Endocrine Abstracts

Section 1: Case history: We present the case of a 35-year-old gentleman referred by his GP to Endocrinology clinic for loss of libido and testosterone deficiency. His co-morbidities included obesity (BMI 59 kg/m2), hypertension and obstructive sleep apnoea (OSA) requiring overnight continuous positive airways pressure (CPAP) therapy. Routine pituitary profile showed luteinising hormone 4.8 IU/l (1–8), testosterone 7.1 nmol/l (8–25), prolactin 232 mU/l (86&...

Malignancy-related hypercalcaemia occurs in over 20% of cancer patients. Most cases are due to enhanced production of parathyroid hormone-related peptide (PTHrP) by tumours and carry a poor prognosis of survival of weeks to months. A 74 year old man with a history of prostate cancer treated with radical radiotherapy in 2013 and androgen blockade until 2015 underwent CT and PET/CT scans in 2017, which showed liver and spleen abnormalities, suggestive of metastases, but unlikely...

Case History: 17 year old boy presented with a six week history of polyuria, polydipsia, headaches and easy fatiguability. Further investigations confirmed hypopituitarism with low early morning urine osmolality. MRI brain revealed soft tissue mass arising from tectal plate extending into cerebral aqueduct resulting in hydrocephalus with normal pituitary gland. Hydrocortisone, Levothyroxine and Desmopressin were started and urgent in-patient transfer to Neurosurgical unit in t...

Section 1&2: Case history and investigations: Primary hyperparathyroidism is a rare condition in pregnancy. The occurrence rate is about 1 % and up to 80 % of the patients are asymptomatic. Clinical symptoms are nonspecific. However, severe maternal, foetal and neonatal complications including neonatal death have been reported in literature. 27 years old Asian lady presented to Emergency Department with abdominal pain in July 2019. She was found to have raised calcium at l...

Case History: 29 year old lady presented with profuse diarrhoea, lethargy and hypokalaemia in 2010. CT scan confirmed mass lesion in tail of pancreas. Chromogranin A and 24 hour urinary 5HIAA were normal. Fasting Gut hormone level showed elevated level of Vasoactive Intestinal Peptide (VIP), suggesting diagnosis of VIPoma. Further investigations confirmed hyperparathyroidism and microprolactinoma. Investigations: Adjusted calcium 2.98 mmol/l (<2.55), ...

We present a case of a 44-year-old female with fluctuating thyroid function over 12-14 years. The patient originally presented with a high TSH, normal free T3/T4 and a negative anti-TPO antibody. She was initially monitored, then went onto Levothyroxine replacement in an antenatal setting. Subsequently, 12-18 months later, she presented with hyperthyroid symptoms and vastly elevated TSH-receptor-antibody (TSHR-ab) titre of >10 IU/L, the upper limit of normal being 2.9 IU/L...

A recent case series commented on adverse COVID-19 outcomes among patients with Cushing’s syndrome, despite minimal symptoms and low inflammatory markers. Excessive glucocorticoids can impede adaptive immune response to viruses, leading to increased infection risks (1). Sarker et al discussed glucocorticoids binding to viral spike-proteins, inhibiting receptor interactions and contributing to prolonged positive swabs, in the absence of symptoms (2). We report the c...

A 70-year old gentleman was referred to the endocrine clinic by the Cardiology team following an admission with blackouts- three in three years, two causing road traffic accidents. During one of the accidents, his capillary blood glucose reading dropped below 3 mmol/l. The patient reported dizzy spells, accompanied by hot flushes, sweats, tremor, change in colour- “looking grey”, feeling hungry and nausea, alleviated by sugary snacks. These episodes were linked to mi...

A 61-year old woman, referred to the endocrine clinic, post Roux-en-Y gastric bypass, exhibited symptoms of dizziness, weakness, light-headedness and sweating. These symptoms were associated with light meal following prolonged fast. A clinical diagnosis of reactive hypoglycaemia was made. She was advised to make lifestyle modification and adopted a low glycaemic index diet. Baseline bloods including cortisol, IGF-1 and urinary metanephrine were within reference range. Mixed me...

Background: Reactive hypoglycaemia following Roux-en-Y gastric bypass (RYGB) surgery poses unique challenges in diagnosis and management. This abstract explores the utility of Metformin and GLP-1 analogues in two distinct cases.Case 1- LH: LH, a post-RYGB patient, presented with recurrent hypoglycaemic episodes, intriguingly manifesting primarily at night; after a long day at work in a fasted state followed by a carbohydrate heavy meal. LH experienced hy...