Endocrine Abstracts

Bilateral laparoscopic adrenalectomy is a treatment option for ACTH-dependent Cushing's syndrome after failed pituitary surgery (Cushing's disease) or when the ACTH source cannot be resected or localized (ectopic ACTH syndrome). It has not, to our knowledge, been reported in the treatment of ectopic ACTH secretion in patients with small cell lung cancer.A 47 year old presented with haemoptysis and a right hilar mass, biopsy of which confirmed inoperable ...

Many patients with Turner's and Klinefelter's syndromes develop osteoporosis. We present the cases of three patients with osteoporosis and chromosomal abnormalities.Case 1: A 65 year old women requested evaluation of osteoporosis because of multiple fractures of hip, elbow and vertebrae. She was kyphoscoliotic, having lost 6 cm from her peak height o 1.76 m. Aged 12 she was told that she lacked female reproductive organs and underwent surgery including v...

INTRODUCTION: Disturbance in thyroid function following larygectomy usually manifests as hypothyroidism. Hyperthyroidism is not well recognized. We present a case of transient hyperthyroidism caused by laryngectomy. CASE STUDY: A 58-year-old man underwent total laryngectomy for laryngeal carcinoma. The surgery was not complicated. 3days following surgery, the patient was noted to have sinus tachycardia with a rate between 100 and 110. On the 7th postoperative day thyroid funct...

We present a case of acquired hypogonadotrophic hypogonadism (HH) in a 54-year-old man that illustrates the need for wider endocrine screening in such patients. Having undergone complete pubertal development as a teenager and subsequently fathered two children, the patient presented with a nine-month history of reduced libido, erectile dysfunction, hot sweats and headaches. His GP had diagnosed HH on the basis of a low testosterone with inappropriately low gonadotrophins. Exam...

Neuroleptic-induced hyperprolactinaemia (NIHP) is a recognised complication of neuroleptic drug therapy.Pituitary tumours however may exist co-incidentally in patients on neuroleptic medications and contribute to hyperprolactinaemia. A potential pitfall is to attribute the elevated prolactin level to drug therapy alone particularly when treatment with neuroleptics has been longstanding.A 35 year old woman with bipolar affective disorder was referred with...

A 71 year old woman presented with visual loss. MR scanning demonstrated a massive invasive pituitary adenoma. She had no features of endocrine dysfunction. 0900hrs cortisol was 278nmol/L. Haemorrhage limited transphenoidal surgery to biopsies. Postoperative CSF leak was repaired 3months later. Histology revealed a corticotroph adenoma on immunostaining.At endocrine follow-up, afternoon cortisol was 645nmol/L, and 875nmol/L fasting, falling after glucago...

SEVERE HYPERCALCEMIA CAUSED BY A VISIBLE PARATHYROID ADENOMA IN AN ADOLESCENT FEMALEU.Das1, H Iassac1, H Kanchi1, DA Price1, GM Humphrey2 & C M Hall1Departments of 1Endocrinology and 2Surgery, Royal Manchester Children's Hospital, Manchester, Hospital Road, Manchester M27 4HA.A 16-year-old female collapsed following a 24-hour history of severe abdominal pain and vomiting. She was shocked, hypertensive (16...

A 71-year-old man presented with a three week history of nausea, vomiting, constipation, polyuria, nocturia, polydipsia and feeling weak. He had sustained a wrist fracture six weeks prior to admission. Since then he had started to consume calcium containing mineral water, cod liver oil and seven seas oil.Examination revealed a palpable mass in the right lower thyroid. Serum calcium level was 4.37 millimols/litre (ref. 2.10-2.70), parathormone level of 72...

Obstructive sleep apnoea (OSA)is associated with increased cardiovascular morbidity and mortality and is an independent risk factor for the development of hypertension. A recent study demonstrated elevated urinary catecholamine excretion in hypertensive males with OSA. However, we have recently observed the phenomenum whereby OSA can rarely induce catecholamine production of sufficient severity to mimic the clinical and biochemical presentation of phaeochromocytoma.<p clas...

INTRODUCTION: Gastrinomas usually arise in pancreas or duodenum and may be small and difficult to localize. These tumours are multiple in 50% of sporadic cases but in MEN1 this figure rises to 90%.CASE REPORT: Our patient presented aged 24 with a neck mass. Investigations confirmed primary hyperparathyroidism and four-gland parathyroidectomy confirmed hyperplasia. When normocalcaemic, her fasting plasma gastrin level was noted to be 129 pmol/l (NR<40)...

We present a patient with asymtomatic primary hyperparathyroidism who became normocalcaemic following spontaneous infarction of a parathyroid adenoma. He was referred by the General Practitioner following an episode of renal colic when he was found to have a raised adjusted serum calcium level of 3.07 millimols/litre (ref 2.10-2.70). Parathyroid hormone level was 33.2 picomols/litre (ref 1.3-7.6), confirming primary hyperparathyroidism. A SESTIMIBI scan revealed a parathyroid ...

A 56 year old female on treatment for colonic Tuberculosis was referred for investigation of possible Cushing's Syndrome. She initially presented with hypertension, hypokalaemia, and proximal myopathy. Repeated Urinary Free Cortisols were elevated at 730, 738, 520 nmol/L, (normal range= 55-270 nmol/L). The patient failed to suppress on low dose dexamethasone suppression, LDDST, (0.5 mg 6 hourly for 48 hours), baseline cortisol= 390 nmol/L, 48hour cortisol = 595 nmol/L, but sup...

Gynecomastia is the most common disorder of the male breast.The aim of the present study was to evaluate its progression with time in children with pubertal gynecomastia for a mean period of five years.PATIENTS AND METHODS :25 boys without evidence of testicular or karyotype abnormalities were included in the study. Mean age was 13.01±1.8 yrs. Duration of the follow up in all patients varied from 1.2 to 5.5 yrs(mean 2.7yrs) ...

Lithium-induced hyperparathyroidism was first described in 1973 by Garfinkel et. al.The two cases aim to illustrate Lithium-induced hyperparathyroidism which was previously thought to be a rare occurrence and outline characteristic features of this disorder.Case 1.A 51 year old male presented with polydipsia and polyuria. He was known to suffer from bipolar affective disorder with lithium treatment was admitt...

A 54yr old female presented with a 12-month history of tremor, sweating, anxiety and occasional palpitations. There was no past medical or family history of note. On examination, she had a fine tremor but no neck masses or eye signs. Her FT4 20.8 pmol/l (8pmol/l-22pmol/l), FT3 7.3 pmol/l (3.5-6.5pmol/l) with a suppressed TSH less than 0.01mu/l (0.35mu/l-5.5mu/l); 99Tc scan showed an autonomous hot nodule in the right lower lobe of the thyroid with partial suppression of the re...

Aims:It is currently well known the pathogenic relationship between abdominal obesity(AO),impaired glucose tolerance(IGT)and insulin resistence(IR).We have proposed the studying of presence of a correlation between the obesity degree,established with the help of the body mass index(BMI)and of its type(indicated by the waist-hip ratio-(WHR)with a IGT frequency or of the non-insulin-dependent diabetes mellitus(NIDDM)and of the hyperinsulinemia(HI)in a bihor county population gro...

Secondary causes of diabetes are uncommon. As 50-80% of patients with diabetes have co-existing hypertension, a high index of suspicion is required to exclude a secondary cause in patients presenting with both conditions. Atypical presentations may delay the diagnosis.A 49 year old man presented with a one year history of polydipsia, polyuria and fatigue. Diabetes was diagnosed with a random blood glucose (RBG) of 12 mmol/l. Hypertension diagnosed 15 yea...

A 66-year-old Caucasian male presented with polydipsia, profound weight loss, blood glucose of 29.1 millimoles per litre and mild acidosis. Urinalysis revealed no ketonuria. A mild acidosis was also identified. A bronzed skin appearance was noted which together with deranged liver function raised suspicions of haemochromatosis in conjunction with newly diagnosed diabetes. Initial treatment involved rehydration, intravenous then subcutaneous insulin therapy. Subsequent abdomina...

Shapiro's syndrome is characterised by agenesis of the corpus callosum, hypothermia and hyperhydrosis. We report a case associated with abnormal water balance and hypothalamic dysfunction.A 20 year old Turkish Cypriot man presented with an 8 month history of profuse sweating associated with a perception of extreme cold. He described progressive problems with speech, memory and clumsiness on walking. Symptoms of polyuria and polydipsia were associated wit...

Background: Fungal infections are a rare cause of primary adrenal insufficiency, raising difficulties in the diagnostic and therapeutic approaches.Case report: A 56 years old diabetic male, who lived in Guinea in 1968, was referred to our inpatients clinic because of a 7,7x3 cm adrenal incidentaloma. He presented with hyperpigmentation, postural symptoms, weakness, fatigue, anorexia and weight loss.The rapid ACTH stimulation test h...

Subcutaneous heparin is commonly used for prophylaxis of deep vein thrombosis. Heparin induced hypoaldosteronism can lead to hyperkalemia and natriuresis. These side effects are more common in elderly, renal insufficient and diabetic patients. We present a case with heparin induced hyperkalemia in a patient with diabetes.An 85 year old lady with insulin dependent diabetes mellitus of 32 years duration with peripheral neuropathy was admitted under the vas...