Endocrine Abstracts

A 32 year old female presented with recurrent episodes of severe hypoglycaemia. Type 1 diabetes had been diagnosed 10 years earlier and she had undergone subtotal colectomy/ileostomy 20 months earlier for chronic diarrhoea. Histology suggestive of eosinophilic colitis. High stoma output (>4 litres per 24 hours) was causing stomal incontinence with disruption of normal lifestyle. Treatment with combinations of loperamide, codeine, omeprazole and octreotide were ineffective....

Generalised resistance to glucocorticoid is a rare familial or sporadic disease with partial target tissue insensitivity to glucocorticoids. Compensatory activation of the hypothalamo–pituitary–adrenal axis occurs with raised andrenocorticotrophic (ACTH) hormone levels and increased synthesis of adrenal steroids. The phenotype varies from asymptomatic to excess glucocorticoid, mineralocorticoid and androgenic effects.A 20-year-old female was fo...

Gynaecomastia is common, occurring in 30–50% of healthy men, and its aetiology is usually benign. Clinical features inclusive of recent onset, rapid progression, and loss of libido and muscle strength, indicate the need to exclude a malignant aetiology.A 48-year-old man presented with an 18-month history of such clinical features. Investigations revealed cortisol 1136 nmol/l, 17-hydroxyprogesterone 6.6 nmol/l, androstenedione 13.3 nmol/l, DHEAS 21.8...

A 48-year-old female received radioiodine ablation therapy for thyrotoxicosis secondary to a solitary toxic nodule. The subsequent unexpected requirement for replacement thyroxine was explained by Hashimoto’s thyroiditis with an anti-thyroid peroxidase antibody level of 692.3 IU/ml. Thirty months later she presented with debilitating left facial pain and painful sensory symptoms of her left arm and leg. She was euthyroid taking thyroxine 75 μg daily with a fT4</...

A 34-year-old female presented with an 18 months history of secondary amenorrhoea, hirsutism, weight gain and low mood. Examination confirmed typical stigmata of Cushing’s syndrome with skin thinning, purpura, acne, facial plethora, central adiposity and hypertension. Investigations revealed fT4 14.7 pmol/l, fT4 4.1 pmol/l, TSH 0.71 μ/l, prolactin 377 μIU/ml, FSH 3.5 μ/l, LH 2.2 μ/l, oestradiol 140 pmol/l, testosterone 5.1 nmol/l,...

Generalised resistance to thyroid hormone (GRTH), a subset of the syndrome of resistance to thyroid hormone (RTH), is characterised by variable reduced target tissue responsiveness to circulating thyroid hormones. Plasma thyroid hormone levels are raised and TSH levels inappropriately non-suppressed. We describe a 54-year-old female with GRTH diagnosed from the finding of raised fT4 and fT3 levels coincidental with non-suppressed TSH levels. A thyrotropin (TRH) test resulted i...

Hydrocortisone treatment in septic shock promotes shock reversal and reduces mortality. We hypothesised the doses that used (200–300 mg/2 h) would result in plasma cortisol levels sufficient to saturate the 11 beta-hydroxysteroid dehydrogenase 2 enzyme (11 beta-HSD 2) with cortisol inactivation overload. Consequently cortisol would access the mineralocorticoid receptor producing mineralocorticoid effects. Hypertensive metabolic alkalotic effects would tend to counteract t...

Insulin resistance has been suggested to have a pathogenic role in polycystic ovary syndrome (PCOS). The use of insulin sensitising drugs might therefore have a therapeutic role in its management.We studied 20 patients (mean age 32.6 years) with PCOS (diagnosed by the Rotterdam Consensus Workshop group criteria, 2003) before and after treatment with metformin (1.5–3 grams daily) for 6 to 12 months.Clinical features studied wer...

Hyperandrogenism of adrenal origin evidenced by elevated dehydroepiandrosterone sulphate (DHEAS) levels has been reported in 20% to 30% of patients with polycystic ovary syndrome.We studied 50 patients with PCOS (defined by the Rotterdam Consensus Workshop group criteria, 2003). Adrenal hyperandrogenaemia was defined as a DHEAS level> 10.5 micromoles/litre was found in 10 patients (20%). Clinical features studied were body mass index (BMI) and hirsut...

A 48-year-old man presented with classical symptoms and physical signs of severe acromegaly. Investigations revealed: fT4 12.8 picomoles per litre, TSH 1.4 milliunits per litre, testosterone 3.9 nanomoles per litre, FSH 4.3 units per litre, LH 2.1 units per litre, cortisol (09.00 hrs) 710 nanomoles per litre, prolactin 1657 microinternational units per millilitre and IGF1 155 nanomoles per litre. Growth hormone levels were greater than 150 milliunits per litre throughout an or...