Endocrine Abstracts

Background: Mitotane is an adrenolytic chemotherapy, currently accepted as first line adjuvant therapy in adrenocortical carcinoma. Mitotane has a narrow therapeutic window. Serum levels of >14 mg/l are required to achieve a cytotoxic effect and levels of >20 mg/l are potentially toxic. There are two strategies for mitotane initiation: a low-dose regimen (3 g) and a high-dose regimen (increase to 6g/day over 4 days and reduce to 4.5 g/day after 10 days).<p class="...

A 29y female presented with an 8y history of hypomagnesaemia. It was noted incidentally when hospitalised with mumps-related pancreatitis. Subsequently symptomatic hypomagnesaemia, with headaches and lethargy, was treated with magnesium glycerol phosphate 4 mg TDS, but she remained symptomatic with occasional need of IV Mg2+. It was thought that she was poorly compliant with her oral Mg2+ supplements. At presentation to our department for follow-up of her...

Background: Pituitary surgery is the initial treatment for the majority of patients with acromegaly. The UK acromegaly register data (UK-AR-2) suggests that surgical remission rates vary widely, with a marked improvement since 2000. The aim of this study was to assess the outcomes of first TSS for acromegaly in our centre over the past 5 years.Methods: We retrospectively analysed data for all acromegaly patients who underwent first TSS between 2007-2011....

Background: There has been little research into methods of learning clinical endocrinology, a speciality encompassing rare conditions and pattern recognition. Problems include limited patient exposure outside specialist centres and increasing pressure on doctors to manage their own educational needs. An understanding of learning methods in use across the spectrum of students and doctors will help to identify trusted resources and untapped techniques.Aim:...

A 20-year-old girl presented to the endocrine clinic with a history of three stone weight gain, and development of numerous purple striae over her lower abdomen, inner thighs and upper arms, gradually progressing over a 12-month period. The onset of symptoms had coincided with the initiation of contraceptive depot medroxyprogesterone acetate, which was discontinued two months prior to her presentation. Her 9 am cortisol was <50 nmol/l.She had a backg...

Several recent publications have advocated that patients with primary and secondary adrenal insufficiency (PAI and SAI) be given emergency injectable hydrocortisone to reduce the risk of adrenal crisis. There is a limited evidence-base for this recommendation and consequently the Edinburgh Centre for Endocrinology (ECE) does not routinely issue kits to its patients. This study assessed the frequency of hospital presentations in ECE’s AI patients, and the severity of their...

A 26yr old man presented to haematology with a short history of easy bruising. There was no spontaneous bleeding. Past medical history was unremarkable. Family history of clotting disorders was negative. On examination there was significant lower limb bruising.Initial investigations revealed platelets of 238 (150–450), prothrombin time (PT) of 12.0 (12.0–17.0 s) and elevated activated partial thromboplastin time (APTT) of 41.0 (24.0–38.0 s...

Background: Conn’s syndrome accounts for 35% of primary hyperaldosteronism. Elevated plasma aldosterone concentration to renin activity is widely used as a screening diagnostic tool. However, we report an unusual presentation of Conn’s syndrome with normal plasma renin aldosterone ratio.A 48-year-old man was seen in endocrine clinic with uncontrolled hypertension and severe hypokalemia. Primary hyperaldosteronism was suspected with blood pressu...

Introduction: Regimens for pre-operative α and β-blockade for patients with secretory phaeochromocytomas/paragangliomas vary widely between centres. The worldwide lack of availability of intravenous phenoxybenzamine (Goldshield) has removed a useful tool in the management of phaeochromocytoma crisis and has necessitated a change in our institution’s routine pre-operative strategy. We compare pre, peri and post-operative surrogate measures of blockade in a cohort...

A 62-year-old lady was assessed following discovery of a retroperitoneal tumour on a CT scan. Fifteen years previously she was diagnosed with irritable bowel syndrome with alternating constipation and diarrhoea, however, within the last 5 years, diarrhoea was the dominant feature with bowel opening every 20 min daily. Investigations for inflammatory bowel disease, hyperthyroidism and coeliac disease were negative. Her anal sphincter was found to be non-functioning and a colost...

Prior to May 2011, we ran four separate consultant-led endocrine services with six-eight new patient referrals identifiable per week with hyperthyroidism. These were seen ‘ad hoc’ in general endocrine clinics, where their needs were not prioritised compared to other endocrine referrals, resulting in concern around the timeliness of their care.We identified 203 patients under active follow-up (FU) (active=on anti-thyroid medications or within 6 ...

Postural orthostatic tachycardia syndrome (PoTS) reflects a disturbance of autonomic function leading to a myriad of clinical features. Subcutaneous octreotide injections and intramuscular long acting preparations of octreotide have been used in the treatment of PoTS. However, inconvenience of frequent injections, side effects and theoretical overexposure, as well as cost of the intramuscular preparation, makes them far from ideal.We present a case of un...

Primary hyperparathyroidism (PHPT) is a common condition, affecting approximately 1% of the general population. In women of childbearing age, the correct diagnosis and management is particularly important since PHPT is associated with miscarriage, pre-eclampsia, intrauterine growth restriction, preterm delivery and postpartum neonatal hypocalcaemia. We describe a case series of six women diagnosed with PHPT and their management during pregnancy. In four cases, the PH...

A 60-year-old woman was referred with a 14 mm right adrenal mass on a contrast CT abdomen whilst being investigated for left iliac fossa pain and increased bowel frequency. She reported a 2-year history of anxiety attacks, poor sleep, excessive sweating and weight loss. She had hypertension, asthma and recurrent vasovagal syncope and had previously undergone an open cholecystectomy. Her medications included Lansoprazole, Salbutamol, Losartan, Citalopram and Diltiazem. Systemic...

Whilst bariatric surgery is the most effective therapy for idiopathic morbid obesity in adults, little is known about its effectiveness in patients with monogenic obesity syndromes. We report 5-year outcome of gastric bypass surgery in a young man with severe super-obesity associated with melanocortin four receptor (MC4R) mutation.A 22-year-old male with a weight of 221.6 kg and BMI 76.7 kg/m2 was referred to our centre for bariatric surgery. ...

Hyponatraemia is the commonest electrolyte disorder in hospitals and frequently encountered in patients with heart failure (HF). Elevated circulating levels of arginine vasopressin AVP correlate with disease severity with higher levels in decompensated HF. The activation of AVP from posterior pituitary is mediated through pressure sensitive baroreceptors by impaired cardiac output resulting in increased passive water reasorption in the kidneys with resultant hyponatraemia. Thi...

A 32-year-old gentleman, of South-Asian origin was admitted with a 4-week history of abdominal pain, nausea and vomiting. He also had history of polyuria, polydipsia and weight loss over 6 weeks. Just prior to these symptoms he had been started on colecalciferol 20 000 units weekly by his GP for Vitamin D deficiency (25(OH) Vitamin D – 10.3 nmol/l (48–145)). On admission he had adjusted calcium of 4.52 mmol/l and acute kidney injury with his eGFR being 38 ml/min per ...

A 48-year-old man was referred for investigation of uncontrolled hypertension on four agents (olmesartan, felodipine, hydrochlorothiazide and spironolactone) and a 3 cm right-sided adrenal adenoma (pre-contrast Hounsfield units 25). Endocrine investigation for the hypertension and adrenal mass included: androstenedione 19.9 nmol/l 2.8–10.5) (elevated on two occasions on a Siemens Coat-A-Count assay), DHEA 0.7 μmol/l (2.1–15.2), 1 mg overnight dexamethasone suppr...

A 73-year-old independent female presented with reduced consciousness following a tonic-clonic seizure. Investigations revealed acute hyponatraemia, with a serum sodium of 103 mmol/l. Cortisol reserve and thyroid function was normal and the biochemical diagnosis was consistent with SiADH. A CT brain scan was normal. Hypertonic saline was commenced with empirical anti-viral and antibiotic therapy. Lumbar puncture revealed a slightly elevated CSF protein and her EEG showed non-s...

We report two cases of hypernatraemia with reset osmostat and pituitary dysfunction.A 35-year-old male was referred with Graves’ thyrotoxicosis associated with hypokalaemic periodic paralysis and an incidental serum sodium 154 mmol/l. He complained of polyuria and nocturia but denied excessive thirst and was otherwise well. Height was 193 cm with BMI 29.5. He had gynaecomastia and sparse body hair. He had a small 6 ml right testicle (originally und...

Introduction: Over 9000 bariatric surgeries are conducted annually in the UK and post-operative micronutrient deficiency is common. We report a case of dry beriberi secondary to thiamine deficiency following Roux-en-Y bypass surgery.Case presentationA 45-year-old Caucasian obese lady (155 kg, BMI 57) presented with progressive proximal limb weakness, upper and lower limb paraesthesia, ataxia and athetoid tremors 18 months following...

Introduction: 85% of cases of primary hyperparathyroidism are caused by a parathyroid adenoma. These are usually small in size, in the range of 70 mg to 1 g. Those weighing more than 2 g are classified as ‘giant adenomas’. Few adenomas weighing more than 30 g have been described in the literature. Here we present one such case.Case report: A 52-year-old female presenting with lethargy was found to have a corrected calcium of 3.15 mmol/l with a ...

Introduction: Vitamin D deficiency is common in ethnic minority population living in UK. It is a relatively easily treatable condition. However, if left untreated it may lead to chronic secondary hyperparathyroidism and onto tertiary hyperparathyroidism. We report three cases of severe vitamin D deficiency who presented with hypercalcaemia.CasesWe report three patients. 60 and 46 years old ladies, both of south-asian origin, a 46 y...

Introduction: We report a patient with hypercalcaemia secondary to parathyroid hormone related peptide (PTHrp) from metastatic oesophageal cancer and co-existing primary hyperparathyroidism.Case report: A 52-year-old lady was admitted to the hospital with a 2-week history of right scapula pain, reduced appetite and weight loss.Blood test revealed an adjusted calcium of 3.99 nmol/l (NR 2.1–2.55 nmol/l), PTH of 147 ng/l (NR 15&#...

A 53-year-old caucasian female presented with tremor, palpitations, sweating, breathlessness and chest discomfort. Examination revealed a non-tender, large diffuse goitre and TFT showed an elevated T4 and undetectable TSH. Thyroid antibodies were elevated; 115 IU/ml (NR <35) and thyroid ultrasound confirmed diffuse vascular goitre. Patient was diagnosed with thyrotoxicosis with a likely aetiology of Grave’s disease.Carbimazole was com...

A 58-year-old female presented with a 20-year history of resistant hypertension and hypokalaemia, with normal renal function. Investigations confirmed primary hyperaldosteronism that was not suppressed following a standard saline infusion test. CT scanning revealed a right-sided adrenal mass of 1.3 cm, with a signal intensity of −1 HU. The left adrenal was normal in appearance. A LDDST excluded ACTH-independent Cushing’s syndrome. Adrenal vein sampling confirmed rig...

Succinate dehydrogenase subunit B (SDHB) mutations are associated with a high risk of developing pheochromocytomas, paragangliomas and renal cell tumours. The risk of malignancy is also higher than that of other SDH mutations.A 23-year-old woman was referred to endocrine clinic following confirmation of an SDHB mutation. Her family was screened when a relative underwent a medical, prior to starting a new job, and a significant family history of renal tum...

A 39-year-old female presented with an 18-month history of borderline hypertension, headaches, palpitations and some anxiety symptoms. Both parents also had hypertension. Blood pressure was 160/102 on no medications. She had a large single cafe au lait spot but no neurofibromata. Urinary dopamine levels were repeatedly elevated (5398–8653 nmol/24 h (n<3900)) with normal noradrenaline and adrenaline levels. Serum calcium was also elevated at 2.83 mmol/l (n...

Background: Lithium-associated hyperparathyroidism (HPT) is an under-recognised side effect of chronic lithium therapy. Cessation of lithium may precipitate relapse of psychiatric illness. Potential treatment with cinacalcet has been described in two case series recently.Aim: We present two cases of HPT secondary to lithium therapy used for bipolar affective disorder, which were successfully managed with cinacalcet.Results: Patient...

In May 2011 a 55-year-old South East Asian man had a tumour removed from the floor of his mouth. The histology was consistent with a brown tumour of hyperparathyroidism. His PTH was raised at 12.3 pmol/l (NR 1.6–7.5) and he was referred to the endocrinology clinic. His serum calcium was 2.22 mmol/l (NR 2.2–2.6 mmol/l) and his serum 25 (OH) vitamin D level was <15 (NR >50 nmol/l) with a normal alkaline phosphatase. He had no symptoms of osteomalacia. He is a v...

A 55-year female from low economic background was referred from the local dental hospital where she had presented with a swelling near her left lower 3rd molar which caused her significant difficulty in eating. On further questioning she conceded to having progressive difficulty in walking and bony pains over the past 6 months with increasing dependency for daily activities. She was frail with proximal muscle weakness and widespread bony tenderness but no other significant neu...

Introduction: We submit a rare presentation of pheaochromocytoma in pregnanacy, diagnosed just before delivery, posing complex management difficulties.Case presentationA 24-year-old primipara had headache, hypertension and visual disturbance but without any palpitations or diaphoresis. Her headache was persistent during pregnancy. Investigations at 39 weeks of gestation showed normal plasma Normetadrenaline at 885.0 (120–1180)...

A 73 years old gentleman with a diagnosis of mesothelioma presented with symptoms typical of hypoglycaemia. Other than the expected abnormal chest signs there were no significant examination findings.Capillary glucose was unrecordable; lab testing confirmed serum glucose of 0.9 mmol/l. He had no history of diabetes mellitus or any medication that may induce hypoglycaemia. There was a slight rise in CRP and white cell count was elevated. There was no clin...

A previously fit and well 49-year-old gentleman presented to hospital with vomiting and myalgia. Three weeks previously he had been admitted with acute pancreatitis, but no cause was found. An incidental hypercalcaemia was also noted at that time. He had lost approximately two stone in weight in the previous three months and had become more short of breath on exertion. He had a strong family history for type I diabetes mellitus, but otherwise there was no significant history.<...

A 38-year-old man presented on the acute medical take with a week’s history of sore throat, dysphagia, neck swelling, and fever. One month prior he had suffered a respiratory tract infection, which resolved without antibiotics. He had no notable past medical and family history. He was a non-smoker and drank 15 units of alcohol per week. On examination he looked well, was afebrile, sweaty and flushed; chest was clear, heart sounds were normal, regular pulse (110 bpm) and B...

Parathyroid cysts are rare, usually asymptomatic and typically present as a neck lump. They are most commonly detected in middle-aged women and can occasionally present with compressive symptoms. True parathyroid cysts are non-functional and benign in nature, allowing a more conservative approach to their management in many patients. We present the case of an 82-year-old lady with a past medical history of a presumed parathyroid cyst which was drained by the ENT surgeons. Thre...

Objective: To report a case of tuberous sclerosis presenting with hyperprolactinemia.Methods: Clinical, laboratory and radiographic data are reported on a 26-year-old female presenting with galactorrhea and menstrual irregularities.Case report: A 26-year-old female with no premorbidities presented with complaints of galactorrhea for the past 10 days and menstrual irregularities over the past six months. Galactorrhea was spontaneous...

A 20-year-old man with a 5-year history of poorly controlled type 1 diabetes presented with epigastric pain, bloating and weight loss. He had attended DAFNE recently and had been commenced on an insulin Pump resulting in improvement of HbA1C from 114 to 76 mmol/mol over a 4-month period. Blood pressure was elevated (157/108 mmHg) with a resting tachycardia of 110. Haemoglobin was elevated at 18.7 g/dl. 24 h blood pressure monitoring revealed an average diastolic blood pressure...

An 89-year-old female family physician presented to an orthopaedic surgeon with a short history of aches and pains. She was suspected to have vitamin D deficiency and was empirically prescribed three intramuscular injections of 6 million units of cholecalciferol at monthly intervals. A few days after the third dose she presented with nausea, generalised weakness, confusion and ataxia. She appeared drowsy and dehydrated. Vital parameters were normal and there were no focal neur...

Introduction: Graves’ thyrotoxicosis and Addison’s disease are disorders with a strong auto-immune basis. Primary hypothyroidism and Addison’s disease are recognised components of polyglandular autoimmune syndrome type II (PGA-II). Despite its autoimmune etiology, Graves disease is not commonly associated with PGA-II. We present a case of a patient with newly diagnosed Graves’ disease presenting in incipient adrenal crisis due to unrecognized Addison’s...

Introduction: Non-islet cell tumour hypoglycaemia (NICTH) is an uncommon but serious complication of disseminated malignancy. The underlying aetiology of hypoglycaemia is tumoral overproduction of IGF2, which results in stimulation of insulin receptors and increased glucose utilization. Extensive tumour burden involving the liver and adrenal glands can also cause severe hypoglycaemia.Case report: An 80-year-old man presented acutely in an unresponsive st...

Introduction: Central pontine myelinolysis, CPM classically occurs in alcoholics, malnourished and elderly, few days following rapid correction of hyponatraemia resulting in permanent neurological squeal. We described two cases of CPM occurring in alcoholics after 3 weeks of hospital admission with complete recovery of gross neurological signs.Case 1: 24-year-old male, known alcoholic, was admitted with left hemiplegia and features of bulbar and pseudobu...

A 75-year-old female presented with increasing drowsiness and no other specific features. Past medical history included the antiphospholipid syndrome, three episodes of myocardial infarction, left ischaemic leg, epilepsy, hypothyroidism and splenectomy. Medications included warfarin. Examination showed pulse 70/min, blood pressure 120/60 mmHg, crepitations at the left lung base, a Glasgow Coma Scale 14/15. Investigations revealed serum sodium 117 mmol/l, urea 8.8 mmol/l, serum...

Background: Primary hyperparathyroidism (PHPT) and concomitant medullary thyroid disease is well described in literature as part of multiple endocrine neoplasia. However, coexistence of PHPT and papillary thyroid cancer (PTC) has only been scarcely documented in sporadic case reports and some surgical series.We present two unusual cases of PHPT associated with synchronous multifocal PTC.Cases: A 62-year-old woman with sporadic PHPT...

A 37-year-old gentleman was admitted following a GP referral for asymptomatic hypercalcaemia. His adjusted calcium was raised at 3.27 mmol/l while phosphate level was normal. The only past medical history was borderline hypertension which was being monitored in primary care. His PTH level was suppressed at 0.43 pmol/l l (1.1–5.5) while 25(OH) Vitamin D was normal at 71.6 nmol/l (48–145). Twenty-four hours urinary metadrenalines were normal. His full blood counts were...

We report two cases with initial presentation of sudden onset ophthalmoplegia in i) a patient recently diagnosed with breast carcinoma and ii) a patient subsequently diagnosed with carcinoma lung. The first patient (68 years) was referred to the tertiary endocrine unit with a 2 weeks history of visual loss associated with 3rd cranial nerve palsy in her right eye and with a temporal hemianopia in her left eye. MRI showed an enhancing sellar and suprasellar mass. Initial biochem...

Background: Acute adrenal insufficiency is a life threatening condition. Signs and symptoms are often non-specific. The adrenal gland has the richest arterial supply of any tissue with limited venous drainage and this mismatch predisposes to haemorrhagic infarction. We present a case report of acute adrenal insufficiency due to bilateral adrenal haemorrhagic infarcts associated with an open ankle fracture.Case history: A 52-year man fell from a ladder su...

We present the case of a 73-year-old woman, who presented with ascites and a history of left radical hemithyroidectomy for localized follicular thyroid carcinoma (FTC) 28 years ago. Computed tomography (CT) scanning of her body revealed extensive metastatic lesions. An omental biopsy showed features suggestive of thyroid follicular epithelial cancer. Serum thyroglobulin was raised at 127 μg/l. She died before the biopsy result was received. Two years before presentation, ...

A 59-year-old gentleman presented to the Medical Admission Unit with facial and ankle oedema following a dog bite. He did not have any significant past medical history. Initially, he was treated for angioedema. His oedema worsened to anasarca, blood pressure rose and was found to be hypokalaemic. Echocardiogram showed a normal left ventricular ejection fraction. Urine protein creatinine ratio was <0.5 g/24 h. Vasculitic and autoimmune screen were negative. Eight weeks late...

Objectives: Diabetic ketoacidosis (DKA) remains a life-threatening emergency. An updated protocol was introduced in Sligo general hospital in 2009 to standardise DKA management. The aim of this study was to audit current practice against the protocol standards.Methods: Clinical notes of all adult patients admitted with DKA between July 2009 and June 2012 were analysed and retrospectively audited against the protocol.Results: Fifty-...

Background: Adrenocortical tumours (adenoma or carcinoma) present in well-recognised ways: hormones excess (Cushing’s, Conn’s, virilisation) or hormonally silent with symptoms of mass effect, or found incidentally on imaging. We present 3 cases of adrenal tumours, referred to our regional adrenal multidisciplinary meeting with unusual presenting features.Case 1: post-menopausal bleeding: A previously well 57-year-old female presented with vagin...

Introduction: Symptomatic hypogonadism affects 5–6% of men aged 30–79 years and is associated with increased morbidity and mortality. There are currently no trust guidelines for the diagnostic workup of these patients.Methods: Retrospective analysis was performed of diagnosis and assessment of adult men with low serum total testosterone (TT) and compared with clinical practice guidelines of The Endocrine Society. We identified all patients with...

A 28-year-old man of Asian origin presented with fever, cough and weight loss over 4 weeks. He had symptoms of worsening headaches and vomiting. The chest X-ray was normal and due to persistent headache and vomiting a lumbar puncture was performed following a normal CT head scan. The CSF findings confirmed the diagnosis of tubercular meningitis and the patient received a complete course of anti tubercular treatment. Six months later he was readmitted with visual blurring, a di...

A 33-year-old lady reported a 6 months history of sweating and worsening palpitations especially after taking sotalol. She had a history of congenital heart disease (double inlet left ventricle, pulmonary valvular stenosis, ventricular septal defect, and Fontan connection surgery at 18 years); Blue Bleb Syndrome with chronic gastrointestinal blood loss, and recurrent pulmonary emboli. She required long-term warfarin treatment and regular blood transfusions. She was found to ha...

Adrenal incidentalomas are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in a number of investigations usually conducted in the Endocrinology clinic.In 2011 we audited the prevalence and management of adrenal incidentalomas identified on abdominal CT imaging over one calendar month in our centre. Consequently, a decision pathway for new adrenal lesions was introduced in the Radi...

Prader–Willi syndrome (PWS) is a genetic syndrome caused by a disorder of chromosome 15 (q11–13) are deleted or unexpressed on the paternal chromosome. It affects both sexes equally.Characteristics of PWS include hypotonia, hyperphagia with excessive weight gain, short stature delayed puberty and hypogonadism. Individuals with PWS are at risk of learning and attention difficulties.Most adults with PWS have deficiencies of...

Primary hyperparathyroidism (PHP) during pregnancy is associated with high risk of maternal, foetal and neonatal mortality. Maternal and foetal complications have been reported in 67 and 80% of cases respectively. Guidelines for the management of PHP in adults exist, but there is no clear consensus regarding optimal management of PHP during pregnancy. We describe a case of PHP managed conservatively during pregnancy, resulting in the delivery of a healthy baby.<p class="ab...

Introduction: Primary hyperparathyroidism (PHPT) can only be cured by parathyroidectomy (PTX) but mild and asymptomatic cases can often be managed conservatively. We carried out a retrospective audit of patients attending the Endocrine clinic at Watford to determine how our practice compared with the different guidelines for surgical referral published in the USA and the UK.Method: A search was carried out of clinic letters from Jan 2010 to Oct 2011. Add...

We report potential effects of antituberculosis (TB) treatment on vitamin D metabolism in the immediate postoperative period following total thyroidectomy.A 50-year woman of Chinese origin was incidentally found to have papillary thyroid carcinoma with local nodal metastasis following FDG–PET imaging done to assess nature of lung nodules on chest X-ray and CT chest. The nature of lung lesion was uncertain and commenced on empirical TB treatment (fou...

Objective: To present a patient with long standing type 2 Diabetes complaining of chronic pelvic pain, due to an uncommon cause of bilateral vas calcification.Methods: Clinical, laboratory and radiographic data are reported on a 62-year-old diabetic presenting with chronic pelvic pain.Results: A 62-year-old man with a history of 17 years of diabetes presented with chronic dull aching, non radiating pain in the pelvis and in the reg...

Background: A 58-year-old male known to have hypertension since 2002 was initially treated with Furosemide and Bendroflumethiazide but was stopped due to hypokalemia. Blood pressure was controlled with Ramipril, Atenolol, Doxazocin and Amlodepine. He was found to be persistently hypokalemia ranging from 2.7 to 3.3 mmol/l.Investigations: Aldosterone: 250 ng/l, renin: <2.3 mU/l, aldosterone:renin ratio: >108, 24 h urine catecholamines×2: norma...

This 23 years old man was noted incidentally to have bilateral adrenal calcification on CT scan of his abdomen for chronic abdominal pain. He had normal growth and milestones with no neonatal events. Aged 10 years he was admitted briefly to a high dependency unit with circulatory shock and hyperthermia, with isolation of Streptococcus mitis from blood culture. One year later he was noted to have bilateral adrenal calcification on abdominal XR, and a short Synacthen (250 μ...

We present a 45-year-old lady who initially presented with neurological symptoms and MRI was noted to show asymmetry of the pituitary gland. There were no endocrine symptoms. In 2011 she developed some visual symptoms (not typical of pituitary disease) and was referred to the ophthalmic department. MRI scan showed an 11 mm right-sided pituitary lesion and she was referred to the endocrine department. She gave a 2-year history of feeling increasingly unwell with back pain, sens...

Introduction: Ectopic ACTH syndrome (EAS) is associated with small cell carcinoma of the lung. It is reported as a rare condition. Here we report three cases of undiagnosed bronchogenic carcinoma who presented with EAS within a period of 12 months.Case 167-year-old lady, smoker, presented with severe proximal myopathy of 4 week duration. Clinically she appeared cushingoid. Newly diagnosed Type two diabetes. Lab tests – potassi...

Case: A 73-year-old Pakistani gentleman with known hypertension and type two diabetes mellitus initially presented to hospital hypotensive, with epigastric pain and vomiting. An abdominal CT confirmed no abdominal aortic aneurysm, but discovered incidental findings of a 5.5×3×3.7 cm left-sided adrenal mass and a 1.5 cm gallbladder stone. He was treated for suspected cholecystitis and 24-h urinary free catecholamines requested. Unfortunately he was lost to follow-up.<...

Background: Thyroid dysgenesis (TD) represents a heterogeneous group of conditions and accounts for 85% of cases of congenital hypothyroidism (CH). This can be due to abnormal gland organogenesis which results in thyroid agenesis (35–40% of the cases), thyroid hypoplasia (5%) and thyroid ectopy (30–45%).Causes of CH can be classified into: one. dyshormonogenesis usually associated with goiter, caused by mutations in the genes coding for the pro...

Aims: To identify any improvements in BMD on NICE recommended treatments in patients with osteoporosis. Also to identify how many patients were taking calcium and vitamin D.Methods: Retrospective audit of 31 patients who had a DEXA scan between June 2011 and October 2012 at Birmingham City Hospital. Patient information was gathered from electronic data base (Clinical Data Archive). Inclusion criteria was at least two DEXA scan T-scores results, ...

A 54-year-old Asian man with type two diabetes diagnosed 6 years ago was admitted to hospital in May 2011 because of deteriorating renal function. His eGFR had been stable until April 2011 when his eGFR dropped from 37 in January 2011–2021. Repeat eGFR 2 weeks later was 17 and his family doctor felt he needed to be admitted to hospital. He was on metformin alone which was stopped. His HbA1c was 6.4% (48 mmol/mol). He had hypertension and was on four antihypertensive agent...

A 59-year-old gentleman with schizoaffective disorder, treated with long-term lithium therapy and depot fluphenazine, underwent elective cystectomy and ileal conduit formation for transitional cell bladder carcinoma.Post operatively, he developed acute renal impairment, evidenced by a fall in eGFR from 68 to 26 ml/min per 1.73 m2. This resulted in accumulation of lithium to a toxic level of 1.82 mmol/l (0.4–1.0); despite stopping lithium,...

Introduction: Endocrinopathy is frequently seen in systemic amyloidosis and commonly involves thyroid and gonads. We report a case of primary adrenal failure secondary to systemic light chain amyloidosis (AL), involving kidney, liver, spleen, gut, nerves and tongue.Case: A 42-year-old Somalian lady presented with 2-year history of lethargy, febrile episodes and 21 kg weight loss. Investigations showed increase in serum lambda light chain 103 mg/l (5.7&#1...

Nesidioblastosis is a well recognized cause of persistent hyperinsulineamic hypoglycemia of infancy. Regardless of the pancreatectomy procedure used, hypoglycaemia may recur during long term follow up. We describe a challenging case of recurrent hypoglycaemic episodes in a young adult.We describe a 33-year-old landscape gardening laborer with history of insulin treated diabetes diagnosed at the age of 3 weeks old following subtotal pancreatectomy for nes...

Case: 81-year-old male with history of insulin-dependent diabetes mellitus (diagnosed in 1984, HbA1c of 8.9%), hypertension presents to the emergency department with 6 days of worsening nausea, vomiting and abdominal discomfort to the point where he couldn’t tolerate any oral diet. He was admitted thrice in the last year with similar complaints. A routine evaluation was always done including X-ray, routine endoscopy which showed gastroparesis and no abnormal cytology in b...

Insulin pump is one of the treatment options for patients with type 1 diabetes mellitus. In July 2008, NICE has issued Technological Appraisal (TA 151) regarding insulin pump therapy guidance.Objective of the audit: To measure current practice in Colchester General Hospital in continuous subcutaneous insulin infusion – CSII (insulin pump) for the treatment of diabetes mellitus against the recommendations in the technological appraisal (TA 151).<...

Case history: A 27 years old lady having presented with a neck mass, underwent a total thyroidectomy for thyroid malignancy in 1967. Histology confirmed papillary carcinoma of the thyroid. In 1968, she complained of tiredness and mild neck swelling despite TSH suppressive therapy. Her thyroid uptake study showed a residuum of thyroid tissue within the neck. She went on to have radioiodine ablation therapy on two separate occasions. She responded well with no evidence of residu...

A 83-year-old gentleman admitted with nausea and feeling generally unwell. Past medical history of hypertension, duodenal ulcer, previous gastric surgery, polymylagia rheumatica and type two diabetes mellitus. Chest XR showed right basal pneumonia which was treated with antibiotics. Patient admitted to significant weight loss therefore he had thoracic-abdominal CT scan performed which showed 4 cm by 4 cm solid cystic lesion in the left adrenal gland possibly malignant. Subsequ...

Case: A 43 years old female with a PMHx of Graves disease initially treated with methimazole (discontinued due to arthralgias) and started on propylthiouracil (PTU). Three years ago she went into remission and the PTU was stopped. About 6 weeks ago, the patient started experiencing typical symptoms of hyperthyroidism including palpitations and hot sweats so she was restarted her on PTU. Patient started noticing fever, chills, myalgias and dry cough. In the hospital her Tempera...

We present this case of a 7-year-old female who had been well, without fever, polyuria or polydipsia, nor temperature intolerance. There was no known family history of auto-immune disorders. Physical exam was unremarkable but further labs revealed hyperglycemia (329 mg/dl), venous pH 7.37, glycosuria (no ketonuria). Her hyperglycemia resolved with intravenous and then subcutaneous insulin. Further labs revealed glutamic acid decarboxylase antibodies to be high (>30.0), and...

A 53-year-old lady of African origin presented to the emergency department with a 2 months history of watery diarrhoea associated with anorexia, general deterioration and weakness. She had lost 10 kg over 2 months. There was no history of recent travel abroad. Her past medical history included a cardiac arrest in 2000 (hypertrophic cardiomyopathy) and she had an internal defibrillator implanted for Brugada-like syndrome. She had hypertension since 1999 and it was noted that sh...

A 56 year old female who was referred to the Endocrine clinic with a history of progressive anterior neck swelling, weight gain, memory impairment and sluggishness. On examination she was found to be pale, had an anterior neck mass which moved with swallowing but not with tongue protrusion, is diffuse, firm non tender, measuring 8 × 6 cm. There was associated submandibular lymph node enlargement.Her thyroid function test revealed primary hypothyroid...