcium on admission was elevated at 2.87mmol/L (2.10-2.60mmol/L). Peri-operative fluid over-resuscitation necessitated boluses of intravenous furosemide, and serum calcium transiently normalised before rapidly incrementing and peaking at 3.04 mmol/L. Serum parathyroid hormone post-operatively was inappropriately high at 9.4pmol/L (1.0–7.0pmol/L) and 25-hydroxyvitamin D low at 24nmol/L (50-150nmol/L). Oral vitamin D replacement was commenced and he received intravenous pamidronate (3x60mg infusions) which briefly restored normocalcaemia. Neck ultrasound and sestamibi scintigraphy demonstrated a left parathyroid adenoma, and he underwent parathyroidectomy. Histology revealed a single parathyroid adenoma. He has been normocalcaemic since surgery. Despite excellent overall recovery, mobility at the left hip remained restricted in all planes of movement. He could not perform simple activities such as putting on his shoe. Plain radiographs showed HO lateral to the left acetabulum, femoral head and neck, with bony bridging to the left ilium on computed tomography. Bone turnover markers (BTMs) measured eleven months post-MVA (and pamidronate) were elevated, with CTX of 750ng/L (100-600ng/L) and P1NP of 207ug/L (15-80ug/L). BTMs gradually reduced over time, plateauing two years post-MVA (CTX 480ng/L and P1NP 103ug/L). Surgery with pre-operative radiotherapy to remove the left hip HO is now planned. Discussion: This man had multiple recognised risk factors for HO, including male sex, trauma followed by immobilisation and pelvic fracture. His hyperparathyroidism may have predisposed HO development through excess calcium-phosphate product promoting soft tissue calcification. Bisphosphonates may also increase the risk2. Elevated BTMs have been demonstrated in the early phase of HO further research may elucidate whether BTMs can guide timing of surgical intervention relative to the pathophysiological processes driving HO. References: 1 Meyers C et al. Heterotopic Ossification: A Comprehensive Review. JBMR Plus 2019, 3: e10172 2 Genêt F et al. Neurological heterotopic ossification following spinal cord injury is triggered by macrophage-mediated inflammation in muscle 2015. J Pathol. 236(2):229–40
Publisher: Mary Ann Liebert Inc
Date: 07-2022
Publisher: Mary Ann Liebert Inc
Date: 09-2022
Publisher: Mary Ann Liebert Inc
Date: 03-2022
Publisher: Mary Ann Liebert Inc
Date: 10-2021
Publisher: Wiley
Date: 06-10-2021
DOI: 10.1002/JBM4.10557
Abstract: Voriconazole‐associated periostitis (VAP) is an underrecognized and unpredictable side effect of long‐term voriconazole therapy. We report two cases of VAP occurring in the post‐transplant setting: a 68‐year‐old lung transplant recipient who required ongoing voriconazole therapy, in whom urinary alkalinization was used to promote fluoride excretion and minimize voriconazole‐related skeletal toxicity, and a 68‐year‐old stem‐cell transplant recipient with a high voriconazole dose requirement, identified on pharmacogenomic testing to be a CYP2C19 ultrarapid metabolizer, the dominant enzyme in voriconazole metabolism. This is the first reported case of pharmacogenomic profiling in VAP and may explain the variability in in idual susceptibility to this uncommon adverse effect. Our findings provide new insights into both the management and underlying pathophysiology of VAP. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
No related grants have been discovered for Matthew Balcerek.