To describe two cases of patients presenting with abdominal pain to the gastroenterologists. These were diagnosed with primary hyperparathyroidism and adrenal insufficiency respectively.
Two case histories, including detailed results of laboratory tests, are presented, and the findings are discussed.
We present a 62 year old gentleman who was referred to the gastroenterology clinic complaining of a long standing history of upper abdominal discomfort. This was associated with weight loss and constipation. A gastrocolonoscopy was normal. In view of persistent symptoms further investigations were performed. He was then found to have a calcium level of 4.11 mmol/l. This was associated with a low phosphate level and a high PTH. A parathyroid sestamibi scan revealed a 3 cm left parathyroid adenoma and our patient was referred for surgical removal of the gland. Our next patient is a 47 year old lady who was referred with abdominal pain. This was associated with profound weight loss, anorexia and diarrhoea. Initially she was found to be hyponatraemic and hyperkalaemic. All gastroenterological investigations were normal including a gastrocolonoscopy and a CT Abdomen. She was discharged with a diagnosis of non-specific abdominal pain. On re-admission she was reviewed by an endocrinologist. Cortisol levels were undetectable; ACTH level was normal and adrenal antibodies were negative. CT adrenals showed small adrenal glands. A diagnosis of adrenal insufficiency was made. Results of tests for secondary adrenal insufficiency are pending.
Patients suffering from endocrine disorders frequently present with vague symptoms to a wide array of medical specialities. Being aware of these disorders helps the astute clinician make an immediate diagnosis, saving the patient from unnecessary invasive and non-invasive investigations and permitting the initiation of treatment as early as possible.
06 - 07 Nov 2006
Society for Endocrinology