Endocrine Abstracts

Vitamin D (VD) deficiency (25 OHD < 50 nmol/l) is common is chronic liver disease at 64%–92% regardless of aetiology. The only guidelines for routine VD supplementation are for cholestatic (C) liver disease; a population considered being at high risk of low bone mineral density (BMD). BMD decreases further following orthotopic liver transplant (OLT). To assess VD intake in an at risk population, retrospective analysis of intake was performed in OLT patients with C liv...

Background: 25-hydroxycholecalciferol (25(OH)D) deficiency is prevalent in the Scottish paediatric population. Paediatric oncology patients are at even higher risk of becoming deficient because they spend more time indoor, often have an inadequate dietary intake and increased 25(OH)D catabolism during treatment. We aimed to assess 25(OH)D and parathyroid hormone (PTH) levels before and after supplementation in Scottish children with cancer.Methods: Plasm...

Ectopic adrenocorticotropic hormone (ACTH) production is a rare cause of Cushing’s syndrome. It is usually seen with small cell lung cancer, bronchial carcinoid, or medullary thyroid cancer. Rarely, the source of ectopic ACTH production can be a phaeochromocytoma. A 55 year old gentleman presented to a general physician following an episode of presumed gastroenteritis with vomiting and general malaise. Further episodes of diarrhoea, joint pains and palpitations followed. ...

Hyponatraemia is commonly encountered in neurosurgical units. Salt wasting syndrome is rare, and thought to occur due to ANP- and BNP-mediated natriuresis, leading to hypovolemic hyponatraemia. A 31 year old male was transferred to the National Neurosurgical Unit with a 12 hour history of back pain, progressive lower limb weakness and sensory loss. MRI demonstrated an epidural haematoma, extending from C7 to T3, and he underwent emergency decompressive laminectomy. Vasopressin...

Case history: A clinically euthyroid 7-year-old boy was noted to have a persistently elevated TSH 7.35–14 mU/l (NR 0.27–4.2) and normal FT4 15.0 pmol/l (NR 10-24) with negative anti-thyroid peroxidase antibodies. Thyroid ultrasonography revealed a eutopically-located thyroid gland of normal size. Following commencement of levothyroxine, he developed insomnia, irritability and headaches, resulting in cessation of treatment. Growth and development proceeded ...

A 24 year old man presented with gait instability, myalgia, and cognitive decline, after a holiday in Crete; his alcohol intake exceeded 200 units/week. He had marked facial dysmorphism, with frontal bossing, and global muscle weakness. He had hypernatraemic dehydration (plasma sodium 175 mmol/l urea 16.9 mmol/l), but denied thirst. Urine concentration was 894 mOsm/kg, excluding diabetes insipidus. CK was elevated at 15,540 U/l. CT brain shown marked hydrocephalus. Rhabdomyoly...

Background: The recently published ‘Consensus on Criteria for Cure of Acromegaly’ (Giustina et al. JCEM, 2010) highlighted concerns regarding the quality of currently available insulin-like growth factor 1 (IGF1) immunoassays which may contribute, at least in part, to the discordance between GH and IGF1 that is observed in up to 30% of patients with acromegaly after treatment. The development of mass spectroscopy (MS)-based technology has been proposed ...

Background: A 52-y-old lady (Mrs M) presented with a 10-day history of progressive generalised weakness, dysarthria and un-coordination. 26 y ago, she had cervical carcinoma, requiring a hysterectomy, oophorectomy and radiotherapy. This led to a vesicovaginal fistula, requiring a cystectomy and ureterosigmoidostomy. She is known to have osteoporosis. Medications: calfovit D3 one/d (started 5 days prior to admission), risedronate, lansoprazole. She had HRT until 50 y. Examinati...

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...

Context: Primary aldosteronism (PA) accounts for 5–10% of all hypertension and 20–25% of refractory cases. Diagnosis is important as PA is associated with increased morbidity and mortality compared with ‘essential’ hypertension, and up to 50% of patients may benefit from unilateral adrenalectomy. Screening requires measurement of plasma renin activity (PRA) or concentration (PRC), and plasma aldosterone concentration (PAC), to yield an aldosterone:renin rat...