Endocrine Abstracts

Background: We present a rare diagnosis of a patient presenting with Takotsubo cardiomyopathy and pituitary apoplexy. The case highlights the difficulty in management of a cardiac event with bleeding risk in a patient with these associated diagnoses.Case report: An 85-year-old woman was admitted to hospital with a severe frontal headache that woke her from sleep. She described chest pain associated with breathlessness later and was mildly confused. Sadly...

A 37-year-old female referred by gynaecologist with elevated serum testosterone found on evaluation for amenorrhoea. She has had oligomenorrhoea for 5 years with induced bleed on Logynon and no change on stopping. Episodes of feeling hot and sweaty and going red in face. On examination: weight 68 kg, BMI 25 kg/m2, euthyroid, euadrenal, no hirsutism. BP: 116/86 (lying) & 110/90 (standing for 2 min). Available blood results: Estradiol- 43–91; LH- <0.1&#15...

Primary Aldosteronism (PA) is caused by autonomous aldosterone production from the adrenal cortex (due to hyperplasia, adenoma or rarely carcinoma) and diagnosis is confirmed by elevated plasma aldosterone level with suppressed renin activity and localized further by CT scan of the adrenal glands and selective adrenal venous sampling (AVS) if required. On the other hand, Addison disease (also known as primary adrenal insufficiency) which represents the other face of the coin i...

This audit investigated the utilization of thyroid peroxidase antibodies testing in our trust. TPOAb, which emerges as a response to thyroid injury, is found in up to 27% of the population and is associated with autoimmune thyroid disorders. However, it is not considered a disease-causing factor or transmitted from mother to fetus. TPOAb is commonly requested in the community. The retrospective audit reviewed 282 requests from the adult service to the laboratory. After excludi...

Introduction: Non-diabetic hypoglycaemia (NDH) has many causes including insulinoma, non-insulin producing cancers and gastric bypass surgery but medications like fluoxetine are rarely reported.Case history: 55 years female, university lecturer, history of Roux-en-Y gastric bypass in 2015 and depression, referred for recurrent symptomatic hypoglycaemia 1 to 2 hours post-meal (reactive hypoglycaemia) with recorded capillary blood glucose up to 1.6 mmol/l ...

A 32-year-old gentleman, of South-Asian origin was admitted with a 4-week history of abdominal pain, nausea and vomiting. He also had history of polyuria, polydipsia and weight loss over 6 weeks. Just prior to these symptoms he had been started on colecalciferol 20 000 units weekly by his GP for Vitamin D deficiency (25(OH) Vitamin D – 10.3 nmol/l (48–145)). On admission he had adjusted calcium of 4.52 mmol/l and acute kidney injury with his eGFR being 38 ml/min per ...

A 37-year-old gentleman was admitted following a GP referral for asymptomatic hypercalcaemia. His adjusted calcium was raised at 3.27 mmol/l while phosphate level was normal. The only past medical history was borderline hypertension which was being monitored in primary care. His PTH level was suppressed at 0.43 pmol/l l (1.1–5.5) while 25(OH) Vitamin D was normal at 71.6 nmol/l (48–145). Twenty-four hours urinary metadrenalines were normal. His full blood counts were...

Background: Glucokinase (GCK) is a gene which plays an important role in recognising how high the blood glucose is in the body. It acts as the glucose sensor for the pancreas. Changes in the GCK gene can lead to increases in blood glucose and affected people may be diagnosed with diabetes although this rise in blood glucose is mild and does not need treatment. Glucokinase diabetes is one of familial diabetes types that called MODY (maturity onset diabetes of the young). We rep...

Introduction: DKA is often seen in people with Diabetes Mellitus I and seldom in Diabetes Mellitus II but rarely seen in Maturity Onset Diabetes of Young (MODY) and even more rare in association with SGLT2i.Case history: 44 years female, genetically confirmed Hepatocyte Nuclear Factor 1 alpha (HNF1A) MODY since 2004 initially treated with maximum doses of metformin and gliclazide and then lost to follow-up. GP initiated Empagliflozin a year before presen...

A 48-year-old healthy, normotensive male was referred by GP due to incidental finding of hypokalaemia of 2.5 mmol/L on routine blood testing. The patient was initially treated with oral potassium supplements with little effect. Biochemical investigations in the endocrine clinic demonstrated mild metabolic alkalosis, eunatraemia, mild hypomagnesaemia 0.6 mmol/L and hypercalcaemia of 2.84 mmol/L with hypophosphataemia of 0.53 mmol/L. PTH was high at 350 ng/L. Renin and aldostero...