Clinical practice/governance and case reports

ea0013p17 | Clinical practice/governance and case reports | SFEBES2007

Isolated ACTH deficiency in a case of Thyrotoxicosis. Spontaneous cure of ACTH deficiency occurred following radioactive treatment of thyrotoxicosis and its resolution.

A 49 year old lady was investigated for palpitation and weight loss of 12 kg over 6 months. She was diagnosed thyrotoxic (TSH- not detectable; free thyroxine-66.4; normal: 1222 pmol/L and triiodothyronine-8.6; normal: 1.33.1 nmol/L) and commenced on 40 mg of carbimazole. Ultrasound of thyroid showed multinodular goitre. Her systolic BP was low (100/70 mm Hg) and she felt tired. Her morning cortisol was 104 (normal; 220700 nmol/L). A short synacthen test showe...

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ea0013p18 | Clinical practice/governance and case reports | SFEBES2007

Isolated ACTH deficiency presenting twenty two years after radiotherapy for nasopharyngeal carcinoma

Rajasekaran Senthil , Chong Jimmy SW LI Voon

A 67 y old man was brought to the A & E department after being found unresponsive. He was drowsy, hypotensive (BP 90/ 60 mmHg) and had low blood glucose of 1.2 mmol/L. Serum Na was 126 mmol/l (135145) and K 3.5 mmol/L (3.55.0). CXR showed a left basal consolidation. Intravenous 10% dextrose and antibiotics were given. Twenty two years prior, he was diagnosed with squamous cell carcinoma of nasal septum associated with nodal involvement in the neck. He underwent...

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ea0013p19 | Clinical practice/governance and case reports | SFEBES2007

Spontaneous recurrent hypoglycaemia due to metastatic gatrointestinal stromal tumour (GIST)

Krishnan Binu , Theodoraki Aikaterini , Ward Helen

A 75-year old gentleman presented with symptoms of increasing lethargy, loss of appetite associated with weight loss and constant micturition. A CT scan showed extensive peritoneal mass in the lower abdomen and pelvis with disseminated intraperitoneal malignancy. A CT guided biopsy confirmed a poorly differentiated tumour. Immunohistochemistry showed that all the cytokeratin markers were negative, but vimentin was positive and CD117 (c-kit) was strongly positive, indicating th...

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ea0013p20 | Clinical practice/governance and case reports | SFEBES2007

Hypokalemia and paralysis- 2 case reports

Hussein Saleh , Siddique Haroon , Dhandapani Shankar , Daggett Peter

Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant disorder characterised by episodic muscle weakness associated with hypokalemia. Hypolemic paralysis can also occur due to other causes including renal tubular acidosis (RTA). We describe 2 cases of hypokalemic paralysis of different aetiologies.Case:1: A 23 year polish man who speaks no English was admitted with profound weakness in his limbs. Laboratory investigations revealed normal rena...

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ea0013p21 | Clinical practice/governance and case reports | SFEBES2007

Hypercalcemia of benignancy

Kashyap Ajit , Anand Kuldip , Kashyap Surekha

A 49-year old woman presented with four months history of drowsiness and weakness. She had twelve years history of intermittent menorrhagia, and was treated with iron and folic acid tablets, with partial relief. Clinically she was dehydrated, drowsy, pale and had pedal edema. Pelvic examination revealed a uterine mass 16 centimeter in diameter. Investigations- hemoglobin 9.0 gm/dl, peripheral smear microcytic, hypochromic anemia,serum albumin- 2.8 g/dl (3.64.7 g/dl), ser...

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ea0013p22 | Clinical practice/governance and case reports | SFEBES2007

The steroid mask

Saunders Simon , McNulty Steven , Hardy Kevin

We describe two similar but distinct cases of newly presenting coexistent adrenocortical insufficiency and type 1 diabetes.Case 1; an 18 yr old woman presented with a two week history of polydipsia, polyuria and accelerated weight loss. Random glucose 20.2 mmol/L but no evidence of ketoacidosis. She was thin, pigmented, hypotensive and dehydrated and confirmed one years weight loss, lethargy, abdominal pain and occasional vomiting. Short synacthen test c...

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ea0013p23 | Clinical practice/governance and case reports | SFEBES2007

An rare cause of reversible left bundle branch block

Wilmot Emma , Sagili Vijay , Sturrock Nigel

We report the case of a 32 year old female, with a family history of thyrotoxicosis, who presented with palpitations, weight loss, anxiety and diarrhoea. The patient was clinically thyrotoxic with tachycardia and tremor. On examination there was no goitre or evidence of Graves opthalmopathy. Biochemistry confirmed thyrotoxicosis with a T4 of 35 (1123 pmol/l) and a T3 of 13.3 (3.56.5 pmol/l). Urea, electrolytes and liver function tests were normal. Electrocard...

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ea0013p24 | Clinical practice/governance and case reports | SFEBES2007

A case of reversible right-sided heart failure due to Grave’s disease

Madathil Asgar , Abouglila Kamal

Background: Thyrotoxicosis can present as heart failure, especially in elderly patients. We report a case of thyrotoxicosis causing reversible right-sided heart failure.Case: A 75-year-old Caucasian lady presented with a months history of shortness of breath, abdominal distension and ankle oedema. She complained of hot sweats with palpitations, On admission, she was thyrotoxic with evidence of severe right sided heartfailure.Her ECG showed fast atr...

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ea0013p25 | Clinical practice/governance and case reports | SFEBES2007

Unilateral blindness following transphenoidal hypophysectomy for large non-functioning pituitary adenoma

Watt Alastair , Vaidya Bijay , Pobereskin Lou

We present the case of a 70 year-old man who presented with several months history of tiredness and lethargy. He had a past medical history of ischaemic heart disease. Examination identified a bitemporal hemianopia. Initial investigations demonstrated hyponatraemia, sodium 117 mmol/L (Reference range 132145) with normokalaemia. Further investigations confirmed hypopituitarism: Short Synacthen Test Cortisol at T=0 min, 125 mmol/L, Cortisol at T=30 mins, 277 mmol/L, free T...

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ea0013p26 | Clinical practice/governance and case reports | SFEBES2007

Chorea - A rare manifestation of hyperthyroidism

Rao Ranganatha Krishna , Mishra Manoj

Introduction: Thyroid Storm is a rarely occurring severe form of hyperthyroidism, almost always brought about by precipitating event. It occurs more frequently with Graves disease. The mortality varies from 20 to 50%. The diagnosis of thyroid storm is mainly clinical along with abnormal thyroid hormone levels. We report a case of thyroid storm with chorea as one of its manifestation.Case report: A fifty year old lady was referred to us for recent o...

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ea0013p27 | Clinical practice/governance and case reports | SFEBES2007

Familial hypoparathyroidism- case notes review and relevance to clinical practice

Maguire D , Peacey SR

Familial hypoparathyroidism is a rare condition. A family with seven affected individuals is described. Six sets of case notes were available for comparison. The most probable type of genetic transmission is autosomal dominant. There is also a family history of renal stones and ankylosing spondylitis.At diagnosis, adjusted calcium levels ranged between 1.77 and 1.92 mmol/L. PTH levels were either undetectable or in the low-normal range. Most cases were s...

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ea0013p28 | Clinical practice/governance and case reports | SFEBES2007

Pseudohypoparathyroidism type 1B complicated by parathyroid bone disease and clubbing

Palin Suzanne L , Shepherd Lisa M , Rahim Asad , Dyer Philip H , Bates Andrew S

Type 1B pseudohypoparathyroidism is characterised by renal resistance to parathyroid hormone in the absence of other endocrine or physical abnormalities. We present a 36-year-old lady with pseudohypoparathyroidism diagnosed aged seven following seizures with hypocalcaemia, hyperphosphataemia, elevated alkaline phosphatase, elevated parathyroid hormone (PTH) at 700 pg/mL (<120) and no cyclic AMP response to bovine PTH. There was no family history or diagnostic phenotypic fe...

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ea0013p29 | Clinical practice/governance and case reports | SFEBES2007

Hyperkalemia in a district general hospital

Rajeev Surya P , Nair Satheesh B , Mahmood Muhammed Muzaffar , Geen John , Baglioni Piero

Objectives: To assess the aetiology and management of hyperkalemia amongst inpatients in a district general hospital.Methods: Individuals with hyperkalemia (defined as potassium>6.5 mmol/L) were identified from a biochemistry lab database. Review of case records in a six month period to assess the aetiology and management. Patients on renal replacement therapy and those<18 years were excluded.Results: 45 patients were ident...

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ea0013p30 | Clinical practice/governance and case reports | SFEBES2007

Two cases of “idiopathic” hypopituitarism – Was more intensive investigation required?

Lewis Anthony , Courtney Hamish , Atkinson Brew

Hypopituitarism usually is the result of a pituitary tumour or its treatment. If, however, pituitary imaging is negative then an alternative diagnosis should be sought. We present two patients initially diagnosed as idiopathic hypopituitarism in whom the underlying diagnosis was delayed with potentially serious consequences.The first case was of a 32 year old male who presented with symptoms and signs of hypogonadism. Serum testosterone (<0.7 nmol/L)...

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ea0013p31 | Clinical practice/governance and case reports | SFEBES2007

The assessment of growth hormone deficiency following pituitary surgery – a need for greater awareness

Lewis Anthony , Courtney Hamish , Hunter Steven , McCance David , Sheridan Brian , Atkinson Brew

Pituitary surgery frequently leads to one or more anterior pituitary hormone deficiencies but the incidence of GH deficiency is unclear. The aim of our study was to establish the incidence of GH deficiency in patients post hypophysectomy. Current NICE guidelines recommend GH replacement in severely GH deficient patients who have one or more other pituitary hormone deficiencies and diminished QoL by AGHDA.Thirty-five patients (M:F 15:20; age range 23&#150...

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ea0013p32 | Clinical practice/governance and case reports | SFEBES2007

Spontaneous pregnancy in a woman with premature ovarian failure-a case report

Madathil Asgar , Bilous Rudy

Background: Premature ovarian failure is not uncommon in patients with polyglandular autoimmune conditions. It is rare for patients to become pregnant beyond the menopause. We present a patient with premature ovarian failure who spontaneously conceived after attaining menopausal state.Case: We had a 41-year-old Asian lady with type1 diabetes mellitus since 30 years of age. She had widespread vitiligo, strongly positive thyroid microsomal antibody and a f...

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ea0013p33 | Clinical practice/governance and case reports | SFEBES2007

An overnight water deprivation test?

Lakshmi Santhosh , Browne Duncan

The differential diagnosis of diabetes insipidus includes psychogenic polydipsia and a water deprivation test is sometimes difficult to perform due to patients confusion, compliance or extreme thirst. We present a simple, cost effective alternative to the water deprivation test.67-year-old male was admitted with a 3 week history of polyuria, polydipsia and extreme thirst. On systemic enquiry he complained of left sided pleuritic chest pain for few ...

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ea0013p34 | Clinical practice/governance and case reports | SFEBES2007

Co-existence of elevated PTH and PTHrP

Lakshmi Santhosh , Browne Duncan

Patients with significant hypercalcaemia unrelated to primary hyperparathyroidism have suppressed or undetectable levels of Parathyroid Hormone (PTH). We present a case where the hypercalcaemia was not due to primary hyperparathyroidism yet the PTH was elevated.82 year old male was admitted with 2 weeks history of lethargy, vomiting, increased frequency of micturiton, light headedness and confusional state. Past medical history included Type 2 diabetes, ...

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ea0013p35 | Clinical practice/governance and case reports | SFEBES2007

Pregnancy, hyperaldosteronism and an adrenal mass – were we Conned?

Kar Partha , Cummings Michael

A 30 year old woman presented at 15 weeks gestation with resistant hypertension (that had been diagnosed prior to pregnancy) and hypokalaemia (2.8 mmol/l). Subsequent tests, whilst on Nifedipine, showed a markedly raised aldosterone/renin ratio of 267 (n<25) [Aldosterone 720 ng/L;Renin 3 mu/L] (Aldosterone reference range: Supine:20190 ng/L, Ambulant 30340 ng/L; Renin reference range: Supine 230 mu/L, Ambulant 340 mu/L).<p class="a...

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ea0013p36 | Clinical practice/governance and case reports | SFEBES2007

Cabergoline treatment resulting in rapid changes to a prolactinoma

Jose Biju , Chowdhury Sharmistha Roy , Varughese George I , Barton David M

Background: Prolactin (PRL) secreting pituitary tumours are the most frequent causes of hyperprolactinaemia in clinical practice.Case: A 78-year old man presented with gradual visual deterioration over two years particularly affecting left eye and getting progressively worse. Formal visual field testing suggested grossly constricted field defect in left eye and superior temporal field defect in right eye. Examination showed no features of acromegaly. Sta...

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ea0013p37 | Clinical practice/governance and case reports | SFEBES2007

Shrinking adrenal mass: Case report of an adrenal pseudocyst

Ravikumar Balasubramanian , Lennard Tom , Pearce Simon

A previously fit 39 year old joiner presented in November 2003 with a 6 month history of intermittent right-sided abdominal pain. There was no associated nausea or vomiting. An abdominal ultrasound requested by his general practitioner revealed a single gallbladder calculus and a 10 cm right-sided cystic mass with some echogenic areas, probably of hepatic or adrenal origin. He was normotensive and clinical examination was normal. CT scan of the abdomen confirmed a 9 cm mass ar...

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ea0013p38 | Clinical practice/governance and case reports | SFEBES2007

A case of recurrent hypoglycemia in a patient with type 1 diabetes: when the obvious is not so obvious!

Trivedi Ruchir , Das Gautam , Cutler Joanne , De Parijat

Hypoglycemia is not uncommonly encountered in healthy type 1 diabetics. It has diverse etiologies but food-insulin mismatch, exercise, drugs, co-existing adrenal, thyroid and coeliac disease, neuro-endocrine tumours & factitious hypoglycemia are the most common causes.We describe the case of a 23-year old Caucasian male with type 1diabetes of 3-years duration with recurrent episodes of unexplained hypoglycemia. He was otherwise well and denied any sy...

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ea0013p39 | Clinical practice/governance and case reports | SFEBES2007

Cinecalcit in the treatment of resistant hypercalcaemia of parathyroid cancer

Theofanoyiannis Panos , Laji Ken

A 64-year-old Caucasian woman presented with hypercalcaemia in 1994 with Parathormone (PTH) of 59.9 pmol/l and corrected Calcium of 2.68 mmol/l.A parathyroid was removed and histology revealed carcinomatous change with vascular invasion suggesting probable dissemination. In November 1998 her corrected Calcium was 2.74 mmol/l with a PTH of 7.2 pmols/l but in 1999 the PTH ranged between 157 and 195 pmol/l with corrected Calcium above 2.80 mmol/l.<p cla...

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ea0013p40 | Clinical practice/governance and case reports | SFEBES2007

Case report: Severe hypoglycaemia associated with uterine fibroid

Erukulapati Ravi Sankar , Hatem MH , Narayanan K , Oxynos Costas

We describe the case of a 76 year old woman who presented to her GP with a two month history of abdominal pain, tiredness and nocturnal sweating episodes. Her past medical history included Hypertension (on Amlodipine, Bisoprolol) and Hypothyroidism (on levothyroxine). Abdominal USS and CT scan revealed a left adnexal mass measuring 15 cm. Ca-125 and CEA were normal. During admission under the Gynae-oncologists for a laparotomy, she suffered recurrent severe symptomatic hypogly...

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ea0013p41 | Clinical practice/governance and case reports | SFEBES2007

Can parathyroid hormone (PTH) levels be useful in predicting postoperative hypocalcaemia in patients undergoing parathyroidectomy?

Morgan Justin , Smart Neil

Introduction: Patients undergoing parathyroidectomy routinely stay in hospital overnight if they have primary hyperparathyroidism or longer if they have secondary hyperparathyroidism due to the risk of postoperative hypocalcaemia. There is no reliable way of predicting whether the often observed transient mild hypocalcaemia will progress, necessitating treatment. Frequent serum calcium checks remain the only way to ensure that hypocalcaemia does not go untreated. Prescribing c...

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ea0013p42 | Clinical practice/governance and case reports | SFEBES2007

Turner syndrome and apparent absent uterus: a case report and review of literature

Demssie Yared , Howell Simon

Turner’s syndrome is one of the most common chromosomal abnormalities affecting 1 in 2500 live births. Short stature and gonadal dysgenesis are known as the hallmarks of the syndrome since Henry Turner described the original cases in the late 1930s. Although the majority of these patients have streak ovaries as a result of stromal fibrosis, the uterus is intact, albeit with atrophic endometrium due to the hypoestrogenic state. We report a case of ...

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ea0013p43 | Clinical practice/governance and case reports | SFEBES2007

Severe hyponatraemia – how low can you go?

Joseph Franklin , Kaliyaperumal Mohanraj , Moss Nicole , Qedwai Farhan , Hill Carol , Khaleeli AA

A 64 year old man presented with confusion and agitation following diarrhoea for 48 hours. He had a background history of hypertension, type 2 diabetes, depression and had a normal sodium concentration of 135 mmol/L a year prior to admission. His medications included bendroflumethiazide and sertraline in addition to metformin, diclofenac sodium, aspirin, simvastatin, nifedipine and enalapril. On examination he was conscious but confused. He was afebrile with a blood pressure o...

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ea0013p44 | Clinical practice/governance and case reports | SFEBES2007

Should primary care have direct access to thyroid ultrasound?

Bravis Vassiliki , Lingam Ravi , Devendra Devasenan

Thyroid ultrasound (US) is a useful tool in a spectrum of thyroid conditions. In some hospitals, primary care has direct access to requesting thyroid US, rather than via a speciality. We were keen to assess the outcomes of thyroid US referred by primary care.We analysed all primary care referrals for thyroid US, retrospectively, during the first six months of 2006 and analysed them according to the following 3 reasons for referral 1) suspicion of ...

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ea0013p45 | Clinical practice/governance and case reports | SFEBES2007

Di-George syndrome presenting as hypocalcaemia in adulthood

Hunter Steven , Johnston Philip , Morrison Patrick

A 29 year old female presented with a two year history of recurrent numbness and tingling in her hands. Trousseaus sign was positive. Investigations confirmed hypocalcaemia with serum calcium 1.64 nmol/L (2.102.60), phosphate 1.23 nmol/L (0.801.55), alkaline phosphatase 82 U/L (35120). Parathyroid hormone was inappropriately normal at 36 pg/ml (1065), Vitamin D 78 nmol/L (5075). Her mother reported a history of hypocalcaemia when she was two...

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ea0013p46 | Clinical practice/governance and case reports | SFEBES2007

Drug-induced symptomatic hypomagnesaemia and hypocalcaemia

Tahrani AA , Rangan S , Pickett P , Macleod AF , Moulik PK

Hypomagnesaemia can cause Hypocalcaemia as magnesium interferes with parathyroid hormone action and secretion. It also causes hypokalemia due to defective membrane ATPase or urinary potassium loss. We present two patients who were admitted to our hospital with symptoms and signs of hypocalcaemia secondary to drug-induced hypomagnesaemia and describe the lessons learned.Patient 1: A 46 year-old lady presented with pins and needles and muscle c...

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ea0013p47 | Clinical practice/governance and case reports | SFEBES2007

Audit of testosterone replacement therapy at South Tyneside

Ibrahim Ibrahim M , Jordan Alice , Parr John , Wahid Shahid

Aims: Despite the plethora of testosterone therapies, Successful testosterone replacement remains a challenge. We assessed patient empowerment, treatment satisfaction and adherence to current testosterone replacement guidelines.Methods: Data were collected from case notes and a testosterone diary questionnaire in 16-patients with testosterone deficiency.Results: Median age was 46-years (range 2169). All patients received an e...

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ea0013p48 | Clinical practice/governance and case reports | SFEBES2007

Restoration of gonadal function and development in hypogonadotrophic hypogonadism

Agarwal Neera , Rees Aled

A 29 year old gentleman was referred for investigation of subfertility and hypogonadism. He gave a history of normal erections and libido but had never shaved in his life. Though he denied anosmia, his maternal uncle had a poor sense of smell and his great uncle had needed to adopt children. He was markedly undermasculinised with micropenis and an empty scrotal sac. Neurological assessment showed subtle features of bimanual synkinesis (mirror movements), suggesting X-linked Ka...

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ea0013p49 | Clinical practice/governance and case reports | SFEBES2007

Severe cushing’s syndrome associated with metastatic prostate adenocarcinoma

Elmalti Akrem , Arefin AN , Thomas M , Jenkins R , Orme S

Introduction: Prostate carcinoma is a recognised yet rare cause of Cushings syndrome. This report describes two cases in which Cushings syndrome was associated with advanced prostate cancer.Case 1: A 70-year man presented with a very short history of swelling of his face and legs. He was known to have prostate adenocarcinoma with bony metastases. He was hypokalaemic and resistant to standard potassium replacement. He had a Cushingoid appearan...

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ea0013p50 | Clinical practice/governance and case reports | SFEBES2007

Ectopic peptide production by phaeochromocytomas

Owen Penelope , Coombes David Scott , Gill Ben Hope , Davies Stephen , Scanlon Maurice , Rees Aled

A 67 year old female presented with hypertension, oedema and cough. A CT scan of her abdomen showed an enlarged left adrenal gland. Urinary free cortisols were grossly elevated and low dose dexamethasone suppression testing confirmed Cushings Syndrome. 24 hour catecholamines were also elevated consistent with a diagnosis of phaeochromocytoma. ACTH levels were high (690 pg/ml) but pituitary MRI was normal. She was commenced on alpha and beta blockade in preparation for su...

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ea0013p51 | Clinical practice/governance and case reports | SFEBES2007

Medical treatment in adrenal insufficiency: Does the patient’s quality of life differ depending on which glucocorticoid is given?

Bleicken Benjamin , Ventz Manfred , Strasburger Christian J , Quinkler Marcus

Objective: Patients from FRG and West-Berlin with primary (1AI) or secondary (2AI) adrenal insufficiency were treated with hydrocortisone (HC) while in contrast patients from the former GDR received prednisolone (PR). Investigation of our study is to detect any differences in quality of life (QoL) in patients on HC or PR medication.Methods: 350 patients of our outpatient clinic were contacted by mail. Up to now 131 patients took part in the survey. 2 sta...

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ea0013p52 | Clinical practice/governance and case reports | SFEBES2007

Primary hyperparathyroidism – an unusual cause of hyperemesis gravidarum

Syed Ateeq , Rehman Atiq-ur , Dale Jane

We present a case of primary hyperparathyroidism in a pregnant woman presenting with recurrent vomiting.A 34 year-old Asian woman was admitted with nausea and vomiting at 8 weeks gestation. Clinical examination was unremarkable apart from dehydration. Electrolytes and thyroid function were within normal limits. A diagnosis of hyperemesis gravidarum was made and patient was discharged after rehydration. Over the next eight weeks she presented with similar...

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ea0013p53 | Clinical practice/governance and case reports | SFEBES2007

Resistant hypercalcaemia: is it always what we think?

Warren Kathryn H , Das Gautam , De Parijat

Hypercalcaemia (calcium level >2.63 mmol/L) is a common metabolic condition. In spite of its diverse aetiologies, primary hyperparathyroidism and malignancy account for more than 90% of cases, parathyroid adenoma alone contributing to 8085% of parathyroid related cases. We describe a case of resistant hypercalcemia in a 75-year-old Afro- Caribbean gentleman.He presented with a 2-month history of constipation, loss of appetite & gradual weig...

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ea0013p54 | Clinical practice/governance and case reports | SFEBES2007

Safety of growth hormone replacement in patients with non-irradiated pituitary and peri-pituitary tumours

Chung Teng-Teng , Evanson Jane , Monson John P , Besser Mike , Grossman Ashley B , Akker Scott A , Walker Dorothy , Drake William M

Background/objective: Published data suggest that growth hormone replacement (GHR) may be safely given to patients with hypopituitarism consequent upon a pituitary/peri-pituitary tumour. However, to date, these series have included a preponderance of patients treated with external pituitary irradiation. We have performed a retrospective study to evaluate the recurrence rate in a group of patients with pituitary/peripituitary tumours treated with GHR.Meth...

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ea0013p55 | Clinical practice/governance and case reports | SFEBES2007

A case of giant macroprolactinoma- rapid response to dopamine agonist therapy

Sudagani Jaidev , Rutherford Scott , Kearney Tara

A 37 year old male presented with visual problems in June 2006.He gave a history of double vision for 18 months and denied headaches.On examination his Glasgow coma score was 15/15, pupils were equal and reactive to light. Visual acuity; right eye - 6/6, left eye- 6/60. Visual field testing showed a temporal field defect in the right eye and poor vision in the left eye.MRI brain scan showed a very large, fair...

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ea0013p56 | Clinical practice/governance and case reports | SFEBES2007

Iron deficiency, hypopituitarism and occram’s razor

Wood LM , Kelly CJ

The relationship between coeliac disease and primary hypothyroidism is recognised, however, a less well recognised association exists with secondary hypopituitarism as illustrated by this case.A 50 year old male was referred with a six month history of altered bowel habit, iron deficiency anaemia and presumed primary hypothyroidism (TSH 15, free T4 <5.0). He had negative investigations for any gastrointestinal blood loss. Duodenal biopsy showed non-s...

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ea0013p57 | Clinical practice/governance and case reports | SFEBES2007

Malignancy associated hypercalcemia with elevated levels of parathormone

George Ajith , Oriolowo A , Flanagan Daniel

A 56 year old lady presented with a short history of neuromuscular weakness. She was dehydrated but conscious, alert and oriented and without focal neurology. Her initial blood results revealed a corrected calcium 5.02 mmol/L, phosphate 1.49 mmol/L, alkaline phosphatase 152 iu/L, urea 31.8 mmol/L and creatinine 266 micromol/L.Intravenous rehydration with normal saline and 90 mg of pamidronate was given. She received 4 litres of normal saline daily and her renal functions norma...

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ea0013p58 | Clinical practice/governance and case reports | SFEBES2007

Extreme pituitary hyperplasia of normal pregnancy presenting as a macroprolactinoma

Acharya Shamasunder , Philip Sam , Danielian Peter , Olson Shona , Bevan John , Abraham Prakash

Case report: A 33-year-old pregnant Nigerian woman presented at 37 wks gestation with a 2-week history of frequent headaches and visual disturbance. She had persistent galactorrhoea following previous pregnancy in 1998, which settled after a short course of bromocriptine. On examination, she had classical bitemporal hemianopia. Her prolactin was raised at 19,220 mU/L (higher than expected in a normal pregnancy), random cortisol 553 nmol/L and thyroid function tests satisfactor...

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ea0013p59 | Clinical practice/governance and case reports | SFEBES2007

How do we manage adrenal “incidentalomas” – an audit of referrals to a teaching hospital endocrine unit

Higgins Kath , Levy Miles , Howlett Trevor

We audited the management of adrenal incidentaloma (AI) in our hospital.29 patients (12 male) were referred with AI, mean age 68y (4887 years). Mode of detection: 7 ultrasound (2 no mass on subsequent CT/MRI), 20 CT, 1 MRI and 1 lumbar XR. Site of tumour: 18 right, 7 left, 1 bilateral, 1 N/A. Size: <4 cm in 17, 46 cm in 4, >6 cm in 2, large in 1, not stated in 4. History: 8 had clinical features of possible hormone excess....

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ea0013p60 | Clinical practice/governance and case reports | SFEBES2007

Short Synacthen Test (Standard and Low dose): Do we need multiple cortisol samples?

Kela Ram , Tahrani Abd , Varughese George , Clayton R , Hanna FWF

Aim: This study was aimed to assess the need for multiple cortisol samples in ruling out adrenal insufficiency by standard dose Short Synacthen Tests (SST) and Low Dose Short Synacthen Tests (LDSST).Method: We assessed the lab results of 767 patients who attended Metabolic Unit of a University Hospital in the UK from 1999 to 2006 for assessment of adrenal reserve. In LDSST, serum cortisol was measured at 0, 30 and 40 min after administration of 1 mcg of ...

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ea0013p61 | Clinical practice/governance and case reports | SFEBES2007

A 57 year old lady bilateral adrenal mass and adrenal insufficiency

Akhtar S , Dunne P , Mishra B

We report a case of a 57 year old lady who presented with marked weight loss, dizziness and general malaise. The physical examination revealed pallor, hypotension, tachycardia and dehydration. There was no muco-cutaneous pigmentation. Routine biochemistry showed normocytic anaemia, hyponatraemia, mild hyperkalaemia and renal impairment. Abdominal ultrasound showed presence of bilateral large supra-renal masses. A short synacthen test showed sub-optimal rise in plasma cortisol ...

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ea0013p62 | Clinical practice/governance and case reports | SFEBES2007

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia presenting as cyclical Cushings Syndrome

Carty David M , Connell John M

We present the case of a 76 year old woman who was admitted to our hospital with severe Cushings syndrome, in association with hair loss and hypokalaemia. Plasma cortisol levels were elevated, and did not suppress with high dose dexamethasone. ACTH levels were detectable throughout the HDDST. MRI pituitary and CT adrenals were normal, but CT of chest revealed an area of nodularity in the right lung. With no specific treatment her symptoms settled, and her biochemistry returned...

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ea0013p63 | Clinical practice/governance and case reports | SFEBES2007

Mixed TSH and GH secreting pituitary macroadenoma presenting with profound weight loss: A case report

Abbas Afroze , Hundia Vikram , Ajjan Ramzi , Orme Stephen

A nineteen year old man was admitted by his GP with profound weight loss. He had avoided contact with primary care services as he feared doctors, but had been referred to an eating disorders clinic. He had a diet of exclusively snack food and had been losing weight for two years.On examination he was cachectic and pale with scanty body hair. His body mass index was 13 kg/m2, with a weight of 44 kg. He was clinically thyrotoxic, a small diffuse...

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ea0013p64 | Clinical practice/governance and case reports | SFEBES2007

Synacthen Tests – Do we overinvestigate?

Parr John , Scorer Gemma , Jordan Alice , Gillespie Susan , Wahid Shahid

The synacthen test is a commonly performed endocrine test; we have looked at whether we overuse this test. Of 150 synacthen tests performed in one year 52 were randomly selected for audit. 19 were undertaken for symptoms alone (Group 1); 16 for a low random cortisol (below 261 nmom/l Group 2); 17 for electrolyte disturbances (either low sodium, high potassium or both Group 3). 3 in Group 2 and 1 in Group 1 were abnormal but in no patient with a random cortisol ab...

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ea0013p65 | Clinical practice/governance and case reports | SFEBES2007

Application of specific thyroid function test reference range in pregnancy

Parr John , Gillespie Susan , Jones Anthony , Wahid Shahid

Thyroid hormone and TSH levels change during pregnancy yet most laboratories use reference ranges derived from subjects who are not pregnant and male. Does this lead to an underestimation of thyroid disorders in pregnancy?We have derived our own reference range for Free T4 and TSH levels in pregnancy. The hormones were measured in 82 euthyroid mothers at booking and 68 at 28 weeks of pregnancy. Mean (95%CI: reference range of +2SD) FT4 levels were...

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ea0013p66 | Clinical practice/governance and case reports | SFEBES2007

Has the management of treated hypothyroid mothers improved?

Parr John , Jones Anthony , Wahid Shahid

In 1999 Haddow et al (NEJM; 1999; 314:549) reported neuropsychological deficits in babies born to inadequately treated hypothyroid mothers. We have compared our management of treated hypothyroidism in 30 pregnancies in 24 mothers delivered before 2000 to 37 pregnancies in 33 mothers since.TSH levels were measured at booking in 22 (73%) in the pre-2000 group, 6 (27%) of which were raised; and 32 (86%) in the post-2000 group where 12 (38%) were raised. 7 m...

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ea0013p67 | Clinical practice/governance and case reports | SFEBES2007

Fluconazole is as effective as Ketoconazole in controlling hypercortosolism

Abdeen Ammar , McCart Cormac , Roberts Graham

We report 29 years old female with recurrence of adrenal carcinoma and hypercortisolism secondary to HCG responsive adrenal carcinoma.which has been surgically excised in 2003 following the birth of a live infant at 28 weeks gestation.A year latter she presented with a tenderness over the right rib cage and had CT scan which showed metastases at the liver and right renal bed.Hypercortisolism was confirmed biochemicaly with a 24 hou...

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ea0013p68 | Clinical practice/governance and case reports | SFEBES2007

Recurrent cystic pituitary lesion - A case report

Sukesh Chandran K , Advani Andrew , Quinton Richard

41 year old male presented in 1992 with 2 years history of blurring of vision, headaches, dizzy spells. Had Right supratemporal visual field defect, pituitary MRI which showed cystic pituitary lesion. Had TSS in May 1992 and histology showed Rathkes pouch cyst. Post operatively developed DI and started on DDAVP.SST,TRH and GnRH tests were normal. Persisted retro orbital head aches, developed nasal and temporal field loss. MRI in Sept 1992 showed large intrasellar recurrence of...

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ea0013p69 | Clinical practice/governance and case reports | SFEBES2007

Successful management of a patient with a carcinoid tumour through 2 major operations using Octreotide – A case report

Sukesh Chandran K , Jones Steven

69-year-old male with background of hypertension and dyslipidaemia was admitted to ENT with a food bolus obstruction. CXR on admission revealed a well-defined mass in the right lower lobe consistent with lung cancer. Oesophagoscopy revealed a narrowing level secondary to external compression. A staging CT of chest and abdomen confirmed a mass on the right base invading the main right lower lobe bronchus. Incidentally there was an 8 cm infra renal abdominal aortic aneurysm. The...

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ea0013p70 | Clinical practice/governance and case reports | SFEBES2007

Serum prolactin normalisation does not always predict tumour shrinkage in prolactinomas: A case report.

Tahrani AA , Rangan S , Pickett P , Macleod AF , Moulik PK

Prolactinomas are the most common pituitary adenomas. The treatment is primarily medical with dopamine agonists. The improvements in prolactin levels are accompanied by reduction in the tumour size in the majority of cases. We report a patient with a macroprolactinoma whose tumour enlarged despite achieving normal prolactin levels.A 55-year-old gentleman was referred to the ophthalmologist with worsening vision in the left eye. Clinical examination revea...

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ea0013p71 | Clinical practice/governance and case reports | SFEBES2007

Psychosis in a patient with acromegaly: Implications for clinical practice

Kings R , Foo L , Varughese GI , Tahrani AA , Clayton RN

We report of a 71-year-old gentleman first diagnosed with acromegaly in 1981. He was initially treated with hypophysectomy and radiotherapy and subsequently bromocriptine therapy; requiring increments in the dose over the next ten-years (19811991) by which time he remained on maintenance dose of 10mgs thrice-daily. Bromocriptine was tolerated well and the patient had no side effects. Treatment was weaned off due to improvement in patients symptoms and growth hormon...

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ea0013p72 | Clinical practice/governance and case reports | SFEBES2007

A cost benefit analysis of gastric electrical stimulation (GES) in patients with severe diabetic gastoparesis

Hannon Mark , Yousif Obada , Dineen Sean , Thompson Christopher J , Quigley Eamonn MM , O’Halloran Domhnaill J

Introduction: Patients who are severely affected with diabetic gastroparesis tend to spend many days as hospital inpatients with intractable nausea and vomiting and consequent dehydration. In patients who do not respond to promotility agents, gastric electrical stimulation (GES) is an option. This is a relatively new therapeutic modality which has shown promise in international trials. It has seen use in a very limited number of patients in Ireland. Here we outline our experie...

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ea0013p73 | Clinical practice/governance and case reports | SFEBES2007

Recurrent hypoglycaemia caused by metastatic insulinoma in a patient with Type 2 diabetes

Sandeep Thekkepat , Hughes Kate , Adamson Karen , Patrick Alan , Frier Brian

Insulinoma is a rare tumour, but is the commonest cause of hyperinsulinaemic hypoglycaemia in adults. It is characterised by symptomatic hypoglycaemia with inappropriately elevated plasma insulin and C-peptide levels. 10% of insulinomas are malignant. The coexistence of insulinoma with diabetes mellitus is extremely rare with only 20 previously reported cases. This can therefore pose a diagnostic challenge.An 83 year old man, who developed Type 2 diabete...

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ea0013p74 | Clinical practice/governance and case reports | SFEBES2007

Unusual cause of adult onset hypoglycaemia post gastric bypass surgery

Al-Ozairi Ebaa , Clancy Thomas , Hamdy Osama

Background: Obesity pandemic continues to grow and currently bariatric surgery is the only interventional method proved to induce significant long-term weight reduction. The number of bariatric surgery has doubled in USA over the past decade. We present a case of adult onset nesidioblastosis, post gastric bypass.Case Summary: A 50 years old female who is 2 years status post Roux-en-Y gastric bypass was admitted to the hospital with a documented hypoglyce...

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ea0013p75 | Clinical practice/governance and case reports | SFEBES2007

Hypercalcaemia associated with HTLV-1 seropositivity, but with no evidence of lymphoma

Ghaffar Adeel , Devendra Devasenan , Colaco Bernie

HTLV-1 associated lymphoma is a rare but well recognised cause of life-threatening hypercalcaemia. It carries a very poor prognosis. We describe a case of a 47 year old Afro-Caribbean lady who presented with 3 months of fever, weight loss and right hip pain. She had a past medical history of quiescent sarcoidosis diagnosed 20 years previously. She also suffered from systemic lupus erythematosus, for which she was taking methotrexate and 20 mg of prednisolone. She also had hype...

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ea0013p76 | Clinical practice/governance and case reports | SFEBES2007

Acute falciparum malaria and parathyroid function

Pal Aparna , Karavitaki Niki , Wass John , Simpson Hugh

We present a rare case of acute falciparum malaria complicated by hypocalcaemia while having normal renal function.Case: A 64 year old African lady presented with a 2 week history of lethargy, weakness and oliguria. She had returned from Malawi a fortnight previously and had not taken antimalarial prophylaxis. Her malaria screen was positive for Plasmodium falciparum and she was commenced on quinine. On day 5 of her admission she developed perioral pares...

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ea0013p77 | Clinical practice/governance and case reports | SFEBES2007

The role of an endocrine specialist nurse in a nurse led testosterone implant clinic

O’Connor Maria , Walker Neil , Karavataki Niki , Wass John

Introduction: In our centre prior to 2003, testosterone implantation was undertaken by rotational junior medical staff. A specialist nurse role in testosterone implantation was developed within the Oxford Department of Endocrinology over a nine month period.Aim: To assess the adverse effects and the complications from testosterone implants offered by a specialist nurse committed to this task.Method: Since 2003, 200 implants have be...

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ea0013p78 | Clinical practice/governance and case reports | SFEBES2007

Apparent hypopituitarism secondary to Cushing’s syndrome due to adrenal carcinoma

Revesz Sarah , Knox Andrew , Vaidya Bijay

A 75-year-old lady presented with hypertension, weight gain, ankle oedema and proximal myopathy. She had clinical features of Cushings syndrome. Blood pressure was 180/99 mmHg. Her visual fields were normal. Investigations confirmed Cushings syndrome with high 24-hour free urinary cortisol levels (2264 nmol/l and 3295 nmol/l; normal range 40305) and a high serum cortisol level following overnight dexamethasone suppression test (serum cortisol 1,550 nmol/l). F...

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ea0013p79 | Clinical practice/governance and case reports | SFEBES2007

Postmenopausal hyperandrogenism of ovarian origin: diagnostic and therapeutic difficulties

Ashawesh K , Jose B , Redford DH , Barton DM

Background: Rapidly progressive hirsuitism or virilization raises the suspicion of an androgen-secreting tumour. Adrenal tumours are usually ruled out by hormonal testing and imaging studies. Small virilizing ovarian tumours may not be detectable by imaging studies.Case 1: A 66 year-old woman presented with 4 year history of hirsutism and virilization. She had a history of longstanding uterine bleeding secondary to fibroids. Investigations revealed raise...

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ea0013p80 | Clinical practice/governance and case reports | SFEBES2007

Hyperchloraemic metabolic acidosis with hypokalaemia and osteomalacia

Gardner Daphne S-L , Flanagan Daniel E

Background: A 52-y-old lady (Mrs M) presented with a 10-day history of progressive generalised weakness, dysarthria and un-coordination. 26 y ago, she had cervical carcinoma, requiring a hysterectomy, oophorectomy and radiotherapy. This led to a vesicovaginal fistula, requiring a cystectomy and ureterosigmoidostomy. She is known to have osteoporosis. Medications: calfovit D3 one/d (started 5 days prior to admission), risedronate, lansoprazole. She had HRT until 50 y. Examinati...

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ea0013p81 | Clinical practice/governance and case reports | SFEBES2007

Use of anti thyroid hormone receptor antibody (TRAB) in Graves’ Disease

Myint Khin Swe , Andappa Gayathridevisa Shankargall , MacFarlane Ian , Gurnell Mark , Wood Diana , Chatterjee Khris , Simpson Helen

TRAB antibody is specific for diagnosis of Graves disease. We have conducted an audit to on our practice on parameters which TRAB could influence.Method: TRAB (NR 01 IU/l) positive patients were identified from biochemistry laboratory form April 2003 to February 2004. Sixty case notes were randomly selected for reviewed. Data were analysed subsequently.Result: 46 cases (77%) were female. Mean age was 42, range 6 to 78 y...

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ea0013p82 | Clinical practice/governance and case reports | SFEBES2007

Prolonged hypocalcaemia following intravenous pamidronate in hypoparathyroidism

Kotonya Christine , Palin Suzanne L , Faghahati Leila , Flutter Laura , Kamal Ali , Rahim Asad , Shakher Jayadave

We present the case of a 77-year-old lady who had a previous total pharyngo-laryngo-oesophagectomy for laryngeal squamous cell carcinoma. Her serum calcium had been normal on alfacalcidol and calcium supplementation for six months. She was admitted with dehydration and symptoms of hypercalcaemia on two different occasions, with corrected calcium 3.86 and 4.67 mmol/l. Each time she was treated with intravenous fluids and intravenous disodium pamidronate 60 mg by the admitting t...

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ea0013p83 | Clinical practice/governance and case reports | SFEBES2007

Pituitary tumour – Contraindication to thrombolysis; Caution with antiplatelet agents

Simon Godwin , Bhatia Nikhil , Al-Mrayat Ma’en

A 63-year-old gentleman with hypopituitarism secondary to non-functioning pituitary macro adenoma, treated with trans sphenoidal surgery 16 years earlier, was admitted with chest pain. His ECG showed 3 mm ST elevation in the inferolateral leads, and his subsequent cardiac enzymes were consistent with acute myocardial infarction. A decision was made not to thrombolyse him, as any intracranial tumour is an absolute contraindication to thrombolysis. He was discussed with the tert...

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ea0013p84 | Clinical practice/governance and case reports | SFEBES2007

Pseudo-Bartters in diuretic and laxative abuse

Dugal Tabinda , Sharfi Osman , Zacharaya S , Nussey S , Bano G

A 63 year old lady born in Ghana was referred by her general practitioner for assessment of secondary hyperparathyroidism. She had corrected calcium of 1.93 (N: 2.182.47 mmol/L), PTH72.2 (N: 1.16.9 pmol/L) and alkaline phosphates of 324 (30100 IU/L). Her GP described her to be very conscious about her weight and she virtually lived on fruits and vegetables. She has history of hyper tension and was on alpha-blocker. Examination revealed BMI of 29 Kg/m2</s...

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ea0013p85 | Clinical practice/governance and case reports | SFEBES2007

Long term follow up following focused parathyroidectomy for primary hyperparathyroidism

Simpson Helen , Fisher Simon , Gurnell Ellie , McFarlane Ian , Berman Lawrence , Balan K , Chatterjee Krish , Wishart Gordon

Aim: Focussed parathyroidectomy is an established technique in subjects where imaging has identified a single parathyroid lesion. The aim of this study was to examine the long-term cure rate following this procedure.Method: Of 188 patients undergoing surgery for primary hyperparathyroidism between 2001 and 2006, 150 had a single parathyroid lesion on imaging using sestamibi +/− neck ultrasound. These patients were treated by focused parathyroidecto...

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ea0013p86 | Clinical practice/governance and case reports | SFEBES2007

An audit on the effectiveness of a change in RAI regime for patients with hyperthyroidism

Cherukuri Vijay Nandini , Mahto Rajni , Ryan Sue , Foley Malcolm , Singh Baldev , Buch Harit

Background: Radioiodine (RAI) has been used for the treatment of hyperthyroidism for over half a century without agreement about its dose or regime. Following our previously presented audit, over the last three years we have used a 400MBq fixed dose (FD) RAI regime for the management of patients with hyperthyroidism, replacing the calculated dose (CD) regime.Aim: To compare the cure rate following the use of a 400MBq fixed dose RAI regime with that achie...

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ea0013p87 | Clinical practice/governance and case reports | SFEBES2007

Radioactive Iodine (I-131) and its effectiveness in treating benign thyroid disease

Patel Kishor , Kalk John

Background: As thyrotoxicosis is associated with significant morbidity, treatment and ultimately cure is essential. Along with anti-thyroid medication and surgery, the use of radioactive Iodine (I-131) has long been established. However, opinion still varies as to when to use I-131, in which patients and whether to give a fixed or tailored dose. To see if our practice was consistent with published data, we conducted an audit of patients treated with I-131 for benign thyroid di...

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ea0013p88 | Clinical practice/governance and case reports | SFEBES2007

Hypoglycaemia secondary to leukamoid reaction

Elrishi MA , Bradley EJ , Lawrence IG

Introduction: Artifactual hypoglycaemia has been reported to occur in leukaemia, and also reported in polycythemia Vera, being caused by in vitro autoglycolysis due to an exaggerated consumption of glucose by white blood cells1. We report a case of recurrent hypoglycaemia found to be artifactual secondary to a leukamoid reaction.Case report: A 78-year-old lady with a poorly differentiated endometrial adenocarcinoma was referred to us with a hi...

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ea0013p89 | Clinical practice/governance and case reports | SFEBES2007

Severe hyperkalaemia and hyponatramia with grossly elevated aldosterone: pseudohypoaldosteronism

Marath Biju , Palin Suzanne L , Kotonya Christine , Jones Alan F , Freeman Hester

A 64-year-old morbidly obese female was admitted with a history of bilateral lower leg ulceration, chronic venous insufficiency and biventricular cardiac failure. There was no relevant family history. She was commenced on furosemide and prophylactic enoxaparin. Biochemical investigations showed persistently elevated serum potassium concentrations (5.7 to 8.2 mmol/L) and low sodium levels (111 to 131 mmol/L). She had not been prescribed non-steroidal anti-inflammatory agents, a...

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ea0013p90 | Clinical practice/governance and case reports | SFEBES2007

Primary hyperparathyroidism in pregnancy-an increasingly common condition?

Chandran Shanthi , Wood Diana , Gurnell Mark , Chatterjee Krish , Wishart Gordon , Simpson Helen

Primary hyperparathyroidism in pregnancy is reported as being rare rare. It can be associated with significant complications. Maternal complications include symptomatic hypercalcaemia, renal calculi, hyperemesis, muscle weakness, and pre-eclampsia. Fetal complications include IUGR, low birth weight, preterm delivery, intrauterine death, neonatal tetany and fits.Patient 1 presented with asthma and was found to have primary hyperparathyroidism, corrected c...

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ea0013p91 | Clinical practice/governance and case reports | SFEBES2007

Unusual presentation of thyroid storm

Dissanayake Sanjaya , Dewan Shivani , Burrows J , Kong Nghi , Hale Peter

31 years old female presented to casualty with acute abdominal pain and vomiting. The physical findings showed acutely unwell female with persistent regular tachycardia and a large goitre with a bruit. There were no demonstrable eye signs indicating Graves disease. Initial investigation showed profound high anion gap metabolic acidosis (PH-7.13,HCO3-5.1, CL-113.6 BE-22.1PCO2 2.69,PO2-12.5) and severe hyperthyroidism (FT4-44 picomol per litre,FT3-24.8 picomol per litre,TS...

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ea0013p92 | Clinical practice/governance and case reports | SFEBES2007

Gynecomastia caused by a urinary bladder carcinoma secreting human chorionic gonadotropin

Jönsson Anders , Larsson Bruno , Falkmer Sture

In March 2006 a 64-year-old farmer complained of a 3-month-history of bilateral enlargement of the breasts, occasionally with blood in the urine. A brother had died in testis cancer at the age of 30. Blood samples from the present patient demonstrated very high plasma values of β-human chorion gonadotropin (β-hCG), estradiol and testosterone. He was on no drugs. The patient was referred to an endocrinologist. Physical examination demonstrated a moderate bilateral gyn...

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ea0013p93 | Clinical practice/governance and case reports | SFEBES2007

NICE Guidelines for Adult Growth Hormone replacement: an audit of impact on practice in Scotland

Philip S , Carson M , Howat I , Patterson C , Schofield C , Booth A , Patrick AW , Leese GW , Bevan JS , Connell JMC

Background: National Institute for Clinical Excellence (NICE) guidelines for the use of Growth Hormone (GH) replacement in adults with GH deficiency (GHD) were published in 2003, and subsequently ratified for use in Scotland.Aim: To identify all adults in Scotland currently receiving GH and to assess whether they meet the NICE criteria for starting and continuing GH replacement.Methods: All endocrinologists in Scotland were surveye...

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ea0013p94 | Clinical practice/governance and case reports | SFEBES2007

Comparison of 30 minute Short Synacthen test and 60 minute Short Synacthen test for assessment of the hypothalamo-pituitary–adrenal axis

Edavalath Mahamood , Hudson Peter , Leigh Jennifer

Aim: Short Synacthen test (SST) has become increasingly accepted and widely used screening test for the assessment of the integrity of hypothalamo-pituitary-adrenal axis (HPA), however there are difference of opinion about the duration of the test and most acceptable is 30 minutes plasma cortisol level after giving 250 μg of synacthen. Therefore we have compared 30 minutes SST with 60 minutes SST for assessment of the HPA axis.Method: Response to th...

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ea0013p95 | Clinical practice/governance and case reports | SFEBES2007

Lanreotide (Somatuline Autogel) causes marked tumour shrinkage in a case of gigantism

Fazal-Sanderson Violet , Karavitaki Niki , Wass John AH

The value of the somatostatin analogues in the treatment of acromegaly is well established. The experience on their efficacy in gigantism is limited involving the administration of octreotide. To our knowledge, no such cases treated by lanreotide have been reported.An 18-year old student presented to the A&E with a month history of blurred vision and headaches. CT showed a suprasellar pituitary tumour with obstructive hydrocephalus. Emergency inserti...

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ea0013p96 | Clinical practice/governance and case reports | SFEBES2007

Cranial diabetes insipidus: An interesting case

Debono Miguel , Banerjee Ritwik

Aim: To present a case of a 54 year old gentleman presenting with polyuria and diagnosed with cranial diabetes insipidus.Methods: The case history, including, detailed results of laboratory tests are presented, and the findings are discussed.Results: Way back in October 2004 Mr Z.A. was referred to the ENT surgeons with hearing difficulties in the right ear. He was diagnosed with catarrhal otitis media and chronic rhinitis. Symptom...

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ea0013p97 | Clinical practice/governance and case reports | SFEBES2007

Endocrine hypofunction as a consequence of metastatic cancer

Srinivasan R , Flood J , Thomas SM , Brackenridge AL , Carroll PV , Powrie JK

Introduction: Endocrine deficiency as a result of glandular infiltration by metastatic cancer is considered rare. Metastases to the adrenal cortex are relatively common and we present the clinical presentation and radiological appearances of cases involving pituitary and adrenal metastases.Case histories: Case 1: An 84 year old male with bronchogenic carcinoma presented with lethargy, polyuria and dehydration. The serum Na+ was 156 mmol...

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ea0013p98 | Clinical practice/governance and case reports | SFEBES2007

Unusual cause of adrenal insufficiency

Srinivasan R , Cheah Yee , Flynn M , Joseph Stonny

Case History: 54 year old man was admitted with 3 week history of dizziness and feeling unsteady on feet. He also had persistent central abdominal pain with no vomiting or diarrhoea. On examination, his lying and standing BP were 117/75 and 73/43 mm Hg respectively. He had tenderness over the right hypochondrium and right lumbar region. His initial investigations showed sodium 128 mmol/L and potassium 4.2 mmol/L. Short synacthen test was arranged and the cortisol...

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ea0013p99 | Clinical practice/governance and case reports | SFEBES2007

Use of thyroid function tests in medical inpatients in a District General Hospital

Theodoraki Aikaterini , Krishnan Binu , Shenoy Rani , Ward Helen

Background: Current UK guidelines for the Use of Thyroid Function Tests provide specific recommendations for the use of thyroid function tests in inpatients. Isolated alterations in TSH occur in 15% of inpatients and <2% will have underlying thyroid disorder. Thyroid function should be repeated every 46 weeks when changing thyroxine replacement dose or when commencing thionamides.Aim: To identify the indications and frequency of thyroid tests i...

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ea0013p100 | Clinical practice/governance and case reports | SFEBES2007

Endocrine Diagnostic Tests: A smoother, more legal diagnostic journey for the patient travelling through the Endocrine Test Care

Zelisko Morag , Price Clair , Sear Janet , Elsheikh Moghah

Endocrine diagnostic tests have long taken place in centres both with and without dedicated endocrine units. Problems with reliability have however been encountered, including difficulty in interpretation, the need for repeat tests with an inevitable delay of diagnosis, poor cost effectiveness and added stress to the patient. With the advent of the Endocrine Nurse post at the Royal Berkshire Hospital, the endocrine diagnostic tests were reviewed. To optimise the quality of the...

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ea0013p101 | Clinical practice/governance and case reports | SFEBES2007

Carney’s Triad

Hayat Haleema , Gilbey Stephen G

Carneys Triad is a rare syndrome, with fewer than 30 cases reported with all three tumors (Gastrointestinal stromal tumor, extra-adrenal paraganglioma and pulmonary chondroma) present, and less than 100 cases with two of the three tumor types.We report a 45 yr old female who presented with bloating, dizziness, sweating and palpitations. Physical examination was unremarkable. Biochemistry showed a normal hormonal profile, 24 hrs urinary catecholamin...

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ea0013p102 | Clinical practice/governance and case reports | SFEBES2007

Gastric adenocarcinoma and ectopic ACTH syndrome

Christodoulides Constantinos , Walker Neil , Karavitaki Niki , Wass John

Ectopic ACTH syndrome (EAS) is characteristically associated with neuroendocrine tumours and small cell carcinomas (SCC) typically of the bronchus. We report a rare case of EAS secondary to gastric adenocarcinoma.A 52-year old man presented to our department with a few week history of proximal myopathy, easy bruising, anxiety and weight loss. He was tanned and hypertensive. Laboratory investigations revealed hypokalaemia (2.3 mmol/l), hyperglycaemia and ...

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ea0013p103 | Clinical practice/governance and case reports | SFEBES2007

Adolescent endocrinology; time to revisit the diagnoses? a case of septo-optic dysplasia

Kumar Rajeev , Nathwani Nisha , Banerjee Ritwik

The patient now aged 28, was seen at the age of 8 years by an ophthalmologist when he fell down stairs and complained that he could not see from his right eye. He was confirmed to have optic disc hypoplasia in his right eye with acuity of 2/60. A CT scan of his head was reported normal. He was also short statured with his height being on 3rd centile. He was suspected to have partial growth hormone deficiency on the basis of insulin tolerance test and patient was placed on grow...

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ea0013p104 | Clinical practice/governance and case reports | SFEBES2007

Inherited causes and associations of medullary thyroid cancer should not be forgotten

Galliford Thomas , Shotliff Kevin

A 43 year old hypertensive lady was referred to a surgical team at a tertiary oncology centre for consideration of completion thyroidectomy following removal of a nodule the histology of which had shown medullary thyroid carcinoma. She was reviewed in the cancer Multi-Disciplinary Team meeting; surgery was deferred until she had been reviewed in the endocrine clinic.There was no known family history of MTC or other endocrine abnormality; however the pati...

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ea0013p105 | Clinical practice/governance and case reports | SFEBES2007

Endocrine genes – are patients getting the optimum fit?

Stewart Susan , Gittoes Neil , Sleighthome Vicky , Cole Trevor

In response to the 2003 Government White Paper entitled Our future, Our inheritance, we piloted a project to promote the genetic service within tertiary medicine. Three clinical nurse specialists (CNS); renal, cardiac and endocrine, are the catalyst for interaction between disciplines. This abstract relates the endocrine genetic experience.Targeting patients and families with genetic endocrine disease is achieved by three methods; identificat...

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ea0013p106 | Clinical practice/governance and case reports | SFEBES2007

Adult growth hormone replacement using a fixed graded initiation phase followed by an individualised titration phase: a single centre experience

Lecka Agnieszka , Prague Julia , Oguntolu Victor , Miell John , McGregor Alan , Aylwin Simon

Most authorities recognise adult growth hormone deficiency (AGHD) as a distinct endocrine disorder, although determining an appropriate strategy for optimising replacement remains controversial.We reviewed the outcome of a cohort of patients treated with a fixed graded initiation phase followed by an individualised titration phase. Patients were initiated on a starting dose of 0.3 mg recombinant human growth hormone (rhGH) for one month, with increases t...

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ea0013p107 | Clinical practice/governance and case reports | SFEBES2007

Double Y syndrome as a cause of gynaecomastia

Sharfi MO , Nussey SS , Bano G

A 68 year old retired accountant presented with loss of libido, reduced shaving frequency, obesity and gynaecomastia. His past medical history included osteoarthritis and facial acne. There was no related family history and he was taking no medications. He reported having two children.On examination the BMI was 31.7 kg/m2 and height 181 cm. He was normotensive and bilateral gynaecomastia was noted. He has reduced body hair; testicular volume w...

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ea0013p108 | Clinical practice/governance and case reports | SFEBES2007

Double Y syndrome as a cause of gynaecomastia

Abstract withdrawn....

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ea0013p109 | Clinical practice/governance and case reports | SFEBES2007

Does cyclical acromegaly exist?

Sharfi MO , Seal LJ , Panahloo AA

A 55 year old woman presented in May 2002 with symptoms of chronic fatigue, depression, intermittent and headaches. She had a history multinodular goitre and was found to have a fT4 of 15 pmol/L (N: 1123) and TSH of 0.32 mU/L (N: 0.54). Medication was citalopram and thyroxine 50 ug once daily commenced by her GP. On examination her BMI was 24 kg/m2. She had scant body hair, was normotensive, and had normal visual fields on confrontation. Baseline investi...

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ea0013p110 | Clinical practice/governance and case reports | SFEBES2007

Multicystic dysplastic kidney – a potential accelerant of complications in type I diabetes

Hillick A , O’Shea LA , El Tayeb E , Callaghan PB , Stack AG

A Multicystic Dysplastic Kidney (MCDK) is a congenital, renal, cystic transformation usually diagnosed perinatally with 1:1000 to 4,000 incidence1. The natural history of MCDK is disputed with involution1, enlargement and development of hypertension2, infection and malignant transformation reported in the literature. We describe the case of a 25-year-old chef in whom an occult MCDK was incidentally detected. He presented with a four month histo...

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ea0013p111 | Clinical practice/governance and case reports | SFEBES2007

Acute presentation of pituitary stalk tumor

Nagareddy VR , Thomas CM , Joshi Ashwin , Wong Stephen , Vora JP , Varma TRK , Whittingham Pauline , Corlett Pamela

An 18 year old lady was seen in endocrine clinic in October 2004 with 10 month history of polyuria, polydypsia and lethargy. Previous medical history includes Graves thyrotoxicosis which is treated with carbimazole.Clinical examination was unremarkable.Investigations and management: Urine osmolality −84 mosmol (250750), serum osmolality −290 mosmol (288298), full blood count, fasting glucose, renal, liver fu...

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ea0013p112 | Clinical practice/governance and case reports | SFEBES2007

Atypical presentation of isolated ACTH deficiency

Nagareddy VR , Thomas CM , Balaguruswamy Saran , Gupta Vikas , Weston PJ , Mannemela Sailaja

A 36 year old gentleman presented to Accident and Emergency with 2 day history of generalised headache associated with dizziness. No significant previous medical history.Clinical examination: Alert, Oriented, Apyrexial, Pulse 80/mt regular, Blood pressure 132/70 with no postural drop. Systemic examination revealed no significant abnormality.Investigations and management: Full blood count, Glucose, Urea and Electrolytes, Liver funct...

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ea0013p113 | Clinical practice/governance and case reports | SFEBES2007

Adrenal emergencies in treated addison’s disease

White Katherine , Wass John , Elliott Alyson

Adrenal crisis is a life-threatening emergency requiring immediate treatment with high glucocorticoid doses. In diagnosed Addisons disease between 3.8% and 29% of patients are estimated to need emergency hospital treatment per annum (Arlt & Allolio, 2003; Fleming & Ostergaard Kristensen, 1999).In 2003 we conducted the largest international survey of diagnosed Addisons patients to date (N=868), enquiring about the causes and fre...

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ea0013p114 | Clinical practice/governance and case reports | SFEBES2007

Inheritance in autoimmune addison’s: the extended family profile

White Katherine , Wass John , Elliott Alyson

Autoimmune hypoadrenalism (Addisons disease) is a rare condition with a European prevalence of up to 140 per million1. It frequently occurs in association with other organ-specific autoimmune diseases, both endocrine and non-endocrine. These conditions are recognised to occur in the extended family, but their prevalence has been hard to determine, because of the rarity of the disease.In 2003 we conducted the largest international survey ...

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