Endocrine Abstracts

Background: Long-term glucocorticoids can result in iatrogenic Cushing’s syndrome with adrenal suppression. Most patients reactivate their hypothalamic-pituitary-adrenal axis once they’re weaned off glucocorticoids. During glucocorticoid withdrawal, many clinicians switch patients to hydrocortisone to benefit from its short half-life1. However, in some patients, hypothalamic-pituitary-adrenal axis recovery is delayed despite the above. It is unclear whethe...

Background: POLR3-related leukodystrophy is an autosomal recessive hypo-myelinating leukodystrophy characterized by specific features on MRI and varying combinations of four major clinical findings1. The latter include neurological dysfunction, abnormal dentition, endocrine dysfunction, and myopia1. Endocrine dysfunction in POLR3-related leukodystrophy includes hypogonadotropic-hypogonadism (HH), short stature, growth hormone deficiency, and less commonly...

A sixty-four-year old lady with a past medical history of total thyroidectomy for Graves’ disease and atrial fibrillation on amiodarone was referred to the endocrine out-patients in view of hypothyroidism. Since starting amiodarone, the TSH was noted to be elevated at 75 mU/l and the free T4 was 18 pmol/l. The patient complained of non-specific lethargy and was administered levothyroxine 50 mcg daily. Despite this her TSH remained elevated at 147 mU/l with a free T4 of 17...

Background: The concept of autoantibody-negative Graves’ disease (GD) is a subject of debate. Studies have revealed that autoantibody-negative GD does exist, albeit rare.1Method: Over a 3-year period, a total of 108 hyperthyroid patients who exhibited diffuse or normal thyroid uptake on thyroid scintigraphy, were assessed in a cross-sectional study. The thyroid function tests, TSH-receptor antibody (TRAb) levels, anti-thyroid peroxidase (anti-TPO) a...

Introduction: Hirsutism is the presence of excess hair growth in females as a result of increased androgen production and/or increased skin sensitivity to androgens. In a postmenopausal female presenting with hirsutism, a high level of clinical suspicion, a detailed history and physical examination, substantiated by focused biochemical and morphological confirmation is necessary.History: The authors present a case of a female with a longstanding history ...

Introduction: Adrenal incidentalomas are masses discovered incidentally on imaging studies performed for possible pathologies other than suspected adrenal disease.Aim: To characterise a cohort of adrenal incidentalomas found on CT.Methods: This was a retrospective analysis, taking into account all the adrenal incidentalomas discovered on CT between July and December 2014 at the main hospital in Malta. The adrenal lesions were then ...

Background: Adrenocortical carcinomas (ACC) are rare malignant tumours, with a quoted incidence of 0.7–2.0 cases/million habitants/year, with ectopic ACC being exceptionally rate. Diagnosis is based on clinical and biological assessment supplemented by imaging. Patients commonly present with features secondary to steroid excess, but around 15% of patients are diagnosed incidentally.Case report: A 54-year old lady, presented to clinic for assessment...

Background: Immune checkpoint inhibitors (ICPis) have become a cornerstone of cancer management. Whilst endocrine-related adverse effects are one of the most common immune-related adverse events, ICPi-induced de novo diabetes occurs at low frequencies1. We describe a case of ICPi-induced de novo type 1 diabetes presenting with severe diabetic ketoacidosis (DKA) in a female with metastatic melanoma.Case report: A 50-year-old l...

Background: Thyrotoxicosis is a well-known complication of amiodarone therapy. Three types of amiodarone-induced thyrotoxicosis (AIT) are recognized; type 1 AIT, type 2 AIT, and mixed/indefinite forms of AIT. Type 1 AIT is an iodine-induced hyperthyroidism that usually occurs in patients with pre-existing nodular goitre or latent Graves’ disease1. We present a case of type 1 AIT associated with a transiently toxic solitary thyroid nodule, with hyperthyroidism r...