Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2012

ea0028p1 | Bone | SFEBES2012

Epidemiology and outcomes in patients with “possible” primary hyperparathyroidism. Parathyroid Epidemiology and Audit Research Study (PEARS)

Yu Ning , Donnan Peter , Leese Graham

A large population-based cohort of “diagnosed” primary hyperparathyroidism (PHPT) (n=2709) was established, 1997–2006, in Tayside, Scotland. We have previously reported on an increasing prevalence and increased risks of mortality and morbidity associated with these patients. In the course of the PEARS, a group of “possible” PHPT cases (n=2950) defined as having persistently elevated serum calcium over several months to years but with no P...

ea0028p2 | Bone | SFEBES2012

A case of HPT-JT syndrome with mutation involving exon 2 of CDC73 gene

Rao Ranganatha , Sivaraman Subash , Harrold Christopher , Murthy Narasimha , Sankar Sailesh

Background: Primary Hyperparathyroidism - Jaw tumour (HPT-JT) syndrome is an autosomal dominant disorder characterised by hyperparathyroidism and ossifying jaw fibromas. Inactivating germline mutations in CDC73 gene (previously known as HRPT2) is the main cause of this syndrome. There is higher incidence of parathyroid carcinoma in these individuals and also an association with other renal lesions have been described. We report a case of HPT-JT syndrome with mutation in the ex...

ea0028p3 | Bone | SFEBES2012

Outcome of patients with negative neck exploration for primary hyperparathyroidism

Parameswaran Rajeev , Gleeson Fergus , Sadler Gregory , Mihai Radu

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disease expected to be curable in 95% of patients undergoing surgical treatment. The aim of this study was to assess the postoperative course of patients with failed surgical treatment.Methods: Prospective database recorded clinical, biochemical, radiological, operative and pathological details of patients operated in a large tertiary referral centre.Results: Betw...

ea0028p4 | Bone | SFEBES2012

The impact of different vitamin D preparations for the treatment of vitamin D deficiency in primary hyperparathyroidism (PTHP)

Ludlam Sophie , Richardson Thomas , Kakad Rakhi , Bates Andrew , Rahim Asad

We have previously demonstrated that 80% of patients with PTHP will have co-existing vitamin D deficiency suggesting an increased metabolism of vitamin D. There are few data assessing the impact and safety of different vitamin D preparations on calcium, parathyroid hormone (PTH) and vitamin D in this group. Here, we report the details of replacement therapy using different vitamin D preparations. In a retrospective study of 22 (20F:2M and 8 Asian:14 Non-Asian) patients with co...

ea0028p5 | Bone | SFEBES2012

Bone mineral density in a clinic-based cohort of hypogonadal men

McLorinan Joanna , Overend Louise , Mason Ryan , Mohamed Yunus Ajmal , McNulty Steven , Furlong Niall , Srinivas-Shankar Upendram

Background: Male hypogonadism is associated with reduction in bone mineral density (BMD). This study aimed to determine the epidemiology of low BMD in a clinic-based cohort of hypogonadal men.Methods: This was a retrospective, cross-sectional observational study of 152 patients (≥18 years with testosterone(T) ≤11 nmol/L) who were consequently reviewed in an endocrine clinic. Data was extracted from electronic patient records and included base...

ea0028p6 | Bone | SFEBES2012

Recurrent pancreatitis in patient with Familial Hypocalciuric Hypercalcaemia (FHH) sucessfully treated with cinacalcet

Gunganah Kirun , Pittaway James , Raja Omair , O'Toole Sam , Druce Maralyn , Grossman Ashley

Case: A 22 year-old female student presented with a history of recurrent pancreatitis since 2007. The most common causes of pancreatitis, including drugs, gallstones, corticosteroids, excess alcohol and hypertriglyceridaemia were excluded. She was noted to have elevated serum calcium, which was considered to be the cause of her pancreatitis, with a detectable serum PTH level. An initial diagnosis of primary hyperparathyroidism was made. However, two neck explorations failed to...

ea0028p7 | Bone | SFEBES2012

Audit on the management of primary hyperparathyroidism by parathyroidectomy

Koppa Narayana Shashithej , Ward Kirsty , Ahmed Abu Baker

Diagnosis of primary hyperparathyroidism is often made incidentally following routine biochemical screening. Parathyroidectomy is usually carried out in patients at risk of disease progression or with clinical features that may improve and that is in line with NIH guidance. Current recommendations suggest that Minimally Invasive Parathyroidectomy (MIP) should take place only if sestamibi and ultrasound findings are concordant. We studied the medical notes of 53 patients, aged ...

ea0028p8 | Bone | SFEBES2012

Ostiopathia striata with cranial sclerosis.

Abdulla Haitham

Osteopathia striata with cranial sclerosis is an X-linked disease caused by mutation in the gene encoding WTX that controls cell signaling affecting bone turn over. While the disease is almost always lethal in males, females exhibit cranial sclerosis, craniofacial dysmorphism and longitudinal sclerotic striations on the long bones. Here is a case of 25 year old female referred to the metabolic and bone clinic for further assessment of chronic back pain and stiffness of the low...

ea0028p9 | Bone | SFEBES2012

A survey of current care for children & adults with osteogenesis imperfecta in glasgow

Narayanan Vidya , Dougan Elizabeth , Duncan Rod , Kinning Esther , Gallacher Stephen , Gallagher Andrew , Galloway Peter , Hinnie John , McLellan Alastair , Panarelli Maurizio , Ahmed Syed

Introduction: As there are scarce data on the clinical case load and multidisciplinary input provided for patients with osteogenesis imperfecta (OI), we performed a survey of patients with OI attending bone and genetic clinics in Glasgow.Methods: Clinical details of 53 children(M:28) and 23 adults(M:9) were obtained by a review of case records.Results: The median age at presentation in children was 4.5 yrs (range 0.2–13.5), wi...

ea0028p10 | Bone | SFEBES2012

The use of teriparatide to treat hypoparathyroidism following thyroidectomy; a case report

De Silva Akila , De Silva Sarah-Jane , Meeran Karim

A 27 year old lady with Graves’ thyrotoxicosis (fT4 50.3 pmol/L, fT3 25.0 pmol/L, TSH<0.05 mU/L) failed to respond adequately to carbimazole (40 mg BD) or propylthiouracil (250 mg QDS). Three months later, following 10 days of potassium iodide to render her biochemically euthyroid, she underwent a total thyroidectomy. Pre-operative bone profile revealed Ca(c) 2.34 mmol/L (NR 2.15–2.60 mmol/L), phosphate 1.36 mmol/L (NR 0.8–1.4 mmol/L), PTH 3.4 pmol/L (NR 1.1...

ea0028p11 | Bone | SFEBES2012

Evaluation of the surgical management of primary hyperparathyroidism in a tertiary referral unit

Kaimal Nisha , Bonello Victoria , Ahmed Babur , Kearney Tara , Doran Helen

Aim: We performed a retrospective analysis to evaluate the surgical treatment of primary hyperparathyroidism in a tertiary referral centre.Methods: We reviewed the case notes of 80 patients who underwent parathyroid surgery (2003 to 2011). Patients were identified from the national BAETS audit.Results: Median age was 56 years (range 25–86). 72.5% of the patients were females and 30% were asymptomatic. Mean adjusted calcium con...

ea0028p12 | Bone | SFEBES2012

A review of the multidisciplinary management of primary hyperparathyroidism in a district general hospital

Garg Anukul , Graja Tomasz , Mehta Gopal , Smith Simon , Jackson Alan

Aims and Objectives: We conducted a study of 71 patients with Primary Hyperparathyroidism being managed in a single site Joint Endocrine Service. We sought to review the adherence to current international guidelines in managing these cases, and the effectiveness of pre-operative localization to inform surgical options.Results: A total of 71 cases were reviewed, of whom 35 were managed conservatively and 36 underwent surgery. Every patient undergoing surg...

ea0028p13 | Bone | SFEBES2012

Osteoporosis in healthy South Indian males: the influence of life style factors and vitamin D status

Asha H , Prabhu Suresh , Paul Thomas , Seshadri M

Osteoporosis in men is increasingly being recognized as a public health issue. Thirty percent of hip fractures occur in men, and one in eight fractures occurs in men above 50 years of age.Objectives: To assess the prevalence of osteoporosis in healthy male subjects using Bone Mineral Density (BMD) as measured by Dual energy X-ray absorptiometry (DXA), and to study the influence of various factors which influence BMD.Methods: Health...

ea0028p14 | Bone | SFEBES2012

Unusual presentation of idiopathic hypoparathyrodism with hyper-CK-emia

Dar Shujah , Bapat Anjaneya , Jahagirdar Vidya , Geevarghese Cheriyan

We report a case of a 51 year-old gentleman with increased serum creatine kinase (CK) due to hypocalcaemic tetany caused by idiopathic hypoparathyrodism. Raised CK (1738 u/L) was incidentally noted in this patient by his GP. He had ongoing symptoms of hypocalcaemia with intermittent tetanic spasms in his hands and scalp and easy fatigability for 2 years. His examination showed normal stature, no evidence of myopathy with normal deep tendon reflexes, Trousseau’s sign was p...

ea0028p15 | Bone | SFEBES2012

Unusual presentation of primary hyperparathyroidism

Shillo Pallai Rappai , Balasubramanian Sabapathy

An 80 year old patient was diagnosed with asymptomatic, mild primary hyperparathyroidism in 2005 and managed conservatively with regular biochemical monitoring. Other medical history included atrial fibrillation, hypertension, CKD stage 3, type 2 diabetes and memory impairment. In 2011, in view of increasing calcium, he was referred to the endocrine surgeons to consider parathyroidectomy. A very low 25 (OH)vit D (12 nmol/L) prompted high dose oral cholecalciferol treatment. Th...

ea0028p16 | Bone | SFEBES2012

A study of vitamin D status and Bone Mineral Density in epileptic patients from South India

Koshy George , Paul Thomas , Asha H , Thomas Nihal , Aaron Sanjit , Thomas Maya , Alexander Mathew , Seshadri M

Introduction: There are many reports describing the association of alternations of bone and mineral metabolism in patients with epilepsy receiving long term anticonvulsant therapy. However, there are only a few Indian studies which have looked at this aspect. Objective: This study was done to compare the prevalence of changes in bone mineral parameters and bone mineral density (BMD) in ambulant individuals on long term anticonvulsant therapy with age and BMI matched healthy co...

ea0028p17 | Bone | SFEBES2012

Audit of pre-operative imaging in primary hyperparathyroidism

McLaren Laura , Gallagher Andrew , Gallacher Stephen , MacLean Fergus , Hinnie John

Introduction: Primary hyperparathyroidism (PHPT) affects 0.3% of the population. It is characterised by hypercalcaemia with an inappropriately high parathyroid hormone level. The majority of patients with primary hyperparathyroidism are asymptomatic and are diagnosed following an incidental finding of hypercalcaemia. Symptomatic disease is related to hypercalcaemia and can present with complications such as renal calculi and osteoporosis. Parathyroidectomy is the treatment of ...

ea0028p18 | Bone | SFEBES2012

Hypercalcaemia secondary to granulomatous disorders- a series.

Humayun Malik , Richardson Tristan

Hypercalcemia is commonly caused by primary hyperparathyroidism. Other causes of hypercalcaemia can be seen in the clinical setting, and it is important to consider these alternative diagnoses as the management differs dramatically from the management of primary hyperparathyroidism. We present a series of four patients presenting with four different granulomatous conditions causing hypercalcaemia. These were secondary to Tuberculosis, Sarcoidosis, Wegener’s granulomatosis...

ea0028p19 | Bone | SFEBES2012

Efficacy of differing vitamin D supplementations, and the associated cost implications

Gill James , Sivaraman Subash , Mistry Hina , Heer Mandeep , Randeva Harpal

The aim of this audit was to assess the efficacy of vitamin D replacement therapies (oral Ergocalciferol D2 and Cholecalciferol D3) on serum Vitamin D (25(OH)D), when dispensed to endocrine outpatients. After exclusions, clinic records of 54 patients were analysed for pre- and post dosage serum 25(OH)D levels, PTH levels, total dosage given, and duration of replacement. Results: Mean total dose of D2 (n=24) was 350,000 (IU) against D3 (n=30) 305,000 (IU), with av...

ea0028p20 | Bone | SFEBES2012

Vitamin D, no longer the forbidden fruit in hypercalcaemia

Zac-Varghese Sagen , Hui Elaine , Meeran Karim

A 70 year old Afro-Caribbean gentleman was referred for investigation of hypercalcaemia. He had a past medical history of prostate cancer treated 10 years previously with radical prostatectomy and radiotherapy, type 2 diabetes and hypertension. There was no family history of note. At the time of his operation, his calcium was noted to be high 2.87 mmol /L (nr 2.15–2.6) and his creatinine was 87 but this was not investigated further. At the first clinic visit, his correcte...

ea0028p21 | Bone | SFEBES2012

An audit of vitamin D status among local multiple sclerosis patients

Lim Yuen Han , Pattman Stewart , Guadagno Joe , Duddy Martin , Smith Gillian , Wilkinson Carmel , Quinton Richard

Background: Multiple sclerosis (MS) is associated with low ambient ultraviolet B (UVB) light in childhood and in utero (relative risk of developing MS is 1.2 for those born in spring). Besides, the MS-linked HLA-DRB1 allele interacts strongly with vitamin D in vitro, and vitamin D levels are lower in MS patients. Fatigue and musculoskeletal aches/pains are prominent symptoms in both MS and vitamin D deficiency. Moreover, having any chronic disease may predispose to stay...

ea0028p22 | Bone | SFEBES2012

Lithium induced hyperparathyroidism

Butt Muhammad , Waheed Najeeb

A 74 year old lady presently to casualty with generalized ill health, vomiting and a mechanical fall. She was well known to the psychiatry team with severe depressive disorder managed with Lithium. Clinical examination was unremarkable. Baseline blood tests confirmed hyperparathyroidism with corrected calcium of 3.24 mmol/l and high parathyroid hormone levels of 13.4 pmol/L. Lithium levels were normal. She improved clinically with intravenous hydration followed by pamidronate ...