We will discuss the case of a 17-year-old male who initially presented to care with shortness of breath on exertion. His symptoms progressed over 7 months to include general weakness, anorexia, and malaise. He presented again to care with tachycardia and hypotension. A combination of dermatological manifestations of autoimmune disease, extensive family history of autoimmune disease, and electrolyte abnormalities prompted a bedside thyroid ultrasound, which led to investigation for thyroid disease. Hormone and antibody testing confirmed the diagnosis of autoimmune polyglandular syndrome type 2 (APS2), and he was successfully treated with levothyroxine, hydrocortisone, and fludrocortisone replacement. We present a case of APS2 in an unusual patient population, with a seldom reported initial manifestation. We will discuss diagnostic clues, investigations, management, and further monitoring of APS2. ResumeNous aborderons le cas d’un adolescent de 17 ans qui a d’abord consulté pour un essoufflement à l’effort. Ses symptômes ont évolué sur une période de sept mois et comprennent une faiblesse générale, une anorexie et un malaise. Puis, il a consulté de nouveau pour une tachycardie et une hypotension. Une combinaison de signes dermatologiques de maladie auto-immune, d’antécédents familiaux importants de maladie auto-immune et d’anomalies électrolytiques a conduit à la réalisation d’une échographie de la thyroïde au chevet du patient, ce qui a mené à la recherche d’une maladie thyroïdienne. Le dosage des hormones et le dépistage d’anticorps ont confirmé le diagnostic de polyendocrinopathie auto-immune de type 2 (PEA2), et il a été traité avec suc-cès par la lévothyroxine, l’hydrocortisone et la fludrocortisone de remplacement. Nous présentons un cas de PEA2 chez une population de patients inhabituelle, une manifestation initiale y étant rarement rapportée. Nous aborderons les pistes de diagnostic, les examens, la prise en charge et la surveillance accrue de la PEA2.

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serves to assist the decision makers in PGH in optimal utilization of oral anticoagulant medicines within the given budget while taking into consideration the benefits and risks of the newer versus conventional therapy. Objective: To determine the outcome of Primary Percutaneous Coronary Intervention (PPCI) for patients with ST Elevation Myocardial Infarction (STEMI), during non-office hours as compared to PPCI done during office hours via the HKL IJN Network (HISNET).Methods: Consecutive STEMI patients referred from HKL to IJN for PPCI between January 2015 and December 2016 were studied. Patients were subdivided into two groups, PPCI done during office hours and those done during non-office hours (Defined as weekend, and weekdays between 5pm till 8am). Patient's demographics as well as in hospital mortality, 30 day mortality, 6 months mortality, 1 year mortality and MACE were observed. MACE was defined as death, re-infarction, bleeding, urgent coronary bypass graft (CABG) and stroke.Results: A total of 277 patients were involved in the study, with 162 patients being treated during non-office hours and 115 patients during office hours. There were 69 patients who had cardiogenic shock during the procedure, with 41 patients presenting during nonoffice hour and 28 during office hour. The First Medical Contact (FMC) to balloon time was 95 minutes (79-128) for non-office hour presentations and 86 minutes (75-108) for those presenting during office hours. The baseline characteristics of the patients involved in the study were similar, with a majority of patients were male (87%). The in-hospital mortality for non-office hours and office hours were nine (6%) and four (4%) respectively. Thirty day and one year mortality for non-office hour's patients' vs office hour patients are three (2%) vs 1(1%) and zero vs one (2%) respectively.Conclusion: PPCI done at our Centre during non-office hours were comparable to those performed during office hours in terms of outcomes and efficacy.