Endocrine Abstracts

A 60 year old pest control worker presented to the dermatologists with a 3-month history of progressive thickening and change in texture of skin lesions affecting the face, lips and eyelids. Histology revealed papular mucinosis/lichen myxoedematosus and he was treated with plasma exchange, high dose steroids and cyclophosphamide. Investigations for associated tiredness, four months following presentation and initiation of therapy revealed impaired GH and cortisol responses to ...

There have been several case reports over the years of hypopituitarism occurring after cerebral oedema caused by diabetic ketoacidosis (DKA). The case reports have ranged from a single hormone defect to a more extensive loss of hormone production. What is not reported in the literature so far is what happens to these patients and their hormone deficiencies in the longer term.This is a case report of a young man who presented with DKA aged twelve who rapi...

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 ...

A 64 year-old Eritrean female presented with a toxic multinodular goitre. Free T4 was 37.8 pmol/L, TSH <0.01 mU/L, and a neck ultrasound scan showed areas of calcification. A Technetium scan revealed an increased tracer uptake of 9.8% with a right-sided dominant nodule and photopenic areas. An ablative dose of radio-iodine was administered as she did not tolerate thionamide therapy.Six months later the patient reported intermittent hoarseness of voic...

A 26 year old lady presented to her general practitioner complaining of fatigue. Investigations showed serum potassium of 2.5 mmol/l, (reference range 3.3–4.7 mmol/l). This was repeated on two more occasions and was 2.6 and 2.8 mmol/l. An ECG showed no features of hypokalaemia. She was seen in Endocrine clinic with serum potassium of 2.5 mmol/l. There was no history of an eating disorder, laxative or diuretic abuse. Her father had type 2 diabetes. Her height was 1.56 m a...

It is generally considered that sight-threatening retinopathy is most unlikely within 5 years of diagnosis in a young patient with acute onset diabetes. We present the case of a 27 year old who developed severe bilateral proliferative retinopathy within 6 months of diagnosis.She consulted her about GP about long standing irregular periods. As she was overweight the GP checked a random blood sugar which was16. HBAIC was 9.2%. There was a family history of...

Clinical case: A 30-year-old Eritrean presented as an emergency to the orthopaedics surgeons with radicular back pain. Following L3/L4 spinal decompression, he was noted to be classically acromegaloid and was transferred to the Endocrine Unit, where a mild bitemporal upper quadrantinopia was noted. GH was massively elevated at 1200 mU/L, IGF1>130 nmol/L, with associated corticotroph and gonadotroph insufficiencies requiring replacement. MRI showed a large pituitary adenoma...

Introduction: Krukenberg tumour is an ovarian metastasis of G I tract cancer; Accounting for 1 to 2% of all ovarian tumours. It is usually bilateral and more common in premenopausal compared to menopausal women. Krukenberg tumours are rare but virilizing Krukenberg tumours are even rarer. We report a case of virilizing Krukenberg tumour.A 58-year-old Caucasian lady who was diagnosed with inoperable metastatic gastric adenocarcinoma, ascites and bilateral...

Ectopic thyroid tissue, defined as thyroid tissue not located anterolaterally to the second and fourth tracheal cartages, is rare. In the majority of the cases it is located in the midline, between the foramen caecum and the proper location of the thyroid gland and most often it is found in the base of the tongue. We present a case of ectopic thyroid in the lower cervical area in a patient with a multinodular goiter. A 27-yr-old asymptomatic woman presented with a recent histo...

Adrenal suppression and iatrogenic Cushing’s secondary to concomitant inhaled steroid and itraconazole is a potentially common and serious drug interaction. A 55 year old patient with bronchiectasis and asthma developed an exacerbation of allergic bronchopulmonary aspergillosis (ABPA). He had been on inhaled fluticasone for over 2 years. He was commenced on itraconazole. The patient was on holiday 6 weeks after itraconazole was commenced when he noted that his face had be...

We report a 29-year old primiparous woman, presenting 3-days post vaginal delivery with a severe frontal headache of gradual onset but particularly severe whenever she tried breastfeeding and accompanied by vomiting. She was conscious, mildly dehydrated and apyrexial. Reflexes were globally brisk and besides for neck stiffness the rest of her central nervous system and major systemic examination was normal. FBC and clotting were normal, C-reactive protein 35 (normal <5). G...

A 48-year-old man presented with classical symptoms and physical signs of severe acromegaly. Investigations revealed: fT4 12.8 picomoles per litre, TSH 1.4 milliunits per litre, testosterone 3.9 nanomoles per litre, FSH 4.3 units per litre, LH 2.1 units per litre, cortisol (09.00 hrs) 710 nanomoles per litre, prolactin 1657 microinternational units per millilitre and IGF1 155 nanomoles per litre. Growth hormone levels were greater than 150 milliunits per litre throughout an or...

We report the cases of two identical twins with Graves’ disease which proved very difficult to control and followed very similar stormy course. Twin A was a 20 years old female of 12 weeks gestation when she was referred to endocrine clinic with history of weight loss, palpitations and tremor. Her thyroid function tests revealed TSH <0.08 mU/L (0.03–4.30), FT4 82.5 pmol/L (12–22 pmol/L) and FT3 44.4 pmol/L (2.8–7.1) with positive thyroid receptor ant...

We report the case of a 27 year old female who was referred to our diabetes team from the antenatal clinic, when she was found to have an abnormal glucose tolerance at 16 weeks of gestation (fasting and 2 hours blood glucose values of 5.1 mmol/L and 12.2 mmol/L respectively). At the same time she was suffering with severe hyperemesis gravidarum for many weeks and had suffered significant weight loss (thyroid function tests were unremarkable). She had no specific symptoms to su...

We report the case of a 22-year old woman with aggressive Graves disease. She was initially found to be clinically and biochemically thyrotoxic in June-2001 when she presented with severe thyroid eye disease. Treatment was commenced with carbimazole but she failed to adequately comply with therapy and follow-up appointments. She fell pregnant whilst thyrotoxic and was converted to propylthiouracil (dose gradually increased due to poor response). She then left the area and had ...

The Charcot joint was originally described as tabetic arthopathy and published in 1868. This occurs in approximately 0.2% of people with diabetes and usually involves a prior peripheral neuropathy. Other factors involved in the pathogenesis of this osteoarthropathy are autonomic neuropathy & trauma.A 74-year-old male presented in August 2004 with a subacute history of right foot swelling & discomfort. There was no discreet history of preceding tr...

A 45 year old female with Type 1 DM for 12 years presented with malaise and frequent episodes of hypoglycaemia. Thyroxine was titrated to 150 mcg once daily over 2 months because TSH was 94 mIU/L [0.2–5.50 mIU/L]. However, her malaise and hypoglycaemia deteriorated, she also developed dense hyperpigmentation in the skin.Primary hypoadrenalism was confirmed by lack of response to 250 mcg IV Tetracosactide (Serum Cortisol at Time 0 min: 98 nmol/L; Ti...

Schizophrenia is associated with higher risk of Type 2 diabetes. There are several reports of Type 2 diabetes presenting as diabetic ketoacidosis, particularly in young obese African-Caribbean subjects. We report 3 cases of new onset diabetes presenting with diabetic ketoacidosis (see Table 1) in African-Caribbean males treated with olanzapine for chronic schizophrenia.Table 1 Metabolic parameters on admissionCase</td...

Non-alcoholic steatohepatitis is part of the spectrum of non-alcoholic fatty liver disease. It is characterised by triglyceride deposition in the liver associated with a lobular hepatitis and elevated circulating aminotransferases. It is associated with insulin resistance and commonly occurs in Type 2 diabetes but is much less widely recognised in patients with Type 1 diabetes.A 29 year old Caucasian male with longstanding Type 1 diabetes presented with ...

A 42 year old lady was referred to the endocrine clinic with a five month history suggestive of hypothyroidism and a high TSH and low T4 levels. Clinical examination revealed increased skin pigmentation, low systemic blood pressure, bilateral axillary lymphadenopathy and hepatosplenomegaly. Short synacthen test confirmed cortisol insuffiency and she was started on thyroxine and hydrocortisone, and went on to have further investigations for the lymphadenopathy and hepatosplenom...

This is a rare case of a previously healthy 21-year old Caucasian male (CM) diagnosed with a new onset of Kawasaki disease concomitant with diabetes mellitus and thyroiditis. He was admitted to ER with high fever (103.0F), generalized erythematous rash with desquamation of palms and soles, fissured lips, arthralgias, and malaise. Physical exam revealed anterior cervical lymph nodes enlargement on the right side. At the time of admission WBC=8300 cell/ml Eosinophil=6.2%, Hb/Hct...