Endocrine Abstracts

Background: Hyponatraemia occurs in 10- 15% of hospital admissions and is associated with an increased rate of mortality, length of stay in hospital and readmission rates when compared to patients with normal sodium levels. We developed a hyponatraemia algorithm pdf document to all non endocrine general physicians (GPs) in our hospital to aid in managing hyponatraemia effectively. However when we re-audited our practice, these guidelines were rarely used and there was a large ...

Hyponatraemia is associated with an increased morbidity and mortality. Despite having a hyponatraemia algorithm (pdf format) on our hospital intranet, it was rarely accessed and a wide variation in care was noticed. A novel digital hyponatraemia diagnostic toolkit (hyponatraemia.wordpress.com) for Foundation doctors (FDs) was introduced to assess our aims if it: A) increases the awareness of FDs to start investigating when serum Sodium is <130 mmol/l B) increases FD...

Objective: Hyponatraemia is the most common electrolyte disturbance encountered in patients – yet its management remains challenging and variable. We audit the management of hyponatraemia in a busy district general hospital, focusing on length of stay (LOS), readmissions and mortality.Methodology: A retrospective analysis was carried out of 30 consecutive inpatients alerted by the hospital biochemistry department with a sodium concentration of &#880...

Overt primary adrenocortical failure is preceded by several stages of subclinical hypoadrenocorticolism. Individuals with type 1 diabetes (T1D) or who have other autoimmune conditions are at risk for the development of Autoimmune Addison's disease (AAD). These at risk individuals can be identified by the detection of adrenal autoantibodies (AAb).The aim of this study was two fold: firstly, to evaluate the sensitivity of early morning cortisol: ACTH ratio...

Thyroid ultrasound (US) is a useful tool in a spectrum of thyroid conditions. In some hospitals, primary care has direct access to requesting thyroid US, rather than via a speciality. We were keen to assess the outcomes of thyroid US referred by primary care.We analysed all primary care referrals for thyroid US, retrospectively, during the first six months of 2006 and analysed them according to the following 3 reasons for referral – 1) suspicion of ...

HTLV-1 associated lymphoma is a rare but well recognised cause of life-threatening hypercalcaemia. It carries a very poor prognosis. We describe a case of a 47 year old Afro-Caribbean lady who presented with 3 months of fever, weight loss and right hip pain. She had a past medical history of quiescent sarcoidosis diagnosed 20 years previously. She also suffered from systemic lupus erythematosus, for which she was taking methotrexate and 20 mg of prednisolone. She also had hype...

A 26-year-old woman presented with vomiting and cortical blindness. CT scan of the brain confirmed a right-sided parietal-occipital infarct, She subsequently developed seizures and neurological extension resulting in global dysphasia. Serum and CSF lactate were elevated (4.4 and 4.3 mmol/l respectively, NR<1.8). MELAS syndrome was confirmed by mitochondrial DNA analysis, which revealed an A3243G mutation in muscle and serum (85% muscle, 63% urinary epithelial cells and 33%...

It is now well established that unilateral autonomous aldosterone secreting tumour (AST) in contrast to bilateral adrenal hyperplasia (BAH) - are corrected by surgery. The optimal method of pre-operatively defining a unilateral autonomous AST still remains controversial. There is agreement that adrenal scanning techniques are often unreliable or misleading. The aim of the current study was to analyse if a random aldosterone:renin (AR) ratio (after stopping anti-hypertensive me...

The glucagon stimulation test (GST) is used as a provocative test of the hypothalamic pituitary adrenal axis (HPAA) but the response to this test is variable and the mechanism of action remains unclear. The GST has never been studied in diabetic patients with autonomic neuropathy (AN). We illustrate the assessment of cortisol response in two diabetic patients with AN who were suspected of having adrenocortical deficiency. Case one: A 40 year old type 1 diabetic suffers from di...

Thyroid nodules are common in the general population. In 2006, we audited and discovered that primary care direct access to thyroid ultrasound (TUS) has limited value in detecting sinister thyroid pathology. To improve quality of thyroid nodule management, in May 2007, we introduced four changes (1) appointed a thyroid MDT coordinator, (2) produced a thyroid nodule proforma to guide primary care referrals, (3) established the rapid access one-stop thyroid ultrasound FNA clinic...