Endocrine Abstracts

Introduction: Icodextrin is a large molecular weight glucose polymer used in the diasylate called Extraneal. It is hydrolysed to oligosaccharides, which are read as glucose by some blood glucose monitoring (BGM) devices resulting in overestimation of capillary blood glucose (CBG) readings. This is dangerous for patients on ambulatory dialysis trying to achieve optimum diabetes control.Case: A lady with type 1 diabetes using an insulin pump for diabetes c...

Introduction: Patients with life-threatening inborn errors of metabolism are usually managed at specialist care centres. These patients are living longer and some of them have migrated to areas far from their specialist care centres. We present two such cases.Case 1: A 37 year old female with Ornithine Transcarbamylase Deficiency (OTCD), well-managed at a specialist care centre since childhood, relocated a few times before settling down in our area. OTCD...

Case history: A 22-year-old woman presented with a week’s history of abdominal pain and constipation. further history revealed episodes of tachycardia during childhood but no cause at that time was identified. On examination she had a sinus tachycardia, her abdomen was mildly tender and the rest of her clinical examination was completely unremarkable, including blood pressure, and there were no clinical findings consistent with Addisonian crisis.Inv...

Introduction: Vasopression-2 receptor antagonists (VPAs) have been licensed for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). As usage extends to other causes of hyponatraemia, over-rapid correction and hypernatraemia remains as important side-effect. We present a patient with severe SIADH highlighting the need for guidance and vigilance when using these potent drugs.Case: A 82-year-old lady...

Introduction: Myxodedema coma comprises a complex endocrinological emergency whereby there is severe clinical hypothyroid state. It is a life threatening yet a potentially reversible condition that may prove rather difficult to recognise due to the complex symptomatology. Very few articles report the specific therapy for myxoedema coma.The case: Here we present an elderly lady with previous total thyroidectomy, who despite receiving oral thyroxin tablets...

IntroductionHyponatraemia is the most common electrolyte abnormality encountered within the inpatient setting and is associated with increased morbidity, mortality and length of hospital stay. It compromises a spectrum of symptoms, from being asymptomatic to varying degrees of neurological disturbances including gait abnormalities with increased risk of falls, confusion and rarely seizures. This is of particular relevance in the midst of an aging populat...

Case history: A 20-year-old male presented with a one-year history of reduced libido, headache and slowly progressive blindness. His symptoms (particularly the visual deterioration) had a great impact on his daily life, leading to dismissal from work. Examination showed decreased visual acuity (12/6 bilaterally), reduced colour vision and a dense bitemporal visual field loss. Testes measured 15 mls bilaterally. He had no clinical stigmata of acromegaly, nor Cushing’s dise...

Background: Primary aldosteronism (PA) accounts for 5–10% of all patients with hypertension, and an even greater proportion of those with refractory hypertension. Accurate assessment of PA is important both for rationalisation of medical therapy and to identify those patients with unilateral disease who may benefit from surgery. Single timepoint testing may miss patients with intermittent (‘cyclical/periodic’) disease, a phenomenon seen in other endocrine hypers...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...