Endocrine Abstracts

Background: Although pheochromocytoma classically presents with headaches, palpitations and paroxysmal hypertension, uncommon presentations such as cardiomyopathy, stroke and subarachnoid haemorrhage have been documented. We present one such infrequent presentation of myocardial infarction with normal coronary arteries (MINOCA).Case presentation: A 79-year Caucasian female presented with central crushing chest pain radiating to left arm associated with h...

Aims: To assess the incidence of Ipilimumab associated hypophysitis and its common presentations.Methods: All patients who developed Ipilimumab induced hypophysitis following treatment for Malignant melanoma at a large tertiary care centre in West Midlands, United Kingdom from 2012 to 2014 were included in the study. Patients with known pituitary disease prior to treatment and/or received other systemic immunotherapy following Ipilimumab treatment were e...

Context: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of classic androgen synthesis. Recent work has highlighted that impaired DHEA sulfation results in enhanced androgen production. Here, we evaluated the relationship between DHEA and DHEAS and androgen excess and metabolic phenotype in PCOS.Patients and methods: We compared 65 women with PCOS to 35 healthy women matched for age and body mass index (BMI). All subject...

A 62-year-old Asian British female presented with increasing tiredness. She had multiple co-morbidities and was prescribed steroid inhalers for suspected asthma. Her type 2 diabetes mellitus, previously well controlled on metformin, had worsened over a short period of time (48 to 85 mmol/mol). On examination, she was obese (weight 82 kg, BMI 43 kg/m2), hypertensive (155/78 mmHg); rest of the examination was unremarkable. The blood test revealed undetectable cortisol...

An 88-year-old Caucasian man with hypertension, single functioning kidney, vitamin D insufficiency and transurethral resection of the prostate was admitted with worsening confusion. On admission, he had acute on chronic renal impairment (Urea- 17.2 mmol/l (range: 2.5–7.5 mmol/l), Creatinine- 163 μmol/l (range: 60–120 μmol/l), eGFR- 35 (Baseline- 60 ml/min/1.73m2) and a normal serum/corrected calcium (2.51 mmol/l (range- 2.2–2.6mmol/l). He wa...

Insulin resistance and androgen excess are the cardinal features of polycystic ovary syndrome (PCOS). The severity of hyperandrogenism and metabolic dysfunction in PCOS are closely correlated, but underlying mechanisms remain poorly understood. Aldoketoreductase type 1C3 (AKR1C3) is an important source of adipose androgen generation, activating androstenedione to testosterone (T). We postulated that AKR1C3 plays a critical role linking androgen metabolism and...

Background: Effective management of diabetic ketoacidosis (DKA) improves clinical outcomes. Regular auditing and performance feedback are key to achieving sustained and significant improvement in the management of DKA. One of the major limitations for maximal impact of an audit is the delay from initiation to results as the latter may not be applicable to the then current practice. In order to overcome this, we created an automated auditing system called Digital Evaluation of ...

IntroductionRecently, apart from its main physiologic role, the active form of vitamin D has also been recognised to have anti-inflammatory and immune-modulating properties. Accumulating evidence suggests that Vitamin D deficiency is associated with increased prevalence of various autoimmune diseases, and in particular, with autoimmune thyroid disease. Despite contradicting evidence, the balance is tipping towards inverse correlation between vitamin D de...

Section 1: Case history: A 37-year-old South Asian woman was referred to our diabetes clinic from the Diabetes Eye Screening Programme. Her retinal blood vessels appeared white, in contrast to the normal pink-red colour. The patient was diagnosed with diabetes secondary to chronic pancreatitis a year prior to this presentation, for which she was on metformin and long-acting insulin but had suboptimal control and multiple hospitalisations with chronic pancreatitis. She was prev...

Introduction: Effective management of diabetic ketoacidosis (DKA) improves clinical outcomes. We created an automated auditing system, Digital evaluation of ketosis and other diabetes emergencies (DEKODE), which identifies DKA episodes based on fixed-rate intravenous insulin infusion (FRIII) prescription.Aim: We validated DEKODE for its ability to audit DKA management against manually collected data.Methods: All episodes identified...