Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2016

Brighton, UK
07 Nov 2016 - 09 Nov 2016

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07 Nov 2016 to 09 Nov 2016 Brighton, UK Further information

ea0044ep1 | (1) | SFEBES2016

An unusual presentation of 17alpha hydroxylase deficiency

Moriarty Maura , Todd Jeannie , Lam Francis , Rumsby Gill , Wernig Florian

17alpha hydroxylase deficiency accounts for less than 1% of all patients diagnosed with congenital adrenal hyperplasia. Almost 100 mutations in the CYP17A1 gene causing 17-hydroxylase/17,20-lyase deficiency (17OHD) have been described (OMIM 609300). CYP17A1 is expressed in both the adrenals and gonads. Hallmarks of 17OHD include hypertension, hypokalaemia, primary amenorrhoea and absence of secondary sexual characteristics. Most patients with 17OHD remain infertile.</...

ea0044ep2 | (1) | SFEBES2016

Cushing’s disease detected following an adrenal incidentaloma

Gohil Shailesh , Kieffer Veronica , Levy Miles

Background: Adrenal incidentalomas are classified as adrenal lesions picked up on imaging performed due to reasons other than to look at the adrenals. With cross sectional imaging becoming more frequent, the frequency of adrenal lesions being detected and referred to endocrine services is increasing and dedicated adrenal incidentaloma clinics are being set up to screen these patients for potential pathology.Case: We present a 63 year old lady who underwe...

ea0044ep3 | (1) | SFEBES2016

Apparent Mineralocorticoid Excess due to daily consumption of liquorice - containing tea

Frizelle Isolda , O'Halloran Domnhal J. , Anjum Mohammed Sohail

Apparent mineralocorticoid excess is a rare syndrome with few reported literature entries. Liquorice tea is a common dietary supplement often used as a slimming aid.We present the case of a 50 year old woman who presented with a two week history of headache, nausea and light sensitivity. Background medical history consisted of irritable bowel syndrome, tubal ligation, thrombosis of a retinal vessel at 17 years of age and a smoker of 10 pack year.<p c...

ea0044ep4 | (1) | SFEBES2016

Failure to suppress TSH in thyroid cancer – could it be Addison’s disease?

Fowler George E , Wadsley Jonathan , Webster Jonathan , Balasubramanian Sabapathy P

Background: Papillary thyroid cancer is the commonest thyroid malignancy. Surgery is first-line treatment, followed by radioiodine and long-term, high dose levothyroxine to suppress TSH.Cortisol is known to suppress TSH secretion by the pituitary, although the mechanism remains unclear. Correspondingly, hypocortisolism may raise TSH levels.Case Summary: A 64 year old woman presented with a right-sided thyroid nodule, normal TSH and...

ea0044ep5 | (1) | SFEBES2016

Adrenal TB: the great master of disguise!

Chinnasamy Eswari , Cosgrove C , Beharry N , Bano G

Delay in diagnosis of adrenal insufficiency is common. About 47% of patients have symptoms for over 1 year and 20% for over 5 years before diagnosis. Autoimmunity is the most common aetiology for Primary Adrenal Insufficiency (PAI) in developed countries. But up to 10–20% of PAI could be due to TB.We present an interesting case of 42 year old Afro Caribbean male with isolated adrenal TB. He had 2 year history of nonspecific illness including reduced...

ea0044ep6 | (1) | SFEBES2016

Prednisolone 3 mg once daily should be the glucocorticoid replacement for hypopituitarism

Machenahalli Pratibha , Choudhury Sirazum , Meeran Karim

A 33 year-old male bus driver with long standing pemphigus requiring high dose prednisolone, presented with acromegaly in 2001. MRI pituitary revealed a 2×2×0.5 cm pituitary adenoma and his GH levels of 14.8–16.4 nmo/L throughout and were not suppressible with glucose. His IGF1 was 191 nmol/l (normal range: 13–64 nmol/L), Prolactin 6,557 milliunit/L, testosterone 2 nmol/L and cortisol uninterpretable as he was on prednisolone. Trans-sphenoidal hypophysectom...

ea0044ep7 | (1) | SFEBES2016

An unusual case of adrenal metastases

Alhelfi Moayed , Mukherjee Annice , Robinson Adam , Nelson Lili , Baker Emma

Section: Case history: 73-year old gentleman referred from GP with a two month history of worsening dizziness, malaise, postural hypotension and general deterioration and spiking pyrexia ranging 38-40°C over 3 weeks. PMH of NSCLC T2b N0- left lower lobectomy & chemotherapy 3 years prior.Section: Investigations and treatment: At re-presentation his CT TAP showed bilateral bulky adrenal glands but no other abnormality. The patient’s bloods sh...

ea0044ep8 | (1) | SFEBES2016

Will the routine use of high dose steroids for alcoholic hepatitis result in an increased incidence of clinically significant hypocortisolism in patients with liver cirrhosis?

Karia Priya , Bravis Vassiliki , Salem Victoria , Radhakrishnan Shiva , Choa Dri

Introduction: Recent evidence supports the use of high dose steroids for 28 days in acute alcoholic hepatitis. We present a patient with Childs Pugh C liver cirrhosis, who developed adrenal axis suppression following such treatment. We discuss the complex aetiology and biochemistry of hypocortisolism in liver disease.Case: 48 year-old female admitted with alcoholic hepatitis, treated with a non-tapering 28-day course of 40 mg prednisolone. The patient wa...

ea0044ep9 | (1) | SFEBES2016

Case of prolonged hypoaldosteronism after unilateral adrenalectomy for Conn’s syndrome

Shrikrishna Natasha , Koko Naing , Jones Ellen , Loumpardia Betty , Wong Steven , Nyunt Aye

Introduction: Unilateral adrenalectomy is an effective treatment for aldosterone producing adenoma. However, after adrenalectomy, suppression of the contralateral zona glomerolura (ZG) function can lead to transient hypotension & hyperkalaemia. We present a protracted case of post-operative adrenalectomy related hypoaldosteronism.Case: A 54-year-old hypertensive male with confirmed primary hyperaldoseronism (PRA<0.1 nm/h, aldosterone 1050 pmol/l;...

ea0044ep10 | (1) | SFEBES2016

Pediatric Cushing‘s Syndrome due to primary pigmented nodular adrenocortical disease

Boudiaf Dia Eddine , Chentli Farida

Introduction: Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing’s syndrome in pediatric population. This entity due to genetic mutation has specific histological appearance and can be associated to Carney’s complex and McCune Albright syndrome. Our aim was to report a pediatric case in order to specify clinical and biological characteristics.Case report: A 6 year-old boy with no family or perso...

ea0044ep11 | (1) | SFEBES2016

Elevated renin levels heralds adrenocortical involvement in a case of adrenoleukodystrophy

Beebeejaun Mehjabeen , To Laura , Hussain Yaqza , Craner Matthew , Coyle Frances , Bingham Emma , Tringham Jennifer

Adrenoleukodystrophy (ALD) is an X-linked, widely heterogeneous, neurodegenerative disorder of peroxisomal metabolism characterised by the accumulation of very-long-chain fatty acids (VLCFA). A mutation in the ABCD1 gene is responsible. ALD has both a neurological and an endocrine interface as VLCFA deposit in the central and peripheral nervous system as well as the adrenal cortex and testis. ALD can present in childhood with a cerebral form or later in life as an adrenomyelon...

ea0044ep12 | (1) | SFEBES2016

Bilateral adrenal haemorrhage secondary to non-meningococcal sepsis

Lubczynska Malgorzata , Macriyiannis Thrasos , Kong Marie-France

A 69 year old man presented to the hospital after he fell from a 6 foot ladder. He was previously fit and well with no co-morbidities apart from a 55 pack year smoking history. He complained of right shoulder and hip pain. CT scan revealed fractures of the left 6th rib and right superior and inferior pubic rami. In addition, there was an incidental finding of a 5.2 cm in diameter abdominal aortic aneurysm (AAA) with no radiological evidence of a leak. He was treated conservati...

ea0044ep13 | (1) | SFEBES2016

Pheochromocytoma in pregnancy

Krishnasamy Ganapathy Kavitha Dhevi , Ganguri Murali , Mahadasu Shilpa , Mukhtar Rasha

Introduction: Pheochromocytoma is extremely rare in pregnancy and occurs 1 in 54000 pregnancies. If undiagnosed, Maternal and fetal mortality amounts to 40–50%. Early detection and prompt treatment decreases the maternal and fetal mortality to <5% and <15% respectively. There are multiple and complex issues in managing this condition in pregnancy. We would like to present such a case with very good outcome.Case: 28-year-old woman was admitte...

ea0044ep14 | (1) | SFEBES2016

Not another case of low sodium

Arshad Sobia , Barnes Denis

An 82 year old man was admitted to hospital with lethargy, anorexia and back pain. His past medical history included chronic lymphocytic leukaemia and hypertension. Blood tests revealed a serum sodium of 115 mmol/l and potassium of 5.4. His irbesartan was discontinued and sodium rose to 126 prior to discharge. 9 am cortisol was 408 nmol/l. He was readmitted to hospital 6 days later with hyponatraemia (116 mmol/l). A short Synacthen test was performed which showed a flat respon...

ea0044ep15 | (1) | SFEBES2016

Primary pigmented nodular adrenocortical disease: a rare cause of Cushing’s syndrome

Kyle Catriona , Stimson Roland

A 34-year-old lady presented with a 3 year history of central weight gain, hypertension and secondary amenorrhoea. Initial 24-hour urinary free cortisol (UFC) was raised (536 nmol/24 hr) and subsequent overnight dexamethasone suppression test (DST) was elevated at 593 nmol/L. Low and high dose DST confirmed the diagnosis of Cushing’s syndrome with a slightly unusual trend of increasing cortisol levels compared with baseline. ACTH levels were undetectable while adrenal ima...

ea0044ep16 | (1) | SFEBES2016

X-linked adrenoleukodystrophy – a rare cause of Addison’s disease

Matta-Coelho Claudia , Souto Selma B. , Marques Olinda

X-linked adrenoleukodystrophy (X-ALD) is a metabolic disorder caused by mutations in the ABCD1 gene leading to accumulation of very long-chain fatty acids (VLCFA) in plasma and all tissues, including the white matter of the brain, the spinal cord and adrenal cortex. There is an estimated incidence of 1 in 17.000 new-borns. The clinical features are variable ranging from primary adrenal insufficiency and progressive myelopathy to cerebral demyelination.Th...

ea0044ep17 | (1) | SFEBES2016

Please don’t operate on this patient - A case of ‘Adrenaline running high’

Khan Irfan , Hasan Faisal , Lonnen Kathryn

Phaeochromocytomas are rare catecholamine secreting tumours arising from the chromaffin cells of the adrenal medulla. The annual incidence is approximately 0.8 per 100,000 person-years. Most of them are sporadic but in about 25–30% of patients, they are part of a familial disorder. The classic clinical features are episodic headache, sweating and tachycardia (with or without hypertension). However, a minority of patients are asymptomatic. We present a clinical case in whi...

ea0044ep18 | (1) | SFEBES2016

Bilateral adrenal nodules and phaeochromocytoma associated with neurofibromatosis

Banu Zeenat , Menon Ravi

We report two cases of unilateral and bilateral phaeochromocytoma in patients with neurofibromatosis type 1 (NF-1) respectively.Case 1 64 year old Caucasian male with known NF-1, hypertension, depression and osteoarthritis was referred with episodic symptoms of palpitation, chest pain and breathlessness. Biochemically confirmed phaeochromocytoma with 24 hr urinary metanephrines of 18595 nmol/24 hrs. CT revealed 4.2 cm right adrenal...

ea0044ep19 | (1) | SFEBES2016

Challenging hypercalcaemia

Tauni Rahat , Ali Nida

Hypercalcaemia is one of the common cases seen in Endocrine clinics. We report another challenging case of hypercalcaemia. A 43 old Asian man was referred by GP initially in 2011 with asymptomatic hypercalcaemia of 2.87 mmol/L. His past medical history included chronic plaque psoriasis with arthropathy, hypertension, stage 3 CKD, Fatty liver with mild fibrotic change secondary to methotrexate and learning difficulties. Hypercalcamia was thought to be contributed by Dovonex (Ca...

ea0044ep20 | (1) | SFEBES2016

Adult presentation of hypophosphatasia due to a novel compound heterozygous Tissue Nonspecific Alkaline Phosphatase (ALPL) mutation

Farrell Catriona , Strachan Judith , Sankar Sripada , McWilliam Catherine , Alipour Faz , Newey Paul , Schofield Chris

A previously well 27-year old female presented with atraumatic foot pain to the orthopaedic service and was identified to have a healing subacute metatarsal stress fracture in the right foot. In view of the unusual presentation, the patient was referred to the metabolic bone clinic for further evaluation.On initial evaluation the patient reported no prior skeletal, joint or dental problems. However at the time of review she reported pain in her right thi...

ea0044ep21 | (1) | SFEBES2016

Severe hypercalcaemia following Vitamin D replacement therapy in patient found to have co-existing sarcoidosis and primary hyperparathyroidism

Sabin Jodie , Scannell Jack , Donald Jane , Evans Alison

Current guidance recommends replacing vitamin D in patients with mild primary hyperparathyroidism although there are reports of worsening hypercalcaemia in some patients. Vitamin D replacement has also been known to cause hypercalcaemia in patients with sarcoidosis. We present a case of a patient with co-existent sarcoidosis and primary hyperparathyroidism, who developed severe hypercalcaemia following treatment with high dose Vitamin D.A 63 year old lad...

ea0044ep22 | (1) | SFEBES2016

Albright hereditary osteodystrophy

Cox Tobias , Mahto Rajni , Raja Umar , Kakad Rakhi

Hypocalcaemia is a common presentation to the emergency department; patient’s symptoms vary but typically report pins and needles and muscle cramps, due to neuromuscular irritability. Other important features include ECG changes (prolonged QTc) and seizures. The most common causes are hypoparathyroidism, vitamin D deficiency and chronic kidney disease.A 25-year old male presented with symptomatic hypocalcaemia who was referred to us for follow up, a...

ea0044ep23 | (1) | SFEBES2016

Idiopathic Infantile Hypercalcaemia (IHH) caused by a missense mutation of 1,25-dihydroxyvitamin D2 24-hydroxylase (CYP24A1)

Stokes Victoria , Gorvin Caroline , Jafar-Mohammadi Bahram , Ryan Fiona , Thakker Rajesh

Idiopathic infantile hypercalcaemia (IHH) is an autosomal recessive disorder typically presenting in the first few months of life with failure to thrive, vomiting, dehydration, and nephrocalcinosis with hypercalcaemia and low or undetectable parathyroid hormone (PTH) concentrations. IHH is caused by loss-of-function mutations of the cytochrome P450 family 24 subfamily A member 1 (CYP24A1) gene that encodes the 514 amino acid protein 1,25-dihydroxyvitamin D3...

ea0044ep24 | (1) | SFEBES2016

An unusual case of hypercalcaemia

Pink Grace , Athavale Ramanand , Sah Shatrughan , Mahto Rajni

We present the case of a 19 year old female who presented to A&E with a three week history of nausea, vomiting and constipation. She was noted to have hypercalcaemia at 4.11 mmol/l. There was no family history of note and prior to this illness she had been fit and well with no regular medications. Investigations revealed a suppressed PTH of <0.6 pmol/L. U&E, vitamin D, TSH, serum ACE and cortisol were within normal range.Examination revealed ...

ea0044ep25 | (1) | SFEBES2016

Association of neurofibromatosis type 1 with primary hyperparathyroidism: report of a case

Austin Emily , Bates Andrew

Introduction: Neurofibromatosis Type 1 (NF1) is an autosomal dominant inherited disorder, which increases the risk of developing both benign and malignant tumours. A Swedish study conducted by Zöller et al in 1997, suggested that up to 25% of these tumours are neuroendocrine in origin, of which phaeochromocytomas were the commonest with a prevalence of 0.1–6%. The association between NF1 and primary hyperparathyroidism is described in the literature but clinically ra...

ea0044ep26 | (1) | SFEBES2016

Osteocalcin suppression may be a useful marker of steroid exposure

Ang Yvette , Leckey Adam , Choudhury Sirazum , Courtney Alan , Tan Tricia , Meeran Karim

Mrs. M is a 66-year-old female who has had secondary adrenal insufficiency for many years following the withdrawal of prednisolone therapy for pulmonary eosinophilia. Synacthen tests revealed complete adrenal suppression when the dose of prednisolone was weaned to 5 mg in previous years. The dose was further reduced by switching to hydrocortisone three times daily, following a 10 mg-5 mg-5 mg regimen. Occasionally, a flare of eosinophilia required restarting high-dose predniso...

ea0044ep27 | (1) | SFEBES2016

Maternal hypercalcaemia due to CYP24A1 loss of function mutations

Upton Thomas , Florkowski Chris , Phillips Ian , Hunt Penny

Background: Significant changes in calcium metabolism occur during normal pregnancy to meet the needs of the growing fetus. These include a rise in 1,25-dihydroxyvitamin D (1,25-(OH)D2 and consequent suppression of parathyroid hormone (PTH). In spite of this, maternal hypercalcaemia is very uncommon and should prompt further investigation.Clinical case: A 24-year-old primigravida woman was referred for assessment of maternal hypercalcaemia. Sh...

ea0044ep28 | (1) | SFEBES2016

Lithium associated Hyperparathyroidism (LAH): Cinacalcet is an effective alternative treatment option

Sagi Satya V , Jampana Neelima , Rajkanna Jeyanthy , Oyibo Samson

Introduction: Lithium associated hyperparathyroidism (LAH) resulting in hypercalcaemia is a known problem. Treatment options are limited in frail elderly patients with multiple co-morbidities, in whom parathyroid surgery could be dangerous. Cinacalcet, a calcimimetic agent can be an alternative option. We report a case of an elderly lady on Lithium, who was initiated on Cinacalcet for hypercalcaemia and has had to continue the Lithium for her bipolar affective disorder.<p ...

ea0044ep29 | (1) | SFEBES2016

Severe hypercalcaemia in sarcoidosis: Is Vitamin D replacement safe?

El-Laboudi Ahmed , Ramli Rozana , Hatfield Emma

Objective: To highlight the issue of vitamin D supplementation in patients with sarcoidosis.Case report: We report the case of a 66-year-old lady, who presented with one week history of general weakness, drowsiness, nausea and confusion. 6-weeks prior to presentation, she underwent right-sided intra-medullary nail insertion for a traumatic femur fracture, whilst abroad. Her past medical history includes stage IV pulmonary sarcoidosis, pulmonary hypertens...

ea0044ep30 | (1) | SFEBES2016

Hypercalcaemia induced psychosis due to primary hyperparathyroidism in pregnancy

Thomas Alice , Gunganah Kirun , Rayanagoudar Girish , Williams Eliot , Hanson Philippa , Drake Williams , Berney Daniel , Parvanta Laila , Kirwin Simon , Metcalfe Karl

Background: Primary hyperparathyroidism is the third most common endocrine condition in pregnancy after thyroid disease and diabetes. Untreated hypercalcaemia due to primary hyperparathyroidism increases the risk of miscarriage, intrauterine death and preterm labour. Pharmacological and surgical limitations in pregnancy often make diagnosing and managing this condition challenging. We report a complex case of hypercalcaemia-induced -psychosis due to primary hyperparathyroidism...

ea0044ep31 | (1) | SFEBES2016

Hypercalcaemia due to Pelvic Sarcoidosis

Burkert Julia , Evans Jane , Neary Nicola

A 51-year-old lady presented as an emergency with disabling, recurrent hypercalcaemia in July and August, 2015 with a peak corrected calcium of 3.94 mmol/l (normal range 2.2–2.6). She had been diagnosed with a stage 1A endometrial cancer, treated with hysterectomy and bilateral salpingo-oophorectomy in April 2014. Significant pelvic and left groin lymphadenopathy was noted, and was found to be enlarging on surveillance CT of July 2015. She was also found to have a left ki...

ea0044ep32 | (1) | SFEBES2016

Normocalcemic tetany after parathyroidectomy for hyperparathyroidism

Aziz Umaira , Mallik Ritwika , Ponnampalam Swarupini , Rathore Ali

Introduction: Hypocalcaemia is a frequent complication after thyroid and parathyroid surgery. We report a case of tetany occurred in a patient with normal serum levels of calcium, magnesium and phosphate after parathyroidectomy for hyperparathyroidism.Case History: 55 year old Caucasian male was referred by general physician with three month history of fatigue, loss of appetite, intermittent constipation and abdominal pain. Systemic examination unremarka...

ea0044ep33 | (1) | SFEBES2016

Can parathyroid carcinoma be predicted preoperatively?

Agha Adnan , Aldridge Kerrie Anne , Salahuddin Sofia

Introduction: Parathyroid carcinoma (PTHCa) is a rare malignant tumour which, although associated with higher calcium and parathyroid hormone (PTH) levels at presentation and younger age group, can only be diagnosed on histological basis. Recent studies have shown a logarithmic formula (using Calcium, PTH and age) can predict PTHCa if it scores more than 5%, with a sensitivity and specificity of 100% and 30% respectively. We describe a case where application of similar formula...

ea0044ep34 | (1) | SFEBES2016

A pain in the neck (or is it in the neck?)

Chelmenciuc Rodica , Tanday Raj

We present the case of a 50 year old with primary hyperparathyroidism and 2 unsuccessful surgeries. Initially presenting in 2012 we question whether further surgical attempts to cure her should be made.She was found to have hypercalcaemia since 2009 with levels 2.60–2.80 mmol/l with PTH 21.9–28.9 pmol/l, vitamin D 9 nmol/l, ACE 37.8 iu/L, normal protein electrophoresis, creatinine 84 umol/l, phosphate 1.06 mmol/l, TSH 0.86 mU/l, Hb 142 g/l, and...

ea0044ep35 | (1) | SFEBES2016

An interesting case of ‘skyrocketing hypercalcaemia’

Khan Irfan , Bashir Jawad , Chau Fong

Disorders of calcium metabolism are common in Sarcoidosis. The frequency of hypercalciuria and hypercalcaemia has been reported as 30–50% and 10–20% respectively. The underlying mechanism is enhanced PTH independent extra-renal production of 1,25-Dihydroxy Vitamin D (Calcitriol) which increase absorption of Calcium from the gut causing hypercalcaemia.A 79 year old lady was admitted with fever, cough and night sweats and was treated for pneumoni...

ea0044ep36 | (1) | SFEBES2016

Periodic episodes of weakness over 7 years

Dales Jolyon , Vasudevan Pradeep , Kong Marie-France

A 24-year-old traffic warden was initially referred to the neurology department with episodes of “funny turns” over the past 7 years. Without warning she would become dizzy and lightheaded with blurring of vision and weak legs. These symptoms would resolve after ingesting something sweet but the relief of her symptoms was not immediate. The episodes could happen at any time of the day but never first thing in the morning and could happen several times a week. She rep...

ea0044ep37 | (1) | SFEBES2016

Spurious hypoglycaemia caused by an IgM paraprotein

Armston Annie , Zarif Nadia , Meeking Daryl

Mrs IP is a 79 year old lady with a past medical history of spleenic marginal zone lymphoma, diagnosed in 2007 and treated with chemotherapy. She has suffered two relapses but despite her diagnosis had remained generally quite fit and healthy until the recent issues. An IgM paraprotein was identified in the patient’s serum an December 2014.In April 2015 Mrs IP presented to her GP complaining of cramping symptoms overnight, especially marked in her h...

ea0044ep38 | (1) | SFEBES2016

Hypokalaemic periodic paralysis

Aarella Vikram , Lenkalapally Anjan , Parasa Ramya , Cheryala Mahesh , Merugu Bhavani

Introduction: Hypokalaemic periodic paralysis is a medical emergency when patients present with acute onset paraparesis usually noticed in the mornings secondary to low serum potassium levels with a prevalence of 1 in100,000. The symptoms resolve promptly with correction of potassium. The patient experiences motor symptoms while the sensation is preserved and can be differentiated from acute inflammatory demyelinating polyneuropathy with preserved ocular, bulbar or respiratory...

ea0044ep39 | (1) | SFEBES2016

A young person with recurrent severe hypokalaemia - familial, iatrogenic or just unknown?

Shafqat Muhammad , Basavaraju Navya , Rangan Srinivasa , Singh Prashant , Moulik Probal

A 26-year-old female presented with 5-year history of episodic muscle weakness, abdominal cramps and facial paresthesia. She had 2 hospital admissions elsewhere within 6months with severe hypokalaemia (1.9 mmol/L). She was started on Lamotrigine for epilepsy 7 years ago and changed to Levetiracetam in October 2010 following further seizures. She is now seizure-free for over 5 years. Her potassium levels before and after Levetiracetam are shown in Table 1.<table boarder="1"...

ea0044ep40 | (1) | SFEBES2016

Insulinoma misdiagnosed as alcohol induced hypoglycaemia

Tofeec Khaled , Howarth Michelle , Rao-Balakrishna Prasanna

A 48 years old male presented with an acute episode of dizziness, weakness, diaphoresis, palpitations, and shakiness. Hypoglycaemia was confirmed with a CBG of 1.6 mmol/L. His symptoms resolved on treatment with Hypostop gel and 10% dextrose. He had an otherwise unremarkable physical examination. In view of his history of consumption of a bottle of vodka daily a diagnosis of alcohol induced hypoglycaemia was made on discharge. A year later he was found being agitated and aggre...

ea0044ep41 | (1) | SFEBES2016

A rare case of Diabetic ketoacidosis (DKA) in a patient with genetically confirmed maturity onset diabetes of young (MODY)

Mcquade Hannah , Ahmad Sajjad , Stephen Stanaway

Maturity Onset Diabetes of the Young (MODY) accounts for upto 2% of all patients with diabetes. Hepatocyte Nuclear Factor 1 alpha (HNF1-A) MODY is the most common subtype accounting for 30–70% of all MODY cases. Typically, it presents in young adults below the age of 45, frequently < 25 with autosomal dominant family history of diabetes, absence of autoimmune markers and insulin resistance and c-peptide positivity.DKA is a rare complication of M...

ea0044ep42 | (1) | SFEBES2016

Birds of a feather flock together: Maternally inherited diabetes and Deafness AND Mitochondrial encephalopathy lactic acidosis and stroke like episodes

Agha Adnan , Ansari Yousuf , Bajwa Hammad , Webber Jonathan

Introduction: The mutation at m. 3243 adenine to guanine (A>G) in mitochondrial encoded transfer-RNA Leucine 1 (MTTL1) gene is the single most prevalent disease-causing mitochondrial DNA (MtDNA) mutation, with carrier status of 1:400 in our general population. The distinct disease phenotype is dependent on the level of heteroplasmy of wild-type vs mutation-type mtDNA in the specific target tissues, ranging from Maternally inherited diabetes and Deafness (MIDD) to mitochond...

ea0044ep43 | (1) | SFEBES2016

Navigating troubled waters: Hyperglycaemic Hyperosmolar State precipitated by Nephrogenic Diabetes Insipidus

Avari Parizad , Sharma Aditi , Samarasinghe Suhaniya , Barnor Quirinius

Hyperglycaemic hyperosmolar state (HHS) is a common medical presentation, typically occurring in older patients with Type 2 diabetes mellitus. Mortality rates have been reported to be up to 60%. Precipitating factors include dehydration, sepsis, cardiovascular disease and drugs. Here, we describe a rare case of HHS, likely to have been precipitated following the development of lithium-induced nephrogenic diabetes insipidus (DI).A 62-year-old female prese...

ea0044ep44 | (1) | SFEBES2016

A case of reversible elevation in liver enzymes in a patient with poorly controlled type 1 diabetes

Obisi Nneka , Al-Hakim Adam , Kahal Hassan , Allan Belinda

Introduction: Hyperglycaemia induced elevation in alanine aminotransferase (ALT) in people with type 1 diabetes has been well described in children but is a less recognised complication in adults.CaseAn 18 year old slim girl was admitted to hospital with diabetic ketoacidosis (DKA). She had type 1 diabetes for 16 years and recurrent hospital admissions with DKA. Her HbA1C was 126 mmol/mol. After correction of her DKA and restarting...

ea0044ep45 | (1) | SFEBES2016

An Unusual Cause of Hypoglycaemia

Law Steven , O'Shea Triona , Hyatt Penelope , Garg Anukul , Nethaji Chidambaram

An 84 year old female with a known history of chronic kidney disease (stage IV) and benign lung tumour presented to the Emergency Department with collapse. She had suffered recurrent collapse over the previous 2 years. Of note she reported significant weight gain during this period. She was diagnosed with symptomatic hypoglycaemia (venous blood glucose 2.8 mmol/l). She was admitted to the ward and found to have recurrent hypoglycaemia both when fasting and post-prandial.<p...

ea0044ep46 | (1) | SFEBES2016

Management of Thyrotoxicosis with Chronic Neutropenia; Case Report

Pasha Nida , Hodson Kathryn , Vidarthyi M , Stojanovic Nemanja , Nkonge Frederick

The new patient with Thyrotoxicosis and neutropenia is not uncommon and requires focussed deliberations on avoidance of iatrogenic neutropenic injury and raises a clinical dilemma when treating patients with pre-existing neutropenia.There is a paucity of published experience on the safety of Carbimazole and Propylthiouracil in defined neutropenic Thyrotoxic patient’s preparation for definitive ablative RAI therapy or thyroidectomy.<p class="abst...

ea0044ep47 | (1) | SFEBES2016

Hyperosmolar Hyperglycaemic state following Diazoxide therapy for Insulinoma

Tabasum Arshiya , Taylor Peter , Dacruz Thomas , Kang Katherine , Wenike-Briggs Mina , Jenkins Katie , Bolusani Hemanth

A 67-year-old lady was admitted through her General Practitioner with a history of reduced oral intake & unresponsiveness. She was diagnosed to have an insulinoma in 2012 and has been on diazoxide 75 mg thrice daily as she was deemed to be unfit for any surgical intervention. On clinical examination, she was pyrexial, tachycardic, hypoxic and had an initial GCS of 3. She was noted to have shingles on her chest & right basal coarse crackles.On adm...

ea0044ep48 | (1) | SFEBES2016

Resistant Hypertension – A Fourth Cause?

Powell Katherine , Myint Khin Swe

Background: Resistant Hypertension is defined as uncontrolled high BP despite treatment with at least three antihypertensive agents. The underlying cause is usually found to be phaeochromocytoma, Conn’s or renal artery stenosis (RAS). We would like to present two cases with difficult control of hypertension which did not fall into these categories.Case 1: History: 68 year old gentleman presented 2012 with >10 year history of hypertension. BP 200...

ea0044ep49 | (1) | SFEBES2016

A case of Euglycaemic Diabetic Ketoacidosis in a patient treated with Canagliflozin

Hodson Katherine , Pasha Nida , Casey Edel , Yakandawala Gangani , Stojanovic Nemanja

Canagliflozin is an oral hypoglycemic agent from the novel class of Sodium Glucose co-Transporter 2 (SGLT2) inhibitors, used in the treatment of patients with Type 2 Diabetes Mellitus (T2DM). Although effective in treatment of hyperglycemia, these medications have been linked to development of diabetic ketoacidosis (DKA) in patients with T2DM. We describe the case of a patient with T2DM, who presented with severe metabolic acidosis while taking Canagliflozin.<p class="abst...

ea0044ep50 | (1) | SFEBES2016

Acute Disseminated Encephalomyelitis (ADEM) secondary to severe diabetic ketoacidosis

DeBray Anne , Munichoodappa Karthik , Puttanna Amar , De Parijat

A 20 year old female with a 3 year history of type 1 diabetes presented to the emergency department unresponsive and was diagnosed with severe diabetic ketoacidosis (DKA). She had no other past medical history and was on a basal bolus regime of insulin only. GCS was 7, pH 6.7, HCO3 3.5 mmol/l, ketones 3+ on urinalysis and blood glucose of 43 mmol/l.She was commenced on fixed rate insulin infusion and IV fluids however also noted to have unequal pupils. S...

ea0044ep51 | (1) | SFEBES2016

Spontaneous hypoglycaemia in a nondiabetic man with end stage renal disease caused by repaglinide or endogenous hyperinsulinaemia: An enigma entangled

Tauni Rahat Ali , Soo Shiu-Ching , Banerjee Ritwik

A 56 year old man was admitted from psychiatry ward after episode of symptomatic hypoglycaemia with capillary blood glucose of 2.5 mmol/L. His background included CKD on thrice weekly haemodialysis, IHD, stroke, hypertension and paranoid psychosis but not diabetes. He denied taking hypoglycaemics, his oral intake was normal and weight was stable. He had another symptomatic hypoglycamia after 22 hours with venous glucose of 1.5 mmol/L, Insulin 320 mU/L (3.0–17.0) and C-pep...

ea0044ep52 | (1) | SFEBES2016

Adrenal carcinoma, a rare incidental finding: case presentation

Hilma Ana Maria , Gogoi Adriana , Jercalau Simona , Badiu Corin

Adrenal carcinoma is a very rare malignancy accounting for 0.05–0.2% of all cancers, with an incidence 0.5–2/106.We present the case of a 60 year old woman with impaired fasting glucose and hypertension, who was incidentally diagnosed, after a non-enhanced abdominal CT, with a right adrenal tumor of 4.5/6 cm. The mass was described as having smooth borders, and a heterogeneous aspect including solid parts, necrotic areas and 1 microc...

ea0044ep53 | (1) | SFEBES2016

Common Features of Giant Prolactinoma and Paranasal Neuroendocrine Carcinoma-Case Report

Gogoi Adriana , Radomir Lidia , Hilma Ana Maria , Stancu Cristina , Picu Maria , Jercalau Simona , Badiu Corin

Giant prolactinoma it’s a very rare tumor that due to its massive extension into surrounding structures can present more often with neurological complications such as visual defects, cranial nerve paresis or even hydrocephalus, unlike the classic prolactinoma presentation with amenorrhea, infertility and galactorrhea. On CT/MRI exams it can present as aggressive skull base tumor and its immunohistochemistry (IHC) may have common features with neuroendocrine neoplasms....

ea0044ep54 | (1) | SFEBES2016

A rare case of type 2 diabetes for 35 years on metformin who developed insulinoma and diazoxide induced renal failure

Alam Muhammad , Agha Adnan , Bajwa Hammad , Mtemrerwa Brian

Background: Insulinoma in a pre existing patient of type diabetes is extremely rare presentation.Methods: We are presenting a a rare case of insulinoma in a pre existing case of type 2 diabetes. A 73 years old patient with type 2 diabetes for 35 years presented to endocrine clinic with hypoglycaemic symptoms ultimatley diagnosed with insulinoma and patient developed renal failure with diazoxide treatment.Result: A 73 years old chin...

ea0044ep55 | (1) | SFEBES2016

Pituicytoma - Lessons from anabolic steroid abuse?

Khan Amber , Littley Malcolm , Lim Jonathan

A 34 year old male, previously healthy nightclub doorman presented with 2 years of reduced libido, fatigue, hot flushes and reduced beard growth. He had fathered three healthy children. He admitted to previous use of veterinary anabolic steroids up until 2 years ago. He had normal secondary sexual characteristics, no features of pituitary hypersecretion, normal visual fields but reduced testicular volumes (8 ml).Biochemical investigation showed growth ho...

ea0044ep56 | (1) | SFEBES2016

An Unusual case of a para-sellar mass

Kumar Ramesh , Surya Ashutosh , Dixon Anthony , Watson David

A 36 year-old female presented with increasing headaches over the previous 8 months. She had seen in the neurology clinic recently and treated for migraines and cluster headache. She also had a history of depression. She had prodromal aura of visual disturbance including blurred vision and photophobia.She was admitted following sudden onset of stabbing pain over the left eye along with nausea. All these symptoms were classic of her usual migraines. On ad...

ea0044ep57 | (1) | SFEBES2016

Co-existent macro-prolactinoma, raised free T4 and right sided facial nerve palsy

Gohil Shailesh , Bhake Ragini , Reddy Narendra , Levy Miles

Background: Pituitary adenomas commonly present with palsies involving the cranial nerves in the cavernous sinus. It is unusual, however, for other cranial nerve palsies to co-present and to have biochemical results that do not fit with the clinical picture.Case: A 47 year old man was admitted with 3 days of headache, vomiting, right sided facial paraesthesia and facial droop. He had no symptoms suggestive of endocrine disturbance. Neurological examinati...

ea0044ep58 | (1) | SFEBES2016

Endocrine Dysfunction in Diamond Blackfan Anaemia

Talla Maria Rita , McIlwaine Louisa , Panarelli Maurizio , Hughes Kate

Introduction: Diamond Blackfan anaemia (DBA) is a rare disorder of red blood cell aplasia characterized by normocytic or macrocytic anaemia and reticulocytopaenia. Short stature, of multifactorial aetiology, is often present. Some patients are glucocorticoid-responsive, while others remain transfusion-dependent leading to iron overload.Case Report: Asymmetrical growth restriction was present at birth. Aged ten weeks, severe anaemia developed. Bone marrow...

ea0044ep59 | (1) | SFEBES2016

New onset Sarcoidosis following treatment of Cushing’s Disease

Cairns Ross Andrew , Hall Lesley

We report the case of a 47-year-old woman with a 5-year history of weight gain, resistant hypertension and uncontrolled type 2 diabetes. She complained of oligomenorrhoea, depression and had a strikingly Cushingoid appearance and so underwent evaluation for Cushing’s Disease.Investigations revealed elevated 24-hour urine free cortisol (UFC) collections on 2 occasions: 540 nmols/24h and 624 nmols/24h. Overnight dexamethasone suppression testing (ODST...

ea0044ep60 | (1) | SFEBES2016

Extra-pancreatic, extra-intestinal pancreatic polypeptide secreting tumour presenting as a case of diarrhoea

Ahmad Ehtasham , Joseph Stonny

Pancreatic Neuroendocrine tumours, P-NETs, comprise 2–3% of all pancreatic tumours. Usually classified as functional or non-functional based on whether these secrete biologically active amines, causing specific syndromes or not. Even non-functional P-NETs in majority of cases secrete substances, not associated with any specific syndrome, like Chromogranin A and Chromogranin B and Pancreatic Polypeptide (PP). An estimated 2% of all the neuroendocrine tumours secrete Pancre...

ea0044ep61 | (1) | SFEBES2016

A rare case of Follicular Stimulating Hormone (FSH) secreting pituitary adenoma in male

Kempegowda Punith , Ayuk John , Toogood Andrew

A 61-year-old man presented to his primary care service with complains of frequent hot flushes, dizziness and headache. Following initial screening, an incidental pituitary lesion was diagnosed on computed tomography (CT) scan and hence was referred to specialist review. Further detailed history revealed similar presentation with dizziness and hot flushes two and a half years ago. He was then diagnosed with essential hypertension after a negative work-up for Cushing disease. H...

ea0044ep62 | (1) | SFEBES2016

Protienurea, oedema, murmur and skin rash – an interesting case of gut carcinoids

Nizamuddin Khwaja , Ahmad Sajjad , Thaman Rajesh , Glover David

A 52 years old man was referred to the renal clinic for persistent proteinurea and leg swelling with suspicion of nephrotic syndrome. He had a history of Hypertension and chronic depression and was taking olanzapine, venlafaxine, Ramipril.He also had diarrhoea of 5–6 stools per day over the last 6 months. He was getting short of breath and had lost weight. On examination he had erythematous rash over the face, limbs and abdomen which he mentioned was exacerbated by stress...

ea0044ep63 | (1) | SFEBES2016

Carney Complex-a 30 year journey

Mlawa Gideon , Affam Dora , Oshodi Marek

Background: Carney complex is rare multiple endocrine neoplasia syndrome affecting adrenal, pituitary and thyroid glands. It’s associated with other non-endocrine tumours such as cardiac, skin, mucosal or breast myxomas, testicular tumours, melanotic shwanomas and abnormal pigmentation (spotty skin pigmentation (freckles).Case: We present the case of a 54 year old lady, who was referred for echocardiography in December 2014 following an episode of p...

ea0044ep64 | (1) | SFEBES2016

A case of anterior hypopituitarism as the initial presentation in pituitary metastasis from breast cancer

Gunawardena Vindya , Candelario-Cosme Madeline , Lilienfeld Howard

Pituitary metastasis has been reported in about 6–8% of the breast cancer patients. Diabetes insipidus is the most common initial presentation in metastatic lesions of the pituitary. Anterior pituitary lobe lacks a direct blood supply and involvement usually is due to spread from the posterior lobe. We present a case of a 68-year-old female with known stage IV breast cancer with bone metastasis on trastuzumab, lapatinib and anastrozole who presented with hypotension, leth...

ea0044ep65 | (1) | SFEBES2016

Pituitary apoplexy precipitated by head trauma in a Nigerian: A case report

Okunowo Bolanle , Eghosa Morgan

Background: Pituitary apoplexy is a neuroendocrine emergency, commonest cause is pituitary adenoma. It can occur with or without precipitating factors. Commonest precipitating factor is hypertension. Post traumatic pituitary apoplexy due to tumour infarction is not common.Case report: 58 year old Nigerian painter presented with loss of consciousness, sudden headache, weakness in upper and lower limbs following fall from 3 meters high ladder while paintin...

ea0044ep66 | (1) | SFEBES2016

Vanishing insulin requirements in patient with type 1 diabetes

Nagi Dinesh , Bachuwar Ravikumar

We describe a case of 31 year young lady with Type 1 Diabetes, who started experiencing reduction in insulin requirement and hypoglycaemia episodes due to an endocrine disorder following Pregnancy. She presented with recurrent episodes of documented hypoglycaemia and amenorrhea following successful pregnancy. Her basal insulin requirements fell from 36 units to 24 units per day and she required little if any insulin as bolus (0.5 unit for every 10 gm). She did not breast feed....

ea0044ep67 | (1) | SFEBES2016

Ectopic somatotroph adenomas

Chentli Farida

Introduction: Ectopic somatotroph adenomas are very rare and their mechanism is still debated. Our aim was to report 2 cases: One was located in the clivus and the other one in the supra sella area.Case 1A woman aged 45 years old, treated for post surgical hypothyroidism, was diagnosed as acromegaly by the family doctor. Growth hormone (GH)=44 ng/ml, IGF1=504 ng/ml (150–350). Prolactin (PRL)=37 ng/ml. The rest of pituitary fun...

ea0044ep68 | (1) | SFEBES2016

Panhypopituitarism secondary to compression by bilateral “kissing” internal carotid artery aneurysms

Daultrey Harriet , Smith Andy

We describe a 91 year old woman who presented to hospital with transient loss of consciousness resulting in facial trauma. In the preceding 6 weeks she described 2 similar episodes of loss of consciousness and general malaise. She had a past medical history of pulmonary hypertension secondary to recurrent pulmonary emboli. Relevant medication included furosemide 20 mg od and life-long warfarin.On examination she had significant orbitofrontal bruising and...

ea0044ep69 | (1) | SFEBES2016

Cushing’s Syndrome secondary to ACTH-producing prostate adenocarcinoma: A case report

Scopazzini Marcello , Pomroy Josh , Hatfield Emma , Ramli Rozana

A 67 year-old man, with metastatic prostate cancer diagnosed in July 2015, presented with a two-week history of lethargy, intermittent confusion, facial flushing, and increased thirst. Other medical history included well-controlled hypertension on irbesartan monotherapy, and paroxysmal atrial fibrillation. On examination, he was flushed and lethargic, but had no other features of Cushing’s Syndrome. His pulse was 66 bpm and BP 179/78. There was no evidence of hypovolaemia...

ea0044ep70 | (1) | SFEBES2016

Rare source of catecholamine secretion in two cases

Khalid Yasmeen , Chinnasamy Eswari , Vlahos Jonny , Snape Katie , Bano Gul

Pheochromocytomas account for increased catecholamine secretion in about 90% of cases. Less than 5% of Less head and neck paragangliomas (PGs) secrete catecholamines. As in all extra-adrenal catecholamine secreting paraganglionomas (CSPs) they produce predominantly norepinephrine and little epinephrine secretion. About 25% of PGs are familial and have mutations involving RET,VHL, SDHB, SDHC or SDHD and other newly described genes.We present two cases of ...

ea0044ep71 | (1) | SFEBES2016

Morvan’s syndrome: could insulin like growth factor- 1 be a marker?

Edeghere Simon , Browne Duncan , McLean Brendan

Morvan’s syndrome is a rare autoimmune disease characterised by peripheral nerve hyper excitability, central nervous system symptoms and autonomic dysfunction which can mimic other endocrine presentations with symptoms including hyperhidrosis, weight loss, neuromyotonia and insomnia. Morvan’s is associated with malignancy, in particular thymomas, suggesting a paraneoplastic aetiology. This case is the first to associate Morvan’s with renal carcinoma and proposes...

ea0044ep72 | (1) | SFEBES2016

A case of pituitary hypophysitis following treatment with ipilimumab

Iqbal Fizzah , Choudhary Nidhi , Flanagan Daniel

Case: We present an interesting case of pituitary hypophysitis following ipilimumab therapy. A 66 year old lady previously diagnosed with left ocular melanoma in 2006 was under oncology follow up, when routine surveillance scan showed recurrence in segment six of the liver. She underwent laparoscopy and was found to have multiple liver metastases following which she was commenced on ipilimumab. Four weeks after completing her second cycle of ipilimumab, she developed severe he...

ea0044ep73 | (1) | SFEBES2016

Somatostatin analogue use to treat visual field loss in acromegaly newly diagnosed in pregnancy

Frizelle Isolda , O'Halloran D.J.

Acromegaly in pregnancy is rare. There is limited literature on the use of medical therapy to treat this condition. We report for the first time somatostatin analogue use in a woman presenting with newly diagnosed Acromegaly in pregnancy to treat visual field loss.This is the case of a 32 year old woman with a background of anxiety, depression, asthma and smokes. The patient underwent brain imaging for recurrent headache at 11 weeks gestation. At this ti...

ea0044ep74 | (1) | SFEBES2016

Hypopituitarism secondary to carotid artery aneurysm complicating a new presentation of hepatocellular carcinoma

Farouk Lavanta , Makaronidis Janine , Garg Anukul

An 82 year old gentleman was admitted with lethargy, shortness of breath and weight loss of 26% total body weight over a two-year period. His past medical history included hypertension, pulmonary fibrosis, thalassaemia trait and unexplained thrombocytopenia.He had previously been investigated for weight loss with a CT thorax/abdomen/pelvis in 2014 which demonstrated no evidence of malignancy and FDG PET had shown no disease.On admi...

ea0044ep75 | (1) | SFEBES2016

The challenges to diagnose and differentiate TSHoma from thyroid hormone resistance: a case report

Hamdan Khaliq , Koulouri Olympia , Gurnell Mark , Chatterjee Krishna , Owen Penelope

TSHoma is rare, with an incidence of 1 per million, and <1% of all pituitary tumours. We reported a case involving a 49-year-old female who was first referred to our endocrine unit in 2006 with excessive lethargy and abnormal TFT’s. She was thought to have thyroid hormone resistance for several years until 2015 when she reported having persistent symptoms and further investigation suggested an alternative diagnosis.Results: Ft4=41.6 pmol/l, TSH=...

ea0044ep76 | (1) | SFEBES2016

Acromegaly gigantism with dilated cardiomyopathy and heart thrombus

Chentli Farida , Laloui Amina , Boudiaf Dia-Eddine , Azzoug Said

Dilated cardiomyopathy with congestive heart failure (CHF) is a very rare complication of growth hormone excess due to (GH)-secreting pituitary adenoma; It occurs in nearly 3% of acromegaly. Our aim was to report a case with CHF, large right auricular thrombus, and pulmonary embolism.Case report: A man aged 41, was known as an acromegaly gigantism due to a large pituitary somatotroph adenoma. That one was operated on twice but the tumor persisted and GH=...

ea0044ep77 | (1) | SFEBES2016

A patient who presented unresponsive and unseated from the sella

Stammers Kathryn , Solomon Andrew

Case History-A 74 year old female patient presented to the emergency department following a witnessed seizure and profound hypoglycaemia (BM 1.1 mmol/l) with an initial GCS of 7/15. Collateral history described 4 days’ feeling unwell with reduced oral intake and multiple recent ‘vacant episodes’. An urgent CT head was unremarkable. Past medical history included hypothyroidism of several years’ duration on T4 50 mcg [3 months’ prior to admission, TSH wa...

ea0044ep78 | (1) | SFEBES2016

Heterogeneous presentation of giant prolactinoma

Radomir Lidia , Gogoi Adriana , Jercalau Simona , Badiu Corin

Giant prolactinomas are rare pituitary tumors, defined as adenomas greater than 4 cm, with extrasellar extension, presenting with PRL levels > 1000 ng/dl. Dopamine agonists (DA) are the first-line treatment. Most (90%) of giant prolactinomas occur in men.We describe two cases of giant prolactinoma. A 17 years man presented with frontal headache, gradual visual deficit, nausea and dizziness. MRI demonstrated a sellar tumor of 6.4 cm with extrasellar e...

ea0044ep79 | (1) | SFEBES2016

Pseudoacromegaly - a differential diagnostic problem for acromegaly

Spencer Rupert , Dahlqvist Per , Dang Mary N. , Johannsson Gudmundur , Korbonits Marta

Introduction: Acromegaly is usually not a difficult condition to diagnose if the possibility of this diagnosis has been raised. However, there are a few conditions presenting with some aspects of acromegaly or gigantism but without growth hormone excess. Such cases are described as ‘pseudoacromegaly’ (acromegaloidism).Methods: A female patient was first investigated for GH excess at 10 y for tall stature since infancy (over 97th perc...

ea0044ep80 | (1) | SFEBES2016

Glioma in an AIP mutation carrier patient

Datta Shiv , Dang Mary N. , Baborie Atik , Korbonits Marta

Introduction: Around 15–20% of patients suffering from familial isolated pituitary adenoma (FIPA) possess heterozygous germline mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene. AIP carriers are predisposed to pituitary adenomas with a penetrance of approximately 20%. No other tumours have been observed in subjects with AIP mutations, hence the name “isolated”. AIP is acting as a tumour suppressor gene in the p...

ea0044ep81 | (1) | SFEBES2016

Retroperitoneal fibrosis presenting with panhypopituitarism

Talla Maria Rita , Hughes Kate , McGeoch Lucy , Boyle James , Drummond Russell , Carty David

A 68-year-old gentleman with hypertension and diet-controlled type 2 diabetes presented in September 2015 with weight loss, fatigue, low libido and cold intolerance.Blood results demonstrated secondary hypothyroidism (TSH 0.59 mU/l (reference 0.35–5.00), free T4 8.3 pmol/l (ref 9.0–21.0)), hypogonadotrophic hypogonadism (testosterone 1.0 nmol/l (ref 10.0–36.0), FSH 1.5, LH 1.1) and a modestly elevated prolactin (795 mU/l (ref <400)). S...

ea0044ep82 | (1) | SFEBES2016

Pituitary atrophy: a rare cause of pan hypopituitarism

Kushe Manish Shrikrishna , Joseph Vinod , Rajeswaran Chinnadorai , Muniyappa Suresha

Introduction: Idiopathic Pituitary atrophy is rare cause of pan hypopituitarism. Various hypotheses were proposed to identify aetiology of idiopathic pituitary atrophy. Still definite cause is not known. There are very few reported cases of pituitary atrophy. We present a case of pituitary atrophy that required complete replacement of pan hypopituirsm to alleviate her symptoms.Case report: About 64 year lady was referred for evaluation of hyponatraemia a...

ea0044ep83 | (1) | SFEBES2016

Sweaty arms and legs: is it acromegaly?

Lim Chong , Moriarty Maura , Narayanaswamy Shakunthala , Todd Jeannie

About 19 year-old, female, presented with sweating in both arms for many years. The sweating has progressively got worse over the last several years. Occasionally, her feet and lower back can also be affected. They do not tend to occur particularly at night and have no association with alcohol, meals or fasting. Her periods are regular. She does not have any associated symptoms such as headache and visual disturbance.She has no significant family history...

ea0044ep84 | (1) | SFEBES2016

Delayed diagnosis in a case of insulinoma due to hypoglycaemia unawareness

Joseph Vinod , Kushe Manish , Rajeswaran Chinnadorai , Muniyappa Suresha

Introduction: Insulinoma is a neuroendocrine tumour derived from the pancreatic islet cells producing excessive amounts of insulin. It can be seen at every age but mostly seen in females above age 50 years old. Because of nonspecific symptoms 20% of cases are misdiagnosed primarily. Major symptoms and signs are related to hypoglycaemia and become significant due to exercise and fasting. This case reveals the diagnostic difficulty due to hypoglycaemia unawareness.<p class="...

ea0044ep85 | (1) | SFEBES2016

Spontaneous resolution of primary amenorrhoea in a patient with mosaic Turner’s Syndrome

Mamoojee Yaasir , Jones Phil , Stewart Jane , Choudhary Meena , Quinton Richard

Turner’s syndrome (TS) results from a genetic abnormality in phenotypical female individuals where the second X chromosome is either absent or present in a mosaic form. The most obvious consequences are short stature and primary amenorrhoea, although there are often dysmorphic features as well as cardiovascular and genitourinary complications. 90% of TS patients experience primary amenorrhoea with subsequent infertility. Spontaneous recovery of ovarian function in patient...

ea0044ep86 | (1) | SFEBES2016

Central autonomization of peripheral precocious puberty

Youssouf Belazzouz Abderahmen

IntroductionThe precocious puberty defines itself by the appearance of secondary sexual characters before the age of 9 years at the boy.We bring back the case of a precocious pseudo puberty iso sexual having evolved towards a central precocious puberty revealed by in an advance of secondary bony age in a delay of diagnosis.ATCD, accepted for reappraisal of a precocious pseudo puberty linked to a bilateral tes...

ea0044ep87 | (1) | SFEBES2016

Thionamide in a Neutropenic Thyrotoxic patient- Culprit or Cure

Kumar P

A 59 yr old man was admitted with sweating, tremors and generalized weakness. Blood tests showed FT4>100 pmol/l, FT3>50 pmol/l, TSH<0.01 mU/l, neutrophils 0.6×109 /l Past medical history included recurrent hyperthyroidism, type 2 diabetes mellitus, and neutropenia of ‘unknown’ origin(under investigation by haematology). Carbimazole 20 mg BD was started 2 days prior to admission by his general practitioner.The neutrop...

ea0044ep88 | (1) | SFEBES2016

Abstract unavailable....

ea0044ep89 | (1) | SFEBES2016

An unusual cause of thyrotoxicosis

Kumar Ramesh , Surya Ashutosh , Dixon Anthony

A 24 years old veterinary nurse presented to the cardiology outpatient clinic with palpitations, breathlessness and lethargy. There was no history of weight loss. She had a past history of bulimia. She was clinically euthyroid. ECG demonstrated sinus tachycardia with heart rate of 120 bpm. Thyroid functions test (TFT) done by GP was normal. She was initially treated with beta-blockers.She was subsequently admitted to hospital a month later with palpitati...

ea0044ep90 | (1) | SFEBES2016

Thyroid dysfunction caused by three different Tyrosine Kinase inhibitors (TKI)

Sivappriyan Siva , Clarke Viktoria , Kumar Jesse , Joshi Supriya

Tyrosine kinase inhibitors (TKIs) are relatively new therapy drugs used for the treatment of metastatic cancers including Renal cell carcinoma (RCC), gastrointestinal stromal tumours, thyroid and neuroendocrine tumours. They block vascular endothelial growth factor and other growth factors Thyroid dysfunction is often a side effect of this treatment. A close monitoring of thyroid hormone levels is a necessity.We have a case of a 69-year-old lady with RCC...

ea0044ep91 | (1) | SFEBES2016

Papillary thyroid cancer within an auto-immune goitre: two birds with one stone

Bremner Emma , Kieffer Veronica , Uddin FJ , Levy Miles

Clinical presentation: This 32 year old lady was referred with a history of weight loss, sweating, tremor and anxiety and biochemical hyperthyroidism; fT4 41 pmols/l (9.00–25.00 pmols/l) TSH <0.05 miu/l (0.30–5.00 miu/l); strongly positive TPO antibodies (1600 IU/ml.). She was toxic clinically, had subtle left sided proptosis and a palpable left sided thyroid nodule. She was started on carbimazole 20 mg and the initial differential diagnosis was between Grave&#14...

ea0044ep92 | (1) | SFEBES2016

A case of uncontrolled thyrotoxicosis and congestive heart failure due to Graves’ disease

Aransiola Clement , Olamoyegun Michael

Introduction: Graves’ disease is the commonest cause of thyrotoxicosis. If left untreated myriad of complications, chief among which are cardiac related morbidity and mortality might supervene.Case presentation: A 31-year-old man presented to the endocrine clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria 19 months ago with features suggestive of hyperthyroidism and a diagnosis of thyrotoxicosis secondary to Graves’ disease was made. He wa...

ea0044ep93 | (1) | SFEBES2016

A different cause of thyrotoxicosis: Alemtuzumab induced thyrotoxicosis

Bawa Fareha , Kalathil Dhanya , McNulty Sid

30 years old female with history of sinusitis, anxiety states, diagnosed with relapsing multiple sclerosis from May 2005, initially had abnormal sensation and weakness of left side of body with MRI finding of demyelinating lesion in the cervical cord, treated with i/v methyl prednisolone with good recovery. Unfortunately had multiple relapses, therefore treated with two doses of Alemtuzumab since June 2012, presented with shakiness and a rash in her neck in July 2012. Clinical...

ea0044ep94 | (1) | SFEBES2016

A case of severe hypercalcaemia caused by hyperthyroidism with concomitant adrenal insufficiency

Sabin Jodie , Coakley Hannah , Evans Alison

Hypercalcaemia is a recognised feature of hyperthyroidism due to accelerated bone turnover caused by thyroid hormone. When present, it is generally mild, usually with levels < 3.00 mmol/l. We present a case of a 19 year old male with thyrotoxicosis, who had severe hypercalcaemia and was also found to have possible co-existent adrenal insufficiency at the same time.He presented with a 4 month history of weight loss, anxiety, tremors and palpitations. ...

ea0044ep95 | (1) | SFEBES2016

Thyrotoxicosis resistant to treatment: Graves’ disease or Factitious thyrotoxicosis: A Puzzle

Nagi Dinesh , Holems Simon , Jenkins Richard

We describe an interesting case of a man who poses a significant ongoing management challenge. He presented with mild biochemical evidence of T3 thyrotoxicosis (FT3, 8.2, FT4 13.6, TSH 0.02). Carbimazole 20 mg was started and despite increasing dosage, he deteriorated significantly. He was concordant with medication. His TBII and thyroid auto-antibodies were negative. A Tc uptake scan showed reduced uptake. Prednisolone was added, thinking that he may have thyroiditis. Despite...

ea0044ep96 | (1) | SFEBES2016

Acute confusion in a cyclist

Giannopoulou Angeliki , Hancock Sian , Kumar Senthil , Mallipedhi Akhila , Rice Sam

A 46-year-old male was brought to the hospital by his uncle as he was found to be acutely confused and agitated ‘talking rubbish’ and giggling inappropriately. Last time he was seen well was 3 days ago. He was a cyclist who lived alone and his past medical history included Graves’ disease and AF. He was on propranolol, carbimazole and warfarin. A month ago he needed admission to a different hospital after falling off his bike. At that time he also developed conf...

ea0044ep97 | (1) | SFEBES2016

Graves’ disease with fluctuating thyroid status and hypothyroidism with positive anti-TSH receptor antibody levels – distinctive autoimmune side-effects following alemtuzumab therapy for multiple sclerosis

Pariani Nadia , Willis Mark , Muller Ilaria , Healy Sarah , Nasser Taha , Jones Joanne , Chatterjee V. Krishna K. , Dayan Colin , Robertson Neil , Coles Alasdair , Moran Carla

Alemtuzumab, a highly effective, newly-licensed, treatment for multiple sclerosis (MS), is notably associated with Graves’ disease (GD), which reportedly has an indolent course.Methods: Case record review of patients who developed thyroid dysfunction (TD) after alemtuzumab treatment in Cambridge & Cardiff, to determine type, frequency and course of TD.Results: 41.8% (104/249; 81F, 23M) of alemtuzumab-treated patients devel...

ea0044ep98 | (1) | SFEBES2016

Thyrotoxic periodic paralysis, and a high carbohyrdate diet; an unusual presentation in a Caucasian male

Ali Tauni Rahat , Arif Rameez , Soo Shiu-Ching

A 54 year old Caucasian male presented with progressive muscle weakness leading to complete paralysis in upper and lower limbs evident on examination. Initial venous gas analysis showed potassium of 2.1 mmol/l, and ECG showed U waves with prolonged QTc. A diagnosis of hypokalaemic periodic paralysis was made, and intravenous potassium administered. The paralysis gradually resolved over the next 3–4 h, as repeat serum potassium level rose to 4.0 mmol/l. He described 6 mont...

ea0044ep99 | (1) | SFEBES2016

Vomiting as harbinger for Graves’ disease

Bejinariu Emanuela , Banerjee Ritwik , Soo Shiu-Ching

Introduction: Isolated vomiting is a rare often forgotten presentation of Graves’s disease and can lead to delayed diagnosis. Multiple case reports quote vomiting in thyrotoxicosis co-presenting with Addisonian crisis, diabetic ketoacidosis or with abnormal liver function and jaundice. Another common association is hyperemesis gravidarum. Vomiting in paraneoplastic hyperthyroidism occurs through a similar mechanism of beta-HCG secretion, mainly related to germ-line tumour...

ea0044ep100 | (1) | SFEBES2016

Sole metastatic spread from a renal cell carcinoma presenting as a goitre 6 years following renal cell carcinoma

Livingstone Rachel , Drummond Russell

Metastatic disease to the thyroid is rare, accounting for 2–3% of thyroid malignancy. The most common malignancy to metastasise to thyroid is renal cell carcinoma (48.1%), followed by colorectal (10.4%) and lung (8.3%). Clinically, clear cell renal cell carcinoma (CCRCC) can present with thyroid metastases years or decades later. Several studies have shown that thyroid gland abnormalities, including nodular goitre or thyroiditis, are more likely to harbour metastases....

ea0044ep101 | (1) | SFEBES2016

The curious case of thyroid dysfunction and the monoclonal antibody

Hasan Faisal , Khan Irfan , Lambert A.P.

Alemtuzumab is the first humanised monoclonal antibody. It is used in haematological malignancies. It is associated with secondary autoimmune adverse effects including Grave’s disease, hypothyroidism, Goodpasture’s disease and ITP. We present a case where there was a drastic change in the thyroid biochemistry in a short span of few weeks- from raging free hormone levels to profound hypothyroidism. A 46 year old man was found to have abnormal th...

ea0044ep102 | (1) | SFEBES2016

Thyrotoxic periodic paralysis in a Nigerian male

Vogazianou Artemis , O'Shea Triona , Hyatt Penny , Nethaji Chidambaram , Garg Anukul

Introduction: Periodic paralysis is a rare condition characterized by muscle weakness in the presence of triggers including cold, heat, high carbohydrate meals or physical activity. It is classically described in the presence of profound hypokalaemia; when this occurs in conjunction with thyrotoxicosis it is termed thyrotoxic periodic paralysis.Case history: A 30-year old Nigerian man presented with a 3 h history of inability to move, on a background of ...

ea0044ep103 | (1) | SFEBES2016

Thyrotoxicosis with ocular myasthenia – A case report

Patel Meghana , Prasad Pothina Narayana

Background: Graves’ disease with ocular myasthenia are autoimmune disorders with their association being rare but well documented. There is overlap of ocular clinical features in both these conditions which can pose a significant clinical challenge. The diagnosis is necessary for both therapeutic and prognostic reasons.Case presentation: A 35 year old lady presented with diplopia on downward gaze for 4 weeks. There is history of unintentional weight...

ea0044ep104 | (1) | SFEBES2016

An unusual case of resistance to thyroid hormone behaving as TSH-secreting pituitary adenoma (TSHoma)

Ahmad Sajjad , Dixon Anthony

A 74 years old man was referred to endocrine clinic with abnormal TFTs with raised free T4 (39.7 pmol/l; NR: 7.0–17 pmol/l), raised FT3 (7.3 pmol/l; NR: 3.5–6.5 pmol/l) and normal TSH (1.9 mU/ml; NR: 0.35–5.5 mU/ml) which were done on routine testing by his GP. PMH included COPD and B12 deficiency. He had no symptoms suggestive of thyrotoxicosis and was clinically euthyroid. Investigations were arranged to exclude the three possibilities of assay interference, R...

ea0044ep105 | (1) | SFEBES2016

Normal neurodevelopment of children from a mother treated with only Liothyronine (T3) during pregnancy – a case report

Khan Sidrah , Wheatley Trevor

Untreated hypothyroidism in pregnancy is associated with severe neurodevelopmental delay. Based on rodent experiments, maternal T3 is said not cross the placenta and to have little if any role in fetal brain development.Case report: A 36-year-old female with known hypothyroidism treated only with liothyronine (T3) 20 μg TDS. attended the antenatal clinic. It was suggested that she changed to treatment with levothyroxine (T4) or a combination of T3 a...

ea0044ep106 | (1) | SFEBES2016

A challenging case of thyroid storm

Mohammed Azmi , Joshi Ashwin , De-Alwis Nimantha

Thyroid storm is a rare complication of thyrotoxicosis, life-threatening if not managed appropriately.We report a 43-year-old woman who presented to emergency services with shortness of breath, palpitations and weight loss. She was pale, cachectic, in atrial fibrillation and had signs of decompensated heart failure. Investigations showed: WBCs: 3.2×109/l, neutrophils 2.1×109/l, Hb 53 g/l, platelet 233, TSH <0.02 mIU/l, FT4 64 (10–25 pm...

ea0044ep107 | (1) | SFEBES2016

Case of pre-tibial myxedema with features of medium-vessel vasculitis on biopsy

Akinlade Akinyele , Anaba Ehiage

26-year-old female lawyer who was first diagnosed to have Grave’s disease in our Endocrinology clinic, when she presented with palpitations, protruding eye balls, progressive weight loss good appetite, heat intolerance and a small goiter and confirmatory TFT results. She was controlled with (and maintained on) 10 mg of carbimazole. She also had flesh-colored swellings, with areas of hyperpigmention and induration on her shins, as well as hyperpigmented patches on her ankl...

ea0044ep108 | (1) | SFEBES2016

Transient thyrotoxicosis following external beam radiotherapy to the neck

Mallik Ritwika , Ponnampalam Swarupini , Ahlquist James

Hypothyroidism is a recognised late complication of radiotherapy to the neck. However, radiation-induced thyrotoxicosis is not generally considered, and may not be diagnosed. We report a case of transient thyrotoxicosis following radiotherapy to the neck. A 71-year-old man with supraglottic squamous cell carcinoma was treated with 65Gy radiotherapy, delivered by volumetric arc therapy in 38 fractions. During radiotherapy he became confused. Three days af...

ea0044ep109 | (1) | SFEBES2016

The night when a floppy Chinese lad almost died due to his thyroid

Bashir Jawad , Price David , Khan Irfan , Saeed Tamar

Thyrotoxic period paralysis is a rare endocrine emergency associated with hyperthyroidism that needs urgent treatment. We present a case of a 19-year-old Chinese student who was admitted with progressive weakness in his lower limbs developing overnight. He was resident at the students’ hostel and went to sleep after ignoring mild leg weakness overnight but could not even get up from his bed in the morning. Luckily his friend called the ambulance and brought him in hospita...

ea0044ep110 | (1) | SFEBES2016

A case of undetectable thyroid hormones

Hayes Samantha , Hawkins Lucy , Halsall David , Joshi Supriya

Positive interference in free thyroxine (fT4) and free triiodothyronine (fT3) immunoassays is well known, however we report a rare case of negative interference in the Roche fT4 and fT3 immunoassays in a 3-year-old girl with undetectable fT4 and fT3. She presented with increasing tiredness, abdominal pain, pain in her lower limbs and constipation. Examination was unremarkable. Thyroid func...

ea0044ep111 | (1) | SFEBES2016

Off legs in a 30 year old: a Grave concern?

Chung Ming-May , de Bray Anne Yingchol , Puttana Amar , De Parijat

A 30-year-old man of Asian descent presented to the emergency department with recurrent episodes of sudden onset limb weakness and difficulty walking over a period of 3 years. Each episode resolved within 2–3 h and he had fully normal mobility in between episodes. He denied any visual, bulbar symptoms or other focal neurology. He had a 9 year history of Graves’ disease for which he had recently discontinued carbimazole therapy in preparation fo...

ea0044ep112 | (1) | SFEBES2016

A lady with psycho-affective symptoms due to Hashimoto’s encephalopathy

Bashir Jawad , Price David , Khan Irfan , Saeed Tamar

Hashimoto’s encephalopathy (HE) is a very rare neuropsychiatric condition associated with autoimmune thyroid disorders which shows a remarkable response to steroid therapy and hence is also called steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). We report a case of 44 year old lady presenting twice with psycho-affective symptoms but not receiving the diagnosis on first presentation. She initially presented with 3 wee...

ea0044ep113 | (1) | SFEBES2016

A big price for a little mistake: similar presentations but diverse management of thyroid storm

Iftikhar Mawara , Crown Anna

Introduction: Thyroid storm is a rare endocrine emergency associated with the reported mortality rate ranging from 10 to 20%. We discussed the management of two cases of thyroid storm with different outcomes. It also showed the successful use of ECMO in the management of severe hyperthyroidism related cardiomyopathy and circulatory collapse.Case History 1: A 36 years old female with known history of Graves’ disease, presented with palpitations and s...

ea0044ep114 | (1) | SFEBES2016

Thymic hyperplasia in Graves’ disease: case presentation and review of current literature

Lewis Alex , Cheer Kelly

A 37-year-old Nigerian lady was referred to the endocrinology clinic with worsening dyspnoea, weight loss, poor sleep and palpitations over the preceding few months. She had a past history of depression treated with citalopram. She was clinically and biochemically thyrotoxic with a TSH <0.01 μ/l [0.4–5] and free T4 49.3 pmol/l [9–19]. TSH receptor antibodies were positive. She was commenced on carbimazole 40 mg once daily and propranolol 40 mg twi...

ea0044ep115 | (1) | SFEBES2016

Could a stitch in time save nine?

Chelmenciuc Rodicaj , Cooper Grace , Tanday Raj

We present the case of a 55 year old woman with Graves’ disease currently in remission but previous agranulocytosis with carbimazole therapy.She has a past medical history of Sjogrens syndrome on no medication. There is a family history of type 1 diabetes and thyroid disease in several members. She is Caucasian, a non smoker and drinks no alcohol. She is a primary school teacher.In December 2014 she presented to her GP with pa...

ea0044ep116 | (1) | SFEBES2016

Can myxedema coma be managed in a ward? A complicated case of myxedema with peg feeding

Bawa Fareha Najeeb Mohideen , Mahgoub Yahya

61 years old female with multiple comorbidities such as ckd-3, Trans abdominal hysterectomy and oophorectomy for endometrial cancer, complicated by entero-cutaneous fistula, ileal conduit and cholecystectomy.She presented with generally unwell, nausea, vomiting, confusion.On Examination she was bradycardic, low gcs, hypotensive and hypothermic.The metabolic causes for confusion was excluded, anion gap was nor...