Endocrine Abstracts

A 79-year-old lady presented with a 6 months history of confusion and slurred speech and was found to have recurrent spontaneous hypoglycaemia (plasma glucose 1.3, 1.8 and 2.6 mmol/l). Pituitary and adrenal function were normal, and raised insulin (102 pmol/l) and C-peptide (630 pmol/l) levels confirmed the diagnosis of insulinoma, which was identified as a solitary 2 cm mass in the head of pancreas. Treatment with diazoxide 100–150 mg tds led to normalisation of g...

We present the case of assumed ectopic GHRH from residual bronchial carcinoid on the basis of an elevated serum GH, an elevated IGF-1 impaired glucose tolerance and an acromegalic appearance. The patient was diagnosed with a left bronchial carcinoid in 1985, aged38 years. Treated with a left pneumonectomy. She remained well until she presented in 1994 with an oesophageal variceal bleed. She had no evidence of portal hypertension or liver disease. CT chest revealed a mediastina...

A 71-year-old man with carcinoma of prostate and bony metastasis, presented with acute bradyarrhythmia, severe hypocalcaemia and acute renal failure 72 h after intravenous infusion of zoledronate. Before therapy, serum calcium was 2.14 mmol/l (normal, 2.10–2.55 mmol/l), serum phosphate 1.4 mmol/l (normal, 0.8–1.5 mmol/l), serum creatinine 95 umol/l and eGFR 74 ml/min. 25OH vitamin D was not measured. Three days later he presented with a syncopal episode. Initial bloo...

We describe two cases of sarcoidosis associated hypercalcaemia, renal failure and anaemia mimicking lymphoma. The diagnosis was made by lymph node biopsy. Within weeks of starting oral steroids, symptoms resolved and biochemical abnormalities almost normalized.Case 1: A 66-year-old lady, presented with generalized weakness, lymphadenopathy and splenomegaly. Hb 96 g/l, MCV 91, urea 16.6 mmol/l, creatinine 227 umol/l, eGFR 15 ml/min, serum calcium 3.4 mmol...

We describe below a 16-year-old male referred with neonatal hypothyroidism. He was commenced on levothyroxine at the age of 3 weeks. The TSH was >100 IU/l (normal: 0.27–4.7) and Total T4 was <10 nmol/l (normal: 60–150) and there was no uptake on thyroid isotope scanning. He was diagnosed as having congenital absence of thyroid tissue and given levothyroxine and the dose adjusted to maintain normal thyroid function. His mother was diagnosed with hypothyroidism...

Vitamin D toxicity is a recognised consequence of vitamin D therapy arising from prescription of pharmacological doses of vitamin D; biochemical monitoring is recommended for these patients. In contrast, patients taking low-dose calcium and vitamin D (Ca+D) supplements, commonly used to reduce the risk of osteoporosis, are not regarded as at risk of vitamin D toxicity, and biochemical monitoring is not routine. We report a patient taking Ca+D supplements who developed hypercal...

Fasting blood glucose is key to diagnosing diabetes, whilst the Oral Glucose Tolerance Test (OGTT) is a valuable adjunct when diagnosis is borderline or inconclusive. The OGTT is often used to detect early changes in glucose tolerance and predict a likely path to overt Diabetes Mellitus for example in gestational diabetes.A 42 year old female, referred to the Endocrine services for episodes of symptomatic hypoglycaemia. Past medical history included pylo...

The proglucagon-derived hormone, glucagon-like peptide–1 (GLP-1), augments both beta cell function and mass. However, GLP-1 is rapidly degraded in plasma, thereby limiting its potential as a treatment for diabetes. One approach to circumvent this problem would be to stimulate synthesis of GLP-1 locally in the islet.Emerging evidence suggests that pancreatic alpha cells, which normally produce glucagon, can adapt to produce GLP-1. This phenomenon may...

Introduction: Central Serous Retinopathy (CSR) is a condition characterized by the accumulation of sub-retinal fluid at the posterior pole of the fundus, creating a circumscribed area of serous retinal detachment. It is associated with increased levels of endogenous or exogenous glucocorticoids and has been described in patients with Cushing’s syndrome (CS).Here we report on two cases we recently managed in our unit, with central serous retinopathy ...

Antiphospholipid antibody syndrome is characterised by recurrent venous or arterial thrombosis, thrompocytopenia and/or recurrent fetal loss in the presence of antiphospholipid antibodies. Antiphospholipid antibody syndrome may be seen in-patients with established Systemic Lupus Erythematosus or alternatively as isolated disease in-patients with no evidence of a lupus type abnormality. Antiphospholipid antibodies have been also associated with a variety of neurological and car...