Clinical practice/governance and case reports

A 20-year-old gentleman with an established diagnosis of Chronic fatigue syndrome was admitted to hospital with palpitations and shortness of breath on exertion. He had been taking healthy supplements for his ME for a year. On examination, he was noted to be tachycardic with a heart rate of 120150 beats/minute. ECG confirmed sinus tachycardia. Further investigations revealed a free thyroxine (fT4) of 29.4 pmol/l and thyroid stimulating hormone (TSH...

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ea0019p23 | Clinical practice/governance and case reports | SFEBES2009

An unusual case of SIADH precipitated by chronic inflammatory demyelinating polyneuropathy

Varadhan L , Newman P , Barton D

Hyponatremia is one of the commonest electrolyte abnormality. Various neurological conditions including Guillain Barre syndrome could precipitate it. Very few citations in literature report SIADH in CIDP.A 68-year-old gentleman was admitted with worsening confusion and unsteady gait following a flu like illness few weeks ago, with increasing drowsiness for 3 days. His past medical history included hypertension and benign prostatic hypertrophy, being trea...

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ea0019p24 | Clinical practice/governance and case reports | SFEBES2009

All that glitters (on a bone scan) is not cancer

George J , Moisey R

Introduction: Malignancies and hyperparathyroidism account for over 90% of cases of hypercalcaemia. When presenting with suppressed PTH, malignancy is its commonest cause. We present a case of PTH-independent hypercalcaemia of immobilisation responding to bisphosphonate therapy.Case summary: A 57-year-old Caucasian male presented with significant weight loss and severe back pain. He consumed 50 units of alcohol a week, had stopped smoking 20 years earlie...

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ea0019p25 | Clinical practice/governance and case reports | SFEBES2009

Prevalence and identification of vitamin D deficiency in a falls population

Gunn Harriet M , Bovill Inaki , Wren Alison M

Background: Falls in the elderly are a major public health burden as more than one in three people over 65 years falls per annum. Vitamin D deficiency is common in the elderly due to decreased sunlight exposure, dietary vitamin D intake and efficiency of cutaneous vitamin D production. Vitamin D deficiency causes myopathy, impaired psychomotor function and increased sway thus increasing the risk of falls, whilst supplementation decreases falls. We hypothesized that vitamin D d...

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ea0019p26 | Clinical practice/governance and case reports | SFEBES2009

Use and monitoring of testosterone replacement therapy at a district general hospital

Ajala O , Chandrasekara WHMS , Balaguruswamy S , Ooi C

Aims: Testosterone treatment is controversial as long-term outcome data are not available; however prescriptions for testosterone are becoming more common.We looked at the symptoms on presentation, indications for testosterone replacement, forms of testosterone replacement, and adherence to present guidelines for monitoring.Methods: Data was collected from case notes of 47 patients on testosterone replacement attending endocrine cl...

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ea0019p27 | Clinical practice/governance and case reports | SFEBES2009

The utility of routine biochemistry in detecting vitamin D deficiency in South Asians with and without type 2 diabetes

Tahrani A , Ball A , Shepherd L , Rahim A , Bates A

Background: Vitamin-D deficiency and type 2 diabetes (T2D) are common in South Asians (SA). The diagnosis of a vitamin-D deficiency in the setting of a chronic disease depends on a high index of suspicion and adequate investigation. This involves bone profile, occasionally in conjunction with serum 25-hydroxyvitamin-D. The ability of routine investigations to identify vitamin-D deficient patients have not been widely studied.Aims: To assess the ability o...

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ea0019p28 | Clinical practice/governance and case reports | SFEBES2009

Hyperglycaemia in a patient with pheochromocytoma

Cho L , Atkin S

A 63-year old woman presented with a 3 weeks history of sweating, panic attacks and vomiting. Urine dipstick on admission was positive for glucose (3+) and ketones (2+) and lab glucose was elevated at 26 mmol/l. Based on the findings she was treated as diabetic ketoacidosis and commenced on insulin. Further investigations showed an elevated urinary catecholamines and marked hypercalcaemia (adjusted calcium 3.10 mmol/l) with unsuppressed PTH at 71 pg/ml (normal 1272 pg/ml...

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ea0019p29 | Clinical practice/governance and case reports | SFEBES2009

Screening for Cushing’s syndrome using the 1 mg overnight dexamethasone suppression test

Wainwright L , Medbak S , Meeking D

Cushings syndrome is a rare disorder of hypercortisolism with an incidence of three cases per million each year. The 1 mg overnight dexamethasone suppression test (ODST) is a commonly used screening test. Other screening tests include 24 h urinary free cortisol and diurnal variability of serum cortisol.We carried out an audit of ODST with the intention of examining patient outcome.Data were collected retrospectively over a tw...

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ea0019p30 | Clinical practice/governance and case reports | SFEBES2009

Bilateral testicular adrenal rests in congenital adrenal hyperplasia

Nayyar V , Bosman D , Laji K

Background: Testicular tumours have been described in patients with congenital adrenal hyperplasia (CAH) and are usually associated with 21 hydroxylase deficiency, occasionally it has been reported in patients with 11 hydroxylase deficiency CAH. Poor compliance to adrenocorticotrohphic suppressive therapy can result in the development of testicular tumours which are due to adrenal rest tissue hyperplasia. This is usually benign but can be mistaken for malignant testicular tumo...

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ea0019p31 | Clinical practice/governance and case reports | SFEBES2009

Bisphosphonate-induced hypocalcaemia on patient with malignancy induced hypercalcaemia

Abouglila Kamal , Ullah Arif

We report two cases of severe hypocalcaemia developed after intravenous administration of pamidronate in patients with severe hypercalcaemia secondary to multiple myeloma. Both of them develop symptomatic hypocalcaemia few days after treatment. Both patients was probably vitamin D deficient (both serum 25-hydroxyvitamin D level was low less than 15 (NR 25120 nmol/l) because of a combination of poor oral intake, inadequate sunlight exposure, and the development of renal f...

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ea0019p32 | Clinical practice/governance and case reports | SFEBES2009

Abstract withdrawn....

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ea0019p33 | Clinical practice/governance and case reports | SFEBES2009

Hypomagnesaemia and associated electrolyte abnormalities

Kalhan Atul , Wordsworth S , Owen PJD , Hullin D , Evans PMS , Page MD

Background: Magnesium, the second most abundant intracellular cation, plays a key role in cellular and metabolic reactions including protein synthesis, neurotransmission and electrolyte balance. There are no specific signs or symptoms of hypomagnesaemia and it can coexist with other electrolyte abnormalities. According to various surveys the prevalence of low Magnesium varies between 210% in hospitalized patients. However, there are no clear guidelines about when to scre...

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ea0019p34 | Clinical practice/governance and case reports | SFEBES2009

Primary hyperparathyroidism: dual localisation to improve cure rate

Wilmot E , Cozens N , Birchall J , Lingam K , Rea R

Aims: Primary hyperparathyroidism is a common endocrine disorder. A preoperative approach that combines ultra-sonography and scintigraphy has been shown to predict the presence of adenomas more accurately than either technique alone. We aimed to investigate our local success rates using dual localisation for parathyroid adenomas.Methods: Endocrine patients who had a parathyroidectomy between July 2006 and January 2008 were identified. Hospital notes were...

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ea0019p35 | Clinical practice/governance and case reports | SFEBES2009

Recombinant human growth hormone in pregnancy

King R , Rajeswaran C , Freeman M

A 34-year-old female was seen in the joint diabetic antenatal clinic during her second pregnancy. She had a very unfortunate first pregnancy, which resulted in a still birth following a traumatic delivery. She also had a large post-partum haemorrhage causing Sheehans syndrome. Hormone replacement therapy had been commenced, including hydrocortisone, thyroxine and growth hormone (GH). Pre-treatment quality of life assessment in GH deficient adults score (Qol-AGHDA) 21, an...

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ea0019p36 | Clinical practice/governance and case reports | SFEBES2009

Carbimazole-induced myositis: a rare but significant adverse reaction

Sagi SV , Sayeed N , Oyibo SO , Roland JM

Introduction: Carbimazole is the first drug of choice for treating thyrotoxicosis. We report a case of an Asian gentleman recently started on carbimazole for thyrotoxicosis who complained of severe generalised muscle pain and weakness.Report: A sixty-four year old gentleman was diagnosed with thyrotoxicosis (TSH <0.01 mU/l, Free T4=40 pmol/l, Free T3=14.9 pmol/l) in the month of July 08 and was started on carbimazole 40 mg daily...

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ea0019p37 | Clinical practice/governance and case reports | SFEBES2009

Autosomal dominant familial cranial diabetes insipidus

Graham UM , Boyle R , Atkinson AB , Morrison PJ , Hunter SJ

A 53-year-old man was referred for assessment of diabetes insipidus. He had been treated with intranasal desmopressin from18 months of age on the basis of an extensive family history but without confirmatory testing. The current referral was because of hyponatraemia in a similarly affected relative, which had raised uncertainty about diagnosis and treatment.The family history included 11 affected individuals across four generations and suggested autosoma...

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ea0019p38 | Clinical practice/governance and case reports | SFEBES2009

A mysterious case of postmenopausal hyperandrogenaemia

Wakil Ammar , Dawson Alison , Ng Ben , Atkin Stephen

A 73 years old female presented in 2005 with 8 year history of face and body hirsutism. Examination confirmed hirsutism but there were no other masculinization features. Her initial investigations revealed a high testosterone of 13 nmol/l, normal androstenedione, DHEA-S and 17 hydroxy progesterone. CT and U/S of pelvis and abdomen, showed normal adrenals, ovaries and a large calcified uterine fibroid. Urinary steroid metabolites ruled out adrenal testosterone source and exogen...

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ea0019p39 | Clinical practice/governance and case reports | SFEBES2009

Use of testosterone undecanoate 1000 mg (Nebido) injections to induce puberty in 2 men with Kallmann’s syndrome presenting in their 6th decade

Siddaramaiah N , Miller M , Quinton R

Nebido (testosterone undecanoate 1000 mg injection) was used to induce pubertal development in 2 apubertal men with Kallmanns syndrome, in their 6th decade.Case 1: Originally diagnosed with Kallmanns syndrome aged 21, but then discontinued treatment for the next 25 years. Now aged 50, he was markedly eunuchoid: G3-4, P3, A1.Investigations: Testosterone 1.0 nmol/l, LH and FSH <0.5IU/l.Normal fe...

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ea0019p40 | Clinical practice/governance and case reports | SFEBES2009

Prevalence of cardiovascular risk factors and related characteristics in women with polycystic ovarian syndrome

Imtiaz KE , Parmar M , Neupane S

PCOS is defined by the presence of hyperandrogenism (clinical and/or biochemical), ovarian dysfunction (oligo-anovulation and/or polycystic ovaries), and exclusion of related disorders. Obesity as a common feature with approximately 33% of women being obese compared with 20% in the general population. We report the analysis of 26 patients with polycystic ovarian syndrome (PCOS), mean age 36 (range 2153), attending the endocrine clinic, using both electronic database and ...

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ea0019p41 | Clinical practice/governance and case reports | SFEBES2009

Retrospective analysis of subfertility, hormonal profile and radiological features in women with polycystic syndrome on presentation

Imtiaz KE , Neupane S , Parmar M

Polycystic ovarian syndrome (PCOS) is common in young women and is the cause of anovulatory infertility in 70% of cases. We report the analysis of 26 patients with polycystic ovarian syndrome (PCOS) on presentation to the Endocrine clinic, mean age 36 (range 2153), using both electronic database and hospital notes. Fifty percent of patients (n=13) were obese, mean BMI 30 (range 1940). Sixty five percent (n=14) never conceived, although 15% (n=4...

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ea0019p42 | Clinical practice/governance and case reports | SFEBES2009

Delayed presentation of pituitary apoplexy as adrenal crisis in a man with vitiligo

Demssie Y , Dissanayanke S , Davies J

Pituitary apoplexy is a potentially life and vision threatening neuroendocrine emergency, which can often be misdiagnosed in the absence of the clinical hallmark of sudden onset headache and visual disturbance in a patient previously known to harbour a pituitary tumour. We report a 30 years old male patient with history of Vitiligo who presented to the emergency department with a 1-week history of vomiting, abdominal pain and lethargy along with postural hypotension and a very...

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ea0019p43 | Clinical practice/governance and case reports | SFEBES2009

Unusual presentation of non – PTH dependant hypercalcaemia

Arutchelvam V , Foulkes A , Napier C , Madathil A , Razvi S , Narayanan KR

Hypercalcaemia is a commonly encountered problem. Though primary hyperparathyroidism and malignancy account for greater than 90% of cases other rare causes need to be considered. We present an unusual but significant cause of hypercalcaemia.Of 87-year-old gentleman presented with acute abdominal pain and a severe hypercalcaemia with corrected serum calcium of 4.36 mmol/l (2.12.6). Significant dehydration was associated with acute renal failure (Tab...

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ea0019p44 | Clinical practice/governance and case reports | SFEBES2009

Lessons from a case of pituitary thyrotrophinoma I: not all TSH-omas are macroadenomas II: thyroid autoimmunity can be associated III: associated central hyperthyroidism can be subclinical

Arutchelvam V , Neely RDG , Mitra D , Hill J , Carrie S , Gurnell M , Quinton R

A 64-year-old lady presented with weight gain, tiredness, palpitations and tremor. She had no goitre and no other extra thyroidal manifestations. Both TSH and thyroid peroxidase antibodies (>1300) were elevated and she was treated by her GP with Thyroxine 50 mcg daily. She felt a lot worse on this, so it was discontinued and a full thyroid hormone profile was checked (see Table 1) which prompted referral; to Endocrinology.Other pituitary hormone leve...

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ea0019p45 | Clinical practice/governance and case reports | SFEBES2009

Total serum cortisol, free cortisol index and salivary cortisol in monitoring oral hydrocortisone replacement

Bano G , Anthonypillai F , McEwen A , Hucklebridge F , Clow A , Evans P , Nussey S

Summary: Physiological replacement of glucocorticoids in hypocortisolemic patients remains a challenge. We assessed the use of salivary cortisol and total serum cortisol profile with CBG measurement in monitoring glucocorticoid replacement in hypoadrenal patients in routine clinical practice.Methods: Serum and salivary cortisol concentrations were measured in 60 hypoadrenal patients previously documented to have cortisol deficiency on provocative testing...

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ea0019p46 | Clinical practice/governance and case reports | SFEBES2009

Non-identical Kallmann’s syndrome in otherwise identical twins

Fenech M , Venu M , Swords F

Two identical twins aged 20 were referred for investigation and treatment of delayed puberty. They were otherwise fit and well, with no significant past medical history. On presentation, both were tall, eunuchoid with no secondary sexual characteristics. Twin A had undergone orchidopexy for an undescended testicle, but had a normal sense of smell on testing. Twin B had normal pre-pubertal external genitalia, but reported anosmia. Neither exhibited synkinesis, abnormal dentitio...

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ea0019p47 | Clinical practice/governance and case reports | SFEBES2009

A case of a disappearing adrenal mass with raised urine catecholamines

Jones A , Fox T , Browne D

Introduction: Adrenal incidentalomas are a common reason for endocrinology referral. We present a case of an incidentally discovered adrenal mass biochemically mimicking phaeochromocytoma with rapid resolution on subsequent imaging.Case report: A 53-year-old female was found to have a 5 cm mass adjacent to the right kidney on ultrasound performed to investigate abnormal liver function tests. CT confirmed a right adrenal mass. The patient was normotensive...

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ea0019p48 | Clinical practice/governance and case reports | SFEBES2009

Multiple endocrinal disorders & nephrotic syndrome in a patient with covert lung cancer

Rana Subhash C , Daverede Luis , Bangar Vijay , Mousa Abdusalam

Objective: We highlight a case of lung cancer presenting with a combination of Ectopic ACTH, SIADH and Nephrotic syndrome where paraneoplastic manifestations are the only presentation of an underlying lung cancer.Case report: Seventy year male, ex- smoker, hypertensive on Amlodipine, Irbesartan. Presented with 5-week history of leg swelling, reduced appetite.Examination showed pitting edema of the legs but no signs of cardiac, live...

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ea0019p49 | Clinical practice/governance and case reports | SFEBES2009

Prepubertal gynaecomastia due to aromatase excess syndrome – novel allele presence in CYP19A1 gene

Sharma Sanjeev , Dutta Vipan

Prepubertal gynaecomastia may be due to increased oestrogen resulting from excessive aromatase activity in extra glandular tissues. CYP19A1 gene on chromosome 15q21.2 encodes aromatase, the key enzyme for oestrogen biosynthesis. Tissue-specific promoters regulating the expression of aromatase activity have been demonstrated in placenta, ovary, testes, brain, skin fibroblasts and adipocytes. Mutations involving aromatase cytochrome P450 (P450arom) have been reported ...

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ea0019p50 | Clinical practice/governance and case reports | SFEBES2009

Hypomagnesaemia and hypocalcaemia with proton-pump inhibitors: an under-recognised phenomenon

Druce MR , Thomas JDJ , Gorrigan RJ , Kelly PA , Coppack SW , Akker SA

Objectives: We describe three patients recently admitted to our institution with severe hypomagnesaemia and hypocalcaemia and a history of proton pump inhibitor (PPI) therapy.Patient 1 was admitted with lethargy, anorexia and leg cramps. Medications included a PPI (omeprazole) prescribed for gastritis. Corrected calcium was 1.54 mmol/l (2.152.65) and magnesium 0.25 mmol/l (0.71.0), with a PTH of 1.0 pmol/l (1.66.9) and 25-OH-vitamin D 5...

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ea0019p51 | Clinical practice/governance and case reports | SFEBES2009

Intestinal neurofibromatosis and subclinical Cushing’s syndrome

Malik I , Panahloo A , Chong WH , Bano G

A 55-year-old gentleman was referred to surgeons for screening colonoscopy in view of family history of bowel cancer. His mother, maternal aunt and two cousins had history of bowel cancer. When seen by the surgeons, he gave 4-month history of intermittent abdominal bloating and rectal bleeding. His past medical history included a recent diagnosis of hypertension, a chronic history of facial neuralgia and history of excision of numerous facial skin tags. He was on amlodipine 5 ...

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ea0019p52 | Clinical practice/governance and case reports | SFEBES2009

A hypokalaemia of all sorts

Mehta SR , Levy MJ , Robinson S

A 31-year-old German lady attended A&E with a 1 week history of bilateral leg swelling. The leg swelling had been gradual in onset and was not associated with shortness of breath, chest pain or haemoptysis. She had no history of renal or cardiac disease. Her only past medical history was of mild indigestion. She did not have any regular medication use. On examination she was systemically well but had bilateral pitting lower limb oedema. Blood pressure was 120/80 mmHg (comp...

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ea0019p53 | Clinical practice/governance and case reports | SFEBES2009

Lithium associated hyperparathyroidism: when to investigate?

Ballav C , Brain H , McLaren A

A 64-year-old woman who had been on Lithium 600 mg/day for 6 years for affective neurosis, presented in 2005 with acute confusion associated with a serum calcium concentration of 3.02 mmol/ which improved with rehydration. She was followed-up in outpatients and diagnosed with Lithium-associated hypercalcaemia likely to be secondary to parathyroid hyperplasia. Results showed a corrected calcium of 2.74 mmol/l (2.12.55), phosphate 1.00 mmol/l (0.741.52), ...

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ea0019p54 | Clinical practice/governance and case reports | SFEBES2009

Tertiary hyperparathyroidism in pregnant women with vitamin D deficiency

Kenz Sami , Norris Andrea , Chohan Zak

Introduction: Hyperparathyroidism is uncommon during pregnancy with less than 200 cases reported worldwide. Untreated, this condition can result in a 2030% incidence of fetal death and 5060% incidence of complications during pregnancy. If recognized early, the condition is treatable with significant improvement in fetal and maternal outcomes.Case: We report the case of 35-year-old asymptomatic Asian female (gravida 9 para 4, one stillbirth) w...

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ea0019p55 | Clinical practice/governance and case reports | SFEBES2009

Following a cardiac arrest in this seemingly healthy 28-year-old, all became clear

de Lloyd Anna , Obuobie Kofi

After suffering three spontaneous pneumothoraces, Mr A was due to have definitive treatment in the form of video-assisted thoracoscopy and pleurodesis. Soon after induction of anaesthesia he developed severe hypertension; 130/80 →300/220 associated with global high take off and ST elevation on the ECG. Labetol was given i.v. after which the blood pressure became unrecordable and an EMD cardiac arrest ensued. Three cycles of cardiac massage and two boluses of ...

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ea0019p56 | Clinical practice/governance and case reports | SFEBES2009

Pituitary ACTH-dependent Cushing’s syndrome caused by ectopic CRF secretion from an intra-adrenal phaeochromocytoma

Woods D , Arutchealvam V , Madathil A , Peaston R , Turner S , Neely RDG , Graham J , Richardson D , Lennard TJW , Bliss R , Bennett SB , Johnson S , Mason JI , Quinton R

A 69-year-old woman was admitted with new uncontrolled diabetes, severe hypertension and bilateral leg oedema. Cushings syndrome was suspected when she developed resistant hypokalemic alkalosis on diuretic therapy. Detailed questioning also revealed a history of episodic sweating, palpitation and tremor.Investigation & management: ACTH-dependant Cushings syndrome was confirmed: Serum ACTH 516 ng/l; urine free cortisol 20 045 nmol/24 h; 09...

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ea0019p57 | Clinical practice/governance and case reports | SFEBES2009

Hyponatraemia in primary care: not always due to inappropriate ADH!

Tran A , Hyer S , Rodin A , Wilcox H

Background: Hyponatraemia is a frequently encountered problem in primary care. Management should be based on the cause as inappropriate treatment e.g. fluid restriction in patients with hypoadrenalism is dangerous and potentially life-threatening.Aims: We present five cases who presented with hyponatraemia in the primary care setting, to highlight diagnostic approach and implications for management.Case 1 - Hyponatraemia secondary ...

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ea0019p58 | Clinical practice/governance and case reports | SFEBES2009

An interesting case of Turner syndrome with spontaneous pregnancies

Aung Theingi , Meston Niki , Shears Debbie , Karavitaki Niki , Wass JAH

Turner syndrome results from the complete or partial lack of one X chromosome and occurs in approximately 1:2500 female live births. The incidence of spontaneous puberty in the 45, X karyotype is about 9%. Spontaneous pregnancy has been reported in less than 5% of the cases, the majority of which have been described in subjects with mosaicism; these are often associated with high rates of miscarriage and stillbirth.A 51-year-old check-out supervisor was ...

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ea0019p59 | Clinical practice/governance and case reports | SFEBES2009

Cabergoline and cardiac valvulopathy – a unit review

Demssie YN , Dewan S , Nair S , Khattar RS , Davies JR

The use of high doses of the ergot-derived dopamine receptor agonists such as cabergoline for treatment of Parkinsons disease has been associated with increased prevalence of echocardiography detected cardiac valve disease. Whether smaller doses of cabergoline used for treating endocrine disorders causes similar valvular abnormalities is not yet conclusively established.We conducted echocardiographic screening of 35 adult endocrine patients on curr...

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ea0019p60 | Clinical practice/governance and case reports | SFEBES2009

Non-classic congenital adrenal hyperplasia and the 18 week wait

Woods D , Chandran S , Putta-Manohar S , Strey C

Targets such as the 18 week wait may help reduce diagnostic and treatment delay. However, we report two cases of supposed non-classic congenital adrenal hyperplasia (CAH) that perhaps highlight the benefit of time and hindsight as diagnostic tools.Case 1 A previously unknown 61-year-old contacted our department requesting alternatives to biphosphonate therapy. Mild CAH had been diagnosed in 1974 on the basis of elevated urinary 17...

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ea0019p61 | Clinical practice/governance and case reports | SFEBES2009

A case of hypopituitarism presenting as hyponatraemia

Richardson K , Bickerton A , Pramodh S

A 64-year-old lady presented feeling unwell with nausea, vomiting, headaches and dizziness. She was taking sulpiride for schizophrenia and had an 8-year history of hyponatraemia. The hyponatraemia, was associated with mild hyperprolactinaemia, prompting investigation for hypopituitarism twice previously by endocrinologists in a different hospital. Secondary adrenal insufficiency had been excluded on the basis of: cortisol 576 nmol/l at 30 min after 250 mcg synacthen and cortis...

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ea0019p62 | Clinical practice/governance and case reports | SFEBES2009

Hypertensive crisis secondary to a germ cell tumour

Thomas J , Kelly P , Powles T , Akker S

A 21-year-old man presented with tonicclonic seizures and two-week history of nocturnal headaches, sweatiness, hot flushes and abdominal pain. Blood pressure was 220/110 mmHg and pulse 120160 bpm. A GTN infusion was commenced and the blood pressure improved to 150/90 mmHg. Examination revealed a large, hard mass in the left hypochondrium. There was no palpable lymphadenopathy and no papilloedema. A 2 cm hard, irregular mass was present on the left testis. CT showed...

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ea0019p63 | Clinical practice/governance and case reports | SFEBES2009

A rare case of hypercalciuria

Gholap N , Jeffcoate W

A 37-year-old Caucasian man was referred for assessment of borderline hypocalcaemia (2.15 mmol/l) associated with hypophosphataemia (0.32 mmol/l) and elevated serum PTH (145 ng/l). Serum 25OH cholecalciferol was normal (39 mmol/l). Some weeks earlier he had been admitted to hospital as an emergency with severe, colicky right sided abdominal pain. The pain had settled spontaneously and no cause was found. He had subsequently suffered isolated attacks of strangury, dysuria and t...

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ea0019p64 | Clinical practice/governance and case reports | SFEBES2009

Thyroxine replacement precipitating adrenal crisis

Choudhary Nidhi , Chikkaveerappa Krishnamurthy , Underwood Paul , Sun Leong King

Primary hypothyroidism and hypoadrenalism may occur concomitantly as part of autoimmune endocrine syndromes. Thyroxine replacement without steroid replacement can precipitate fatal adrenal crisis in this subgroup of patients. We report two patients with autoimmune primary hypothyroidism presenting with acute adrenal crises after commencing thyroxine replacement.Case 1: A 36-year-old patient with type 1 diabetes for 15 years was admitted with vomiting, ab...

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ea0019p65 | Clinical practice/governance and case reports | SFEBES2009

Prostate cancer- a rare cause of hypopituitarism

Joshi Ashwin , Singh P , Haq A , Howell Simon

A 62-year-old man presented with 1 month history of lethargy, nocturia, thirst and diplopia. On examination he had left 3rd nerve palsy with complete ptosis. MRI pituitary demonstrated a 1.3×1.1 cm enhancing mass on the left side of the pituitary gland, with invasion of the left cavernous sinus. Endocrine work up revealed partial DI, TSH and gonadotrophin deficiency. Because of unusual appearance of the pituitary lesions, a biopsy was arranged but initial histology was in...

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ea0019p66 | Clinical practice/governance and case reports | SFEBES2009

Hyponatraemia- management dilemma

Joshi Ashwin , Howell Simon

A 55-year-old lady presented with visual deterioration of 2 years duration affecting both eyes. Initial examination demonstrated reduced visual acuity in the LE at finger perception and RE 6/9 with right temporal superior quadrantopia. Rest of the systemic examination was unremarkable. Relevant endocrine tests revealed a FSH-146.9 U/l and FT4-14 pmol/l. MRI pituitary demonstrated a pituitary adenoma with significant suprasellar component compressing the optic nerves...

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ea0019p67 | Clinical practice/governance and case reports | SFEBES2009

Secondary ovarian failure in a patient with prolonged anorexia

Kennedy A , Shepherd L , Hughes D , Rahim A , Bates A , Bellary S

The association of low body weight due to excessive exercise and/or eating disorders, and hypothalamic amenorrhoea is well documented. Delayed or arrest of puberty may occur if low body weight occurs before or during puberty. Normal menstruation is restored once a healthy body weight is regained. In this case, body weight normalised but ovarian function did not.A 34-year-old woman attended our thyroid clinic for subclinical hypothyroidism following an ep...

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ea0019p68 | Clinical practice/governance and case reports | SFEBES2009

Generalised glucocorticoid resistance diagnosed by chance

Owen E , Lloyd L , Wayte A , Wilton A

Generalised resistance to glucocorticoid is a rare familial or sporadic disease with partial target tissue insensitivity to glucocorticoids. Compensatory activation of the hypothalamopituitaryadrenal axis occurs with raised andrenocorticotrophic (ACTH) hormone levels and increased synthesis of adrenal steroids. The phenotype varies from asymptomatic to excess glucocorticoid, mineralocorticoid and androgenic effects.A 20-year-old female was fo...

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ea0019p69 | Clinical practice/governance and case reports | SFEBES2009

Diagnostic and therapeutic challenges in virilised female with learning difficulties

Osborne L , Balen A , Freeman M

Case: A 22-year-old lady was referred with marked hirsutism for 12 months and secondary amenorrhoea for 4 years. She has a complex medical background including persistent hyperinsulinaemic hypoglycaemia of infancy (PHII) necessitating subtotal pancreatectomy with subsequent diabetes. Perhaps a result of PHII, she also has learning difficulties and epilepsy. Other problems include myopathy and mild chronic thrombocytopaenia.Medications: insulins glargine ...

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ea0019p70 | Clinical practice/governance and case reports | SFEBES2009

A case of reversible pseudo-phaeochromocytoma

Kahal H , Malik M

A 39-year-old man was referred to the endocrinology clinic with a suspected phaeochromocytoma. He had a history of hypertension, episodic flushing and erectile dysfunction. He denied any recreational drugs abuse. His past medical history included primary hypogonadism of unknown cause and hypertension. He was on ramipril 5 mg od, atenolol 50 mg od and susatnon injections.Clinical examination was unremarkable away from BMI of 35, facial flushing and raised...

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ea0019p71 | Clinical practice/governance and case reports | SFEBES2009

Audit of a nurse-led thyroid telephone consulting service for the management of thyroid dysfunction

Clark J , Anthony-Pillai F , Bano G , Nussey S

Aims and objectives: Patients with thyroid dysfunction typically require frequent monitoring of thyroid function tests in order to titrate drug treatments and achieve normal thyroid function. A nurse-led thyroid telephone consulting service was established in 2006 to allow monitoring of thyroid function tests without the need for a hospital doctors appointment, with the aim of offering increased convenience for patients as well as significant cost savings. This audit aim...

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ea0019p72 | Clinical practice/governance and case reports | SFEBES2009

Late onset congenital adrenal hyperplasia masquerading as subclinical Cushing’s syndrome

Loh V , Krishnan B , Prentice M , Panahloo A , Seal L

A 54-year-old AfroCarribean woman developed worsening obesity, hypertension, and proximal muscle weakness. Clinical examination revealed cushingoid facies, truncal obesity (BMI 34.8), abdominal striae and a BP of 150/90, FerrimanGallway score 12.Investigations:- FBG 10.7 mmol/l, 24 urine cortisols 147 mmol/l, 207 mmol/l (NR 25280 nmol/24 h), normal short synacthen test (cortisol 471 rising to 1002 nmol/l). Subsequent testing revealed a ...

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ea0019p73 | Clinical practice/governance and case reports | SFEBES2009

A case of macroprolactinoma associated with a giant carotid artery aneurysm

Sihota S , Porte M , Thow J

We report a 56-year-old male patient who presented in September 2006 with a left eye inferior temporal visual field defect and a left relative afferent pupillary defect. Imaging demonstrated a 4 cm giant cavernous left carotid aneurysm causing pressure symptoms resulting in the above visual failure.The patient had internal carotid coil embolisation of the left internal carotid artery.The patient re-presented in February 2008 with e...

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ea0019p74 | Clinical practice/governance and case reports | SFEBES2009

Thiazolindinediones are useful in achieving female type fat distribution in male to female transsexuals

Malik I , Barrett J , Seal L

A 45-year-old male to female transsexual presented with poor female fat distribution. She had been treated with oestrogen for 13 years, initially as ethinyl oestradiol to a maximum dose of 150 ug/day, presently taking 100 mcg with GNRH analogue. On this regimen she had B cup breast development but underwent breast augmentation surgery and still suffered from low self-esteem. She was dissatisfied with her body image because she perceived a male body fat distribution. Her initia...

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ea0019p75 | Clinical practice/governance and case reports | SFEBES2009

Fronto-ethmoidal mucocele: a late complication of trans-ethmoidal pituitary surgery and a cause of unilateral proptosis in the endocrine clinic

Hocking R , Davies J , Scanlon M , Rees D

Introduction: A Mucocele is a collection of mucus enclosed by sinus epithelium within the paranasal sinuses. The pathogenesis is debated but a history of nasal obstruction, nasal surgery, nasal polyps or trauma is common but not universal. Mucoceles can erode local bone structure and invade the orbits. Four cases of sphenoidal mucoceles presenting with headache, 115 years post trans-sphenoidal pituitary surgery have previously been reported. We present two cases of front...

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ea0019p76 | Clinical practice/governance and case reports | SFEBES2009

The ‘new start’ weight loss programme: developing and piloting a real world intervention for patients with severe morbid obesity

Douek IF , Andrews RC , Watson S , Grant T , Edmond JR

Background: In a research setting, complex behavioural interventions are effective in changing lifestyle behaviour and inducing weight loss. However, these are viewed as requiring a high number of different health care professionals to be successful and thus few are available in the NHS setting. Here we describe how we developed and piloted a complex behavioural intervention for participants with severe morbid obesity.Methods: Using input from a psycholo...

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ea0019p77 | Clinical practice/governance and case reports | SFEBES2009

Expansion of a VHL-associated spinal haemangioblastoma in pregnancy

Carty D , Brennand J , Dominiczak A , Connell J

Von-Hippel-Lindau syndrome (VHL) is an autosomal-dominant disorder associated with CNS haemangioblastomas, phaeochromocytomas, renal carcinomas and retinal haemangiomas. We present the case of a 33-year-old woman with VHL who developed clinical progression of a CNS lesion during pregnancy. The patient had undergone removal of a cerebellar haemangioblastoma at age 18, and bilateral phaeochromocytomas were removed at age 27. The only other abnormality on regular review was a mix...

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ea0019p78 | Clinical practice/governance and case reports | SFEBES2009

Managing hyponatraemia – a challenge

Simon GK , Thomas A , Brooks AP

Hyponatraemia is common in acute medical admissions, to district general hospitals presenting with neurological complications and increasing length of stay. We have carried out an audit against the following standards: full drug history; assessment of volume status; paired plasma and urinary osmolalities; appropriate fluid and Na+ management and monitoring; and target Na+>125 mmol/l on discharge.Fifty two patients with hyponatra...

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ea0019p79 | Clinical practice/governance and case reports | SFEBES2009

Directly observed medication supplementation for non-compliance in a patient with hypothyroidism and hypoparathyroidism

Pickett P , Iqbal R , Mundinamani D , Macleod A , Moulik P

Introduction: Hypocalcemia in post-operative hypoparathyroidism responds to oral vitamin D and calcium replacement. We describe a case of persistent symptomatic hypocalcemia and hypothyroidism despite oral replacement and management with supervised weekly supplementation.Case history: A 56-year-old lady had total thyroidectomy for multinodular goitre. Persistent post-operative hypoparathyroidism and hypothyroidism necessitated replacement with calcitriol...

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ea0019p80 | Clinical practice/governance and case reports | SFEBES2009

Are young people with congenital adrenal hyperplasia engaging with adult endocrine care?

Gleeson H , Jones J , O'Shea E , Amin R , Patel L , Banerjee I , Hall C , Wu F , Ray D , Davis J , Clayton P

Objective: To evaluate whether patients with congenital adrenal hyperplasia (CAH) have been successfully transitioned to adult endocrine care.Methods: All patients with CAH who had attended the paediatric adrenal clinic at RMCH and were currently between 16 and 30 years of age were identified. Current status of adult endocrine care was recorded.Results: Sixty-eight patients were identified. There was inadequate information on 16 pa...

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ea0019p81 | Clinical practice/governance and case reports | SFEBES2009

Acute myopathic paraparesis as the first manifestation of thyrotoxicosis

Malipatil N , Srinivas-Shankar U , Sharma D , King S , Ikpoh A , Weston P

Background: Musculoskeletal symptoms are common but unrecognized symptoms of thyroid dysfunction. We present a case report of an elderly man presenting with acute paraparesis as the first manifestation of thyrotoxicosis.Case report: A 73-year man presented with 1-week history of weakness in both legs and inability to mobilize or stand. Neurological examination revealed severe proximal muscle weakness (grade 0/5 power) of both lower limbs with reduced ten...

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ea0019p82 | Clinical practice/governance and case reports | SFEBES2009

Flucloxacillin induced hypokalaemia and hypomagnesaemia

Bdiri A , Smith M , Lawrence J

A 70-year-old woman presented with low back pain. A diagnosis of discitis (L4-L5) was made and the patient was started on IV flucloxacillin 1 g every 6 h and fusidic acid. The back pain was improving and the serum electrolytes were all within normal range with potassium level at 4.4 mmol/l (normal: 4.05.5) and magnesium at 0.68 mmol/l (normal: 0.71.1). However two weeks after starting the IV flucloxacillin, the patients electrolytes showed a persistent hypoka...

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ea0019p83 | Clinical practice/governance and case reports | SFEBES2009

Screening for primary aldosteronism in a secondary care diabetes population

Steven S , Mettayil J , Chapman J

Introduction: Hypertension remains a significant co-morbidity in the population with diabetes, with a prevalence of 2060%. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance. In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy.Aims: To investigate the prevalence of, and to stratify, hypertension in our diabetes clinic population. To investigate prevalence of risk fact...

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ea0019p84 | Clinical practice/governance and case reports | SFEBES2009

New onset addison’s disease presenting as prolonged hyperemesis in early pregnancy

Hincz P , Lewandowski KC , Cajdler-Luba A , Salata I , Lewinski A

A 32-year old Caucasian was admitted with at 14 weeks of gestation with hypotension and weight loss. Family members noted that she appeared tired prior to pregnancy. Past medical history included primary hypothyroidism treated with thyroxine (100 μg/day). Her mother had also been hypothyroid. She had a healthy daughter aged 2.5 years who had been born small for gestational age.At about 8 weeks of gestation she started to vomit several ti...

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ea0019p85 | Clinical practice/governance and case reports | SFEBES2009

Assessing the impact of a fracture liaison service: a comparative audit of secondary prevention of osteoporosis in post-menopausal females treated in two fracture units, one with a fracture liaison service and one without

Callachand F , Wallace I , Elliott J , Gardiner P

Background: Osteoporosis leads to significant morbidity and disability through an increased susceptibility to fracture. Post-menopausal females are a high-risk group. A fracture liaison service model has been proposed as a method to maximise initiation of treatment for secondary prevention following a fragility fracture.Aim: To compare practice in two fracture units to guidelines contained in the National Institute for Clinical Excellence (NICE) Technolo...

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ea0019p86 | Clinical practice/governance and case reports | SFEBES2009

A case of totally inappropriate administration of ADH

Simon GK , Field JL , Brooks AP

An 82-year-old lady, who was fit and well, presented with 4 days history of confusion, vomiting and slurred speech.She had recurrent cystitis, hypertension and nocturnal enuresis. She was on Adalat LA 20 mg, dosulepin 50 mg, co-amilozide 5/50 mg alternate mornings. She was started on desmopressin 0.2 mg nocte, for nocturia ten days prior to her admission.Examination showed AMTS 4/10, pulse 65/ min, blood pressure 136/66 mmHg, with ...

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ea0019p87 | Clinical practice/governance and case reports | SFEBES2009

Cinacalcet treatment to predict the results of parathyroidectomy: a report of two cases

Selby P , Parrott N , Davies M

Cinacalcet, a calcimimetic, is licensed for the management of primary hyperparathyroidism (PHP) where surgery is deemed inappropriate. It is unclear when patients might be deemed more appropriately managed by medical treatment rather than surgery. We report two cases in which cinacalcet has been used to predict the effect of parathyroidectomy and a choice to be made between surgery and conservative management.A 43-year-old woman had a parathyroid adenoma...

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ea0019p88 | Clinical practice/governance and case reports | SFEBES2009

Quality of life in adult patients with congenital adrenal hyperplasia – results of the congenital adrenal hyperplasia adult study executive

Krone N , Willis D , Hahner S , Wild S , Allolio B , Ross R , Arlt W , CAH Adult Study Executive CaHASE

Congenital adrenal hyperplasia (CAH) represents the most common inborn metabolic error and is associated with significant morbidity and mortality. There is a paucity of clinical data in adult patients, a lack addressed by congenital adrenal hyperplasia adult study executive (CaHASE), a multicentre cross-sectional study of the health status of adults with CAH that recruited 203 patients from 17 centres (54% of patients contacted). Psychometric evaluation was assessed by validat...

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ea0019p89 | Clinical practice/governance and case reports | SFEBES2009

Transient secondary hypoadrenalism after a single intra-articular steroid injection-a case report

Alfitori G , Mahmood M , Malik S

A 39-year-old man was referred to our department with an incidental finding of low blood glucose. He had presented to rheumatology with non-traumatic left knee pain and swelling. He had a longstanding history of obstructive sleep apnoea and hiatus hernia. He had not been taking any medications. Examination was unremarkable apart from tender left knee with an effusion. A diagnosis of reactive arthritis was made. An incidental finding of low blood glucose (2.7 mmol/l-normal 3.4&...

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ea0019p90 | Clinical practice/governance and case reports | SFEBES2009

On adequate thyroxine replacement and still symptomatic

Kamaruddin MS , Pearce SH

Hypothyroid patients often present with non-specific symptoms and some of these may persist despite adequate thyroxine replacement, including weakness, poor memory, paraesthesia and numbness or coldness of the extremities. In patients on thyroxine who have been referred due to persistent symptoms, we routinely look for vitamin B12 deficiency, if symptoms persist once thyroxine replacement has been optimised.We present three patients who remained symptoma...

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ea0019p91 | Clinical practice/governance and case reports | SFEBES2009

Dilemmas in the diagnosis of primary hyperaldosteronism

El-Gayar H , Shaikh H , Hatfield E , Morganstein D

Primary hyperaldosteronism (PHA), accounts for 510% of all hypertensive patients and is associated with increased cardiovascular risk. However, making the diagnosis is not always straightforward.A 50-year-old male was admitted with an acute myocardial infarct. He was markedly hypertensive (BP 190/100 mmHg) and hypokalemic. He was commenced on beta-blockers and an Angiotensin converting enzyme inhibitor (ACEI). Plasma aldosterone concentratio...

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ea0019p92 | Clinical practice/governance and case reports | SFEBES2009

A case of mistaken identity: metastatic thyroid follicular carcinoma masquerading as an incidental solitary pulmonary carcinoid lesion

Barber TM , Herbert A , Wingfield-Digby E , ElSheikh M , Simpson H , Marks N

We present a fascinating and instructive case of unexplained suppression of thyroglobulin (Tg) levels following resection of a presumed carcinoid tumour, subsequent re-examination of which revealed it to be a solitary metastasis from a follicular thyroid carcinoma.The patient, RB is a 79-year-old woman who presented 11 years ago with a 2-week history of neck swelling. Examination revealed a 5 cm diameter nodule in the left lobe of the thyroid, confirmed ...

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ea0019p93 | Clinical practice/governance and case reports | SFEBES2009

Near-normoglycemic remission in diabetic ketoacidosis: a case report

Woodhead N , Rees J , Jose B , De P

Ketosis-prone, Jamaica (J) type diabetes is an uncommon form of diabetes described in a sub-population of mainly Afro-Caribbean patients who often present acutely with diabetic ketoacidosis (DKA) but during follow up demonstrate clinical, metabolic, and immunologic features of Type II diabetes. We present such a case.A 37-year old Afro-Caribbean man with a family history of Type II diabetes presented with polyuria, polydipsia and weight loss. He was over...

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ea0019p94 | Clinical practice/governance and case reports | SFEBES2009

Audit of investigation & management of adrenal incidentaloma

Troke R , Bala A , Kaplan F , Winocour P

Introduction: Adrenal masses may be found as incidental features during abdominal imaging investigations, raising questions as to the need to investigate these lesions for endocrine function or malignancy. This audit utilised published articles and consensus papers to compare our current approach with reported practice in other centres.Method: A retrospective review of the case notes of 21 patients referred to the Endocrine service in the Trust from Nove...

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ea0019p95 | Clinical practice/governance and case reports | SFEBES2009

An audit of thyroid surveillance in amiodarone treated subjects – room for improvement

Singh Prashant , Drodge A , Premawardhana LDKE

Introduction: Thyroid dysfunction is relatively common in amiodarone treated subjects, partly because of its high iodine content. The benefits of surveillance, early identification and management of such thyroid dysfunction have been established. We undertook a retrospective case notes audit of all amiodarone treated subjects in our hospital to evaluate thyroid surveillance and outcome.Methods: All patients treated with amiodarone between 2001 and 2004 w...

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ea0019p96 | Clinical practice/governance and case reports | SFEBES2009

When is subclinical hypothyroidism just subclinical?

Ratnasabapathy R , Baburaj R

A 58-year-old man was diagnosed with subclinical hypothyroidism on routine biochemistry in primary care. His initial thyroid stimulating hormone (TSH) was 10.7 mu/l, Free T4 (fT4) 24 pmol/l and thyroid peroxidase antibody negative. He was treated with levothyroxine and doses escalated due to elevated TSH (9.620.58 mu/l) and low fT4 (12.024.9 pmol/l). Despite good adherence to treatment his TSH was persistently raised and hence he wa...

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ea0019p97 | Clinical practice/governance and case reports | SFEBES2009

Acute adrenal insufficiency due to bilateral adrenal haemorrhagic infarction in antiphospholipid syndrome

Sharma D , Srinivas-Shankar U , Malipatil R , Vora J

Back ground: Acute adrenal insufficiency is a life threatening condition with multiple aetiologies. The adrenal gland is susceptible to thrombosis and hemorrhagic infarction due to rich arterial supply and limited venous drainage. We present a case report of a simultaneously detected acute adrenal insufficiency due to bilateral adrenal haemorrhagic infarcts with ischemic bowel as the first manifestation of antiphospholipid syndrome (APS).Case history: A ...

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ea0019p98 | Clinical practice/governance and case reports | SFEBES2009

Endocrine genes – have we improved the fit? (project development to service provision)

Stewart S , Gittoes N , Cole T

In 2006, responding to the Government White Paper, Our future, our inheritance, a project commenced promoting genetics in mainstream medicine.By 2008, the original project framework has evolved to address logistical constraints, patient preference and cost effectiveness, offering a streamlined service for clients with inherited endocrine disorders. Recognised patient pathways and a dedicated endocrine genetic clinical nurse specialist (EGCNS)...

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ea0019p99 | Clinical practice/governance and case reports | SFEBES2009

Testosterone replacement therapy in Prader-Willi syndrome with diabetes markedly improves glycaemic control

Muraleedharan V , Rolfe C , Jones TH

Prader-Willi syndrome is characterized by severe hypotonia and feeding difficulties in early infancy, followed in later infancy or early childhood by excessive eating and gradual development of morbid obesity and learning difficulties. Hypogonadism occurs in both males and females, manifested by genital hypoplasia, incomplete pubertal development, and infertility. Type 2 diabetes mellitus is common in obese individuals, most likely secondary to hyperphagia. Diabetes is often d...

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ea0019p100 | Clinical practice/governance and case reports | SFEBES2009

Iatrogenic Cushing's syndrome due to Kaletra and Seretide: learning points

Kar P , Slater C , Price P , Ahmed S

History: A 27-year-old woman with a background of HIV presented to the GUM department with sudden onset of weight gain (approximately five stones over 3 months). She had been started on kaletra (Lopinavir with Ritonavir) for her HIV, about 11 months previously, while she was on fluticasone (seretide) for her asthma. Clinically, she had a cushingoid appearance with extensive purplish striae marks over her abdomen and arms. Her Seretide was stopped and changed to ventolin- due t...

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ea0019p101 | Clinical practice/governance and case reports | SFEBES2009

Severe obstructive sleep apnoea causing a pseudo-Cushing's state

Bravis V , Todd J , Dhillo W , Martin NM , Tan T , Meeran K

A 59-year-old lady presented with significant weight gain, and a history of hypertension for investigation of possible Cushings syndrome. Her BMI was 29, with mainly central obesity. Initial tests revealed elevated untimed cortisol on two separate occasions, at 905 nmol/l and 893 respectively with detectable midnight cortisol, at 548 and 481. Of 24-hour urinary free cortisol (UFC) was also elevated on two separate occasions, at 931 nmol/24 h and 827 respectively. ACTH wa...

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ea0019p102 | Clinical practice/governance and case reports | SFEBES2009

Propylthiouracil-induced antineutrophilic cytoplasmic antibody-positive vasculitis

Bravis V , Kong C , Johnston C

A 38-year old lady from the Philippines presented with a 2-year history of a painless thyroid lump, without pressure symptoms. Over the previous year it had gradually enlarged in size. She gave a history of disturbed sleep, tremor, anxiety and weight loss over the 2-year period. Past medical history included right middle lobectomy for bronchiectasis 10 years previously. Thyroid function tests revealed TSH<0.05 mu/l, FT4 86 pmol/l, FT3 18.3 pmol/l and ...

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ea0019p103 | Clinical practice/governance and case reports | SFEBES2009

Idiopathic urticaria and angioedema in a patient with autoimmune thyrotoxicosis

Bravis V , Shah N , Dear J , Davey S , Johnston C , Kong C

A 29-year-old lady with known autoimmune thyrotoxicosis (TPO 712 IU/ml) presented with an urticarial rash. She was on carbimazole. A diagnosis of drug-induced reaction was suspected and treated as such. Her carbimazole was discontinued. After a day of treatment with steroids and antihistamines, she experienced flushing, orthostatic hypotension and difficulty in breathing. She was treated for anaphylaxis with adrenaline on intensive care unit. A formal Dermatology opinion was p...

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ea0019p104 | Clinical practice/governance and case reports | SFEBES2009

Recurrence of hyperthyroidism – 12 years after radioiodine induced hypothyroidism; a case report

Mahmood Muhammad , Ulahannan Thomas

A 20-year-old man presented to his general practitioner in 1990 with 4-months history of general malaise. He was clinically and biochemically thyrotoxic. Carbimazole was started but the patient stopped treatment on his own after 2 months. Two years later he was referred to our department with severe thyrotoxicosis marked by lethargy, shaking, palpitations and weight loss (FT4 116.6 pmol/l (reference range 1024.5 pmol/l) TT3 8.8 nmol/l (1.02.5 ...

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ea0019p105 | Clinical practice/governance and case reports | SFEBES2009

Acute presentation of Addison’s disease with idiopathic intracranial hypertension in a young female

Sharma D , Moore P , Macfarlane I , Cuthbertson D

Background: Idiopathic intracranial hypertension (IIH) can rarely be associated with underlying endocrine disorders such as Cushings syndrome, hyperthyroidism or with administration of thyroxin or growth hormone. We describe a case of acute adrenal deficiency presented along with IIH.Case history: A 24-year-old Caucasian female (body mass index 21 kg/m2) presented with nausea, vomiting and collapse. She had several months of generalised ...

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ea0019p106 | Clinical practice/governance and case reports | SFEBES2009

The challenges of implementing consensus recommendations for GH therapy in GHD adolescent survivors of childhood cancer during the transition period

Gleeson H , Whitehouse A , Smethurst L , Shalet S , Brennan B , Clayton P

Background: Re-evaluation of the diagnosis of GHD at the completion of linear growth is a key task.Objectives: To audit the impact of consensus recommendations on diagnosis of GHD and initiation of GH therapy in adolescents previously treated for a brain tumour (BT) or haematological malignancy (HM).Population: Sixty one patients who had received GH therapy until final height following treatment for a BT (n=40) or a HM (n...

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ea0019p107 | Clinical practice/governance and case reports | SFEBES2009

A case of malignant paraganglionoma presenting as mass in the right clavicle

Shaikh GM , Osullivan Sheila

I would like to present a case of malignant paraganglionoma which first presented as a mass in right clavicle in a 32-year-old female at Cork University Hospital. Her other medical background included Type 2 diabetes controlled on oral hypoglycemic agents and hypertension. On further imaging, she was found to have another mass in peri aortic region and biopsy confirmed the diagnosis and further verified by MIBG scan in March, 2005. Molecular analysis confirmed deletion of exon...

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ea0019p108 | Clinical practice/governance and case reports | SFEBES2009

Case of persistent mild hypocalcaemia? Carbamazepine induced osteomalacia

Natarajan G , Foster M , Zacharia S

A 41-year-old female was diagnosed with generalised seizures in 1984 and her EEG showed excess slow wave activity in the temporal region. She was commenced on carbamazepine. In 2005 she was diagnosed to have a bipolar affective disorder for which olanzapine was added.She was found to be hypocalcaemic with corrected calcium of 2.08 mmol/l in 2005 after sustaining a right undisplaced distal radial fracture following a seizure. She was empirically commenced...

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Society for Endocrinology BES 2009

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