Endocrine Abstracts

Autoimmune adrenal insufficiency may be familial or non familial. We report a case of identical female twins, both with Addison’s disease and detectable antibodies to adrenal cortex.Case report: Twin A at age of 27 developed Addison’s disease and hypothyroidism. She was found to be positive for anti-adrenal antibodies, anti-thyroid antibodies and intrinsic factor auto antibodies. Therefore Twin B was tested for the same auto antibodies and was ...

An 18 year old nursery nurse suffered two probable seizures. She was commenced on Phenytoin. She had had a cleft palate repair. Clinical examination revealed hypertelorism and short fourth metatarsals. Early papilloedema was noted. Routine blood tests showed profound hypocalcaemia of 1.2 mmol/l. Serum phosphate , magnesium and parathormone levels were normal. She suffered a further seizure and was given intravenous calcium. She suffered no further seizures and calcium levels w...

The objective of the study was to assess the effect of intra-muscular testosterone on constitutional symptoms, sexual symptoms, memory and in men with hypogonadism and poorly-controlled type-2 diabetes. This is a randomised double-blinded placebo-controlled add-on trial of intramuscular testosterone undecanoate(Nebido®) administered every 12 weeks in 65 hypogonadal men with poorly-controlled diabetes. Phase-1 patients were randomly assigned to either treatment ...

Introduction: With increasing prevalence of hypogonadism, testosterone replacement therapy (TRT) remains the mainstay of treatment for male hypogonadism. Polycythaemia, the commonest reported side effect of TRT is often claimed to be less with transdermal preparations than intramuscular.Case history: A 48 years gentleman, initially presented in primary care with reduced libido, erectile dysfunction(ED), low energy levels. Early morning testosterone level...

Introduction: DKA is often seen in people with Diabetes Mellitus I and seldom in Diabetes Mellitus II but rarely seen in Maturity Onset Diabetes of Young (MODY) and even more rare in association with SGLT2i.Case history: 44 years female, genetically confirmed Hepatocyte Nuclear Factor 1 alpha (HNF1A) MODY since 2004 initially treated with maximum doses of metformin and gliclazide and then lost to follow-up. GP initiated Empagliflozin a year before presen...

Background: Increased endogenous post-prandial GLP-1 release is a key mediator of improved glycaemic control following Roux-en-Y gastric bypass (RYGB) surgery. GLP-1 receptor agonists (GLP-1 RA) augment glucose-stimulated-insulin-release and suppress glucagon release, and do not usually cause hypoglycaemia. The use of GLP-1 RA have been shown to be safe for patients requiring additional glycaemic control following RYGB. We present a case of severe recurrent fasting nocturnal h...

Case history: A 62-year-old male presented with generalised weakness, decreased oral intake, increased lethargy and polydipsia. He had a background of type 2 diabetes, hypercholesterolemia, and was a heavy smoker. No family history of parathyroid disease, other disorders causing hypercalcaemia or other endocrine tumours.Investigations: Initial blood results showed severe hypercalcaemia adjusted calcium 3.87mmol/l (2.2 - 2.55mmol/l), significantly raised ...

Insulin autoimmune syndrome (Hirata syndrome) is a rare cause of hypoglycaemia. It was described by Hirata in 1970 and characterised as spontaneous hypoglycaemia, with elevated insulin levels, and associated high titres of insulin autoantibodies. It is most commonly reported in Japan and is associated with autoimmune disease or exposure to sulfhydryl-containing drugs.Continuous glucose monitoring (CGM) devices measure interstitial glucose and were initia...

Inpatient hypoglycaemia is common and associated with adverse outcome during admission and post discharge. We investigated management of hypoglycaemia using the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with clinical guidelines.Methods: Inpatient CBG data from 8 hospitals over a 7 y period were analysed. Primary care prescribing information was available, and admissions were associated with insulin or SU...

Background: Hypocalcaemia post parathyroidectomy and thyroidectomy is common and usually transient. A variety of drugs including tyrosine kinase inhibitors can cause hypocalcaemia. We present a case where a patient with primary hyperparathyroidism on imatinib with pre-op calcium 2.86 mmol/l, post-operatively developed resistant hypocalcaemia necessitating prolong hospitalisation and multiple calcium infusions which was not solely attributable to hungry bone syndrome.<p cla...