Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2014

Poster Presentations

Clinical practice/governance and case reports

ea0034p52 | Clinical practice/governance and case reports | SFEBES2014

Clinical application of the levothyroxine absorption test

Butt Muhammad , Gupta Nidhi , Greenfield Fiona , Waheed Najeeb

Background: Poor adherence with thyroxine treatment is a common problem faced by endocrinologists the world over. Abnormally elevated TSH levels, with rising levels of treatment is an ongoing management challenge, especially with patient insistence of compliance. There are a number of investigative tools advocated. We present a case managed through an observed thyroxine absorption test.Methods: A 36-year-old woman was referred by her primary care practit...

ea0034p53 | Clinical practice/governance and case reports | SFEBES2014

Recurrent hypomagnesaemia, tackling modifiable risk factors

Alhelfi Moayed , Demssie Yared N

A 68-year-old lady presented to the medical assessment unit with history of muscle cramps involving both hands and legs of 5 days duration. She also gave a history of diarrhoea of 2 weeks duration. Her background medical history includes hypertension, hypercholesterolemia and dyspepsia for which she was taking Irbesartan/hydrochlorothiazide combination tablets, simvastatin and omeprazole.General physical examination revealed positive Chovstek’s and ...

ea0034p54 | Clinical practice/governance and case reports | SFEBES2014

Thyrotoxicosis after severe hypothyroidism in a patient with a history of Hodgkin's lymphoma and neck irradiation

Lewandowski Krzysztof , Dabrowska Katarzyna , Makarewicz Jacek , Lewinski Andrzej

Background: Neck irradiadion is associated with several complications including both hypo- and hyperthyroidism. We present a case of severe hypothyroidism, followed 5 years later by thyrotoxicosis.Case description: A 27-year-old female presented with clinical and biochemical thyrotoxicosis (TSH 0.01 μIU/ml (ref. range: 0.27–4.2 μIU/ml); FreeT4 1.58 ng/dl (ref. 0.98–1.63 ng/dl); FreeT3 4.56 pg/ml (ref. 2.6–4....

ea0034p55 | Clinical practice/governance and case reports | SFEBES2014

Large testicular adrenal rest tumours in a patient with congenital adrenal hyperplasia: a consequence of poor drug compliance

Rajkanna Jeyanthy , Oyibo So

Introduction: Testicular adrenal rest tumours (TART) are benign corticotrophin-dependent tumours that occur in males with congenital adrenal hyperplasia (CAH). We present a patient with bilateral large TART as a consequence of poor compliance to treatment and follow-up for his CAH.Case: A 25-year-old gentleman presented to the endocrine clinic in 2009 with a history of tiredness, reduced libido and bilateral large testicles, which he wanted surgically re...

ea0034p56 | Clinical practice/governance and case reports | SFEBES2014

A case of precocious puberty in a 4-year-old boy: differential diagnosis and treatment goals

Kirton Ella-Grace

Introduction: Precocious puberty is uncommon in males and presents an interesting differential that can be narrowed down by an understanding of endocrine physiology. This case illustrates this and also led the author to explore the research basis for the treatment goals in this condition.Case: A boy of 4½ years was referred to paediatric endocrinology clinic due to concerns about tall stature and pubic hair growth noted over the last 2 months. His p...

ea0034p57 | Clinical practice/governance and case reports | SFEBES2014

Fixed dose radioactive iodine treatment for hyperthyroidism: experience of a district general hospital

Manjunatha Rashmi , Harris Katherine , Nawaz Sarfraz , Mahto Rajni , Horrocks Peter

Background: The short- and long-term clinical outcome of patients receiving radioactive iodine treatment (RAI) differs in various studies. There is little consensus regarding the most appropriate dose of RAI to be administered. The range of activities currently prescribed varies between 200 and 800 MBq, with majority of patients receiving 400–600 MBq. In our centre, all patients receive a standard fixed dose of 400 MBq.Aim: To assess the cure rate w...

ea0034p58 | Clinical practice/governance and case reports | SFEBES2014

Investigation of inpatient hyponatraemia in a teaching hospital

Tzoulis Ploutarchos , Nair Devaki , Leyland Rebecca , Woolman Emma , Martin Nick , Bouloux Pierre Marc

Introduction: Hyponatraemia is the most common electrolyte disorder in hospitalised patients and is associated with significant morbidity and mortality.Methods: This retrospective study included all inpatients with serum sodium (sNa) ≤128 mmol/l at any point during hospitalisation at a teaching hospital over a 3-month period (1st March 2013 to 31st May 2013). Demographic, clinical and laboratory data obtained from patients’ case notes and labo...

ea0034p59 | Clinical practice/governance and case reports | SFEBES2014

Unexpected adrenocortical carcinoma 8 years after diagnosis of adrenal incidentaloma

Yadagiri Mahender , Barton David

Adrenal incidentalomas (AI) are incidentally discovered adrenal masses on imaging studies requested for reasons unrelated to adrenal pathology with a prevalence of 8% in autopsy and 4% in radiologic series. Although most AI are non-functioning benign adenomas, their increasing prevalence presents diagnostic and therapeutic challenges. We report a case of adrenocortical carcinoma (ACC) in an asymptomatic 83-year-old man, 8 years after being diagnosed with AI. ACC is an uncommon...

ea0034p60 | Clinical practice/governance and case reports | SFEBES2014

Characteristics, comorbidities and aetiology of hospitalised patients with hyponatraemia

Tzoulis Ploutarchos , Bouloux Pierre Marc

Introduction: Hyponatraemia is the most common electrolyte abnormality encountered in hospitalised patients.Methods: This retrospective study included all inpatients with serum sodium ≤128 mmol/l at any point during their hospital stay between 1st March 2013 and 31st May 2013. Full review of medical case notes and laboratory results was undertaken in order to determine the comorbidities, drug history and aetiology of inpatients with hyponatraemia.<...

ea0034p61 | Clinical practice/governance and case reports | SFEBES2014

Endocrine complications of thalassemia and its treatment: a local experience

Deller Serena , Mistry Radhika , Burbridge Wyn , Pancham Shivan , Wright Christine , De Parijat

Introduction: Treatment of β thalassemia major results in excessive iron deposition in most tissues including the endocrine glands.Aim: To find out the prevalence of endocrine complications in our thalassemia-endocrine clinic as set out by the UK thalassemia society guidelines.Methods: Clinic notes and electronic results of all patients attending Birmingham City Hospital for the 2-monthly thalassemia-endocrine MDT clinic (2010...

ea0034p62 | Clinical practice/governance and case reports | SFEBES2014

Juvenile granulosa cell tumour of the ovary presenting with hyperprolactinaemic amenorrhoea and galactorrhoea

Iqbal Ahmed , Lubina-Solomon Alexandra , Webster Jonathan

Background: Ovarian granulosa cell tumours are rare, aggressive, hormonally active neoplasms.Case: A 16-year-old, nulliparous, Eastern European woman presented with a 9-month history of secondary amenorrhoea and a 2-month history of galactorrhoea. She denied headache or visual symptoms. Past medical history was unremarkable with menarche at age 14 and a previously normal menstrual cycle. She had never used hormonal contraception. Only medications were pa...

ea0034p63 | Clinical practice/governance and case reports | SFEBES2014

Analysis of hyponatraemic inpatients who died in a teaching hospital

Tzoulis Ploutarchos , Bouloux Pierre Marc

Introduction: Hyponatraemia is associated with increased inpatient mortality, but there is debate about whether hyponatraemia per se contributes to mortality or is merely an epiphenomenon of severe illness.Methods: This retrospective review of medical records included all inpatients with serum sodium (sNa)≤128 mmol/l who died at a teaching hospital over a 3-month period. The aim of this study was to examine the clinical course and the pote...

ea0034p64 | Clinical practice/governance and case reports | SFEBES2014

Elevated hounsfield units and large tumour size on radiological imaging are both suggestive of functionality in incidental adrenal tumours

Abraham Dilip , Raasz Jadwiga , Kearney Edward , Joseph Stonny

Widespread use of CT and MRI scan has led to the identification of incidental adrenal tumours. The need to determine functionality often results in a battery of investigations that are a drain to scarce resources and are frequently normal. Studies to identify tumour radiological features that suggest functionality and hence enable targeted investigations are few in the literature. To this effect we set out to analyse which features on imaging that are best predictive of functi...

ea0034p65 | Clinical practice/governance and case reports | SFEBES2014

Spontaneous hypoglycaemia in a non-diabetic patient with insulin antibodies

Graham Una , McQuillan Laura , Lindsay John

A 58-year-old non-diabetic Caucasian man was admitted with a capillary glucose of 1.9 mmol/l following an episode of confusion and disorientation. During his admission he had frequent episodes of nocturnal and early morning hypoglycaemia with capillary glucose <3.0 mmol/l. After 21 h of supervised fasting he was symptomatic with plasma glucose 2.3 mmol/l, insulin >1000 mU/l and C-peptide 19.6 μg/l. Sulphonylurea screen was negative. Given the magnitude of serum in...

ea0034p66 | Clinical practice/governance and case reports | SFEBES2014

Severe hypercalcaemia requiring emergency haemodialysis due to postpartum hypophysitis and thyroiditis

Gao Jing Mia , Whitelaw Benjamin , Mustafa Omar , Cheeroth Salim

A 34-year-old African woman presented with a 4-month history of profound lethargy, weight loss and a 3-day history of vomiting, fever, confusion, and drowsiness. She had given birth to her third child 6 months previously. Her pregnancy and delivery were uncomplicated and she had breastfed for 5 months prior to discontinuing due to exhaustion.Investigations showed severe hypercalcaemia (4.94 mmol/l) and undetectable PTH. Hypercalcaemia was unresponsive to...

ea0034p67 | Clinical practice/governance and case reports | SFEBES2014

Parathyroid adenoma presenting solely as acute necrotising pancreatitis in an adolescent girl

Jeeragi Mallikarjuna , Zaveri Shabber , Palankar Nagaraj , Prabhakar Karthik

Parathyroid-adenoma is a rare cause of primary-hyperparathyroidism in children. We report a case where in a 15-year-old girl presented with acute necrotising pancreatitis as its sole manifestation.This high-school girl presented with 2-month history of nausea, vomiting, upper abdominal pain, and weight-loss. An episode of severe acute abdomen led to her hospitalisation. At admission, she was tachycardic, dehydrated and had tenderness in peri-umbilical ar...

ea0034p68 | Clinical practice/governance and case reports | SFEBES2014

Pseudo-secondary hyperparathyroidism due to vitamin D deficiency and coexisting familial hypocalciuric hypercalcaemia

Mitchell Anna Louise , Bliss Richard , Pearce Simon H S

A 54-year-old lady presented with malaise, weakness, and constipation. She was found to be mildly hypercalcaemia (adjusted calcium 2.68–2.76 mmol/l; reference range 2.12–2.60 mmol/l) and was referred to local endocrinology services. Her PTH was 79 ng/l (range 10–60) and a diagnosis of primary hyperparathyroidism was made. Imaging to localise a parathyroid source was negative. She was referred to the endocrine surgeons at the Royal Victoria Infirmary, Newcastle, ...

ea0034p69 | Clinical practice/governance and case reports | SFEBES2014

An unusual cause and an unusual complication of Cushing's syndrome

Ameen Zana , Kakad Rakhi , Watkinson John , Boelaert Kristien

We present a 71-year-old gentleman who was referred with a 3-month history of tiredness and proximal myopathy, diarrhoea, rapid weight loss and new onset diabetes mellitus.On examination, he had features consistent with cortisol excess including thin skin, abdominal striae, proximal muscle wasting and peripheral oedema to his thighs. Neck examination revealed a palpable 2-cm right-sided thyroid nodule.Laboratory investigations show...

ea0034p70 | Clinical practice/governance and case reports | SFEBES2014

Not every Gestational Diabetes is Mellitus!

Ameen Zana

A 21-year-old lady referred for an endocrine review from labour ward HDU after developing polyurea and polydipsia following a difficult labour which was complicated by severe post-partum haemorrhage.She was passing about 500 ml of urine per hour and drinking around ten jugs of water a day. Her bedside observations were stable and her capillary blood glucose level was 4.7 mmol/l. She was referred to ITU where she had a stat dose of IV-desmopressin. Furthe...

ea0034p71 | Clinical practice/governance and case reports | SFEBES2014

A rare endocrine cause of severe resistant hypoglycaemia

Ameen Zana

A 68-year-old lady presented to hospital with several weeks’ history of paroxysmal symptoms including sweating, pre-syncope and syncope. She also had 2 months history of weight loss. She was a chronic heavy smoker, but did not drink any alcohol and did not take any regular medications.On examination, she appeared cachectic and had a non-tender palpable liver. There were no signs of decompensated chronic liver disease. Her bedside capillary blood glu...

ea0034p72 | Clinical practice/governance and case reports | SFEBES2014

Enigma of an 18 year Acromegalic Window: what your mind knows but eyes may still miss?

Foucault Danielle , De Parijat

A 46-year-old Asian male attended our endocrine unit in April 2013 following a referral from his GP for the investigation of a neck mass. Serum TSH level was normal and USS revealed a euthyroid multinodular goiter. He mainly complained of increasingly frequent and severe headaches, polydypsia, polyuria, perspiration, and night sweats.On examination, the patient had prognathism, an enlarged and protruding tongue, thickened lips, prominent supraorbital rid...

ea0034p73 | Clinical practice/governance and case reports | SFEBES2014

Adrenal masses-a bleeding problem

Chang You-Jin , Khan Angela Alina , Arshad Sobia , Scobie Ian

Adrenal haemorrhage is comparatively rare. A 64-year-old female presented with acute right sided abdominal and chest pain shortly after a left knee replacement. She had recently started treatment dose low molecular weight heparin for presumed DVT for persistent pain in the left knee. A subsequent Doppler study of left leg was negative for DVT but an abdominal US revealed a solid lesion at the upper pole of the left kidney. CT urography showed large bilateral adrenal masses. No...

ea0034p75 | Clinical practice/governance and case reports | SFEBES2014

Stuttering priapism

Siddiqi Ahmed Imran

Introduction: Here, I present an interesting case of stuttering priapism in a 48 years old man. He was 30 years old when he was diagnosed with this condition. He is being treated with cyproterone acetate with significant improvement in his symptoms.Clinical case: A 30 years old man (now 48) presented to A&E with painful prolonged erection (priapism). He denied any history of trauma, blood disorders, use of recreational drugs, over the counter drugs o...

ea0034p76 | Clinical practice/governance and case reports | SFEBES2014

Recovery of adrenal function in confirmed Addison's disease

Baxter Mark , Gorick Sondra , Swords Francesca

Background: Addison’s disease is characterised by immune mediated destruction of the adrenal glands. This process is widely deemed to be irreversible. We present a case of confirmed Addison’s disease where adrenal function appears to have spontaneously recovered.Case report: A 37-year-old presented in 1997 with classical Addison’s disease: pigmentation, dizziness, weight loss, and nausea. There was no relevant family history. Random cortis...

ea0034p77 | Clinical practice/governance and case reports | SFEBES2014

Hypercalcaemia: a mixed family picture

Hunt Leanne , Robinson Robert , Shillo Pallia , Cranston Treena , Thakker Rajesh

Hereditary hypercalcaemia can be a diagnostic challenge. We present a family with autosomal dominant hypercalcaemia that illustrates this. A 48-year-old man was referred with asymptomatic long standing hypercalcaemia (2.8–3.04 mmol/l), with plasma PTH levels between 45 and 48 ng/l (normal 15–65), and a high urinary calcium excretion, (24 h calcium collection 10.4 mmol/l (2.5–7.5), with high calcium excretion indexes) all consistent with primary hyperparathyroidi...

ea0034p78 | Clinical practice/governance and case reports | SFEBES2014

Severe hypercalcaemia and acute kidney injury secondary to Graves’ thyrotoxicosis

Min Thinzar , Cozma Lawrance , Benjamin Silas

A 46-year-old woman presented with 2 months history of thirst, polydipsia, polyuria, constipation, three-stone weight loss, and abdominal pain. She had no other significant medical problem except from personality disorder, which was controlled with antipsychotic medications. She denied use of over-counter medications. She had been off lithium for 5 years.On examination, she was dehydrated, tachycardic and appeared anxious. She had palmar erythema, fine t...

ea0034p79 | Clinical practice/governance and case reports | SFEBES2014

Patient feedback on receiving copies of clinic correspondence

Narayanan Ram Prakash , Chiran Preeti , McNulty Steven J , Shankar Upendram Srinivas , Furlong Niall

Background and aim: The Department of Health and NHS Plan both recognise that sending patients copies of clinic correspondence can help inform and empower them. At St Helens and Knowsley Teaching Hospitals NHS Trust, Endocrinology Clinic we routinely provide patients with a copy of the clinic correspondence sent to their General Practitioner (GP), unless patients specifically opt out. Our aim was to evaluate patients’ views on receiving such copy correspondence following ...

ea0034p80 | Clinical practice/governance and case reports | SFEBES2014

Carbimazole induced agranulocytosis: a case report in the setting of a young female, on low dose and duration of treatment of more than one year

Tan Hiang Leng , Douek Isy

Introduction: The incidence of agranulocytosis with thionamide therapy is uncommon, ranging between 0.2 and 0.5 percent. Most reports document agranulocytosis after short duration of high dose Carbimazole in older patients. We report a 32-year-old lady with Graves’ disease who developed neutropaenic sepsis secondary to Carbimazole therapy on 5 mg daily and on treatment for the last 13 months.Case report: Our patient was diagnosed with Graves’s ...

ea0034p81 | Clinical practice/governance and case reports | SFEBES2014

The patient with broken heart

Solomon Alexandra Lubina , Iqbal Ahmed , Harrison Barney , Webster Jonathan , Bennet William

A 58-year-old gentlemen presented with severe neckache, sweating, feeling hot, and cold. PMH included hypertension and MI. On examination, he was clammy, with blood pressure (BP) 205/107 mmHg. Laboratory results showed leucocytosis 28.5 and TroponinT 2002 ng/l (reference range <14.0). ECG showed inferolateral ST depression. CT angiogram showed a normal aorta and a 6 cm right adrenal mass. An echocardiogram showed severe LV impairment and normal valves.<p class="abstext...

ea0034p82 | Clinical practice/governance and case reports | SFEBES2014

Do you know where the hypo box on the ward is? A revealing audit…

Willmott Michelle

Episodes of in-hospital hypoglycaemia are uncommon but serious events, which cost the NHS financially and cost the patient in terms of poor clinical outcomes, and rarely, mortality. The National Patient Safety Agency reported that in 2007, one in four adult diabetics experienced an episode of hypoglycaemia whilst in hospital. Moreover, one in 30 required i.v. glucose or i.m. glucagon therapy, and between 2003 and 2009 there were four deaths involving insulin overdose2</su...

ea0034p83 | Clinical practice/governance and case reports | SFEBES2014

Plasma 25-hydroxycholecalciferol before and after supplementation in paediatric oncology patients from Scotland: a time-series cross-sectional study

Iniesta Raquel Revuelta , Paciarotti Ilenia , McKenzie Jane , Brougham Mark , Wilson David

Background: 25-hydroxycholecalciferol (25(OH)D) deficiency is prevalent in the Scottish paediatric population. Paediatric oncology patients are at even higher risk of becoming deficient because they spend more time indoor, often have an inadequate dietary intake and increased 25(OH)D catabolism during treatment. We aimed to assess 25(OH)D and parathyroid hormone (PTH) levels before and after supplementation in Scottish children with cancer.Methods: Plasm...

ea0034p84 | Clinical practice/governance and case reports | SFEBES2014

Long-term follow-up of patients treated with tolvaptan for resistant hyponatraemia

Humayun Malik Asif , Elliot Rosina , Cummings Michael , Kar Partha , Meeking Darryl , Cranston Iain

Background: We previously published data for short-term outcomes in patients with SIADH-related hyponatraemia unresponsive to fluid restriction and treated with tolvaptan. In light of concerns over longer-term side-effects we have revisited the topic and extended both group size and follow-up period to determine longer-term safety and treatment implications.Aims/methods: We report ongoing treatment outcomes (case-note review) for 25 patients (age 71&#177...

ea0034p85 | Clinical practice/governance and case reports | SFEBES2014

A rare cause of primary adrenal insufficiency

Watt Bethany , Barwick Catrin , Searell Catrin , Wilton Tony

Primary adrenal failure is a rare disorder with a prevalence in developed countries of 93–140 per million and an incidence of 4.7–6.2 per million. Autoimmune adrenalitis is the main cause (80%) followed by tuberculosis (15%). The remaining 5% of cases represent rare disorders with bilateral adrenal haemorrhagic infarction secondary to primary antiphopholipid syndrome being very rare (0.5%).A 57-year-old female presented with a 3-week history of...

ea0034p86 | Clinical practice/governance and case reports | SFEBES2014

A feminising adrenocortical carcinoma

Watt Bethany , Wenham Sarah , Mitra Kakali , Wayte Avril , Wilton Tony

Gynaecomastia is common, occurring in 30–50% of healthy men, and its aetiology is usually benign. Clinical features inclusive of recent onset, rapid progression, and loss of libido and muscle strength, indicate the need to exclude a malignant aetiology.A 48-year-old man presented with an 18-month history of such clinical features. Investigations revealed cortisol 1136 nmol/l, 17-hydroxyprogesterone 6.6 nmol/l, androstenedione 13.3 nmol/l, DHEAS 21.8...

ea0034p87 | Clinical practice/governance and case reports | SFEBES2014

Look before you leap… An adrenal mass and elevated metadrenalines may not be phaeochromocytoma

Galloway Iona , McAulay Vincent , Ferguson Stewart

A 73-year-old female with previous tuberculosis, primary hypothyroidism, depression and caecal cancer was referred to Endocrinology when interval CT scanning reported a 2.5 cm adrenal mass, stable in size over 4 years. No symptoms or signs of hormonal production were noted. Screening tests were abnormal: post-1 mg dexamethasone cortisol was 98 nmol/l, 24-h urinary free metadrenaline was elevated tenfold (3256 nmol/24 h, range 0–350) to a concentration reported to have hig...

ea0034p88 | Clinical practice/governance and case reports | SFEBES2014

Is demeclocycline safe and effective in the treatment of SIADH?

Mongolu Shiva , Nasruddin Azraai

Background: Demeclocycline is a well-known treatment for syndrome of inappropriate ADH secretion (SIADH). We studied the use of demeclocycline for treatment of SIADH in our hospital to assess its efficacy and safety.Materials and methods: A search was performed for all discharge summaries containing demeclocycline over period of 1 year. 40 results obtained of which five were excluded as demeclocycline was mentioned but not actually used. 35 admission epi...

ea0034p89 | Clinical practice/governance and case reports | SFEBES2014

Low dose tolvpatan (7.5 mg) is effective in the management of SIADH in oncology patients (results from a retrospective audit at The Christie Hospital and Wythenshawe Pulmonary Oncology Unit)

King Jennifer , Kyriacou Angelos , Issa Basil , Taylor Paul , Higham Claire

Tolvaptan (a selective V2 receptor antagonist) is licensed for the inpatient management of SIADH induced hyponatraemia, a common complication in patients with malignancy. Licensed daily doses start at 15 mg but there is evidence that some patients have a rise in serum sodium (Na) of >12 mmol/l per 24 h in response to this. Lower initial doses (7.5 mg) may therefore be appropriate1,2.Methods: A retrospective case note audit was performed. T...

ea0034p90 | Clinical practice/governance and case reports | SFEBES2014

Teriparatide infusion for post-thyroidectomy hypocalcaemia: a case report

Hamdan Khaliq , Bashir Jawad , Khan Ishrat , Okosieme Onyebuchi , Agarwal Neera , Aldridge Andrew

Hypoparathyroidism post-thyroidectomy is a recognised complication and treated with calcium supplements, vitamin D, and rather recently with recombinant human parathyroid hormone therapy (teriparatide). We report a case of a 68-year-old female who developed refractory hypocalcaemia and hypomagnesaemia following thyroidectomy for a multinodular goitre. Her management was complicated by inflammatory bowel disease, surgically treated with an ileostomy in situ. Post-opera...

ea0034p91 | Clinical practice/governance and case reports | SFEBES2014

Kallmann syndrome, gender dysphoria, thrombophilia and multiple sclerosis: a complex case report

Renukanthan Aniruthan , Quinton Richard , Turner Ben , Korbonits Marta

A 34-year-old male with two decades of gender identity issues considered gender reassignment and attended pre-orchidectomy sperm-banking when he was found to be azoospermic. He described a history of difficulty learning to play the piano and of deep-vein thrombosis at 19 years. He was 187 cm tall with a span of 189.7 cm, and exhibited L-sided undescended testis, R testis 1.8×2.5×3.7 cm, bilateral prominent gynaecomastia, a female body habitus, micropenis, bimanual sy...

ea0034p92 | Clinical practice/governance and case reports | SFEBES2014

An audit of clinical follow-up and management of adult patients with Turner's syndrome at the Royal Devon and Exeter

Whittle Elizabeth , Donohoe Mollie , Brooke Antonia

Introduction: Turners’ syndrome (TS) affects one in 2500 live births. Multiple comorbidities affect TS patients and recommendations for long-term management advocate annual review with a ‘checklist’ approach. This audit of current practice of a specialist TS clinic aims to identify gaps in patients’ management.Methods: A checklist of recommendations for health screening based on the National Turner’s Syndrome Guidelines was devel...

ea0034p93 | Clinical practice/governance and case reports | SFEBES2014

Can a random cortisol predict outcome of short Synacthen test in non-acute patients with low pre-test probability?

Kannan Rajendran Bellan , Krishnasamy Senthil , Nayak Ananth , Jose Biju , Varadhan Laks

Background: Short Synacthen test (SST) is being increasingly used in various clinical conditions, mainly for completion purpose of ruling out adrenocortical insufficiency rather than actively suspecting it (for instance hypothyroidism with tiredness, type 1 diabetes with hypoglycaemia). The aim of our retrospective analysis was to assess if a random cortisol could predict the outcome of SST.Method: Data were collected on all SST done at the endocrine uni...

ea0034p94 | Clinical practice/governance and case reports | SFEBES2014

An unusual case of recurrent hypercalcaemia: sleeping parathyroid hyperplasia?

Graham Una , Eatock Fiona , Atkinson Brew

A 60-year-old man presented with symptomatic primary hyperparathyroidism. At this time serum corrected calcium was 3.1 mmol/l (2.15–2.65 mmol/l) and after investigation bilateral parathyroid exploration was performed. A suspected adenoma was identified in the right inferior gland and removed. The remaining glands appeared normal. The adenoma was confirmed histologically. Early post-operative calcium was normal (2.48 mmol/l).He remained well and calc...

ea0034p95 | Clinical practice/governance and case reports | SFEBES2014

Hypokalaemia attributed to liquorice use: not Allsorted!

Hunter Louise , Agarwal Shailesh , Tymms James , Pearce Sushmita

We present two patients with significant hypokalaemia initially attributed to liquorice use.Case 1: A 52-year-old engineer was noted to have a potassium level of 2.5 mmol/l (3.5–5.3 mmol/l) at a Well Man check-up. He had no significant past history, and took no medications. He was normotensive. The patient reported regular liquorice use. The hypokalaemia corrected with supplementation equivalent to 48 mmol K+ daily, and with cessation of ...

ea0034p96 | Clinical practice/governance and case reports | SFEBES2014

Pre clinic tests accelerate decision making, reduce delays in treatment and are highly popular with endocrinology patients and staff

Srinivas Vidya , Gomez Javier , Kerry Susan , Swords Francesca

Background: Thorough history taking and clinical examination is vital in the assessment of all medical patients. However, diagnosis of endocrine disease also relies on appropriate biochemical tests. Previously in our unit, tests were only performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted.Method: In 2009 clinicians, nurses and chemical pathology representatives reviewed av...

ea0034p97 | Clinical practice/governance and case reports | SFEBES2014

Carbimazole-induced antineutrophil cytoplasmic antibody positive vasculitis: a case report

Wong Kah Fai , Buch Harit

Introduction: Vasculitis is a rare complication of anti-thyroid medications and is more common with propylthiouracil than carbimazole. Patients often have multisystem involvement although renal and dermatological manifestations are common. Although most cases resolve following withdrawal of the offending agent, not all do and rare instances of death have been reported in the literature. Immunosuppressive therapy can be used to improve organ function and prevent progression.</p...

ea0034p98 | Clinical practice/governance and case reports | SFEBES2014

Outcomes following pituitary surgery: a single centre audit

Manolopoulos Konstantinos , Bates Andrew S , Shad Amjad , Rahim Assad

Introduction: Pituitary surgery is associated with post-operative complications including hypopituitarism and visual field defects. In order to ensure that our surgical outcomes were comparable with other centres, we audited the outcome of a cohort of patients referred for surgery at a single centre.Methods: A retrospective audit of 27 consecutive patients diagnosed with pituitary adenoma at Heartlands Hospital Birmingham, who underwent trans-sphenoidal ...

ea0034p99 | Clinical practice/governance and case reports | SFEBES2014

Hyperparathyroidism in early pregnancy: a case report

Ling Yong Yong , Falinska Agnieszka , Woods David , Vakilgilani Tannaz , Tanday Raj , Todd Jeannie

A 36-year-old lady (gravida 2 para 0) presented with subfertility, dysmenorrhoea and mild hyperprolactinaemia (prolactin of 881 mU/l no macroprolactin). She was also found to be hypercalcaemic whilst on calcium supplements. Despite a negative home pregnancy test, her β-HCG was elevated at 1471 IU/l confirming she was pregnant.She remained hypercalcaemic despite stopping calcium supplements and starting colecalciferol. At 9 weeks into her pregnancy, ...

ea0034p100 | Clinical practice/governance and case reports | SFEBES2014

Distinguishing between primary hyperparathyroidism and familial hypocalciuric hypercalcaemia: the role of genetic testing in patient with equivocal results

Ling Yong Yong , Falinska Agnieszka , Vakilgilani Tannaz , Tanday Raj , Todd Jeannie

A 64-year-old gentleman was referred with persistent hypercalcaemia following two previous parathyroidectomies from an external hospital. He was found to be hypercalcaemic incidentally by his GP in 2011. Prior to surgery in January 2011, his corrected calcium (cCa) was 2.83 mmol/l, PTH 1.9 pmol/l, vitamin D 38 nmol/l, 24 h urine calcium creatinine clearance ratio (24 h UCCR) was 0.0135. Histology from his 1st neck exploration revealed one hyperplastic parathyroid gland. A furt...

ea0034p101 | Clinical practice/governance and case reports | SFEBES2014

Efficacy and safety of doxazosin in perioperative management of phaeochromocytoma

Das Gautam , Clark James , Field Benjamin , Zachariah Sunil

Case history: We present the case of a 40-year-old man who was referred to a cardiologist with hypertension. He was initiated on bisoprolol and doxazosin. Investigations revealed elevated urinary metanephrines and catecholamines, with normetadrenaline 7.4 μmol/24 h (normal <2), noradrenaline 820 nmol/24 h (normal <500) but normal dopamine levels. He was referred to our clinic. Two further 24 h urine catecholamine assays were elevated. Dexamethasone suppression tes...

ea0034p102 | Clinical practice/governance and case reports | SFEBES2014

Are we appropriately referring patients for short synacthen testing?

Foucault Danielle , Guthrie Sara , De Parijat

Aims: Short synacthen test (SST) is commonly used to diagnose adrenal insufficiency (AI), and with serum ACTH, can help differentiate between primary and secondary AI. The aim of this audit was to evaluate the clinical appropriateness of SST in our endocrine unit.Methods: We looked at all SSTs performed between August 2012 and August 2013. Relevant clinical information was collected from patient notes and database. A SST was considered inappropriate if n...

ea0034p103 | Clinical practice/governance and case reports | SFEBES2014

The use of s.c. denosumab for cases of hypercalcaemia refractory to i.v. bisphosphonate therapy

Khan Muhammad , Perkins Karen , Joseph Franklin

Despite i.v. bisphosphonates, including pamidronate and zoledronate, representing the established agents used to reduce calcium levels, a proportion of patients with hypercalcemia either fail to respond to such treatments or relapse following their use.We present a case of hypercalcaemia refractory to conventional treatments that was treated with the use of the human MAB denosumab.A 70-year-old male presented to the emergency depar...

ea0034p104 | Clinical practice/governance and case reports | SFEBES2014

Localised Charcot of the Hallux

Rys Andrzej , Woodrow Tania , Chant Harvey , Farmer Kim , Butler Michael , Browne Duncan

In patients with diabetes an isolated ‘sausage toe’ is suggestive of underlying osteomyelitis. Neuropathic (Charcot) arthropathy, devastating complication of diabetes, normally presents in the midfoot and can be precipitated by surgery or minor trauma.We report a 62-year-old man with a 2-year history of well controlled type 2 diabetes (HbA1c 56 mmol/mol), with no micro or macro vascular complications, referred to diabetic podiatrist with a hot,...

ea0034p105 | Clinical practice/governance and case reports | SFEBES2014

Phaeochromocytomas and paragangliomas: a 20 year experience

Velusamy Anand , Karunakaran Vanitha , Kirtchuk David , Quin John

Phaeochromocytomas and paragangliomas account for about 0.1% of cases of persistent hypertension. Only 50% of these are being diagnosed as symptoms are often paroxysmal.We report a retrospective data analysis on 16 random patients (age 24–71 years, mean 51) diagnosed and treated for phaeochromocytoma and paraganglioma in our centre over the past 20 years. Symptom duration was 6 weeks to 15 years with female preponderance 2:1 (69 vs 31% in males). Sy...

ea0034p106 | Clinical practice/governance and case reports | SFEBES2014

Autoimmune adrenal insufficiency presenting as severe hypercalcaemia

Carroll Matthew , Kyriacou Angelos , Cooksley Tim , McGlynn Stephen

Case history: A 42-year-old female presented to the emergency department with dizziness, vomiting, abdominal pain and thirst. While investigating a 3-month history of lethargy, menstrual irregularity and weight loss, her GP had found a raised TSH, FSH and LH and had prescribed levothyroxine and, 1 week prior to admission, Adcal-D3 supplements. On examination, she was hypotensive and hyperpigmented.Investigations: Na+130 mmol/l (132–144), ...

ea0034p107 | Clinical practice/governance and case reports | SFEBES2014

Somatostatin analogue therapy with good biochemical response in a patient with ectopic ACTH secretion due to high grade metastatic neuroendocrine tumour

Choudhary Nidhi , Dugal Tabinda , Creely Steven , Hopwood Benjamin , Browne Duncan

Case: We present the case of a previously fit and well 53-year-old lady who presented with persistent hypokalaemia (1.9 mmol). She was cushingoid and testing confirmed Cushing’s syndrome with random cortisol of >1750 nmol/l, ACTH 838 ng/l and non-suppressed cortisol (1099 nmol/l) after low dose dexamethasone suppression test. MRI pituitary was normal. Abdominal CT scan showed bilateral adrenal hyperplasia and large (>10 cm) mass with necrotic centre replacing the ...

ea0034p108 | Clinical practice/governance and case reports | SFEBES2014

Improving the quality of endocrinology teaching to clinical medical students

Vega Philippa , Gishen Faye , Solomon Andrew

Background: This project endeavoured to improve the quality of endocrinology teaching to clinical medical students through the use of a new multi-stage process.Methods: We created a co-ordinated block containing 4-h teaching sessions (4×1 h) in which eight students in their first clinical year presented answers to questions based on clinical endocrinology cases they had seen and selected. The process started with identification of cases in the out-p...

ea0034p109 | Clinical practice/governance and case reports | SFEBES2014

An audit into the screening tests used for Cushing's syndrome

Platt Mark

Cushing’s syndrome (CS), is the prolonged exposure to excess cortisol within the body and has a significant negative prognostic impact if left untreated. There are several screening tests available for CS: urinary free cortisol (UFC), overnight dexamethasone suppression test (oDST), and late night salivary cortisol test (LNSC).This audit evaluated the screening of patients for CS by the Manchester Royal Infirmary (MRI), in 2012 against guidelines pr...

ea0034p110 | Clinical practice/governance and case reports | SFEBES2014

Testicular adrenal axis lymphoma

Vidyarthi Madhurima , Awad-Elkarim Awad , Saja Khalid , Brownell Alison , Nkonge Frederick

77-year-old male presented with a 1 year history of lethargy, anorexia, abdominal discomfort, weight loss since September 2011. He has a background of psoriasis, primary hypothyroidism (TPO normal), cataract, glaucoma and in 2003 testicular lymphoma treated with CHOP14, intrathecal methotrexate and orchidectomy.GP assessment showed upper abdominal fullness, mild anaemia elevated ESR, ferritin and LDH hence the haematology referral. Total body CT describe...

ea0034p111 | Clinical practice/governance and case reports | SFEBES2014

A rare case of Cushing's syndrome caused by ‘cyclical’ ectopic ACTH secretion

Behary Preeshila , Kadiyala Raghunath , Falinska Agnieszka , Beckwith Hannah , Jackson James , Mitchell Catherine , Todd Jeannie F

A 61-year-old lady presented with rapid onset of lethargy and reduced mobility with inability to use stairs over 1 month. Prior to this, she was fit and well and was a lifelong non-smoker. At presentation, she was overweight and had evidence of skin bruising and severe proximal myopathy of her legs. A midnight cortisol was >1710 nmol/l with a corresponding ACTH of 610 nmol/l confirming ACTH dependent Cushing’s syndrome. Serum potassium was 2.6 mmol/l and a new diagnos...

ea0034p112 | Clinical practice/governance and case reports | SFEBES2014

Management of hyponatremia in secondary care

Mescall Sophie , Hashi Amataullah , Begum Polly , Karamat Muhammad Ali

Introduction: Hyponatraemia is the most frequent electrolyte disturbance in clinical practice. It is encountered in isolation or as a complication of other medical conditions. The classification of hyponatraemia by volume status and severity – mild (125–134 mmol/l), moderate (115–124 mmol/l), and severe (<115) is of significance both prognostically and as a means of guiding management.Methodology: A retrospective review was carried out...

ea0034p113 | Clinical practice/governance and case reports | SFEBES2014

A case of severe hypercalcaemia

Devah Vilashini Arul , Lee Xiang , Turner Paul , Shetty Vinutha , Imtiaz Komal , Howell Simon , Kaushal Kalpana

We present the case of a 74-year-old man who was admitted with a short history of confusion and reduced mobility. He had a raised serum corrected calcium (cCa) of >5 mmol/l, serum parathyroid hormone (PTH) of 1.9 pmol/l (range 1.6–6.8 pmol/l) and acute renal failure. He was rehydrated and given a dose of i.v. zoledronate. Two days later his serum cCa remained elevated (4.39 mmol/l) with persistently impaired renal function. He underwent dialysis and serum cCa improved...

ea0034p114 | Clinical practice/governance and case reports | SFEBES2014

Baseline assessment of patients referred for ‘metabolic surgery’: managing the myriad of metabolic abnormalities

Imran Hafsa , Varughese George , Cheruvu Chandra , Nayak Ananth , Cooper Emily , Varadhan Lakshminarayanan

Aim: Nutritional abnormalities are common after bariatric surgery and it is vitally important to assess and replace them pre-operatively to ease management post-operatively. The aim of our study was to assess the prevalence of various metabolic abnormalities at first visit to a tertiary combined bariatric endocrine clinic.Methods: Data was collected on 200 patients referred for consideration of bariatric surgery. Being a retrospective analysis and theref...

ea0034p115 | Clinical practice/governance and case reports | SFEBES2014

Detecting vitamin D deficiency in South Asians: is a population or targeted method better?

Mostafa Samiul , Khunti Kamlesh , Bodicoat Danielle , Webb David , Davies Melanie

Background: UK South Asians (SA) are at risk of vitamin D deficiency (VDD, defined as 25-OH vitamin D <25 nmol/l) and insufficiency (VDI, 25-OH vitamin D 25–49 nmol/l), which increases the risk of metabolic bone disease. As VDD and VDI are often asymptomatic, many individuals will be unaware of this metabolic abnormality. As there is little information on how to detect VDD/VDI in the community, we wished to investigate if they were identified more effectively using ei...

ea0034p116 | Clinical practice/governance and case reports | SFEBES2014

Endocrinology in a district general hospital; it's not all thyroid disease

Brown Emily , Shah Momin , Saunders Simon

Aims: We set out to dispel the commonly held myth that endocrine practice in district general hospitals is dominated by thyroid disease. A local questionnaire revealed trainees felt thyroid disease made-up >50% of DGH referrals.Methods: We reviewed consecutive new patient referrals to our endocrine clinic over a 2-year period. We documented the referral and outcome diagnosis and looked at the distribution of these referrals across the areas of the en...

ea0034p117 | Clinical practice/governance and case reports | SFEBES2014

Polycythaemia is a common side-effect of testosterone therapy, regardless of treatment mode, and careful monitoring of haematological indices is required

Bhatti Rahila , Grimmett Belinda , McCarthy Maeve , Agusttson Tomas , McGowan Barbara , Powrie Jake , Carroll Paul

Background: Testosterone replacement is the mainstay of treatment for male hypogonadism. The most commonly reported adverse event in testosterone trials is polycythaemia. This study assessed the prevalence of polycythaemia in males receiving testosterone replacement and compared prevalence rates between different treatment preparations.Methods: 216 men were included in this retrospective observational study conducted from January 2009 to December 2012. 1...

ea0034p118 | Clinical practice/governance and case reports | SFEBES2014

Gastrinoma: difficult to diagnose difficult to treat

Siddiqi Ahmed Imran

Introduction: I present here a challenging case of gastrinoma which posed challenges in diagnosis and treatment. Gastrinomas are tumours of pancreas or duodenum secreting excessive gastrin leading to acid over secretion in stomach leading to ulcer, perforations, and diarrhoea.Clinical case: A 77-year-old lady had been suffering from gradually worsening bouts of severe watery diarrhoea and vomiting for previous 10 years and six stones weight loss. Frequen...

ea0034p119 | Clinical practice/governance and case reports | SFEBES2014

Severe hyponatraemia, hypokalaemia and associated seizure following the administration of sodium picosulfate/magnesium citrate (picolax): a case report

Storrow John , Raja Urmar

Introduction: Bowel preparation is known to cause minor electrolyte disturbances. There are only five reported cases of severe electrolyte disturbances following bowel preparation that have caused seizures. We report the case of a patient with severe hyponatraemia and hypokalaemia, resulting in a seizure, following the administration of picolax.Case report: A 60-year-old female patient with no significant past medical history and taking no regular medica...

ea0034p120 | Clinical practice/governance and case reports | SFEBES2014

Bilateral adrenal hyperplasia: a rare cause of Cushing's syndrome in chidren

Kamath Akshatha Taranath , Mandliya Shiny Goyal , Rao Sanjay , Kumar Sampath Satish

Cushing’s syndrome (CS) is a rare endocrine problem in children. Most of the cases in children are iatrogenic in nature due to extensive usage of topical, inhaled and oral corticosteroids. Endogenous hypercortisolism in children is mainly because of ACTH-dependent pituitary adenomas and constitutes ~70–80% of CS in children. ACTH-independent CS is rare in children above 5 years of age. Here, we are presenting a rare case of ACTH-independent macronodular adrenal hyper...

ea0034p121 | Clinical practice/governance and case reports | SFEBES2014

Micrometastases in a paraganglioma

Tabassum Fareeda , Hossain Belayat

Background: PTHrP related hypercalcemia is a common cause of humoral hypercalcemia of malignancy associated with carcinoma of the lung, prostate, and breast and uncommonly in haematological malignancies and malignant pheochromocytoma.We present a case with an unusual finding of micrometastases within a benign paraganglioma and PTHrP release from micrometsatses.: Case presentation72 years old lady presented with tiredness, poor appe...

ea0034p122 | Clinical practice/governance and case reports | SFEBES2014

Mitotane ameliorates testostoxicosis due to metastatic Leydig cell tumour

Johal Nicholas , Cullen Michael , Guest Peter , Porfiri Emilio , Arlt Wiebke

Leydig cell tumour (LCT) is a stromal testicular tumour comprising 3% of testicular neoplasms. Metastases are rare, have a poor prognosis and can appear many years after tumour removal. Current therapy for metastatic disease is limited, with no role for radiotherapy and poor efficacy of chemotherapy regimens. About 50–70% of metastatic LCT show associated steroid excess, comprising not only androgens but sometimes steroids physiologically produced in the adrenals. Here we...

ea0034p123 | Clinical practice/governance and case reports | SFEBES2014

Hypomagnesaemia during proton pump inhibitor therapy causing functional hypoparathyroidism

Krishnasamy Senthilkumar , Abbott Vineet , Kannan Rajendran Bellan , Varughese George , Nayak Ananth , Varadhan Laks , Jose Biju

Proton pump inhibitors (PPI) are widely prescribed. PPI-induced diarrhoea and hypomagnesaemia are well-documented in literature. Hypomagnesaemia is well-known to cause functional hypoparathyroidism. We describe a patient who had transient profound hypoparathyroidism which improved on discontinuing PPI and normalising severe hypomagnesaemia.A 72-year-old male, who was on oral anti-diabetic medications, calcium/vitamin D3 supplements and PPI, presented wit...

ea0034p124 | Clinical practice/governance and case reports | SFEBES2014

Anti-GAD antibody encephalitis: a potentially treatable syndrome

Krishnasamy Senthilkumar , Varughese George , Al-araji Adnan , Varadhan Laks , Nayak Ananth , Natarajan Indira , Jose Biju

Autoimmune encephalitides are being increasingly recognised as important and potentially reversible non-infectious causes of the encephalitic syndrome. Myriad of clinical presentation and lack of symptom specificity leads to a wide differential diagnosis. Failure to diagnose the correct aetiology of an encephalitic syndrome can lead to significant morbidity and mortality. A 57 years old right handed female with no significant medical problems initially presented with left side...

ea0034p125 | Clinical practice/governance and case reports | SFEBES2014

Intravascular pituitary invasion by large B-cell lymphoma is a rare cause of SIADH and hypopituitarism; a case report

Aitken Marc , Akhtar Simeen , Jude Edward

Hyponatraemia is a very common electrolyte abnormality with varied presenting features depending on the underlying cause. The authors report the case of a 75 years old, previously fit, gentleman who presented with weight loss, lethargy, and blackouts. He was admitted to the hospital repeatedly under the general physicians over an 8 month period.Investigations revealed persistent hyponatraemia (serum sodium 113–120 mmol/l, serum osmolality 258 mOsm/k...

ea0034p126 | Clinical practice/governance and case reports | SFEBES2014

Double trouble: pseudo-phaeochromocytoma in a patient with adrenocortical cancer

May Christine , Jahagirdar Vidhya , Chortis Vasileios , Jenkins David , Arlt Wiebke , Ayuk John

A 34-year-old male with no significant past medical history presented with severe abdominal pain. On detailed questioning his symptoms included tremors, headache, sweating, and agitation. Despite recent weight gain he had obvious muscle wasting. On admission blood pressure was 166/107 mmHg. Abdominal examination revealed a palpable left upper quadrant mass.CT scan demonstrated a 15 cm mass in the left supernal region with extensive signs of haemorrhage i...

ea0034p127 | Clinical practice/governance and case reports | SFEBES2014

Audit on investigations and diagnosis of hyponatremia in in-patients at a district general hospital

Sithamparnathan Niruthika , Dooley Rebecca , Malik Isha

Background: Hyponatremia is associated with increased, inpatient mortality and length of stay and correct management necessitates doing appropriate investigations for accurate diagnosis of the cause.Aim: The aim of this audit was to identify, the number of medical and surgical patients admitted with hyponatreima over a 4-week period; number of cases with mild (<135) vs moderate to severe cases of hyponatremia (<130 mmol/l); determine if hyponatre...

ea0034p128 | Clinical practice/governance and case reports | SFEBES2014

Three cases of octogenarians with Cushing's syndrome

Sabin Jodie , Popli Urvi , Gibson John , Kraus Alex , Searell Catrin , Wilton Tony

Cushing’s syndrome is a rare disease with an incidence of 0.72–2.4/million per year. Approximately 14% of patients are over 60 years of age but <1% are over 80 years of age. In a 2-month period, we diagnosed three females over 80 years of age as having Cushing’s syndrome. None of them had a typical cushingoid appearance.Patient 1, 80 years of age. Presentation: coincidental finding of bilateral adrenal hypertrophy on CT scanning as par...

ea0034p129 | Clinical practice/governance and case reports | SFEBES2014

Spontaneous hypoglycaemia induced by ACE-inhibitor: a case report

Wong Kah Fai , Baskar Varadarajan , Raghavan Rajeev

Background: Hypoglycaemia is rare in people without diabetes. Certain medications are known to cause hypoglycaemia in non-diabetic patients.Case details: A 65-year-old man with background congestive cardiac failure, previous pulmonary TB (1997), bronchiectasis and pulmonary fibrosis (long-term oxygen therapy) was admitted for exacerbation of bronchiectasis. He completed a course of antibiotics and steroid treatment. While awaiting discharge, he had two e...

ea0034p130 | Clinical practice/governance and case reports | SFEBES2014

The role of genetic analysis in the diagnosis of familial hypocalciuric hypercalcaemia

Ameen Zana , Shakher Jayadave

Familial hypocalciuric hypercalcaemia (FHH) is a benign condition, occurs as a result of inactivating mutation in the calcium sensing receptor (CASR) gene and is autosomal dominant.We present a 56-year-old lady with periodic mild hypercalcaemia since 2004. Her highest corrected calcium concentration was 2.76 mmol/l (NR 2.2–2.6). She was asymptomatic. Her parathyroid hormone concentration was also mildly elevated at 9.7 pmol/l (NR 1.6–6.9). Her ...

ea0034p131 | Clinical practice/governance and case reports | SFEBES2014

Epidural abscess as a complication of infected diabetic foot ulcers: a case report.

Aitken Marc , Marzoug Abdelaziz , Jude Edward

A 59-year-old gentleman presented with a 6-month history of painless, progressive lower limb weakness. There was no history of trauma or weight loss although he had been suffering night sweats. He had been bed bound for 4 weeks prior to admission. He was an insulin-dependent type 2 diabetic.Examination revealed marked symmetrical wasting of the leg muscles with reduced power (3/5) and absent reflexes and plantar reflexes were up-going. He was in urinary ...

ea0034p132 | Clinical practice/governance and case reports | SFEBES2014

Alternating high and low TSH levels post subacute thyroiditis

Kong Marie-France , Karmali Rafik

A 43-year-old African lady initially presented in September 2007 with hypothyroidism (fT4 0.6 ng/dl (0.8–2.0) and TSH 110 mU/l (0.3–4.00)). She gave a history of pain in the neck with transient symptoms of thyrotoxicosis. It was felt that she had gone hypothyroid following an episode of subacute thyroiditis and was started on L-thyroxine. Her compliance was questioned as her TSH fluctuated from being high to being suppressed on 25 μg of...

ea0034p133 | Clinical practice/governance and case reports | SFEBES2014

Pituitary apoplexy during a second pregnancy in a woman with prolactinoma

Gheorghiu MonicaLivia , Caragheorgheopol Andra , Dumitrascu Anda , Ionescu Virgil

Introduction: Pituitary apoplexy is a rare syndrome due to hemorrhagic infarction of a pituitary adenoma. It may be clinically overt (sudden, severe headache, visual disturbances, impairment in pituitary function, and altered consciousness), or subclinical. Pregnancy is a rare predisposing factor, which may raise difficulties in the diagnosis and treatment.Case presentation: A 25 years woman diagnosed with a 1/0.8 cm prolactinoma, initial serum PRL 61.5 ...

ea0034p134 | Clinical practice/governance and case reports | SFEBES2014

Endocrine considerations in ever-improving HIV-related mortality outcomes: a clinical perspective

Mensforth Sarah , Jose Biju , Varughese George , Bodasing Neena , Singh Gurdeep , Fernando Kieran

Since the advent of effective combined antiretroviral therapy (ART), mortality due to HIV disease has significantly declined. Changing trends in HIV-associated morbidity is surfacing, firstly due to the effect of HIV on virtually every human organ system and secondly due to improved life expectancy and consequent development of natural co-morbid illnesses. HIV associated endocrinopathies and metabolic diseases pose a significant disease burden in these patients. We discuss thr...

ea0034p135 | Clinical practice/governance and case reports | SFEBES2014

Next generation sequencing approach for molecular genetic diagnosis of familial partial lipodystrophy

Thomas Nihal , Asha H S , Chapla Aaron , Manika V , Shetty Shrinath

Background: Familial partial lipodystrophy type 2 (FPLD2) is an autosomal dominant inherited form of lipodystrophy due to mutation in the LMNA gene on chromosome 1q22. It is characterized by selective loss of subcutaneous adipose tissue from the limbs and trunk, with accumulation of fat in the neck and face, insulin resistance, diabetes mellitus and dyslipidemia.Objective: To study the clinical features and establish the molecular diagnosis of two subjec...

ea0034p136 | Clinical practice/governance and case reports | SFEBES2014

The H-syndrome and next generation sequencing for molecular genetic diagnosis

Thomas Nihal , Mahesh D M , Chapla Aaron , Asha H S , Shetty Shrinath , Shetty Sahana , Lydia M , George Renu

Background: The H-syndrome is a recently described very rare monogenic systemic autoinflammatory autosomal-recessive genodermatosis with young onset of diabetes without evidence of autoimmunity. It is caused by mutations in the SLC29A3 gene, which encodes the equilibrative nucleoside transporter hENT3.Objectives: To study the clinical features and confirm the genetic diagnosis in a subject with young onset of diabetes.Subject and m...

ea0034p137 | Clinical practice/governance and case reports | SFEBES2014

Adrenal incidentalomas, a district hospital perspective

Mtemererwa Brian , Bray Anne de , O'neill Anne-Marie , Webster Alice , Alazzani Halimah , Sada Priyo , Raskauskiene Diana

An incidentaloma is a mass lesion found by chance on imaging for a reason unrelated to the site of the lesion. Adrenal incidentalomas, as a result of advances in imaging technology, have an increased incidence, especially in the aging population. An endocrine referral is advised to determine if the lesion is functional, to exclude malignancy and offer on going appropriate follow-up.Aim: To assess the incidence and audit the management of adrenal incident...

ea0034p138 | Clinical practice/governance and case reports | SFEBES2014

Acute confusional state in the thyroid clinic: autoimmunity as a multi-edge knife

Chortis Vasileios , Edmunds Matthew , Littleton Edward , Boelaert Kristien

A 67-year-old lady with a 3-year history of Graves’ hyperthyroidism complicated by florid Graves’ ophthalmopathy attended the thyroid clinic at University Hospital Birmingham for routine follow up. Her thyrotoxicosis had been managed with long-term carbimazole treatment with good control. Her past medical history included coeliac disease and hypertension. On clinic review, she appeared acutely confused and disorientated and had evidently lost weight. Her family repor...

ea0034p139 | Clinical practice/governance and case reports | SFEBES2014

Jumping the gun: an audit of adrenal biopsies in a tertiary referral centre

Chortis Vasileios , Scordilis Kassiani , Arlt Wiebke , Crowley Rachel

New adrenal lesions discovered during cross-sectional abdominal imaging pose an increasingly common diagnostic challenge; their initial management should focus on the exclusion of malignancy and autonomous hormone excess. The role of adrenal biopsies in this context is limited and pathologists often struggle to differentiate benign from malignant adrenal tissue even when analysing the entire tumour specimen. Guidelines recommend that adrenal biopsy should only be considered if...

ea0034p140 | Clinical practice/governance and case reports | SFEBES2014

Is levothyroxine availability enhanced by grapes?

Khan Ishrat , Aldridge Andrew , Ahmed Ruhina , Onyebuchi O E

Introduction: Patients with hypothyroidism are routinely advised to take levothyroxine without food or beverages but the pharmacokinetic effect of many common foods are unknown. We describe a patient with an unusually high levothyroxine requirement who only achieved adequate replacement by taking grapes along with levothyroxine. Through a cycle of challenge, withdrawal, and-re-challenge, we were able to demonstrate that levothyroxine availability was enhanced by grapes in this...

ea0034p141 | Clinical practice/governance and case reports | SFEBES2014

Granulomatosis with polyangiitis presenting as a pituitary lesion

Christou Louise , Katreddy Mahesh , Dutta Shouma , Kamath Sanjeet , Shaw Simon , Jose Biju

Granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis, is a rare heterogeneous vasculitic disease characterised by necrotising granulomatous inflammation typically affecting lungs and kidneys. GPA affecting pituitary is rare and usually results in posterior pituitary involvement causing diabetes insipidus. We describe a case of GPA, presenting with pituitary involvement causing headaches and anterior pituitary hormone deficiencies.<p cla...

ea0034p142 | Clinical practice/governance and case reports | SFEBES2014

A case of hypoadrenalism

Akiboye Funke , Nicholls Adam , Richardson Triston

A 69-year-old man was referred to Endocrine clinic after presenting to his GP with dizziness, syncope, and fatigue. 0900 h cortisol was low at 39 nmol/l. The remainder of the anterior pituitary profile was unremarkable. He had been diagnosed with HIV in 1997 and was treated with highly active anti-retroviral therapy (truvada 1 OD, ritonavir 100 mg OD, and darunavir 800 mg OD) in addition to acyclovir 400 mg OD with control of his CD4 count and viral load. In addition, treating...

ea0034p143 | Clinical practice/governance and case reports | SFEBES2014

Mayer-Rokitansky-Kuster-Hauser syndrome and pituitary adenoma: a co-incidence?

Kannan Rajendran Bellan , Nayak Ananth , Varadhan Laks , Varughese George , Jose Biju

Background: Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital failure of the Mullerian duct to develop, resulting in complete or partial absence of the cervix, uterus, and vagina. It can be isolated (MRKH type I) or associated with renal, vertebral, and, to a lesser extent, auditory and cardiac defects (MRKH type II). Pituitary disease is not a known association. We report a patient who has isolated MRKH syndrome (MRKH type I) and a pituitary...

ea0034p144 | Clinical practice/governance and case reports | SFEBES2014

Madness on the medical ward: ectopic ACTH producing tumour

Puttanna Amar , Patel Viraj , Raskauskiene Diana , Clayton Richard

A 51-year-old Afro-Caribbean lady with a history of primary hyperparathyroidism, type 2 diabetes and hypertension was admitted with confusion. Her medication at the time included five anti-hypertensives.She was treated for an infection but despite a long course of antibiotics she remained confused with visual hallucinations and aggression.She was noted to have resistant hypertension with systolic blood pressures over 220 mmHg and p...

ea0034p145 | Clinical practice/governance and case reports | SFEBES2014

Training needs in adolescent health and transition in paediatric and adult trainees in diabetes and endocrinology in the UK

Gleeson Helena , Wright Rohana , Besser Rachel , Cheer Kelly , Dimitri Paul , Chapman Simon , on behalf of AYASIG

Background: Training is adolescent health and transition is lacking in medical education. Clinicians working in diabetes and endocrinology across paediatric and adult services need to have the skills to work effectively with this age group. Our aim was to identify the current state of training and to ascertain training needs in trainees.Methods: A questionnaire was developed based on existing questionnaires. Using trainee representatives all paediatric a...

ea0034p146 | Clinical practice/governance and case reports | SFEBES2014

Delayed hypocalcaemia following treatment of malignant hypercalcaemia with denosumab

Puttanna Amar , Khan Ahsan , Padinjakara Noushad

Denosumab is a MAB currently licensed for use in treatment of osteoporosis. It is designed to inhibit RANK ligand to prevent bone breakdown by osteoclasts. Its use for treatment of malignant hypercalcaemia is still to be fully investigated.We present the case of a 71-year-old south Asian gentleman with recurrent resistant hypercalcaemia secondary to follicular non-Hodgkin’s lymphoma. Calcitriol levels were elevated which was thought to be lymphoma r...

ea0034p147 | Clinical practice/governance and case reports | SFEBES2014

Non islet cell tumour hypoglycaemia: management strategies for a rare and challenging condition

Kalathil Dhanya , Roughneen Simon , Shah Momin , Akram Ali , Zaidi Reza , Purewal Tejpal , Ahmad Aftab , Weston Philip

We previously reported a case of non islet cell tumour hypoglycaemia (NICTH) due to increased ‘big’-IGF2 production in a lady with haemangiopericytoma (HAP). We now describe the challenges in managing this lady who had recurrent, disabling hypoglycaemia requiring frequent hospitalisation.This patient presented with symptomatic hypoglycaemia 15 years after the diagnosis of parasaggital HAP. At presentation she had tumour recurrence with liver an...

ea0034p148 | Clinical practice/governance and case reports | SFEBES2014

Diabetes: the forgotten complication of parathyroidectomy

Othonos Nantia , Patel Vinod , Nair Rajiv , Ayre Stephen , Saravanan Ponnusamy

A 64-year-old female presented to the acute medical take with hypercalcaemia. She had a 3 weeks history of polyuria, polydipsia, constipation, intermittent abdominal pain and feeling depressed. She reported weight loss of 3.5 kg over the past 6 months. She denied symptoms of dysphagia, dyspnoea, haemoptysis, haematemesis, or malaena. Her past medical history included anaemia, ischaemic heart disease, chronic obstructive pulmonary disease and uterine prolapse. She was an ex-smo...

ea0034p149 | Clinical practice/governance and case reports | SFEBES2014

Adrenocortical carcinoma, where's the delay?

Aziz Aftab , Dyer Rob , Dunn Julie , Goodman Andy , Brooke Antonia

Adrenocortical carcinomas are rare malignancies (incidence 1–2/one million). They present in a variety of ways and carry a poor prognosis. Prompt diagnosis and early intervention offers better outcome.We describe 5 cases of adrenocortical carcinoma to help identify and improve delays in their pathway of care. Five patients (four females and one male), age range 38–76 years, presented between September 2011 and April 2013. Three patients referre...

ea0034p150 | Clinical practice/governance and case reports | SFEBES2014

Tertiary hyperparathyroidism: a long-term complication of pseudohypoparathyroidism type 1b?

Witczak Justyna , Owen Penelope , Page Mike

Introduction: Pseudohypoparathyroidism is a rare group of heterogenous disorders. PHP1b consists of renal resistance to PTH in the absence of other physical or endocrine abnormalities and is associated with reduced 1,25-OH vitamin D synthesis, increased phosphate secretion and hypocalcaemia. Despite calcium and vitamin D replacement many patients still have chronically elevated PTH.Case description: A 31-year-old white female presented with symptoms of t...

ea0034p151 | Clinical practice/governance and case reports | SFEBES2014

Liraglutide as an effective therapeutic agent in a patient with Prader Willi syndrome and type 2 diabetes

Witczak Justyna , Owen Penelope

Introduction: Prader Willi syndrome is a genetic disorder associated with learning disability, hyperphagia and obesity which leads to early development of obesity related complications. The weight and appetite management remains a challenge with not much success with appetite suppressant drugs and bariatric surgery.GLP-1 receptor analogues appear to be a promising alternative given their effect on appetite control, weight loss and HbA1c and were shown to...

ea0034p152 | Clinical practice/governance and case reports | SFEBES2014

Cushing's disease with hepatic adrenal rests

Border Daniel , Aftab Saboor , Pelluri Lavanya , Barber Thomas , Randeva Harpal

We present the case of a 58-year-old woman who presented 30 years ago. She was noted to have abdominal obesity, moon-face and skin bruising/thinning, as well as hypertension. Serum cortisol was elevated and she was presumed to have Cushing’s disease (although we have no record of dynamic tests or imaging from the time of her original presentation). Owing to her desire for future fertility, she underwent bilateral adrenalectomy at the age of 31 years. She received hydrocor...

ea0034p153 | Clinical practice/governance and case reports | SFEBES2014

The prevalence and mortality in hospitalised patients with mild, moderate, and severe hyponatremia

Shakher Jayadave , Gandhi Nirav , Shepherd Lisa , Pitt Christopher , Chatha Kamaljit

Introduction: Hyonatraemia, defined as serum sodium <135 mmol/l is the commonest electrolyte abnormalities and is associated with increased morbidity and mortality.Aim: To determine the prevalence of mild, moderate, and severe Hyponatraemia in the hospitalised patients and estimate mortality between these three groups and compared to Normonatraemia.Methods: This is a retrospective audit in patients admitted to hospital from Jul...

ea0034p154 | Clinical practice/governance and case reports | SFEBES2014

Profound hyponatraemia secondary to indapamide

Prague Julia , Zalin Ben

Background: Severe hyponatraemia and other electrolyte disturbances secondary to indapamide are documented in the literature. We report two cases that presented with neurological sequelae of profound hyponatraemia without seizures secondary to indapamide.Cases: An 86-year-old female presented with a history of confusion, vomiting and frontal headache associated with lethargy and anorexia. She had been started on indapamide 1 month earlier. She was on no ...