Endocrine Abstracts

There are traditionally two major methods of treating autoimmune biochemical hyperthyroidism (Grave's disease) with anti-thyroid medication employed by Endocrinologist's in the UK today. The first is ‘dose titration’ and the second is ‘block and replace’, each treatment regime has it's own advantages and disadvantages and there is sometimes controversy over which is the best approach. A Cochrane review in 2005, undertook a systematic evaluation of all the g...

Primary Amenorrhoea is usually the result of a genetic or anatomical abnormality. Androgen insensitivity syndrome (AIS) is an uncommon cause in which individuals with a 46XY male karyotype are resistant to testosterone due to a defect of the androgen receptor.A 16-year-old female of non-consanguineous parents presented with primary amenorrhoea. There was no family history of delayed puberty. She was of normal female appearance (height 5′9″, B...

A 74 year old female presented with symptoms of recent fatigue, nausea and weight loss. No other symptoms were present. She had previously had a hysterectomy with conservation of both ovaries 30 years previously for fibroids. The rest of her history was unremarkable. No undue clinical findings were apparent on examination. Initial bloods revealed normal haematology, biochemistry and liver profiles. Corrected calcium was elevated at 3.07 millimoles per litre(2.1-2.6). Subsequen...

Osteomalacia is most commonly caused by vitamin D deficiency. This typically results in features of secondary hyperparathyroidism and hypophosphataemia. PTH secretion is however dependant on normal serum magnesium levels. Hypomagnesaemia due to malabsorption, diuretic or laxative abuse may lead to functional hypoparathyroidism despite typical features of osteomalacia.A 24-year old Afro-Caribbean woman presented with bilateral knee and upper back pain wit...

A 71-year-old gentleman was referred for investigation of bilateral enlarged adrenals first discovered after presenting with subacute bowel obstruction. A CT scan of his abdomen revealed the left adrenal was 8×5 cm, the right 3 cm. No other abnormalities were detected.The patient was otherwise well. No other medical history was volunteered. On examination, he was of short stature (height 1.47 m) with a normal pattern of pubic and axillary hair. Bloo...

A 62-year-old man presented with 1 month history of lethargy, nocturia, thirst and diplopia. On examination he had left 3rd nerve palsy with complete ptosis. MRI pituitary demonstrated a 1.3×1.1 cm enhancing mass on the left side of the pituitary gland, with invasion of the left cavernous sinus. Endocrine work up revealed partial DI, TSH and gonadotrophin deficiency. Because of unusual appearance of the pituitary lesions, a biopsy was arranged but initial histology was in...

We studied the practice of investigations for diagnosing and localising insulinoma in our hospital. We looked at the number of investigations performed before exact localisation of insulinoma.We identified 5 cases that were confirmed on clinical, biochemical or histopathological bases and were recorded on the histopathology and IT database as ‘insulinoma’ from 1986 to 2004. We looked retrospectively at the case notes of these cases.<p class...

A 30 year-old man was assessed for gynaecomastia. He had been treated for GH deficiency from the age of 3 to 16. His non-consanguineous parents were of short stature (maternal height 1.22 m, paternal height 1.58 m), as was a half-sister (1.55 m). The patient’s height was 1.55 m with an arm span of 1.48 m and his BMI was 31. Testicular volume was 18 mL and secondary sexual characteristics were normally developed. Lipomastia was diagnosed and subsequently treated surgically...

We present a case of 55 years old obese man with type 2 diabetes of 13 years duration, seen in diabetes clinic. His HbA1c had been 8–10% for about 7 years despite being on maximum doses of sulphonylurea and metformin.It was decided to start him on 30/70 mixed insulin and Metformin was continued. His HbA1c did not improve despite aggressive insulin titration. His injections became painful as insulin doses increased and resistance was noted on injecti...

We present three cases of metastatic medullary thyroid carcinoma who developed severe Cushing’s syndrome from ectopic production of ACTH by the tumour. Following total thyroidectomy and external beam radiotherapy, the patients had remained symptom-free for 4, 9 and 25 years after initial presentation despite the presence of widespread hepatic metastases. However, with the onset of Cushing’s syndrome, patients became unwell with severe muscle weakness and lethargy. Me...