Endocrine Abstracts

Background: The aim of this report is to describe a fortuitely discovered association between parathyromatosis and occult sclerosing papillary carcinoma of the thyroid.Case description: A 56-year-old woman presented with pyelic relapsed stone, bone pains and iPTH=348 ng but normal calcemia as manifestations of recurrent primary hyperparathyroidism after a right inferior parathyroid adenoma resection done elsewere 6 years ago Sonography showed a 5 mm hypo...

Introduction: Carcinoid tumors are neuroendocrine tumors derived from enterochromaffin or Kulchitsky cells (that secretes serotonin or other chemicals into bloodstream), which are widely distributed in the body, but they are traditionally described as originating from the foregut, midgut, and hindgut. A case of carcinoid syndrome is reported.Case: A 55-year-old man with medical history of Parkinson disease. Was admitted to internal medicine outpatient cl...

Background: Poor glycaemic control with erratic blood glucose levels manifesting as recurrent hyperglycaemia with unpredictable episodes of hypoglycaemia is problem still faced today in daily practice. The causes include poor compliance and failure of oral hypoglycaemic. Despite being on insulin (38% of type 2 diabetes patients who require insulin treatment after 10 years) and type 1 diabetes patients continue to have fluctuing glucose concentration. The poor glycaemic control...

Background: Lithium remains a first-line treatment for bipolar affective disorder and acute maniac state despite the introduction of newer and effective treatment. Lithium therapy is associated with a variety of side effects. Although thyroid dysfunction is the most widely recognised endocrine side effect, hypercalcaemia and more rarely a biochemical picture resembling primary hyperparathyroidism or familial hypocalciuric hypercalcaemia may develop. Recognition of this less co...

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracelluler muscle contents into systemic circulation. It can became a life-threatening disorder when complicated by acute tubuler necrosis and renal failure. Fenofibrate, a fibric acid derivate, is used to treat diabetic dyslipidemia, hypertriglyceridemia and combined hyperlipidemia alone or in combination with statins. Rhabdomyolysis associated with fenofibrate is extremely rare. In nearly all...

The objectives of this study were to assess the quality management system of 95 medical laboratories at regional and general hospitals under the jurisdiction of the office of the permanent secretary, Ministry of Public Health, Thailand, in relation to ISO 15189:2007 and determine the relationships between role perception, leadership and organization climate with medical laboratory quality management. This study was a cross-sectional study. Data were collected by self-assessmen...

This paper studies the attitudes of postgraduate medical students towards endocrinology and diabetology as a career.Fifty post graduate students, pursuing residency in internal medicine, at various colleges throughout India, were requested to fill up a pre-tested, five point Likert scale questionnaire designed to assess their likings for various branches and aspects of medicine.The average age of the respondents was 27 years, with ...

Foreign bodies represent a rare cause of granulomatous mastitis. In the last three years we diagnosed three women with granulomatous mastitis consecutive to exposure at building materials containing glass fibers. All of them were young (21–34 years), with regular menses, without any pathological histories and were admitted to our hospital for bilateral galactorrhea spontaneous in one case and by squeezing the nipple in the other two cases. Clinical and ultrasonographic ev...

The population of the world is aging and is estimated that by 2030 – 21% of global population will be aged 65 years and older. At present, under-nutrition in older people is a serious and growing global problem affecting even developed countries. As one ages, several physiological and pathlogical changes may contribute towards the development of protein energy malnutrition. This syndrom brings with it many adverse health outcomes and a significant cost to the individual, ...

A 16-years-old male, with familiar precedents of familiar macrocephaly, he has been visited in external consultations of digestive in 2008 because he had rectal bleedings. A colonoscopy was made two times, in those situations some intestinal polyps have been extirpated. The result of the pathological antomy was polyps ganglioneuromas.Due to the pathological compatible anatomy with ganglioneuromas, it stemmed to external consultations of endocrinology to ...

Syndrome of inappropriate antidiuresis hormone (SIADH) with many disorders of the nervous system have been reported frequently but its association with multiple sclerosis (MS) is extremely rare (only six cases reported in the literature).A 46 years old woman was admitted to our hospital because of hypersomnolence, confusion and visual disturbances. She presented 6 months before a variety of neurological symptoms suggestive of demyelinating disease withou...

A 69-year-old woman developed hypertension, polyuria and hyperglycemia over the course of several months. The initial biochemical investigation revealed ACTH-dependent hypercortisolism (UFC 409.7 μg/24 h, NR 10–80; ACTH 43.3 pg/ml, NR 8–50; OST 28 μg/dl) and moderately elevated urinary catecholamines (E 80.5 μg/24 h, NR 2.5–33.6; norE 235.8 μg/24 h, NR 18.1–128.2). Further investigations disclosed absent ACTH and cortisol responses to CR...

Introduction: Metachronic metastasis of renal carcinoma to the thyroid gland, a rare entity occurring sometimes many years after nephrectomy, have been already reported by literature. Thyroidal synchronous metastasis, instead, are more uncommon. We herein report a patient with thyroidal metastasis and intrajugular thrombo embolic involvement as initial presentation of a misunderstood renal carcinoma.Case Report: A 83-years-old woman, with silent medical ...

Introduction: The psychiatric consequences of inoperable Cushing’s syndrome can be difficult to manage medically. Etomidate, an imidazole derived anaesthetic agent, inhibits cortisol synthesis and may be useful in this circumstance.The case: A 57-year-old woman presented with symptoms and signs of hypercortisolism. She gave a history of recent onset intermittent right sided stabbing chest pain and worsening breathlessness.Two ...

Introduction: The association of autoimmune diseases in the same individual is common. It is well documented that Graves’ disease (GD) is associated to various autoimmune diseases, including: pernicious anemia, vitiligo, type 1 diabetes, Addison’s disease, systemic sclerosis, myasthenia gravis, Sjogren’s syndrome, rheumatoid arthritis and systemic lupus erythematosus. In addition, primary biliary cirrhosis (PBC) may be associated with rheumatoid arthritis, Sjogr...

Introduction: Phaeochromocytomas commonly present with episodes of sweating, palpitations, and hypertension. Urinary catecholamines measurement is the most common screening test for suspected phaeochromocytoma in the UK. We report a series of three cases in which the reason for hypertension and raised catecholamines was not a phaeochromocytoma and treating the underlying condition corrected the clinical and biochemical abnormality.Cases: Three patients w...

Carney’s triad is a very rare syndrome, which comprises three tumors of different origin: gastrointestinal stromal tumor (GIST), thoracic chondroma and extraadrenal pheochromocytoma. It is found mainly in young female patients with blood group A. Two of the tumors need to be present for the diagnosis.Here we present the case of a 58-year-old male with blood group B. In July 2004 patient underwent resection of a part of small intestine with two GISTs...

Background: The detectable levels of thyroid antibodies in patients suffering from Riedel’s chronic fibrosing thyroiditis (RT) suggest a link between RT and Hashimoto’s thyroiditis, but the pathogenesis of RT is not really known. Lyme disease is the most frequent tick-borne infection with variable manifestations in different organs caused by Borrelia burgdorferi (Bb).Case report: A 59-year-old woman presented in our outpatient clinic wit...

Introduction: Intravenous methylprednisolon pulses (IVMP) are commonly accepted treatment in Graves orbitopathy (GO) However acute and severe liver damage has been reported in sporadic cases during such therapy. The aim of this study was to present the cases of severe liver damage after second and third course of IVMP.Case report: The white women 60 years of age with Graves disease diagnosed in 1983. Firstly she was treated with antythyroid drugs for 2 y...

Transplantation of endocrine cell/tissue can be considered as an alternative method of treatment for hormonal insufficiency (type I diabetes, hypocorticism, hypothyroidism, hypogonadism). Compared with replacement therapy transplantation of hormonal active cells provides a big advantage, especially, in the cases of individual intolerance or hypersensitivity to hormonal preparations.In order to make this method of hormone level restoration more preferred ...

11β-hydroxylase deficiency (11β-OHD), an autosomal recessive disorder, is the second most common cause of congenital adrenal hyperplasia. It is caused by the mutation of the CYP11B1 gene that encodes the enzyme. In classical 11β-OHD, genetic mutations of CYP11B1 lead to activity decrease or loss, but mutations in nonclassical 11β-OHD are not definite. The vast majority of mutations are associated with classic 11β-OHD, and only a few mutations causing n...

Background: Primary hyperparathyroidism (PHPT) is a common condition, which in some patients can lead to complications such as osteoporosis and renal stones. This survey investigated diagnosis and treatment strategies for PHPT across Europe.Methods: The survey was conducted in five European countries (France, Germany, UK, Italy and Spain). 286 of the 421 interviewed physicians were endocrinologists; the remainder were rheumatologists (46), internists (50...

Acromegaly is a chronic disease with typical clinical signs evoked by overproduction of growth hormone (GH) and insulin-like factor 1 (IGF1). It is nearly always caused by somatotroph adenoma which can be visualized by MRI scanning. Other causes of acromegaly are very rare and comprises ectopic secretion of GH or GH-RH by other neoplasms.Here, we present a case of 62-year old acromegalic woman. Acromegaly was firstly diagnosed 9 years ago. Her GH concent...

Case report: A 56-year-old woman admitted to emergency department with fever, dyspnea, productive cough, palpitations, diffuse myalgia, and malasia. Physical examination revealed an anxious-appearing woman with fine tremor in the hands. Her pulse was 140 beats/minute and irregular; blood pressure, 140/90 mmHg; temperature 38.6 °C, respiratory rate 40 breaths per min, and oxygen saturation 91% without supplemental oxygen. In auscultation, bilaterally rales and bronchial br...

Introduction: Generalized pustular psoriasis is a rare and the most severe form of psoriasis. It is usually seen in adults. Generalized pustular psoriasis is characterized with sudden eruption of yellowish pustule groups on the shiny erythematous skin, measuring 2 to 3 mm, and cover the all body in a short time. In this report, we presented a patient with Cushing’s syndrome (CS) who had determined pustular psoriasis.Case report: A 35 years old woman...

Introduction: Common reasons of chronically elevated liver enzymes are; fatty liver associated with alcohol abuse or obesity, chronic viral hepatitis, autoimmune hepatitis, chronic bilier disease and hereditary metabolic disorders. Adrenocortical insufficiency can also cause elevated liver enzymes. Until now, there are few cases in the literature with abnormal liver function associated with Addison’s disease. We reported this case to kept mind the Addison’s disease w...

Objective: To study the spectrum of chromosomal anomalies in three cases as related to the phenotypic variability of patients with anomalies of disorder of sexual development.Female 18 years old with secondary amenorrhea, stigmata of Turner’s syndrome, Tanner stage II. Ultrasound showed streak gonads. Hormonal analysis revealed elevated levels of FSH, LH and a low plasma estradiol level. The chromosomal investigation showed gonosomal mosaicism 45,X(...

Objectives: To investigate effects of testosterone in hypogonadal men with Crohn’s disease (CD).Design and methods: Thirteen men, aged 45–67 years were diagnosed with subnormal plasma testosterone. They received treatment with parenteral testosterone undecanoate. They also suffered from CD. The Crohn’s disease activity index (CDAI) (1) was used to assess the severity of the disease. Levels of testosterone and C-reactive protein (CRP) were ...

Objective: Describe a case of a patient diagnosed with papillary thyroid carcinoma by a retropharyngeal tumor.Methods: A 46-year-old male was referred from the otorhinolaryngology consult to our department with the post-operative diagnosis of papillary thyroid carcinoma, with 6 months history of upper airway dyspnea and dysphagia to solids. Physical examination: right side adenopathies, not painful on palpation. No goitre. Laryngoscopy: hypertrophy of ri...

AbstractThyroid angiosarcoma is an aggressive and very rare type of thyroid malignancy originally diagnosed in iodine-deficient areas. The prognosis is poor and in most cases surgery proved to be inefficient. The fine needle aspiration biopsy (FNAB) and histology can rarely differentiate angiosarcoma from anaplastic carcinoma, and the final diagnosis is based on immunopositivity for vascular markers and absence of epithelial markers. We present he...

The most typical signs of Cushing’s syndrome (CS) are easy bruising, hypertension and ‘cushingoid’ phenotype with central deposits of fat tissue. Moreover, hypercortisolemia may affect also reproductive system leading to loss of libido and impotence in men and menstrual disturbances and infertility in women.However, some of the patients remains fertile, although pregnancy is uncommon and is associated with fetal morbidity and mortality in ...

Introduction: Osteogenesis Imperfecta (O.I.) is a genetic disorder commonly known as brittle bone disease. The majority of people with O.I. have a mutation in one of two genes, COL 1A1 or COL 1A2, that encode type I collagen. In most families, O.I. is inherited in an autosomal dominant pattern. Dual Energy X-ray Absorptiometry - bone mineral density (DXA-BMD) test provides information about bone quantity, not quality. The bisphosphonates - treatment can minimizing fractures by...

Background: A testicular adrenal rest tumor in an adult males who complaint with testicular enlargement and fertility request, and diagnosed with congenital adrenal hyperplasia due to 11-beta hydroxylase deficiency with homozygous mutation L299P in the CYP11B1 gene and accompanied by impaired spermatogenesis and Leydig cell failure was reported.Case Report: A 27-year-old man was complaint with bilateral progressive painful enlargement of the testes, cont...

Introduction: Neurogenic tumors in abdomen arise from ganglion cell origin and usually seen in the distribution of the sympathetic ganglia along paraspinal areas or adrenal medulla or the organ of Zuckerkandl.Ganglioneuroblastomas are the tumors of sympathetic cell origin which have the features of both malignant and benign neuroblastoma. The presence of immature tissue indicates potentially a malignant behavior. Ganglioneuroblastomas are most often seen...

We would like to point out that the incidence of amiodarone induced thyreotoxicosis is considerable. It is essential that both cardiologists and endocrinologists tightly cooperate when treating patients with amiodarone.Methods: We analysed retrospectively data of 150 pacients (100 male and 50 female), whith average age 63.97±12.13 years, treated with amiodarone, followed-up on arythmologic outpatient clinic from 1.1.2005 till 31.12.2006. All of the ...

Background: A high percentage of adult smokers try to quit, but most of these attempts fail. The ability to predict the success or failure of smoking cessation efforts will be useful for clinical practice. Stress response is regulated by two primary neuroendocrine systems. Salivary cortisol has been used as a marker for the hypothalamus-pituitary-adrenocortical axis and salivary α-amylase as a marker for the sympathetic adrenomedullary system.Method...

We present the history of two brothers, 19 and respectively 21 years old who were admitted in our department for reevaluation in the context of renal complications. From their medical history we keep in mind that central DI was diagnosed 15 years ago and desmopresin treatment was indicated. Meanwhile, patients received desmopresin unsteady for very short periods of time (less than 2 years) due to poor adherence and obvious inefficiency of the treatment. They claim medical care...

We present a family with Von Hippel - Lindau disease (VHL). First two brothers were diagnosed with pheochromocytoma, one of them consecutively in both adrenals in a 16-years’ interval. Then the daughter of one of these two men was diagnosed with pheochromocytoma in both adrenals and one extraadrenal tumour. Later the daughter of the second man was successfully operated for unilateral pheochromocytoma. No neurological signs were present, no other tumours found, and the ocu...

Hyponatraemia is the most common electrolyte disorder encountered in clinical practice, occurring in 15% to 30% of both acutely and chronically hospitalised patients. Hyponatraemia is important clinically because: 1) acute severe hyponatraemia can cause substantial morbidity and mortality; 2) mortality is higher in hyponatraemic patients with a wide range of underlying diseases; 3) overly rapid correction of chronic hyponatraemia can cause osmotic demyelination; 4) even mild &...

We describe two very rare genetic diseases characterized by particular physical features and deviation from normal growth. The first patient, CM, was admitted for delayed growth (113 cm at 8 years of age, -3 S.D.). The child had short lower arms with small hands and clinodactyly of the fifth finger. He had round widely spaced eyes with long eyelashes, a flat profile and prominent forehead, short upturned nose, misaligned teeth and gum hypertrophy. We diagnosed a...

Graves’ orbitopathy (GO) represents ophthalmic symptoms that affect, usually, patients with Graves’ disease. Rarely, it can occur in subjects without thyroid dysfunction or with hypothyroidism (2–5% of the cases).In this report we present a rare case with unilateral GO and initial euthyroidism, which progressed to hypothyroidism, due to an autoimmune atrophic thyroiditis.A 39-year-old woman, long-term smoker, was ref...

Cushing’s disease is relatively rare and affects most commonly adults aged 20 to 40. It is associated with high morbidity and mortality; early detection and diagnosis of Cushing’s disease may lead to decreased this two facts and improved quality of life.We present a 32-year-old man with abdominal purple striae, central obesity with typical ‘moon face’ and oscillatory blood pressure values.Hormonal exams revealed...

The last decade has provided major progress in the development of highly specific and selective pharmacological agents that have facilitated a more aggressive approach to the treatment of patients with acromegaly. Initial transsphenoidal surgery still appears to be the first line of treatment, but in many cases the biochemical cure targets are not reached and the patient needs adjuvant therapy. Somatostatin analogues have become the mainstay of the medical treatment of acromeg...

Thyroid antibodies are a heterogenous group of antibodies with diverse and partly unknown properties. The effect of these antibodies on other organ systems and especially on the renal system is unknown. There is however some evidence that thyroid, in particular thyroglobulin antibodies, may affect renal function and may cause glomerulonephritis and possibly nephrotic syndrome. Nephrotic syndrome may alter thyroxine metabolism, as it affects its renal excretion and its albumin ...

Background: Short stature can be a sign of a wide variety of pathologic conditions or inherited disorders.Aim: To show the etiology of short stature in our region in order to asses the rationale treatment and genetic advice.Material and methods: Between January 2004 and December 2009, we have studied the prevalence and etiologic profile of the children admitted in the Endocrinology Department of Children’s Clinical Hospital Ti...

Multiple endocrine neoplasia (MEN-1) is a rare congenital disease with genetic background. The MEN-1 gene encodes the menin protein, which acts as a tumour suppressor. Mutation of one allele and the inactivation of the other allele of this gene lead to clonal proliferation and to the development of tumours. The clinical manifestation of MEN-1 is a combination of endocrine (most commonly parathyreoid adenomas, entero-pancreatic endocrine tumours, pituitary tumours) and non-endo...

Pituitary carcinoma is rare (0.1–0.2% of pituitary tumors), with a poor prognosis. It usually presents as invasive and secretory (ACTH or prolactin) macroadenoma. The diagnosis is confirmed by the presence of metastases. The latency period between the diagnosis of adenoma and carcinoma is variable (9.5 years for corticotrophinoma). The treatment includes surgery, radiotherapy and chemotherapy.We report a 58-year-old male, complaining of visual distu...

Objectives: It has been reported that metformin administration lowered TSH levels in patients with type 2 diabetes mellitus and hypothyreosis. The aim of the study was to investigate effect of metformin on TSH levels in type 2 diabetic patients with primary hypothyroidism and also in patient with type 2 diabetes mellitus only.Methods: We included in our study 9 type 2 diabetic patients with primary hypothyroidism on stable l-thyroxine replacement doses a...

Introduction: Autoimmune thyroid disease is often associated with other autoimmune diseases. Coeliac disease is one of those autoimmune diseases, together with is wide spectrum of intestinal and extraintestinal manifestations. Atrophy of intestinal mucosa, one of the characteristics of coeliac disease, among everything else, leads to poor absorption of l-tyroxine used in therapy of hypothyroidism.Aim and results: We like to present a clinical case of our...

Introduction: Carcinoid tumours commonly originate from the gastrointestinal tract. Cardiac manifestations occur in 10–41% of patients with carcinoid syndrome, usually associated with liver metastases. We report an atypical case of a carcinoid tumour associated with right sided heart disease without distant metastases.Case description: A 75-year-old lady with no significant past medical history and a lifelong non-smoker, was admitted with 3 months h...

Case 1: Thirty-eight year woman consulted to gynecologist for oligomenorrhea in the last 4 years; PRL 51 μg/l and TSH 8.4 mU/l were discovered, initiating treatment with levotiroxine (f-T4). She got pregnant, persisting elevated levels of TSH and increasing f-T4, with normal campimetry. With the diagnostic of hyperthyroidism due to inadequate TSH secretion, treatment with PTU was initiated. After normal delivery, MRI showed a 22 mm. hypophisary macroadenoma and a transesp...

Introduction: Neoplastic lesions in the retroperitoneum may originate from kidneys, ureters, adrenal glands or peripheral nervous, connective, muscle and adipose tissues. Neuroendocrine tumours are exceptionally located in the retroperitoneum.The case study: A woman aged 51, with a tumour of the left adrenal gland found incidentally during an ultrasound examination of the abdominal cavity, which was performed because of dysuria. A CT confir...

Background: Permanent hypoparathyroidism can result from immune-mediated destruction of the parathyroid glands. Alternatively it may result from activating antibodies to the calcium sensing receptor that decrease parathyroid hormone (PTH) secretion. Autoimmune hypoparathyroidism is a common feature of poliglandular autoimmune syndrome type I. Other causes, all very rare, include irradiation and storage of infiltrative diseases of the parathyroid glands. Neurological signs of h...

Data on coexisting Graves’ disease (GD), systemic lupus erythematosus (SLE), and hypoparathyroidism (hypop) are limited. Scanty case reports have described hypoparathyr or hypothyroidism (late complication) following external irradiation to the neck. The thyroid and parathyroid glands may be sensitive to the immunologic or irradiation damage.A 34-year old AA woman presented with tetanic-like cramps, easy skin bruising, fatigue, weight gain, nocturia...

Necrotizing fasciitis is a rare infection of the soft tissues with consequent necrosis of fascial planes and surrounding tissues. If misdiagnosed or not properly treated it can be fatal. It typically follows trauma and it have already been described after intramuscular or intravenous injection of insulin.The authors present a case of a 24-year-old man, with type 1 diabetes mellitus for more than ten years, admitted to the emergency room for diabetic keto...

Introduction: Successful whole pancreas transplantation is at the present the most effective treatment for type 1 diabetes but allograft dysfunction related with infection, vascular compromise or immunological causes are not uncommon. Usually, graft vascular thrombosis or haemorrhage, as well as infectious complications are responsible for early pancreas graft failure; late cases occur more frequently by immunological causes, either allograft rejection or recurrence of the &#1...

Introduction: POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) syndrome is a rare multisystemic disease. Diagnosis requires two major criteria and at least one minor criterion. Major criteria include polineuropathy and a monoclonal plasma proliferative disorder (almost always lambda). Minor criteria include osteosclerotic bone lesions, Castleman disease, organomegaly (including lymphadenopathy), oedema, pleural effusion or ascites, e...

Introduction: Ectopic Cushing’s syndrome is a rare disease, with a reported incidence of 0.1/million per year. This disorder accounts for approximately 12–17% of patients with ACTH-dependent Cushing’s syndrome. Small cell lung carcinoma is responsible for about 20% of cases, although ectopic ACTH hypersecretion occurs in only 0.5–2% of these tumours. Hypercortisolaemia is usually severe and of rapid onset. Optimal treatment is surgical excision of the tumou...

Background: Serum IGFI measurements are used during GH replacement in GHDA for titration of the GH dose, to monitor compliance and to avoid overdosing, but it is uncertain if pretreatment IGFI is a determinant of the GH dose or the response to GH treatment.Methods: Data from the NordiNet IOS have been analyzed to determine pretreatment serum IGFI concentrations in GHDA and to analyze if they influence the GH starting dose and/or the therapeutic response ...

We report a 61-year-old lady with sudden onset diplopia caused by abducent palsy which was initially right- and later left-sided. MRI scanning revealed an extensive sellar and suprasellar mass and the lady was referred to our department for transphenoidal surgery with the imaging diagnosis of pituitary adenoma. Upon close inspection of the films, cavernous sinus invasion of the tumour as a morphologic correlate of the N. VI palsy was missing; however, there was an unusual cont...

Papillary carcinoma is the most common differentiated malignant thyroid neoplasm. Metastasis commonly occur in regional lymph nodes and distant metastasis ia a late and rare occurrence.Papillary thyroid carcinoma with metastasis to the parietal skull is very rare.We present the case of a parital skull metastasis arising from a papillary carcinoma prior to the diagnosis of thyroid tumor. The patient was a 58 caucasian woman with pre...

Benign symmetric lipomatosis (BSL) is a very rare disorder characterized by the growth of uncapsulated masses of adipose tissue, predominantly located in the neck and shoulders. Benign symmetric lipomatosis is usually described in adults between 30 and 60 years of age and is slightly more frequent in men with heavy alcohol consumption. A 70-year-old woman presented with a great growth of soft tissues in the cervico-occipital region who had never consumed any alcohol. Laborator...

A 50-year-old man admitted to our institution with labile hypertension. His blood pressure was 150/90 mmHg and the pulse rate was 96 beats per minute. He had hypertensive attacks every 2–3 days. His blood pressure was found 210/110 mmHg at hypertensive attact. He had palpable thyroid nodule. Ultrasonography of the thyroid gland showed a 2.6 cm sized, irregularly marginated, calcified thyroid nodule. His serum free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin ...

Primary adrenal failure may be of autoimmune or infectious aetiology, tuberculosis being a well known cause. In tuberculosis vitamin D deficiency has been described, while vitamin D sufficiency has been reported to be necessary for the mounting of an efficient immune response to the mycobacterium.The aim was to describe the case of a patient with primary adrenal failure of tuberculous aetiology and severe vitamin D deficiency.A fem...

Carbimazole is a commonly used antithyroid drug with a rare but potentially life-threatening side effect of agranulocytosis. We present a case of a 47-year-old lady who was diagnosed with hyperthyroidism four years previously and treated with carbimazole despite persistent neutropenia.At diagnosis the patient had clinical features of hyperthyroidism and thyroid function test (TFT) showed free T4 40.8 pmol/l (10.6–21.0), free T3...

Introduction: Weight gain following treatment of hyperthyroidism is well recognised. This may lead to compliance problems both in patients with/without eating disorders and subsequent failure of therapy. We describe two cases where this was successfully managed with supervised in-patient therapy.Case 1: A 30-year-old overweight lady was diagnosed with Grave’s disease following childbirth. Thyroid function test (TFT) at initiation of treatment showed...

Objective: The presence of a single parathyroid adenoma is a cause of primary hyperparathyroidism in most cases. Minimally invasive parathyreoidectomy is a treatment of choice in PHPT patients and precise localization of the changed parathyroids is crucial for successful removal.The aim of the study was to assess usefulness of parathormone level estimation in the material obtained during FNAB of the focal neck lesions in order to differentiate structures...

Background: There are over 650 liver transplants performed in the UK each year and about 5000 throughout Europe. After transplantation patients suffer from bone loss due to multiple factors. We present a unique case of severe Vitamin D deficiency resulting in life threatening hypocalcaemia following liver transplantation.Case: A 65-year-old Indian lady underwent an uncomplicated liver transplant, for hepatocellular carcinoma related to Hepatitis C. Pre a...

Introduction: Periodic review of hospital deaths is important to know the changing pattern of mortality in our environment. Ankara Ataturk Education and Research Hospital is a tertiary center with 18 in-patient beds in Endocrinology and Metabolism Clinic. Critical patients with endocrine-related diseases are also followed in intensive care unit. In this study, we aimed to evaluate demographic characteristics, hospitalization indications and causes of death in patients who died...

Current treatment for acromegaly includes dopamine agonists (DA), somatostatin receptor ligands (SRL) and GH receptor antagonists (GHRA). DA in monotherapy, is less than 10% effective achieving control of the disease, and its efficacy in addition to ongoing SRL is less studied, without obvious determining factors of response. We report 2 operated patients with incomplete response to SRL and to whom Cabergoline addition led to disease control.Case 1: A ma...

Twelve years following hemicolectomy for colon adenocarcinoma, a 75-year-old patient with prostate cancer was treated for 4 weeks with the antiandrogen nilutamide and then with the long-acting GnRH agonist buserelin. The serum testosterone and prostate-specific antigen (PSA) levels had decreased dramatically after 3 months of treatment. After 2 years of buserelin administration, the hormonal state was examined. Serum estradiol, testosterone, DHEA, DHEAS, FSH and LH levels prov...

Introduction: Calcitonin is the main MTC marker. However, it has limitations: rapid in vitro degradation, a concentration-dependent biphasic half-life, presence of different isoforms and high cost of a single trial. Other markers of MTC can be procalcitonin and ProGRP.Aim: The aim of the study was to evaluate the diagnostic performance of marking the levels of procalcitonin and ProGRP in monitoring patients with MTC.Material...

Somatostatinomas are rare neuroendocrine tumors of the pancreas and small intestine that can occur sporadically or in a syndromic form. Duodenal somatostatinomas are often associated with neurofibromatosis type1 (NF1). Their presenting features are mostly related to local effects of the tumor mass rather than functional clinical syndrome. Nesidioblastosis is extremely rare cause of persistant hyperinsulinemic hypoglycaemia in adults.We present a case of ...

Introdution: Central diabetes insipidus(CDI) is a rare disease, with multiple aetiologies such as cranioencephalic traumatism and multiple sclerosis (ME). However, the association with ME is not commonly described. The clinical suspicion must be made in the presence of polyuria and polydipsia.Case report: Woman, 67 years-old, revealing history of ME relapsing-remitting subtype with 8 years of evolution, hypertension and dyslipidemia, medicated with inter...

Introduction: Diagnosis of pheochromocytoma is rarely established in pregnancy, although can cause threat to health and life of foetus and mother. Exact and early diagnosis is crucial for effective treatment.Purpose: The purpose of our study is to present a case of patient with pheochromocytoma and medullary thyroid carcinoma (MCT) – MEN2A syndrome - diagnosed in 9-th week of pregnancy.Material and method: Twenty nine-year-old...

In certain patients with autoimmune diseases (AID) and with rheumatoid arthritis (RA), moderate hyperprolactinemia can be present.Aim: Our aim was to investigate free PRL levels in RA, using two different PRL assays known to react with a different sensitivity to MPRL. The relationship between PRL and the disease-specific autoantibodies (antibody to cyclic citrullinated peptide:cCP-Ab and antinuclear antibody:AN-Ab) were analyzed also.<p class="abstex...

Introduction: Despite the presence of antinuclear (ANA) and anti DNA antibodies in Graves’ disease, the association with Systemic Lupus Erythematosus (SLE) is rare. Responsible for this association seem to be mutations in the PTPN22 gene.Case Report: We report a case of a 27-year-old woman, who presented in January 2009 in our department, at 6 months postpartum, after extensive investigations for autoimmune disease. She had negative results for poly...

Autonomy of ACTH secretion has been described in patients with chronic dysinhibition of ACTH secretion. We here present the very unusual case of a 31-year old female patient who had congenital adrenal hyperplasia and developed Cushing’s disease, including clinical examinations, laboratory data, endocrine function tests, histological and genetic analyses.The affected patient had clinical signs and a typical history of hypercortisolism. Endocrine func...

Authors present a 35-year-old female with thyroid orbitopathy (EO) associated with Graves disease. After initial antithyroid therapy, thyroidectomy was indicated and performed uneventenfully. Due to persisting severe clinically active EO, thyroablative therapy with 131I was performed three years later, intravenous pulse of methylprednisolone was given and consecutive oral therapy with prednisone initiated. This caused weight gain (from 63 to 80 kg) and iatrogenic Cu...

The polyglandular autoimmune syndromes (PAS) comprise a wide spectrum of autoimmune disorders and are divided into a very rare juvenile (type I) and a relatively common adult type with (type II) or without adrenal failure (PAS III). For PAS II/III, susceptibility genes are known inreasing the risk for developing autoimmune disorders, but without being causative. Actual diagnosis of PAS involves serological measurement of organ-specific autoantibodies and subsequent functional ...