Endocrine Abstracts

Hypercalcaemia is a recognised feature of hyperthyroidism due to accelerated bone turnover caused by thyroid hormone. When present, it is generally mild, usually with levels < 3.00 mmol/l. We present a case of a 19 year old male with thyrotoxicosis, who had severe hypercalcaemia and was also found to have possible co-existent adrenal insufficiency at the same time.He presented with a 4 month history of weight loss, anxiety, tremors and palpitations. ...

In September 2021 the pathology department announced it would be going paperless, a change that resulted in endocrine monitoring being added to the trust risk register. To manage this risk several options were considered including the DAWN system used by rheumatology and systems used by other local hospitals. Unfortunately, none of these were viable options. Discussions were started with the IT systems development team about building a database for management of thyroid patien...

An endocrine specialist pharmacist has been running an adrenal incidentaloma clinic since September 2020. As of Jun-22 258 patients have been seen in clinic and managed using a local protocol. Adrenal incidentaloma patient referrals are screened as per current guidelines on receipt; those measuring <1 cm are declined, suspected adrenocortical carcinomas are seen by a consultant and referred elsewhere if needed. All others are seen by the endocrine pharmacist within 4 weeks...

Introduction: Increasing evidence is emerging that demonstrates the increased prothrombotic risk associated with DKA.1 We present the case of a child who developed multiple complications which we believe can be explained by his hypercoaguable state.Case history: A 14-month-old male was admitted in DKA at first diabetic presentation, complicated by cardiovascular shock. Initial blood tests showed blood glucose 80 mmol/l, blood ketones 5.9 mmol/...

Background: Pituitary metastases are a rare occurrence, accounting for just 0.4% of intracranial metastatic tumours and are most often associated with breast and lung malignancies. The vast majority of lesions are asymptomatic and due to the predilection of metastasis to the posterior lobe of the pituitary gland, clinical presentation with anterior pituitary insufficiency is uncommon and rarely reported in literature.Case summary: A 51-year old male with...

Background: 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is characterised by cortisol deficiency, androgen excess, varying degrees of virilisation and salt-wasting. CAH management involves replacement therapy with hydrocortisone, and, often, fludrocortisone. High levels of androgens cause the advancement of bone age (BA) with the potential to increase bone mineralisation. Hydrocortisone therapy on the contrary can contribute to reducing bone mineralisation. P...

Background: The glucagon tolerance test (GTT) is used to diagnose growth hormone deficiency (GHD) in younger children or in patients where the insulin tolerance test is contraindicated. We assessed GTTs carried out over five years in a tertiary paediatric centre to assess growth hormone (GH) and cortisol axes. The aim was to assess at which time points the GH peak was observed, and assess whether any predictive value is gained from demographics or IGF-1....

Introduction: Tolvaptan, a selective vasopressin 2 receptor antagonist is proving beneficial in managing hyponatremia secondary to SIADH.Case report: A 75-year-old male with history of traumatic SAH developed hyponatremia secondary to SIADH. He had multiple admissions with symptomatic hyponatremia. His sodium level kept dropping despite putting on fluid restriction and trial of sodium chloride tablets. He was started on Tolvaptan 7.5 once weekly initiall...

Introduction: Type 1 diabetes (T1D) is a lifelong condition affecting over 29 000 children in the United Kingdom, the majority of whom are in full time education. Both hypoglycaemia and hyperglycaemia have been shown to impact the young person’s overall school performance and learning capacity. During exams, children and young people (CYP) with T1D have the additional stress of managing their diabetes appropriately, and therefore require special provisions. Currently, the...

Introduction: Diabetes mellitus is the commonest cause of chronic kidney disease leading to end-stage renal failure (ESRF). Fluid replacement is one of the cornerstone treatments of DKA, however anuric dialysis patients are at risk of fluid overload. Information for managing DKA in haemodialysis patients is relatively sparse.Case report: A 76-year-old gentleman with type 1 diabetes was admitted with drowsiness. He has twice weekly dialysis and on 700 ml/...