Endocrine Abstracts

A 58-year-old male was admitted through the emergency department with symptomatic severe euvolemic hyponatremia. Biochemistry was consistent with SIAD (plasma sodium (pNa) 107 mmol/l, plasma osmolality 230 mOsm/kg, urine sodium 36 mmol/l, urine osmolality (UOsm) 638 mOsm/kg, 0900 h plasma cortisol 484 nmol/l and thyroid function tests normal). Chest X-ray was normal but CT thorax confirmed a lung mass suspicious for malignancy. As the patient had symptoms of cerebral irritatio...

A 56-year-old male presented in 2017 with acute symptomatic hyponatraemia. He was admitted with a seizure and a plasma sodium of 112 mmol/l. His past medical history was notable for alcohol excess and smoking. The acute presentation was managed with 3% hypertonic saline infusion in ITU. Plasma osmolality was 240 mOsm/Kg, urine osmolality 327 mOsm/kg and sport urine sodium 28 mmol/l. CT TAP showed some oesophageal thickening only; endoscopy was normal. He made a good recovery f...

Alemtuzumab is a monoclonal antibody directed against CD52 licenced for the treatment of relapsing remitting multiple sclerosis (MS). Thyroid dysfunction occurs in one third of patients, likely secondary to lymphocyte reconstitution.Case 1: A 36 year old female, treated with alemtuzumab 15 months prior, presented to antenatal clinic at 12 weeks gestation with symptoms of thyrotoxicosis. fT4 was 83.7 pmol/l (RR 12-22), TSH suppressed, TRAB positive. She w...

There is growing recognition within Endocrinology physician and patient groups of morbidity and mortality in association with prescribing errors and dysnatraemia, in hospitalised patients with cranial diabetes insipidus (CDI). The study had two aims; firstly, to assess outcomes in hospitalised patients (paediatric and adult) with CDI by review of electronic records from 2012-2021, and secondly, to assess the same patient cohort’s perceptions of their care via telephone qu...

Background: Alpelisib is a novel phosphotidylinositol 3-kinase (PI3K) inhibitor which, in combination with fulvestrant, has been shown to increase progression-free survival in patients with HR+/HER2-/PI3KCA mutated advanced breast cancer[1]. Hyperglycaemia, including alpelisib-induced diabetic ketoacidosis is a known adverse effect, along with rash, diarrhoea and stomatitis. No other associated endocrinopathy has been reported to date. Case presentation: We present th...

Transsphenoidal surgery (TSS) to resect a corticotroph adenoma is the first-line treatment for Cushing’s disease (CD); remission rates of up to 80% have been reported in cases of microadenomas. Endocrine Society guidelines define post-operative biochemical remission as morning serum cortisol <138 nmol/L within seven days of surgery. Our practice is to use a cut-off of <50 nmol/L at day 3 post-op to indicate biochemical remission. If serum cortisol on day 3 is 50&#...

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of poli...

The diagnosis of Cushing’s Syndrome (CS) requires demonstration of excess circulating cortisol. Measurement of late night salivary cortisol (LNSF) has been advocated as a simple, non-invasive and reliable outpatient diagnostic tool for patients with suspected CS but the usefulness of its metabolite cortisone (LNSE) remains unclear. LNSE levels are approximately six times higher than LNSF in saliva due to the rapid action of 11β-hydroxysteroid dehydrogenase type 2 (11...

There is growing recognition within Endocrinology physician and patient groups of morbidity and mortality in association with prescribing errors and dysnatraemia, in hospitalised patients with cranial diabetes insipidus (CDI). The aims of this study were firstly, to assess outcomes in hospitalised patients with CDI by review of electronic records from 2012-2021, and secondly, to assess the same patient cohort’s perceptions of their care via telephone questionnaire. 109 pa...

Background: Adrenal insufficiency remains a potentially life-threatening condition, necessitating adequate glucocorticoid replacement and appropriate stress-related adjustment to avoid crisis. Flu-like illness is a key precipitant of adrenal crisis. While some authorities recommend annual influenza vaccination for such patients, uptake rates in this population are unknown. Additionally, while seasonal vaccines may lead to minor symptoms in the general population, there are no ...