Endocrine Abstracts

A 34-year-old woman with seasonal allergic rhinitis was poorly controlled with fexofenadine. She began to use beclomethasone nasal inhaler, 42 ug of drug per nasal pump unit, 2 sprays in each nostril twice daily. There was no history of substance use or drug intake. Two months later she complained of easy fatiguability, and pain in her thighs and arms, on walking distances and climbing stairs which were easily tolerated earlier. There was no history of proximal muscle weakness...

Abstract for Society for Endocrinology Conference 2003Category: Clinical case report (Young Endocrinologist)AbstractTitle: A CASE OF HYPERTHYROIDISM PRESENTING AS HAEMATOLOGICAL MALIGNANCYAuthors: K.M. Evans, D.E. Flanagan; Dept. of Endocrinology and Diabetes, Derriford Hospital, Plymouth, PL6 8DHA 30 yr old man was referred to the Haematology department with axil...

A 55 year old lady was referred by her general practioner with a six months history of generalised lethargy and cold intolerance.This was associated with abdominal bloating and constipation.She had been more irritable recently and was getting depressed. She also described symptoms suggestive of carpal tunnel syndrome. The only past history of note was of lactose intolerance.There was no family history of thyroid disorder.On examination she was clinically...

Background: 20% of patients with acromegaly can have visual field defect due to compression of optic chiasm. This patient presented with visual field defect but no evidence of pressure effect on optic chiasm, but later found to have pituitary macroadenoma and acromegaly.Clinical Details: 59 yr old man presented 7 years ago to ophthalmologist with left inferior field defect of 2 months duration. The field defect was confirmed with perimetry. Subsequent CT...

A 62 year old woman presented in May 2001 with a one year history of palpitations. A 24 hour tape showed a short run of supra ventricular tachycardia only.In December 2001 she was admitted with palpitations, presyncope and a labile blood pressure. Systolic pressures of 150-186mmHg and diastolic pressures of 95-112mmHg were recorded. 24 hour urine collection for catecholamines revealed normal adrenaline levels but elevated noradrenaline at 5265 nanomols p...

A 27y old woman presented with a 2yr history of secondary amenorrhoea and mild hyperprolactinaemia. CT scan demonstrated an enlarged pituitary gland abutting the optic chiasm. Goldman perimetery was normal and trans-sphenoidal hypophysectomy undertaken. Post-operatively she suffered temporary diabetes insipidus responding well to desmopressin. At endocrine assessment, she was growth hormone deficient, had partial diabetes insipidus and a sub-optimal cortisol response. Desmopre...

A 32 year old man with a history of epilepsy since childhood presented in 1992 with a grand mal seizure and clinical features of tuberous sclerosis (TSC). One year later he was referred with classical Cushingoid features. His serum Na was 140 mmol/l, K 3.4 mmol/l, 9 AM cortisol 1018 nmol/l with lack of diurnal variation and ACTH 42-50 ng/l. Urinary cortisol: 797 nmol/24 h. After overnight, low and high dose dexamethasone suppression, cortisol was 1018, 1154, and 62 nmol/l resp...

A 19 year old university student who participated in athletics presented with secondary amenorrhoea. Examination revealed no features of endocrine disease. A pituitary profile showed normal serum thyroid function and prolactin, but undetectable LH, FSH, and oestradiol. Random serum GH level was detectable (9 milli units per litre), but IGF1 level was low, 72 (190-530 micrograms per litre). An OGTT demonstrated a paradoxical rise in her GH levels (3.5, 2.2, 38, 33, 20; mean GH ...

A 44-year old man, previously well, presented with acute confusion and having collapsed at home. His capillary blood glucose was 2.2mmol/L and he was resuscitated with an intravenous dextrose infusion. His collapse had resulted in a fracture to his right neck of femur.Given the possibility of a pathological fracture he had a bone scan, which revealed widespread bony metastasis. In search for the primary source, an abdominal computerised tomography (CT) s...

Encephalocoeles are congenital defects in the skull through which meninges and brain tissues herniate. Basal encephalocoeles represent 1.5% of all encephalocoeles and are found in 1:35,000 live births. Transphenoidal basal encephaloceles are very rare, representing only 5% of all basal encephaloceles. The pituitary and surrounding structures are drawn into the encephalocele with visual and hormonal disturbances being recorded in the few cases described.A...

A 44 year old woman presented in November 2000 with a two week history of headaches, vomiting and blurred vision. Past history consisted of type 2 diabetes and migraine. Initial investigation revealed hyponatraemia (sodium 114 mmol/l) and deranged liver biochemistry. ANA, anti dsDNA, cANCA, pANCA, anti Ro, La, RNP, Scl-70, Jo-1, smooth muscle and mitochondrial antibodies were negative. MRI revealed a 13x18x15mm pituitary mass elevating the optic chaism, without evidence of rec...

A 20 year old Asian housewife presented with a history of irregular periods and six months subfertility. On May 1 2002 she had a prolactin of 2,200 mIU/L (normal range 63-211) and subclinical hyperthyroidism : thyroid stimulating hormone (TSH) 0.3mIU/L (normal range 0.4-5.5) and free thyroxine (fT4) 12.6 pmol/L (normal range 10.3-23.2). At her first hospital visit on September 9 2002 she was 9 weeks pregnant. She did not have hyperemesis gravidarum. On examination, she was cli...

Erratic release of insulin accounts from periodic nature of the symptoms in insulinoma. Islet-amyloid polypeptide has been demonstrated in human insulin producing tumours- insulinoma. Presence of amyloid tissue has been demonstrated in pancreatic islets in patients with diabetes mellitus. Impaired islet function is a feature of diabetes mellitus. Hyperglycaemia, as in diabetes, enhances amylin secretion. Presence of insulinoma has been documented in past but insulionoma presen...

Lymphocytic hypophysitis is a rare autoimmune disease of the pituitary gland.A 39-year-old woman presented with a 6-month history of general malaise, anorexia, nausea and vomiting followed by a 3-month history of secondary amenorrhoea. Basal pituitary function testing revealed: fT4 5.1 picomoles per litre, TSH 1.6 milliunits per litre, cortisol 32 nanomoles per litre, prolactin 1167 microinternational units per millilitre, LH 2.8 units per litre and FSH ...

This 42-year-old male presented with a six-month history of general lethargy and mood changes. He had experienced weakness & difficulty climbing stairs; weight loss; ankle swelling and increased frequency of micturition. There was no significant past medical history.Initial investigations revealed Na+ 144mmol/L (135-145);K+ 2.3mmol/L(3.5-5.2); U 8.8mmol/L (2.6-6.7); Cr 75μmol/L (60-125); TCO2 41mmol/L (21-31); Fasting glucose 7.4mmol/L; TSH 0.21mU...

The clinical relevance of macroprolactin and its prevalence among those with 'hyperprolactinaemia' are unclear(1). Macroprolactinaemia has often been described as asymptomatic, benign and not related to pituitary disease(2,3,4). Recent reports, however, suggest that macroprolactinaemia is common among those with 'hyperprolactinaemia', can often be symptomatic and may be occasionally associated with pituitary adenoma(5,6). Pituitary imaging has been recommended in all symptomat...

Graves' disease is known to occur with increased frequency in patients with Type 1 diabetes mellitus (T1DM) especially women. Undiagnosed thyrotoxicosis can aggravate glucose intolerance and precipitate diabetic ketosis and ketoacidosis. Among the various presenting symptoms of hyperthyroidism, vomiting is a recognized but uncommon symptom.We present the case history of a 30 year old woman with T1DM of 10 years duration presenting with a short history of...

Most cases of primary hyperparathyroidism are due to either parathyroid adenoma or hyperplasia. Parathyroid carcinoma is a rare cause of hyperparathyroidism, usually diagnosed post operatively .Prognosis is poor with a 5 year survival rate of 50-75%.A 74 year old man presented with a 2 week history of weight loss, anorexia and constipation but no abdominal or bone pain. Past history included hypertension and gout and was not on drugs known to cause hyper...