Endocrine Abstracts

Primary thyroid lymphoma accounts for <5% of thyroid malignancies. The most common (up to 70%) and clinically aggressive sub-type is non-Hodgkin’s B-cell lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma is less common (up to 30%) and clinically more indolent. Females are more frequently affected than males (4-8:1) with onset in 6th and 7th decades. A strong association with Hashimoto’s disease (>90%) is recognised. A 66 year old male presented with...

Primary adrenal failure is a rare disorder with a prevalence in developed countries of 93–140 per million and an incidence of 4.7–6.2 per million. Autoimmune adrenalitis is the main cause (80%) followed by tuberculosis (15%). The remaining 5% of cases represent rare disorders with bilateral adrenal haemorrhagic infarction secondary to primary antiphopholipid syndrome being very rare (0.5%).A 57-year-old female presented with a 3-week history of...

Opiate use is a well-recognised cause of hypogonadotrophic hypogonadism. Adrenocorticotrophic hormone and growth hormone deficiencies are much rarer.A 56-year-old female presented with weight loss, lethargy, and nausea of ~3 years duration. She had received treatment with morphine sulphate 100 mg twice daily for ~15 years for back pain due to disc prolapse and osteoarthritis. A 0900 h cortisol of 110 nmol/l requested by her general practitioner had resul...

A 68-year-old female was found to have a supra sellar mass on CT scanning for investigation of long-standing tremor. She had experienced thirst, polydipsia, polyuria, nocturia and malaise for 1 year. Primary hypothyroidism had been diagnosed 5 years earlier. A left temporal visual field defect found 3 years earlier had been attributed to a structural anomaly of the optic nerve head. MR scanning confirmed the presence of a mass lesion of the infundibulum with displacement of th...

Autonomous cortisol secretion (ACS), a term that refers to biochemical evidence of excess cortisol, but without the overt Cushing’s syndrome in people with adrenal adenomas. Prevalence of adrenal tumours is 5-10%. Up to 50% of benign adenomas present with some degree of cortisol excess. There is little guidance for investigating and managing these patients leading to different standards of care. Cortisol secretion here is in wide range although post dexamethasone suppress...

Gitelman’s syndrome (GS) is an autosomal recessive renal tubular disorder caused by mutations of the SLC12A3 gene coding for the thiazide-sensitive sodium chloride co-transporter (NCCT). Hypokalaemia, hypomagnesaemia, hypocalciuria and metabolic alkalosis are consequent. Sjorgren’s syndrome (SS) is a connective tissue disorder primarily affecting lacrimal and salivary glands resulting in sicca complex. The coincidental presence of both syndromes is rare. A 28 year ol...

Graves’ disease (GD) is the most common cause of hyperthyroidism with incidence rates of 20-50 cases per 100,000. Genetic predisposition and environmental factors are known to play a role in its pathogenesis. After perceiving an increase in the number of cases presenting to our thyroid clinic we confirmed a rise in the incidence of GD in North West Wales since the start of the COVID-19 pandemic. The annual incidence of GD was calculated using the number of positive thyroi...

A 73 year old female presented with a 5-year history of fatigue, anorexia and weight loss of 15 kg. Her primary care physician recorded a 09:00 h cortisol of 163 nmol/l. Previous medical history was one of abdominal diffuse B-cell lymphoma 9 years earlier treated with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin and prednisolone) followed by CT-guided radiotherapy. Medications were transcutaneous buprenorphine 20 mg/hour, aspirin 75 mg od and omeprazole 20 mg o...

Pseudohypercalcaemia is defined as an elevated total calcium level coincidental with a normal ionised calcium level. This rare phenomenon occurs in monoclonal gammopathy of unknown significance (MGUS). We report two cases of MGUS and a case of atopy with grossly elevated IgE levels exhibiting the phenomenon.Case 1: 31 year old female with MGUS, hypercalcaemia and normal parathyroid (PTH) levels. Parathyroid imaging normal. Consensus diagnosis of primary ...

Introduction: Most children & young people (CYP) with symptoms of type 1 diabetes (T1D) tend to present to primary care. Delayed diagnosis is common and is associated with a risk of developing diabetic ketoacidosis (DKA). The prevalence of DKA at diagnosis over the last 20 years remains unchanged despite current NICE guidance and Diabetes Delivery Plans which promote prompt diagnosis of T1D. The aim of this QI initiative was to develop effective pathways to facilitate earl...