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

Poster Presentations

Clinical practice/governance and case reports

ea0028p38 | Clinical practice/governance and case reports | SFEBES2012

The relationship between Vitamin D and HbA1C in a type 1 diabetic paediatric population

Magee Lucia , Mughal Zulf , Ehtisham Sarah , Marshall Marie , Campbell Judith , Ainsworth Susan , Bone Mark , Doughty Ian , Clayton Peter

Clinical, epidemiological and in-vitro studies have found evidence for an association between Vitamin D and diabetes. Vitamin D receptors are found on pancreatic beta-cells, suggesting they have a role in glycaemic control. Vitamin D analogues inhibit inflammatory cytokines involved in destruction of Beta-cells. This study aimed to assess the relationship between Vitamin D and glycaemic control, as measured by HbA1C, in a Type 1 (T1) diabetic paediatric population. HbA1C value...

ea0028p39 | Clinical practice/governance and case reports | SFEBES2012

A UK epidemic of testosterone prescribing 2000–2010: ‘Never mind the testes’

Gan Earn , Pattman Stewart , Quinton Richard , Pearce Simon

Male hypogonadism is characterised by sexual dysfunction, loss of muscle bulk, central obesity, fatigue, mood and sleep disturbances, osteoporosis and anaemia. Although these features are associated with low serum testosterone concentration, not all men with a low serum testosterone are definitively hypogonadal, and there is a large symptom overlap with obesity and non-endocrine illness. Importantly, testosterone replacement therapy may not be appropriate for men with mild, fu...

ea0028p40 | Clinical practice/governance and case reports | SFEBES2012

Hunting for the underlying cause of Cushing’s syndrome

Sennik Devesh , Kenchaiah Manohar , Elhag Ali Hisham , Garusinghe Chaminda , Hodgson Shirley , Bano Gul

A 66 year old lady with a previous diagnosis of Retinitis Pigmentosa (RP) was referred to our endocrine clinic with excessive sweating and was also noted to have hypertension, thin skin, extensive bruising and central obesity. Her past medical history included a benign thyroid nodule, gastric erosions, osteoporosis, hyperlipidaemia and depression. On examination, blood pressure was 164/86 mmHg and BMI was 30.7 kg/m2 with central obesity. Biochemical testing revealed...

ea0028p41 | Clinical practice/governance and case reports | SFEBES2012

Low prevalence of pituitary pathology in men presenting with isolated hypogonadotrophic hypogonadism

Gibb Fraser , Strachan Mark , Zammitt Nicola , Walker Brian

Background: Male hypogonadotrophic hypogonadism is an increasingly common cause of referral to endocrine clinics. Subnormal testosterone levels are frequently observed in obesity, type 2 diabetes mellitus and in the elderly. Endocrine Society guidelines suggest stratification of investigations based on the degree of androgen deficiency, with full pituitary function testing and MRI recommended only in those with serum testosterone levels less than 5.2 nmol/L. However the eviden...

ea0028p42 | Clinical practice/governance and case reports | SFEBES2012

Endoscopic ultrasonography is a sensitive tool in the preoperative localization of insulinoma

Joseph A , Kapoor Nitin , Asha H , Simon Ebby , Chacko Ashok , Thomas Elsa , Eapen Anu , Ramakrishna Banumathi , Abraham Deepak , Paul M , Paul Thomas , Thomas Nihal , Rajaratnam Simon

Introduction: Various imaging modalities are used in the preoperative localization of insulinoma. CT is the modality that is in widespread use. Endoscopic ultrasound (EUS) allows the transducer to be placed in close proximity to the pancreas, thereby yielding images of higher quality, leading to accurate localization. An accurate preoperative localization results in a minimal invasive surgery and less occurrence of residual tumors, translating into a better clinical outcome. O...

ea0028p43 | Clinical practice/governance and case reports | SFEBES2012

Disconnection hyperprolactinaemia in non-adenomatous sellar/parasellar lesions practically never exceeds 2000 mU/L

Korevaar Tim , Wass John , Grossman Ashley , Karavitaki Niki

Hyperprolactinaemia in association with a large sellar lesion could represent either tumoural secretion of prolactin (PRL) or stalk disruption by a non-prolactinoma: the differentiation has important therapeutic consequences. We have previously shown that based on currently used assays disconnection hyperprolactinaemia associated with non-functioning adenoma (NFA) practically never exceeds levels above 2000 mU/l. We aimed to verify our proposed disconnection hyperprolactinaemi...

ea0028p44 | Clinical practice/governance and case reports | SFEBES2012

Determining the utility of the 60 minute cortisol measurement in the short synacthen test

Chitale Aditi , Musonda Patrick , McGregor Alan , Dhatariya Ketan

Context: Despite the widespread use of the short synacthen test (SST), there remains no clear consensus on sampling times for the measurement of serum cortisol that best determines adrenal reserve.Objective: To establish whether there is any value in measuring serum cortisol at 60 minutes following administration of synacthen.Design and setting: Retrospective data analysis of 500 SST results measuring 0, 30 and 60 minute cortisol l...

ea0028p45 | Clinical practice/governance and case reports | SFEBES2012

A protocol for avoidance of post-thryoidectomy hypocalcaemia, results of first 12 months’ audit

Alexandre Leo , Pain Simon , Turner Jeremy

Background: Total and completion thyroidectomy are commonly performed operations for the treatment of thyroid disease. Post-operative hypocalcaemia is a frequent complication of this surgery, and is associated with morbidity and prolonged length of stay (LOS).Methods: In January 2010 we introduced a protocol for the avoidance and management of post-operative of hypocalcaemia based on risk-stratification by post-operative PTH levels in patients undergoing...

ea0028p46 | Clinical practice/governance and case reports | SFEBES2012

Improvement of health-related quality of life in adult women with 21-hydroxylase deficiency over a 7 years period

Quinkler Marcus , Ventz Manfred , Hinz Andreas , Bleicken Benjamin

Introduction: Health related quality of life (HRQoL) is impaired in adult patients with 21-hydroxylase deficiency (21-OHD). Up to now, only cross-sectional and no longitudinal studies are available, and it is not known if HRQoL can be improved in adult 21-OHD patients. Objective: To investigate HRQoL in adult female 21-OHD patients over a longer time span.Methods: Longitudinal, single centre, follow-up study over seven years with three visits including 1...

ea0028p47 | Clinical practice/governance and case reports | SFEBES2012

Management of Vitamin D deficiency: a clinical audit of two loading regimens.

Theodoraki Aikaterini , Ihuoma Ajibola , Prelevic Gordana

Vitamin D deficiency is common and various supplementations regimens are in use. The purpose of this audit was to compare the efficacy of two short-term colecalciferol loading regimens in treating Vitamin D deficiency. Sixty-four consecutive patients with serum 25OH VitaminD ≤30 nmol/L were assigned to 12 or 16 weeks treatment with 40,000 IU colecalciferol orally once a week. The main endpoint was to identify which duration of treatment is adequate for achievement of suf...

ea0028p48 | Clinical practice/governance and case reports | SFEBES2012

A comparative quality assessment of evidence-based clinical guidelines in Endocrinology

Hazlehurst Jonathan , Armstrong Matthew , Sherlock Mark , O'Reilly Mick , Rowe Ian , Franklyn Jayne , Stewart Paul , Tomlinson Jeremy

Evidence-based clinical guidelines in Endocrinology attempt to improve and standardise patient care. There has been an expansion in guideline production although some of the heterogeneous methods used to assess the underlying evidence base may limit interpretation and implementation. Current and archived guidelines from The American Association of Clinical Endocrinologists (AACE), The Endocrine Society (ES), The American Thyroid Association, The British Thyroid Association and...

ea0028p50 | Clinical practice/governance and case reports | SFEBES2012

Barts Endocrine Telephone Advice Clinic (ETAC): utilisation and outcomes from the first 18 months

O'Toole Sam , Pittaway James , Gunganah Kirun , Druce Maralyn

Background: In May 2010 a dedicated Consultant-delivered Endocrine Telephone Advice Clinic (ETAC) was launched at St Bartholomew’s Hospital as a direct point of access for primary care doctors to obtain endocrine advice about new patients. The proposed benefits of this clinic were to: 1. Reduce unnecessary clinic attendances that could be managed in primary care. 2. Allow for more detailed and less hurried discussions of non-urgent cases than was possible via the on-call ...

ea0028p51 | Clinical practice/governance and case reports | SFEBES2012

Audit of outcome of childhood onset growth hormone deficiency in young adults at the Royal Hospital for Sick Children, Yorkhill, Glasgow from 2005–2011.

Ahmid Mahjouba , Perry Colin , Donaldson Malcolm , Ahmed Syed , Shaikh M

Background: GH therapy in adolescents with childhood onset GH deficiency (CO-GHD) is often necessary to prevent adult GHD syndrome. This requires re-evaluation of the GH axis on attainment of final height.Aim: Retrospective review of outcome in young adults diagnosed with CO-GHD Design: Clinical details were collected on young adults with CO-GHD patients between 2005 and 2011 at one tertiary centre. Result: 62 former CO-GHD patients, 40 male: 22 female, ...

ea0028p52 | Clinical practice/governance and case reports | SFEBES2012

The cost, efficacy and safety of Omnitrope compared with Genotropin in adults with growth hormone deficiency

Ullah Arif , Peacock Helen , Arutchelvam Vijayaraman , Nag Sath , Ashwell Simon

Omnitrope is a biosimilar growth hormone (GH) preparation with a lower acquisition cost than other GH preparations. We switched adult patients with growth hormone deficiency treated with Genotropin (n=14, age 59.2±13.7 [mean±SD] yrs, 8 male) to Omnitrope at an equivalent dose. There followed titration visits every month for 3 months then visits every 3 months until 9 months. GH dose (0.5±0.0 vs 0.5±0.0 mg [mean±SD],...

ea0028p53 | Clinical practice/governance and case reports | SFEBES2012

Antiphospholipid syndrome and adrenal insufficiency: a case series

Whyte Martin , Grove Grace , McGowan Barbara , Carroll Paul , Powrie Jake

Introduction: Antiphospholipid syndrome (APS) is the association of anti-cardiolipin antibodies and venous & arterial thrombosis. APS accounts for <0.5% of cases of hypoadrenalism. We present a series of 5 such cases occurring at our institution plus a further patient identified with unilateral adrenal haemorrhage. Case 1 presented with nausea, vomiting and weight loss. Lupus anticoagulant positive. Commenced aspirin 300 mg. 6-weeks later represented with dehydration, ...

ea0028p54 | Clinical practice/governance and case reports | SFEBES2012

Survey of hypercalcaemia and audit of further management with focus on primary hyperparathyroidism

Raghavan R P , Gkastaris K , Chortis V , Woltersdorf W W , Bradley K J

Background: Hypercalcaemia is independently associated with increased cardiovascular morbidity/mortality. It is a poor prognostic marker in malignancy. Best practice dictates further investigation of any high calcium values. Recognition of primary hyperparathyroidism (PHPT) is important for long term follow-up and management.Aims: Survey of causes of hypercalcaemia in adults (>18 years) from samples sent to one hospital lab over 1 year with particula...

ea0028p55 | Clinical practice/governance and case reports | SFEBES2012

Role of adrenal vein sampling in primary hyperaldosteronism: our experience

Mirshekar-Syahkal Negar , Srinivas Vidya , Gorick Sondra , Burgess Neil , Girling Simon , Myint Khin Swe

Background: In primary hyperaldosteronism (PHA), CT is the sensitive imaging to visualise adrenal adenoma. However, because of the high incidence of adrenal incidentalomas, adrenal venous sampling (AVS) is frequently required to indentify unilateral (UD) or bilateral (BD) disease. AVS can be technically difficult and result can be operator dependant.Method: We retrospectively reviewed the last 14 cases of AVS performed in our hospital. The criterion of U...

ea0028p56 | Clinical practice/governance and case reports | SFEBES2012

Secondary adrenal suppression and Cushing’s syndrome caused by ritonavir boosted effects of inhaled fluticasone, injected triamcinolone and topical clobetasol: A case series of 11 patients.

Gurazada Kalyan , Marshall Neal , Johnson Margaret , Hillman Tobias , Bouloux Pierre , Khoo Bernard

The HIV protease inhibitor (PI) ritonavir is used in conjunction with other antiretroviral treatments as a pharmacokinetic booster due to its potent inhibition of hepatic cytochrome P450 3A4 (CYP3A4). Co-administration of glucocorticoids metabolized by CYP3A4, with ritonavir leads to accumulation of these glucocorticoids, markedly increasing the risk of iatrogenic Cushing’s syndrome and suppression of the Hypothalamic-Pituitary-Adrenal axis. We present 11 patients receivi...

ea0028p57 | Clinical practice/governance and case reports | SFEBES2012

DEME (Diabetes Endocrinology in Medical Education) Survey - Evaluation of Endocrinology and Diabetes teaching at a UK Medical School

Jose Biju , Bedward Julie , Davison Ian , Narendran Parth , Cooper Mark

Concerns have been raised that undergraduate medical education in Endocrinology/Diabetes (E&D) is not preparing students adequately for clinical practice. This project assessed trainer perceptions of the delivered D&E curriculum and identified areas for improvement. We surveyed E&D consultants at the 12 hospitals which accept students from our medical school using an online questionnaire. Emails were sent to 50 consultants. The response rate was 46% (23/50 recipien...

ea0028p58 | Clinical practice/governance and case reports | SFEBES2012

Role of plasmapheresis in rapid pre-operative stabilisation of severe Grave’s thyrotoxicosis

Kankara ChenchiReddy , Browne Duncan

We describe the use of plasmapheresis for pre-operative stabilisation in a case of refractory Grave’s thyrotoxicosis. Our case is a 21 year woman with 12 month history of severe Grave’s disease. Her serum freeT4 was >100 pmol/L (ref.range 11–24) and TSH <0.014 mU/L at diagnosis, had no goitre and negative thyroid peroxidase antibodies. Thyroid uptake scan confirmed Grave’s disease. She was treated with carbimazole 60 mg daily and propranolol. She re...

ea0028p59 | Clinical practice/governance and case reports | SFEBES2012

Tricky sums: The endocrine manifestations of hypoalbuminaemia

Sennik Devesh , Elhag Ali Hisham , Kenchaiah Manohar , Garusinghe Chaminda , Mansour Sahar , Mortimer Peter , Bano Gul

A 41 year old man was initially referred to lymphoedema clinic. He had leg swelling of 10 years duration but was otherwise fit and well. Examination revealed marked lipohypertrophy affecting his thighs bilaterally. There was no oedema and his distal lower limbs were normal. MRI investigation confirmed focal lipohypertrophy. Biochemical investigation revealed a very low albumin of <10 g/l, a low calcium of 1.96 mmol/l and hyperlipidaemia (cholesterol 9.3 mmol/l, LDL 6.4 mmo...

ea0028p60 | Clinical practice/governance and case reports | SFEBES2012

Case Report: Postoperative hypocalcaemia, a novel management option

Zhyzhneuskaya Sviatlana , Chapman John , Carey Peter , Nayar Rahul , Pearce Simon

Postoperative hypocalcaemia is usually transient; we present a case report of persistent symptomatic hypocalcaemia following elective thyroid surgery; its challenging pharmaceutical management including the successful use of a novel therapeutic agent. A 56 yr old woman with known type 2 diabetes, morbid obesity (treated with gastric band), and benign intracranial hypertension underwent total thyroidectomy for a multi-nodular goitre, following which she became symptomatic with ...

ea0028p61 | Clinical practice/governance and case reports | SFEBES2012

Referral pattern & biochemical work-up of adrenal lesions and the role of endocrinologists in managing patients undergoing surgical adrenalectomy: A single centre audit of 10 years of laparoscopic adrenalectomies

Aghili Azin , Chitale Sudhanshu , Armitage Jim , Swords Frankie , Burgess Neil , Dhatariya Ketan

Introduction: Laparoscopic adrenalectomy is the gold standard treatment for adrenal lesions. High volume centres with input from endocrinologists and urologists with a special interest in adrenal lesions may have best outcomes. Aims: To audit our practice and set standards with reference to preoperative workup and postoperative follow-up. This is a single centre, single surgeon experience of surgical adrenalectomy.Material & Method: Over a 10 year pe...

ea0028p62 | Clinical practice/governance and case reports | SFEBES2012

Web-based 360-degree assessment survey to assess care and service improvement needs in an Endocrine unit

Gordon Nadia , Prague Julia , Aylwin Simon JB

Context: Better, reproducible and structured methods of assessing care provided to endocrine patients are needed. Similarly, access to regional units and referral pathways could be improved with nationally agreed standards for waiting times.Objective: To gain views on the current level of patient care and how services might be improved using a 360-degree assessment process.Method: Three web based surveys were created using SurveyMo...

ea0028p63 | Clinical practice/governance and case reports | SFEBES2012

GLP-1 dependent hyperinsulinaemic-hypoglycaemia following partial-gastrectomy and Roux-en-Y bypass in a lean patient

Fox Thomas , English Patrick

Hyperinsulinaemic-hypoglycaemia has been described following Roux-en-Y gastric bypass for obesity and is thought to be due to hyperfunction of pancreatic β cells. It has been questioned whether the β cell hyperfunction may have preceded the bariatric surgery and contributed to the obesity. We report a case of hyperinsulinaemic-hypoglycaemia in a non-diabetic, lean patient (BMI 26 kg/m2) who underwent distal gastrectomy and Roux-en-Y bypass for a benign gas...

ea0028p64 | Clinical practice/governance and case reports | SFEBES2012

Danazol falsely elevates oestradiol levels in a woman with ovarian failure

Devine K , Freel E , Perry C

A 29 year old woman with multiply-relapsed Hodgkin’s lymphoma became amenorrhoeic with vasomotor menopausal symptoms following multiple cycles of chemotherapy. Subsequent biochemistry confirmed primary gonadal failure (LH 30.7 U/L, FSH 49.9 U/L, oestradiol <70 pmol/L). Following allogeneic bone marrow transplantation she developed severe haemolytic anaemia and thrombocytopenia. This was resistant to standard therapies, including methylprednisolone, mycophenolate mofet...

ea0028p65 | Clinical practice/governance and case reports | SFEBES2012

A streamlined strategy for the biochemical investigation of adrenal incidentalomas

Ellis Nicola , Wright Dianne , Peacey Steven

It is important to identify whether benign adrenal incidentalomas are hormonally active. Traditionally, investigations were arranged during the first medical consultation and relied heavily on the patient remembering a considerable number of instructions. The patient was required to collect urine bottles from pathology, a prescription from pharmacy and perform multiple tests including renin, which was often incorrectly performed in outpatients. Due to the cumbersome nature of ...

ea0028p66 | Clinical practice/governance and case reports | SFEBES2012

Correcting hyponatraemia on the AMU: learn to walk before you can run?

Webb David , Witherall Ruth , Ellis Holly , Griffiths Adam , Levy Miles

Introduction: Significant hyponatraemia (serum sodium <128 mmol/l) is a potentially modifiable cause of prolonged hospital length of stay (LOS). By correcting euvolaemic hyponatraemia more rapidly than imposed fluid restriction, vasopressin receptor-2 antagonists may be useful adjuncts to existing treatments.Aim: To explore the potential clinical utility of vasopressin antagonists by describing the frequency and nature of hyponatraemia typically enco...

ea0028p67 | Clinical practice/governance and case reports | SFEBES2012

Adrenal incidentalomas outside the Endocrinology clinic

Amajuoyi Adaugo , Theodoraki Aikaterini , MacLachlan Jody , Bouloux Pierre-Marc , Khoo Bernard

Adrenal masses discovered incidentally during imaging (adrenal incidentalomas) are common and constitute a common reason for referral in the Endocrinology clinic. Our aim was to audit the prevalence of adrenal masses discovered in all computerised tomography (CT) abdominal imaging done over one calendar month in our centre. A secondary aim was to identify the underlying diagnosis and fate of the discovered adrenal nodules. All 690 CT scans done in March 2011 in our centre that...

ea0028p68 | Clinical practice/governance and case reports | SFEBES2012

Acute presentation of ectopic Cushing’s syndrome due to Phaeochromocytoma co-secreting ACTH

Kankara ChenchiReddy , Creely Steven , Foote John , Dugal Tabinda

We present a case of Phaeochromocytoma co-secreting ACTH as a rare cause of Cushing’s syndrome. Our patient is a 49 year lady admitted acutely with sudden onset headache and severe hypertension. CT brain and CSF analysis were normal. Her urinary catecholamines were found to be elevated. Noradrenaline 709 and 972 nmol/ mmol of creatinine (ref range 0–48), Adrenaline 215 and 256 (ref range 0–10). CT abdomen revealed 4.2 cm left adrenal mass, MIBG scan confirmed ph...

ea0028p69 | Clinical practice/governance and case reports | SFEBES2012

An unusual case of hypercalcaemia as the presenting feature of pneumocystis jivorecii pneumonia (PCP)

Narayanaswamy Anil Kumar , Gibson Anthony , Okosieme Onyebuchi , Agarwal Neera

Case Summary: A 72 year-old man presented with a one month history of anorexia, weight loss, lethargy, constipation, increased thirst and generalised aches and pains. He had a background of hypertension, ischaemic heart disease, aortic stenosis, and a renal transplant 23 years ago with declining renal function. No significant abnormalities were noted on physical examination. Investigations confirmed hypercalcaemia, with serum calcium rising from 2.8–3.05 mmol/l. This was ...

ea0028p70 | Clinical practice/governance and case reports | SFEBES2012

Hypoglycaemia outbreak: a new danger on the streets?

Pura Narayanaswamy Anil Kumar , Williams Nia , Agarwal Neera , Okosieme Onyebuchi

Hypoglycemia is an uncommon clinical problem in patients without diabetes mellitus. Potential aetiologies include drugs, critical illness, hormone deficiencies, and non islet cell tumors. In the absence of these causes, the possibility of accidental, surreptitious, or even malicious hypoglycemia should be considered. We present three cases of severe, prolonged hypoglycemia occurring spontaneously in healthy young men without a history of diabetes mellitus or chronic illness. A...

ea0028p71 | Clinical practice/governance and case reports | SFEBES2012

Long-term remission of postmenopausal ovarian hyperandrogenism may occur following a period of gonadotropin-releasing hormone (GnRH) agonist therapy

Lawrence Carly , Dyke Claire , Cox Sue , Smith Jamie

Excessive ovarian androgen production developing in post-menopausal women can be associated with severe hirsutism and virilisation. In the absence of an identifiable androgen-secreting tumour, medical therapy rather than surgical removal is a potential treatment option. Despite this, the role and outcomes of medical therapy are not well characterised in this context. We present the long-term outcomes of 2 women with postmenopausal ovarian hyperandrogenism, both of whom were tr...

ea0028p72 | Clinical practice/governance and case reports | SFEBES2012

We should “ruddy well follow them up” - An unusual complication of suboptimally treated Congenital Adrenal Hyperplasia

Shillo Pallai Rappai , Macinerney Ruth , Robinson Robert

A 40 year old man with CAH and significant needle phobia presented with left leg pain in January 2011. He had been discharged from follow up at another trust. Medications were hydrocortisone 10 mg BD and fludrocortisone 100 mcg OD. Admission haemoglobin was 19.9 g/dl, haematocrit 0.554. A thorough work up to investigate causes of polycythaemia revealed the only significant abnormality as a testosterone of 45.7 nmol/L (8–27), with low gonadotrophins. The blood sample for 1...

ea0028p73 | Clinical practice/governance and case reports | SFEBES2012

Transient thyrotoxicosis following parathyroidectomy

Jose Biju , Hiwot Tarek , Inston Nicholas , Ready Andrew , Gittoes Neil

Introduction: Thyrotoxicosis of iatrogenic origin is well recognized, particularly with use of drugs such as amiodarone and lithium. However, thyrotoxicosis after parathyroid surgery is rarely reported and has been poorly characterized within prospective studies. We report the case of a lady who underwent parathyroidectomy who developed self-limiting thyrotoxicosis.Case: A 42 year old lady presented with recurrent urinary tract infections due to bilatera...

ea0028p74 | Clinical practice/governance and case reports | SFEBES2012

Protease inhibitor and fluconazole-induced adrenal insufficiency - a case report

Lim Kok Haw Jonathan , Mahmud Mohammad , Quin John

Introduction: Adrenal insufficiency (AI) is a potential life-threatening emergency with patients presenting with hypovolaemic shock. Although glucocorticoid-induced AI is well known, there are only a few reports of other drug-induced aetiologies.Case Report: A 50-year-old HIV-positive Caucasian female on ritonavir, darunavir, abacavir and lamivudine presented generally unwell with dizziness on standing, fatigue and weakness. Two days prior to admission, ...

ea0028p75 | Clinical practice/governance and case reports | SFEBES2012

A rare case of prolactinoma presenting with psychosis

Witherall Ruth , Gleeson Helena , Howlett Trevor , Levy Miles

Case History: An 84-year-old women presented to a psychiatric unit with a 5-month history of fluctuating confusion, paranoid behaviour, anxiety, reduced cognition and unsteadiness. There was no history of galactorrhoea, headache or visual field disturbance. Past medical history included hypertension, chronic kidney disease, congestive heart failure, premature menopause and hyperlipidaemia. She had been taking bendroflumethiazide, furosemide, mirtazepine and sulpiride. A CT hea...

ea0028p76 | Clinical practice/governance and case reports | SFEBES2012

Letrozole induced Hypertestosteronism

Krishnasamy Senthilkumar , Macleod Andrew , Moulik Probal

Background: Letrozole is a potent aromatase inhibitor licensed for use in women with breast cancer. It is also used by body builders for reduction of gynecomastia when taking anabolic steroids. Supply for this unlicensed use is readily available through internet. Testosterone production is regulated by negative feedback of estrogen on the pituitary. The use of letrozole can therefore cause supraphysiological levels of testosterone in men. We present such a case.<p class="a...

ea0028p77 | Clinical practice/governance and case reports | SFEBES2012

Haemofiltration as a treatment for severe, resistant hypercalcaemia

Pittaway James , Raja Omair , O'Toole Sam , Gunganah Kirun , Srirangalingam Umasuthan , Hanson Philippa , Drake William

Introduction: We describe two patients admitted to our institution with severe hypercalcaemia, resistant to conventional treatment, requiring haemofiltration. Patient 1 was admitted to hospital with profound hypercalcaemia (5.8 mmol/L) secondary to primary hyperparathyroidism (PTH >263 Pmol/L). The hypercalcaemia had been discovered on a surgical admission 3 months previously and was being managed with 0.9% normal saline and pamidronate infusions at an outside hospital. On...

ea0028p78 | Clinical practice/governance and case reports | SFEBES2012

An Unusual Clinical Presentation May Indicate an Unusual Condition: Phaeochromocytoma presenting as Acute Left Ventricular Failure

Hariman Christian , Jenkins David , Newrick Paul

Introduction: Acute left ventricular failure is rarely caused by phaeochromocytoma. The rarity and severity of this presentation may result in delayed investigation and incorrect management.Case Report: A 22 year old woman was admitted with headache, vomiting, back pain and malaise. She was initially treated for suspected septic shock with intravenous antibiotics and fluids. Within 24 hours of admission, she rapidly deteriorated and developed pulmonary o...

ea0028p79 | Clinical practice/governance and case reports | SFEBES2012

A reversible cause of dilated cardiomyopathy

Salahuddin Sofia , Wu Frederick

Case Presentation A 27 year old male presented with shortness of breath and sweating and on examination had signs of heart failure. An echocardiogram showed global akinesia and an ejection fraction of 15%. He was diagnosed with dilated cardiomyopathy secondary to viral infection and commenced on medical treatment. During a routine cardiology clinic visit he became hypotensive with a systolic BP of 60 mmhg and diaphoretic, his ECG showed sinus rhythm. He was admitted for invest...

ea0028p80 | Clinical practice/governance and case reports | SFEBES2012

Renal calculi as a presenting feature in a patient with familial hypocalciuric hypercalcaemia (FHH).

Reddy Monika , Tanday Raj , Feeney Claire , Darko Daniel , Hadjiminas Dimitri , Cox Jeremy

A 46-year-old Columbian man, with a previous history of pulmonary sarcoid and renal calculi in 2001, was referred to the Endocrinology clinic in 2005 with persistent hypercalcaemia despite successful treatment of the sarcoid. The initial hypercalcaemia work-up results were as follows: adjusted calcium 2.96 (2.15–2.60), parathyroid hormone (PTH) 9.0 pmol/l (1.1–6.8), 25-(OH)2 vitamin D 71 nmol/l (>50), magnesium 0.99mmol/l (0.65–1.00), creatinine 97 umol/l...

ea0028p81 | Clinical practice/governance and case reports | SFEBES2012

Proton Pump Inhibitor (PPI) induced severe symptomatic Hypomagnesaemic Hypoparathyroidism

Rana Subhash , Bangar Vijay , Mousa Abdusalam

We report a case who presented with severe symptomatic hypocalcaemia secondary to Hypomagnesaemic Hypoparathyroidism associated with use of PPI. A fifty-seven years male smoker presented with pins and needles in arms and legs for two months with intermittent attacks of his hand becoming locked and stiff (carpopedal spasm) and calf spasms. He was on long term Omeprazole for Barrett’s oesophagus. He had positive Chvostek’s and Trousseau’s sign. Investigations reve...

ea0028p82 | Clinical practice/governance and case reports | SFEBES2012

Ectopic parathyroid cyst presenting with parathyroid crisis

Krishnasamy Senthilkumar , Moulik Probal , Macleod Andrew

Background: Primary Hyperparathyroidism is mainly produced by an adenoma and it is mostly a benign condition. Most of the patients are asymptomatic. We present a case of ectopic parathyroid cyst presenting with this condition.Case: A 76 yr female presented with new onset confusion, abdominal pain, vomiting, diarrhoea and dehydration. She was currently being treated for a urinary tract infection. Investigations showed acute kidney injury with creatinine 3...

ea0028p83 | Clinical practice/governance and case reports | SFEBES2012

When is a thyroid eye not a thyroid eye?

Greig Marni , Macinerney Ruth

A 63 year old female was referred to ophthalmology in December 2007 with a 10 day history of redness, itching and watering of her left eye: the eye had congestion, chemosis and mild proptosis, and ocular movements were mildly restricted. There was no reduction in visual acuity. MRI in January reported no intraocular or intraorbital lesion, and an inflammatory cause was sought - possibly thyroid eye disease. She did not improve on pressure lowering treatments but had some impro...

ea0028p84 | Clinical practice/governance and case reports | SFEBES2012

Adrenal insufficiency secondary to primary adrenal lymphoma

Stone Stephanie , Currie Gemma , Steve Cleland , Drummond Russell

Primary adrenal lymphoma is a rare phenomenon with a male preponderance. There is bilateral gland involvement in two thirds of cases. Histology usually reveals an aggressive diffuse large B-cell subtype. Adrenal insufficiency is a recognised complication. We present a 62 year old man with a 4 month history of weight loss, night sweats and malaise. Clinical examination revealed right renal angle tenderness with no palpable lymphadenopathy. Inflammatory markers were raised with ...

ea0028p85 | Clinical practice/governance and case reports | SFEBES2012

Tolvaptan-cost effective treatment for hyponatraemia (SIADH in hospitalised patients)

Shakher Jayadave

Hyponatraemia, the commonest electrolyte disorder in hospitals is associated with increased length of stay, morbidity and mortality. The treatment of euvolaemic hyponatraemia with fluid restriction and demecocycline is ineffective. Tolvaptan, a V2 receptor antagonist is licensed for treatment of SIADH, based on two RCT, SALT 1 and SALT 2 studies. The cost of Tolvaptan restricts its use in NHS hospitals with no clear indications with regards to suitable cases. These case report...

ea0028p86 | Clinical practice/governance and case reports | SFEBES2012

Isolated HSV infection in Waterhouse-Friderichsen syndrome

Anthonypillai Fiona , Seal Leighton

A 59 year old women presented to the accident and emergency department with tachycardia and hypotension following a one day history of feeling unwell. She was peripherally shutdown, cyanosed, hypoxic, had a purpuric rash and numbness to her fingers. CT scan revealed bilateral adrenal haemorrhage consistent with Waterhouse-Friderichsen syndrome. This was further confirmed with a Short synacthen test(SST) showing a peak 30 minute cortisol of 102 nmol/l. She was commenced on oral...

ea0028p87 | Clinical practice/governance and case reports | SFEBES2012

Charge syndrome - easily missed as it presents to multiple specialties

Bhat Amar , Brahma Anupam , Jennings Adrian

A 20 year old male presented with short stature (height below 3rd centile for age since aged 13 years) and lack of secondary sexual characteristics. Past history included repaired Fallot’s Tetralogy, sensorineural deafness, repaired cleft lip and palate, learning difficulties, possible unilateral coloboma, and surgery for undescended testes. There was no significant family history. Clinical examination revealed a BMI of 22.7 (height 1.68 m, weight 64 kg). He had a narrow ...

ea0028p88 | Clinical practice/governance and case reports | SFEBES2012

High levels of patient satisfaction after introduction of a one stop thyroid lump clinic

Haddadin Firas , Powell Kathy , Srinivas Vidya , Pawaroo Davina , Tyler Xenia , Swords Francesca

Thyroid nodules are common, but the incidence of thyroid cancer occurring within them is very low. Nonetheless, patients presenting with thyroid lumps are frequently worried that they have cancer, and the wait for a diagnosis to be confirmed or refuted is highly stressful. This presents challenges to the clinician, in determining who requires extensive investigations, and how best to reassure patients in whom this is not indicated. However, satisfied patients are more likely t...

ea0028p90 | Clinical practice/governance and case reports | SFEBES2012

IGF-2 Mediated Hypoglycaemia, secondary to Adenocarcinoma of the Prostate

Grant Paul , Prague Julia , Whitelaw Ben , Aylwin Simon

Hypoglycaemia in non-diabetic patients has a multitude of causes from exogenous insulin to paraneoplastic syndromes. We explore the importance of obtaining a ‘golden sample’, a serum blood sample, during the episode of hypoglycaemia, prior to reversal with treatment. The case herein describes a patient with recurrent episodes of unexplained hypoglycaemia which precipitated several hospital admissions. Standard screening tests did not detect any obvious cause for his ...

ea0028p91 | Clinical practice/governance and case reports | SFEBES2012

Liothyronine an effective treatment for patient with hypothyroidism and ulcerative colitis

Yip May , Sabir Numaera , Vali Saaliha , Elrishi Mohamed

A 49 yrs old lady was referred to us as her primary hypothyroidism deteriorated after exacerbation of her ulcerative colitis (UC). She also has coeliac disease. Although on levothyroxine (oral T4) 175 mcg, her thyroid stimulating hormone (TSH) remained above 40 mU/L (0.35–5.00 mU/L), and free thyroxine (FT4) was <5.15 pmol/L (9.0–20.0 pmol/L). A step wise increase of oral T4 to 900 mcg proved no benefit. Changing oral T4 tablets to syrup and addition of low dose ...

ea0028p92 | Clinical practice/governance and case reports | SFEBES2012

The utility and impact of a joint thyroid clinic

Ashwell Simon , Trurun Peter , Potter Lewis , El-Saify Wael , Durning Patricia

A joint thyroid clinic (JTC) was established in February 2007 with the aim of improving the care of patients in whom an endocrine surgical opinion was required. The monthly clinic is attended by a Consultant Endocrinologist and a Consultant Endocrine Surgeon who together assess patients with thyroid, parathyroid and adrenal problems. Using retrospective case record analysis, we aimed to assess the impact of the clinic by studying the care of people referred with thyrotoxicosis...

ea0028p93 | Clinical practice/governance and case reports | SFEBES2012

Intractable nephrogenic diabetes insipidus, transient thyroiditis and hypercalcaemia complicating long term Lithium therapy

Kamath Chandan , Govindan Jyotish , Premawardhana Amila , Wood Sarah , Adlan Mohamed , Premawardhana Lakdasa

Introduction Lithium (Li) is an effective treatment for bipolar and schizo-affective disorders. It has a narrow therapeutic index, and produces common side effects when this is exceeded. Li causes endocrine disruption by predictable and some hitherto unclear mechanisms. We present a subject who developed multiple Li induced endocrinopathies concurrently, and was a therapeutic challenge. Case presentation and investigations Mr. DM had been on Li for 10 years and developed polyu...

ea0028p94 | Clinical practice/governance and case reports | SFEBES2012

A case of parathyroid carcinoma presenting as primary hyperparathyroidism in a young female subsequently diagnosed with Hyperparathyroidism- Jaw Tumour Syndrome

Asher William , Sivakumaran Darshi , Nithiyananthan Ratnasingam

A 27-year-old female presented with severe lethargy; she was found to have hypercalcaemia with corrected calcium of 3.27 mmol/L and biochemistry suggestive of primary hyperparathyroidism (PTH–64.7 umol/L [1.5–7.5 pmol/L]). She had no notable family history of endocrinopathies or malignancies. Imaging suggested two possible parathyroid adenomas at the upper and lower poles of the posterior right lobe of the thyroid and she was referred for surgical intervention. Intra...

ea0028p95 | Clinical practice/governance and case reports | SFEBES2012

Recurrent atypical adrenocorticotrophic hormone (ACTH) secreting carcinoid tumour causing Cushing’s syndrome

Mlawa Gideon , Lambert Kimberley , Norris Andrea , Li Voon Chong Jimmy

Background: Atypical carcinoid tumours are rare which account for about 15% of all carcinoid tumours. Some of those tumours secrete adrenocorticotrophic hormone (ACTH) causing Cushing's syndrome. We present a case which recurred 16 years after being first diagnosed.Case: A 39 years old woman was referred with few months history of weight gain, irregular menstrual periods, muscle aches, difficult going up the stairs, headaches and blurred vision.She was i...

ea0028p96 | Clinical practice/governance and case reports | SFEBES2012

Cyclical Cushing’s disease in an obese patient

Seetho Ian , Chee Carolyn , Tan Garry

When investigating patients for possible Cushing’s, repeat testing should be considered despite initial negative results if there is a high index of suspicion. We report a case of a patient whose initial tests for Cushing’s yielded conflicting results; cyclical Cushing’s Disease was diagnosed following persistent testing. A 40 year-old lady (BMI 38.0 kg/m2) was seen in the obesity clinic with a 12-month history of weight gain. She had clinical feature...

ea0028p97 | Clinical practice/governance and case reports | SFEBES2012

Unusual presentation, multi speciality effort and excellent outcome – A case of ovarian carcinoid

Mathew Anna , Katreddy Venkata , Buch Harit

Carcinoid tumours are the commonest neuroendocrine tumours (50%), with a prevalence of 3–5/100,000. 10% present with carcinoid syndrome due to release of kinins and serotonin, released directly from the tumour in to the blood or due to liver metastases. Carcinoid heart disease due to ovarian carcinoid is extremely rare. Here we present such a case. A 69 year old female presented to surgeons with increased bowel frequency and weight loss. Blood tests, colonoscopy and biops...

ea0028p98 | Clinical practice/governance and case reports | SFEBES2012

Audit of detection and management of adrenal incidentalomas at a district general hospital

Krishnasamy Senthilkumar , Moulik Probal , Macleod Andrew

Objectives: Increasing use of scanning has led to a significant increase in detection of adrenal incidentalomas. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons have issued guidelines for evaluation of adrenal incidentalomas in 2009. We audited our current practice at Royal Shrewsbury Hospital against the 2009 guidelines.Method: Retrospective audit of patients found to have adrenal masses on imaging st...

ea0028p99 | Clinical practice/governance and case reports | SFEBES2012

A rare cause of hypokalaemia: primary hyperparathyroidism in a patient with Gitelman syndrome

Arutchelvam Vijayaraan , Swiecicka Agnieszka , Siddramaiah Naveen

A 48-year-old healthy, normotensive male was referred by GP due to incidental finding of hypokalaemia of 2.5 mmol/L on routine blood testing. The patient was initially treated with oral potassium supplements with little effect. Biochemical investigations in the endocrine clinic demonstrated mild metabolic alkalosis, eunatraemia, mild hypomagnesaemia 0.6 mmol/L and hypercalcaemia of 2.84 mmol/L with hypophosphataemia of 0.53 mmol/L. PTH was high at 350 ng/L. Renin and aldostero...

ea0028p100 | Clinical practice/governance and case reports | SFEBES2012

A case of unrecognized maternal PTH resistance and severe impact on neonatal bone mineralisation

Sivaraman Subash , Rao Ranganath , Murthy Narasimha , Weickhert Mi , Randeva Hs , Sankaranarayanan Sailesh , Harrold Christopher

A 25 year old lady was referred to the endocrine clinic after her newborn baby was noted to have respiratory problems, marked osteopenia and hypocalcemia. Further investigations on the mother showed corrected calcium of 1.11 mmol/L; however she was relatively asymptomatic. Reviewing her history in detail, she was born in Nigeria and moved to the UK 2 years prior to the presentation. She used to get intermittent cramps in her hands, legs and body since the age of 10 in addition...

ea0028p101 | Clinical practice/governance and case reports | SFEBES2012

Audit of which better first line screening tests for Cushing’s Syndrome

Siddiqi Ahmed , Shaafi Khalifa , Estlea Katrina

Obesity is almost invariably present in Cushing, but is of little diagnostic value because of its high incidence in the population as a whole , particularly in women between the age of 20 and 50 years who are the most likely to be suffering from Cushing’s Syndrome. Clinical acumen, however, is insufficient to establish the diagnosis, and confirmation depends on showing that cortisol production is in excess of normal. Because obesity is increasing at an alarming rate throu...

ea0028p102 | Clinical practice/governance and case reports | SFEBES2012

The economics of the treatment of Grave’s disease; different medication regimes, a cost-benefit analysis

Grant Paul , Haq Masud

There are traditionally two major methods of treating autoimmune biochemical hyperthyroidism (Grave's disease) with anti-thyroid medication employed by Endocrinologist's in the UK today. The first is ‘dose titration’ and the second is ‘block and replace’, each treatment regime has it's own advantages and disadvantages and there is sometimes controversy over which is the best approach. A Cochrane review in 2005, undertook a systematic evaluation of all the g...

ea0028p103 | Clinical practice/governance and case reports | SFEBES2012

Admission and mortality patterns of endocrine-related diseases in the emergency room of a tertiary health care center in Lagos

Anyanwu Anthony , Olofin Kayode , Mojeed Adefemi

Introduction: Knowledge on the admission and mortality patterns of endocrine-related diseases will give insight into the magnitude of the condition and provide effective tools for planning, delivery and evaluation of healthcare needs.Methods: Records of patients that visited the emergency unit of the hospital from May to October 2011were retrieved from the hospital admissions and death registers. Demographic data were obtained. Diagnoses were classified ...

ea0028p104 | Clinical practice/governance and case reports | SFEBES2012

In-patient insulin prescriptions: Legal? Correct? Appropriate?

Sugrue Michelle , Bennett Luke , Cranston Iain

Patients with diabetes represent 15-20% of the total adult population in UK hospitals. Insulin is now recognised as the drug with the highest number of prescribing errors in the NHS. In order to determine insulin-related glycaemic morbidity we reviewed a random representative sample of 50 insulin prescription and administration records (25 medical and 25 surgical)over a 4 week period (11 T1DM, 39 T2DM) Initially we audited the legality of the prescriptions against well-describ...

ea0028p105 | Clinical practice/governance and case reports | SFEBES2012

Diagnostic dilemmas in patients presenting with large adrenal masses – 2 case reports

Mathew Anna , Kennedy Amy , Basu Ansu , De Parijat

The presentation of a patient with an adrenal tumour often causes diagnostic difficulty for the endocrinologist. Adrenal tumours are rare occurrences, particularly when large in size. We present two cases, where large adrenal tumours were found in inpatients on CT scanning and discuss the difficulties which arose in each case when attempting to obtain a definitive diagnosis. Case 1 A 38 year old Bangladeshi woman was being investigated for fevers, sweats and pancytopaenia. She...

ea0028p106 | Clinical practice/governance and case reports | SFEBES2012

A fatal outcome of a patient with a thyroid goitre

Chahal Harvinder , Nikookam Kash , Casey Edel

We report a case of a female patient who initially presented aged 35 yr with shortness of breath and type 2 respiratory failure at 12 weeks of her pregnancy. She was previously known to have a multinodular goitre under another hospital, which had been stable for several years, and had no other medical problems. Clinically and biochemically she was euthyroid (free T4 12.6 pmol/L [11.0–23.3], TSH 0.42 mu/L) and there were no signs of obstruction. An ultrasound scan showed a...

ea0028p107 | Clinical practice/governance and case reports | SFEBES2012

Functioning cardiac paraganglioma with underlying heterozygous SDHD mutation, diagnosed following an acute myocardial infarction- A case report

Ahluwalia Rupa , Hung John , Sreemantula Gayatri , Vora Jiten

Background: We report a case of a 51-year-old man with functioning cardiac paraganglioma diagnosed subsequent to a primary coronary event. Following a myocardial infarction aged 39; he was incidentally found to have a cardiac tumour in the pericardial sac. This was assumed to be benign and followed up with serial imaging. Recent scans suggested a possible paraganglioma with evidence of very slow tumour growth leading to an endocrinology referral. On further questioning he did ...

ea0028p108 | Clinical practice/governance and case reports | SFEBES2012

Hypoglycaemia: a near death experience

Chahal Harvinder , Casey Edel , Hawkins Anna , Nikookam Kash

We report a case of a 27 yr female patient who initially presented with jaundice at 38 weeks gestation, with biochemical transaminitis. She had a caesarean section which was complicated postoperatively by hypotension due to haemorrhage requiring 20 units of blood/blood-products. A specialist liver unit felt the jaundice was secondary to fatty liver of pregnancy. She had difficulty breastfeeding and 18 months post partum she still had secondary amenorrhea so was commenced onto ...

ea0028p109 | Clinical practice/governance and case reports | SFEBES2012

Postmenopausal hirsutism: Ovarian hyperthecosis or androgen secreting adrenal tumour

Krishnasamy Senthilkumar , Moulik Probal , Macleod Andrew , Richmond Kathy

Background: Post menopausal hirsutism should raise suspicion of androgen secreting tumors. We present a case due to bilateral ovarian hyperthecosis with an adrenal incidentaloma.Case history: 57 year old female patient was referred to us with history of new onset hirsutism over the past 2 years. She went through menopause 6 years back. On examination she had hirsutism affecting all her body, no evidence of virilization and no organomegaly on abdominal ex...

ea0028p110 | Clinical practice/governance and case reports | SFEBES2012

Audit of the West of Scotland endocrine adolescent transition clinic model, RHSC Glasgow, 2008–2010

Mason Avril , Donaldson Malcolm , Ahmed S. , McNeil Ethel , Campbell Victoria , Perry Colin , Shaikh M.

Introduction: Various models of transition are used to help engage and improve the health of young adults. Our transition clinic model: a multi-disciplinary endocrine Adolescent Transition Clinic (ATC), was instituted at the Royal Hospital for Sick Children, Glasgow, in October 2008 serving young people in the West of Scotland. A good transition process should improve clinic attendance, health outcomes and quality of life into adulthood.Aim: To review th...

ea0028p111 | Clinical practice/governance and case reports | SFEBES2012

Asymptomatic hypercalcaemia in a hypoparathyroid patient: vitamin D toxicity or calcium alkali syndrome?

Misra Shivani , Ramachandran Radha , Zac-Varghese Sagen , Gulati Malvika , Meeran Karim , Oliver Nick

A 65-year-old lady presented to the emergency department with breathlessness due to an exacerbation of chronic airways disease. Her past medical history included laryngeal carcinoma treated with total-laryngectomy, thyroidectomy and adjuvant radiotherapy in 2003. She remained on stable post-operative replacement doses of 125mcg of levothyroxine and 1mcg 1-Alfacalcidol/1g Sandocal TDS for hypoparathyroidism for several years. Three days prior to her admission, strontium ranelat...

ea0028p112 | Clinical practice/governance and case reports | SFEBES2012

Intrathyroidal parathyroid carcinoma: Putting the pieces together

Sivarajah Vernon , Anderson John , Berney Dan , Parvanta Laila

Parathyroid carcinoma (PTC) is a rare condition that lacks pathognomonic features, making diagnosis and therefore management challenging. In the very few cases of intra-thyroidal PTC reported, failure to achieve a pre-operative diagnosis has often led to unnecessary bilateral neck exploration and re-operation. We describe for the first time a case of intra-thyroidal PTC suspected pre-operatively. A 37-year-old Bangladeshi man presented with a 3-week history of mood changes, mu...

ea0028p113 | Clinical practice/governance and case reports | SFEBES2012

A Case Report - Primary hyperparathyroidism presenting during pregnancy

Rathi Manjusha

Newly diagnosed Primary Hyperparathyroidism during pregnancy is extremely rare condition. The diagnosis is obscured by the normal (physiological) pregnancy-induced changes that lower the total serum calcium and suppress parathyroid hormone levels. Hyperparathyroidism in itself can have a negative impact on both maternal and foetal health. However, there are no evidence-based parameters that reliably predict the outcome of hyperparathyroidism in pregnancy and optimal management...

ea0028p114 | Clinical practice/governance and case reports | SFEBES2012

Tolvaptan treatment for the syndrome of inappropriate antidiuretic hormone (SIADH): a case report

Meek Claire , Kaplan Felicity , Vanderpump Mark

Tolvaptan is an ADH antagonist licensed for the treatment of the syndrome of inappropriate ADH secretion (SIADH). We describe the case of a patient with severe symptoms due to refractory SIADH who was successfully treated with tolvaptan. A 35-year old patient developed a chordoma involving the pituitary gland and optic chiasm and was treated with surgery, radiotherapy and gamma knife therapy. After several years, she developed recurrent, severe, symptomatic hyponatraemia due t...

ea0028p115 | Clinical practice/governance and case reports | SFEBES2012

It is not always an Addisonian Crisis

Harris Sophie , Scobie Ian

A 46 year old male presented with abdominal pain, lethargy and intermittent fever. He described abdominal fullness with cramp-like pains in the left iliac fossa. He reported early satiety and flatulence, but denied weight loss. He had Addison’s disease, diagnosed 18 years earlier with similar symptoms at presentation and diagnostic short Synacthen test, treated with hydrocortisone 20 mg am and 10 mg pm with 100 mcg fludrocortisone once daily. He had however been increasin...

ea0028p116 | Clinical practice/governance and case reports | SFEBES2012

Hypoadrenalism following bilateral adrenal hemorrhage secondary to metastatic lung carcinoma

Ajala Olubukola , Flanagan Daniel

The adrenal glands are common metastatic sites of lung and other cancers. Secondary adrenal hemorrhage due to these metastases is extremely rare and to our knowledge, only 3 cases have been described in literature. We present a patient who developed hypoadrenalism due to bilateral adrenal hemorrhage secondary to adrenal metastases from lung carcinoma. A 66 year old man with a 3 year history of non-small cell lung cancer previously treated with neo-adjuvant chemo-radiotherapy p...

ea0028p117 | Clinical practice/governance and case reports | SFEBES2012

A case of posterior reversible encephalopathy syndrome in a patient with acute intermittent porphyria

Ranjan Nishant , Hosker John

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity characterized by seizures (91.7%), headache (83.3%), visual disturbance (62.5%),encephalophathy (29.2%), and paralysis (8.3%). Co-morbidities included systemic lupus erythematous (29.2%), kidney disease (20.8%), eclampsia(20.8%), renal artery stenosis (12.5%), Takayasu arteritis (4.2%), Sheehan's syndrome(4.2%), and acute intermittent porphyria (AIP) (4.2%). We report a 31-year-old woman w...

ea0028p118 | Clinical practice/governance and case reports | SFEBES2012

Primary hyperparathyroidism due to ectopic parathyroid gland adenoma

Butt M , Waheed Najeeb

A 68 years old lady was referred to our endocrine clinic after she had routine blood tests done as a part of monitoring of her chronic kidney disease stage 3. She had high corrected calcium of 2.85 mmol/l and parathyroid hormone levels of 13 pmol/l consistent with primary hyperparathyroidism. She was clinically symptomatic with high calcium and had polyuria, polydipsia and constipation. There was no history of renal calculi or fractures although DEXA scan confirmed osteoporosi...

ea0028p119 | Clinical practice/governance and case reports | SFEBES2012

Cushing’s syndrome secondary to a thymic carcinoid tumour

Iliopoulou Amalia , Milton Richard , Parker Cornelle , Murray Robert

Ectopic ACTH secretion accounts for 11–25% of Cushing’s syndrome, most commonly resulting from small cell lung carcinoma and bronchial carcinoid tumours. Ectopic ACTH requires meticulous consideration in the differential of ACTH-dependent Cushing’s syndrome. Thymic carcinoids are a very rare cause of ectopic ACTH secretion, accounting for 5–12% of cases. A 28 year old gentleman was diagnosed with Cushing’s syndrome after presenting with lethargy, hyper...

ea0028p120 | Clinical practice/governance and case reports | SFEBES2012

Bacterial meningitis as first presentation of pituitary macroprolactinoma

Aggarwal Naveen , Khan Hamza , Mitra Dipayan , Ball Steve

A 37 year old gentleman with no significant past medical history presented with 2 day history of acute onset headache, nausea, vomiting, photophobia and fever. He was pyrexial. He had no focal neurological deficit but marked neck stiffness. His inflammatory markers were raised. CT head showed large pituitary tumour. He was started on Dexamethasone and IV Ceftriaxone and transferred to tertiary centre. MRI brain showed large pituitary macroadenoma projecting into right cavernou...

ea0028p121 | Clinical practice/governance and case reports | SFEBES2012

T3 a life saver

Chahal Harvinder , Hawkins Anna , Nikookam Kash

We report a case of a female patient who presented aged 37yr with tiredness, weight gain and oligomenorrhea. Biochemically she was diagnosed with primary hypothyroidism with a TSH 10.9 mu/L and free-T4 8.2 pmol/L (10.5–22.0); she was commenced onto Thyroxine 50 mcg once a day (OD). Six months later her thyroid function tests improved with a TSH 2.2 mu/L and free-T4 13.0 pmol/L, however she felt her symptoms had worsened. The dose of thyroxine was increased to 75 mcg OD. ...

ea0028p122 | Clinical practice/governance and case reports | SFEBES2012

Invasive basal skull prolactinoma with CSF rhinorrhoea and normoprolactinaemia

Kankara Chenchi Reddy , Browne Duncan

We present a complex case of basal skull prolactinoma presenting with CSF rhinorrhoea and without elevated prolactin. Our case is a 41 year woman who presented 2 years ago with streptococcal meningitis and CSF rhinorrhoea. Initial imaging suggested right sphenoid tumour eroding the skull base involving structures in anterior and middle cranial fossa. After the tumour was biopsied by ENT team, she developed signs of recurrent meningitis, therefore referred to neurosurgery. She ...

ea0028p123 | Clinical practice/governance and case reports | SFEBES2012

Primary adrenal lymphoma – an unusual case of hypoadrenalism with adrenal masses fluctuating in size

Swiecicka Agnieszka , Arutchelvam Vijayaraman , Siddaramaiah Naveen , Ashwell Simon , Nag Sath

A 66-year-old HIV positive male presented to gastroeneterologist with a 2 months history of severe fatigue, weight loss, dizziness and nausea. He had background of ulcerative colitis which was quiescent and he has not received steroids for more than 12 months. Baseline blood results revealed normal biochemistry with mild normocytic anaemia, neutropaenia and lymphopaenia. As there was a high clinical suspicion of adrenal insufficiency, the short synacthen test was performed whi...

ea0028p124 | Clinical practice/governance and case reports | SFEBES2012

Non-compliance in a childhood cancer survivor

Gorick Sondra , Temple Rosemary

We present the case of a 24 year old childhood cancer survivor with non-compliance of medication. Patient SB d.o.b. 30/07/1987, presented with a squint and loss of vision in the right eye at the age of four years. He was diagnosed with a craniopharyngioma and had a frontal craniotomy. Two years later, an MRI showed recurrence so he had further frontal surgery followed by irradiation (50 Gy in 28 fractions). Post operatively he was diagnosed with panhypopituitarism and remained...

ea0028p125 | Clinical practice/governance and case reports | SFEBES2012

Acute kidney injury due to Addisonian crises as presentation of undiagnosed Addison’s disease

El-mahmoudi Bashir , Stott Victoria

A 28 year old man with a background of hypothyroidism presented to hospital following a collapse. He had a one week history of unrelenting vomiting with malaise. On examination, he appeared dehydrated and was profoundly hypotensive with a blood pressure of 56/25 mm Hg. General examination was otherwise unremarkable. The blood tests demonstrated acute kidney injury with serum creatinine 227 mmol/L and hyponatraemia with serum sodium 130 mmol/L. His potassium was within normal l...

ea0028p126 | Clinical practice/governance and case reports | SFEBES2012

Madam, your symptoms make no sense

Adesina Olubiyi , Otukoya Ayodeji , Otubogun Folajimi , Adeniji Olaleye

Introduction: Adrenal and Thyroid disease symptoms remain enigmatic because of their pronounced non-specificity. Physicians need to have a high index of suspicion for these clinical conditions in order to save patients from unnecessary turmoil.Case Presentation: OA, a 35 year old Nurse presented at the Endocrine clinic on self referral in July 2011 after having presented at both the Out-patients and Gynaecology units at various times in the previous 8 mo...

ea0028p127 | Clinical practice/governance and case reports | SFEBES2012

A case of normocalcaemic hyperparathyroidism

Konya Judit , Kahal Hassan , Wakil Ammar , Sathyapalan Thozhukat , Atkin Stephen , Aye Mo

Introduction: Normocalcemic hyperparathyroidism is a less recognised variation of primary hyperparathyroidism (pHPT). Patients present with normal calcium and elevated level of PTH.Case: A 70 years old woman presented to her general practitioner with left sided loin pain. She had no past medical history of note and she was not taking any medications. Ultrasound of the urinary tract showed bilateral nephrocalcinosis. Her blood tests showed raised PTH leve...