Endocrine Abstracts

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...

The insidious onset of symptoms and slow progression of acromegaly often results in a delay in diagnosis for several years. We report an unusual case who presented with progressive lymphoedema of the lower limbs 25 years before the diagnosis of acromegaly became apparent.A 51 year old lady presented to the surgical outpatient clinic with a twenty four year history of bilateral leg swelling and hypertension of 21 years duration. There was no antecedent h...

IntroductionCurrent guidelines recommend a single elevated prolactin measurement drawn without excessive venepuncture stress as sufficient for diagnosing hyperprolactinaemia. However, previous studies have demonstrated that the cannulated prolactin test is more reliable at eliminating stress-induced hyperprolactinaemia, thus avoiding unnecessary additional investigations. We routinely perform morning serial prolactin sampling immediately after brachial v...

BackgroundSomatostatin receptor ligands (SRL) are commonly used in patients with acromegaly to control insulin growth factor 1 (IGF1) concentrations. Biliary sludge or gallstone formation are well-recognised biliary adverse events (BAE) from SRL therapy. Our current practice is to routinely monitor patients with acromegaly on SRL with ultrasound scanning (USS). Once BAE are detected, ursodeoxycholic acid (UDCA) therapy is initiated.<p class="abstext"...