Endocrine Abstracts

Opioids –Yet another Cause for Adrenal Insufficiency. Opioid prescriptions have almost doubled in the last decade in the UK. Opioid related hypogonadotropic hypogonadism is a well-recognised clinical entity. Opioid therapy as a cause of adrenal insufficiency is an under-recognised endocrinopathy with potentially lifethreatening adverse effects. We present the case of a 57 year old lady referred to the endocrine clinic with symptoms of generalised fatigue and weakness. Her...

We present a case of recurrent troublesome hypothyroidism with three pathologies to vex her medical attendants. This 75 year old lady was treated for Grave’s thyrotoxicosis elsewhere when she was 55 years old. She had positive TSH receptor antibodies and high uniform uptake of radioactive iodine. She presented to us age 65 with relapsed thyrotoxicosis and was maintained on carbimazole 5 mg OD for 8 years which was then stopped. She had been off medication for 2 years when...

Immunotherapy targeting the CTLA-4 and PD-1pathways has revolutionised the treatment of several cancer types, and is under investigation in many others. However, its use is associated with a variety of side effects, many of which associated with immune system activation. In metastatic melanoma, the combination of ipilimumab (an anti-CTLA-4 antibody) and nivolumab (an anti-PD-1 antibody) has been shown to have greater efficacy than either drug as monotherapy, though as expected...

A 47-year-old female presented with facial swelling, easy bruising, and concern regarding possible Cushing’s syndrome. She had developed secondary amenorrhoea 3 years previously; biochemistry suggested hypogonadotrophic hypogonadism, felt to be hypothalamic secondary to low BMI and intense exercise. She was normotensive, and BMI was 17.4. There was no evidence of abdominal striae, proximal myopathy or hirsutism, but her face appeared rounder and plethoric compared with a ...

Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7–8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analysed.Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18-month period beginning from April 2013, i...

Introduction: Selective oestrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) potentially increase endogenous gonadotrophin and testosterone secretion in men. They are used off-label in men with hypogonadism and/or infertility. There is a lack of guidance on using these agents in men with secondary hypogonadism, though these agents are widely used in these people as a cheaper alternative to gonadotrophins. Methods: Systematic search was co...

A 64 year old Caucasian man with long standing type 1 diabetes and complications of retinopathy, neuropathy and nephropathy was referred with suspected deep venous thrombosis (DVT) in the left lower limb. He had a week’s history of worsening pain and swelling in the medial left thigh and struggled to weight bear on that leg. He felt unwell a day before admission and was found to have hyperosmolar hyperglycaemic state with ketosis on admission. Ultrasound Doppler was nega...

Introduction: Diabetic patients on insulin therapy are compelled to use sharps such as insulin needles and lancets on a regular basis. As a result thousands of used sharps and bloodstained materials are generated daily by them. While there is a huge concern over sharps disposal practices in healthcare settings, the sharps disposal practices of diabetic patients living at home has been poorly documented.Methodology: Randomly selected sample of 158 diabeti...

Objective: To investigate if the event of late-onset circulatory collapse (LCC) implicated in dysfunction of adrenal steroidgenesis due to impairment of adrenal remodeling in preterm infants.Methods: Eleven in the patient group (case) with clinical signs compatible with LCC diagnosis (hypotension, oliguria, and hyponatremia) and 11 in the control group (control) matched them for gestational age without such signs. Steroids in serum were separated and pur...

Background: In patients with phaeochromocytoma, sudden and/or chronic exposure to catecholamines may predispose to cardiac pathology, including left ventricular (LV) hypertrophy, myocardial infarction, stress-induced cardiomyopathy and heart failure. We conducted the first prospective, multicentre study using cardiovascular magnetic resonance (CMR) imaging to describe the variety and incidence of cardiac abnormalities in phaeochromocytoma.Methods: Fifty ...