UP Philippine General Hospital Division of Endocrinology, Diabetes & Metabolism Consensus recommendations for in-Patient managementof Diabetes Mellitus among persons with COVID-19 / Journal of the ASEAN Federation of Endocrine Societies

@#Diabetes mellitus (DM) is a known risk factor for morbidity and mortality among patients with COVID-19 based on recent studies. While there are many local and international guidelines on inpatient management of diabetes, the complicated pathology of the virus, the use of glucose-elevating drugs such as glucocorticoids, antivirals and even inotropes, and various other unique problems has made the management of in-hospital hyperglycemia among patients with COVID-19 much more difficult than in other infections. The objective of this guidance is to collate and integrate the best available evidence that has been published regarding in-patient management of diabetes among patients with COVID-19. A comprehensive review of literature was done and recommendations have been made through a consensus of expert endocrinologists from the University of the Philippines-Philippine General Hospital (UP-PGH) Division of Endocrinology, Diabetes and Metabolism. These recommendations are evolving as we continue to understand the pathology of the disease and how persons with diabetes are affected by this virus.

Elevated Metanephrines in a Normotensive Filipino woman with a lateral neck mass / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Schwannomas are benign biochemically non-secretory neoplasms that originate from the myelin sheaths of nerves. Functioning schwannomas, especially that of the head and neck, are exceedingly rare with only a few published in the literature. This case aims to report the uncommon presentation of a patient with a neck schwannoma in an adult female with elevated urine metanephrines@*Case@#A 33-year-old Filipino female, non-hypertensive, was admitted for a two-year history of progressively enlarging non-tender pulsatile right lateral neck mass, without any symptoms. The patient underwent aspiration biopsy revealing no malignant cells. Contrast-enhanced CT Scan demonstrated well-defined heterogeneously enhancing soft tissue mass in the right paracervical area, with an initial impression of paraganglioma or nerve sheath tumor. To discriminate further, urine metanephrine was ordered and demonstrated high results (3.997 mg, 5.018 mg; Reference: 0-1.00 mg/24hr) on two occasions. Gadolinium-enhanced MRI showed the 6.3x3.9x4 cm mass as isointense on T1WI and hyperintense on T2WI. Despite normotension, terazosin was administered for pre-operative alpha blockade. She underwent excision of the tumor without post-operative complications. On follow-up, the histopathology and immunohistomorphologic features confirmed the mass as a Schwannoma. Four weeks later, the patient remained normotensive and repeat urine metanephrines yielded normal results (0.670 mg, 0.192 mg)@*Conclusion@#Surgery, which remains to be the cornerstone of treatment, heralded the biochemical remission of the urine metanephrines in the patient. Although there were no identified neuroendocrine elements in the histopathology, the decrease in urine metanephrines after tumor removal likely points to a secretory schwannoma