Biotin is a readily available supplement that is part of the B-complex vitamins. It is an essential co-factor for five carboxylases involved in fatty acid synthesis and energy production. The recommended daily intake (RDI) of biotin ranges from 30 to 70 mcg per day. At high doses (10,000 times RDI), biotin improves clinical outcomes and quality of life in patients with progressive multiple sclerosis (MS). It has been reported to cause interference in immunoassays resulting in abnormal thyroid function tests. Hereby we are describing the case of a patient having MS who was on high-dose biotin, seen in the clinic for a follow-up visit with thyroid function tests suggestive of Graves’ disease with no signs and symptoms of hyperthyroidism and completely normal physical examination. In the case we have described, the laboratory measurements suggestive of thyrotoxicosis were attributed to interference of the patient’s high-dose biotin treatment with the biotin-streptavidin chemistry of the immunoassays. We observed normalization of the thyroid stimulating hormone (TSH) and free T4 measurements when the patient withheld biotin for a week. As our case illustrates, early consideration of biotin interference minimizes unnecessary repeat laboratory studies. As trials in MS are progressing, we expect to see more patients on high-dose biotin treatment with spurious laboratory measurements. Therefore, we advise careful history taking and close communication with the laboratory when the clinical picture does not match with the laboratory results.

Malignant hypertension (MH) has been described in association with high-dose (50 - 100 mcg) estrogen oral contraceptive pills (OCPs). Although the rise in blood pressure (BP) is usually mild, some women will have a more significant increase in BP, and hypertensive emergencies may very rarely occur. We present a 21-year-old Caucasian female with a past medical history of fibromyalgia and family history of hypertension (both grandparents) who was admitted with a three-day history of headache and blurring of vision in her left eye with a BP of 210/150. Her medications, which were continued on admission, included tramadol, 100 mg twice daily (bid), and low-dose estrogen OCP. During the hospital course, she received different antihypertensive medications and her hypertension was controlled. A diagnosis of MH due to OCP was made. All antihypertensive medications were stopped, except metoprolol, and the patient was discharged home on metoprolol with a BP of 107/55 mmHg. On follow-up in the medical clinic three months later, her visual disturbances had completely resolved and her BP was 98/56 mmHg. One-third of patients aged 15 - 44 years old who develop MH are likely to be on high-dose estrogen OCP. As far as we know, our case is the third documented case of MH occurring in patients on low-dose estrogen OCP. Chronic use of oral contraceptives will slightly increase the systemic BP in most women. It is advisable to avoid OCP in high-risk patients and do regular BP checks on patients on OCP. In patients presenting with hypertension or MH while on OCP, the OCP should be discontinued.

Background Cystic Fibrosis (CF) is the most common autosomal recessive disorder in Caucasians and can involve multiple organ systems. Cystic Fibrosis Related Diabetes (CFRD) is the most common complication which affects at least 40-50% of the adult patients with CF. Untreated CFRD adversely affects pulmonary function, nutritional status, and is associated with overall poor outcomes. Early diagnosis and treatment with insulin improve nutritional status, pulmonary function and is associated with reduced mortality. An annual two-hour Oral Glucose Tolerance Test (OGTT) is recommended for all patients with CF beginning at 10 years of age. Unfortunately, OGTT screening rates remain very low in patients with CF. The aim of this study was to identify patient barriers to OGTT screening and list them in order of relative importance from patient perspective. Methods A survey was designed to identify patient barriers associated with completing the screening OGTT in the CF population. Data collection included patient demographics and pertinent clinical information. All patients >18 years of age and who receive care at the Cystic Fibrosis center at our institute received a survey. Survey was sent through email, postal mail, or during CF center visits. Patients who did not initially complete survey received a reminder email, phone call, and hand survey during CF appointment. Participants were excluded if they had a diagnosis of CFRD or were currently pregnant. There was no intervention planned during this study. Results 49 patients without CFRD and 19 patients with CFRD responded to survey. Only 12.2% patients were appropriately screened by OGTT in last 1 year. The survey demonstrated that the top 3 barriers to obtaining OGTT in descending order were "I don't think I have diabetes, I don't need this"; "I don't like the taste of glucola"; and "I don't think OGTT is important for assessing my health". Conclusions The prevalence of CFRD continues to increase as the median life expectancy increases in patients with CF and is associated with worse outcomes. Early diagnosis and treatment with insulin are crucial. Unfortunately, screening for CFRD remains low in this population. Our study highlights the patient perceived barriers for screening OGTT. The top 3 barriers noted in study show the importance of patient education and awareness about CFRD. Further research is needed to identify specific interventions that will improve CFRD screening and lead to earlier diagnosis and treatment. Presentation: No date and time listed