Endocrine Abstracts

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Case history : A 44-year-old female presented with 6-week history of gradual deterioration in her left vision associated with eye pain. She saw an ophthalmologist who noted that she had reduced visual acuity (6/24) and colour vision (Ishihara colour vision score 3/15) in her left eye with left relative afferent pupillary defect (RAPD). It was thought that she may have a left retrobulbar neuritis so she was advised to attend A&E for an urgent neurology assessment. On examin...

A 30-year-old female presented to her general practitioner with a three-month history of fatigue, visual disturbance, polydipsia and dizziness. She was treated for iron deficiency anaemia, but re-presented two-months later with new-onset headache and worsening visual disturbance. Previously, she had childhood leukaemia, treated in Brazil with no cranial irradiation. On examination there was left eye loss of light/dark perception and right temporal vision loss. She was referred...

Introduction: Macroprolactin is a physiologically inactive form of prolactin, usually composed of a prolactin monomer and an IgG or anti-prolactin antibody molecule. Whilst clinically non-reactive, it interferes with immunological assays used for prolactin detection. It is identified by polyethylene glycol (PEG) precipitation, and levels of macroprolactin are generally believed to remain stable over time.Case: We present the case of a 36-year-old gentlem...

Background: Correct identification of patients with HPA axis dysfunction following trans-sphenoidal pituitary surgery is important. Our centre measures post-operative day 5 0900 h serum cortisol (24 h after the last dose of glucocorticoid) to identify the need for glucocorticoid replacement. This is given if post-operative day 5 0900 h cortisol concentration is <300 nmol/l, until dynamic pituitary function assessment occurs.Methods: Data were reviewe...

We present the case of a 33-year-old woman diagnosed with congenital adrenal hyperplasia (CAH) due to classical 21-hydroxylase deficiency following a salt-losing crisis as a newborn. She had previously been controlled on dexamethasone 0.25 mg bd and fludrocortisone 100 mcg od, as evidenced by high-normal 17-hydroxyprogesterone (17-OHP) and low-normal testosterone levels (8.5 and 0.4 nmol/l respectively).However, she had experienced significant symptoms o...

This gentleman was diagnosed with hyperparathyroidism at the age of 34 and was found to have multiple manifestations of MEN1.Hyperparathyroidism: He was diagnosed with hyperparathyroidism and underwent a parathyroidectomy with removal of 2 glands. Four years later calcium levels were raised once again and two further hyperplastic glands were removed, with cure of his hypercalcaemia.Gastrinoma and other pancreatic islet cell tumours...

Background: Alemtuzumab is an anti-CD52 monoclonal antibody used in the treatment of relapsing-remitting multiple sclerosis (MS). Between 20 and 40% of Alemtuzumab-treated MS patients develop autoimmune thyroid disease (AITD) as a side effect. It is currently unknown whether development of AITD correlates with MS disease activity following Alemtuzumab treatment.Aims: To characterise the types and frequency of AITD that MS patients develop following Alemt...

Our 42-year-old patient presented with breathlessness and signs of congestive cardiac failure. Her ‘spade-like hands and acromegalic appearance’ were noted on the post-take round. She had headaches, orthopnoea and secondary amenorrhoea. She was a poorly controlled diabetic (so OGTT was not performed), anaemic, and previously had a thyroidectomy.Pituitary profile showed secondary hypogonadism, normoprolactinaemia and normal free T4 indicating ad...