Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology Endocrine Update 2018

Clinical Update

Workshop E: Disorders of the adrenal gland

ea0055we1 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Lumps and bumps, fears and phaeos: Infrequent symptoms and conflicting test results in a man with three lesions in three organs

Houlford Ben

A 42 year old gentleman was referred to endocrinology clinic by a consultant urologist due to an incidental finding of a 14 mm adrenal nodule on the patient’s right adrenal gland. He was originally seen by gastroenterology having been referred due his 7 year history of twice yearly attacks lasting around 30 min, comprising of flushing of the face, palpitations, burning sensation in his stomach, sweating, vomiting and loose bowel motions. The gastroenterology consultant di...

ea0055we2 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Challenges in managing primary hyperaldosteronism

Sawhney Natasha , Graveling Alex , Abraham Prakash

Background: A 59 year old man was referred to Endocrinology from Neurology with a 2 year history of hypertension, and a 1 year history of mild hypernatraemia (146–148 mmol/l) and hypokalaemia (3.2–3.4 mmol/l). He had a past history of a cerebral aneurysm and superficial siderosis. His main complaints were severe fatigue, poor balance and tinnitus. His medications at diagnosis were Amlodipine 5 mg and Sertraline 50 mg.Investigations: Blood press...

ea0055we3 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Pheochromocytoma: A reversible cause for hypertension

Ahmad Ehtasham

The case: The case described is a 49 year old lady referred to emergency department with history of episodic palpitations, headache and sweating with possible weight loss for last 14 years but symptoms now worse in the past few days. Past medical history was significant for modest hypertension with retinal changes treated with Lisinopril. Patient stopped going to the gym recently as it seemed to exacerbate the symptoms. Patient recently registered with a new GP who in view of ...

ea0055we4 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Challenging diagnosis of phaeochromocytoma

Anandappa Samantha , Ilangaratne Charmaine , Abedo Itopa , Ogunko Arthur , Mohandas Cynthia

A 64 year old female with a background history of hypertension resistant to dual therapy had recurrent admissions to the local emergency department with pulmonary oedema and chest tightness over the preceding 3 months associated with fluctuations in Troponin I levels. This led to multiple cardiac investigations including invasive coronary angiogram which did not report any abnormality. Her blood pressure was elevated at 200/120 mmHg and an electrocardiogram demonstrated sinus ...

ea0055we5 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Case report of malignant hypertension secondary to Renal Artery Stenosis due to Fibromuscular Dysplasia in a young female patient

Parsad Meenakshi

Secondary causes for Hypertension account for 5% of hypertension cases. Renal Artery Stenosis due to Fibromuscular Dysplasia is an uncommon cause of Secondary Hypertension. This is a case of a 35-year old lady who presented with headache and vomiting and was found to have malignant hypertension with resultant acute left caudate nucleus infarct in the brain. A mild hypokalaemia on admission prompted measurement of renin and aldosterone which were both elevated. She also had ele...

ea0055we6 | Workshop E: Disorders of the adrenal gland | SFEEU2018

From hyper- to hypoaldosteronism: a rare but important complication to recognise post adrenalectomy

Wu Xilin , Goodchild Emily , Brown Morris , Drake William

A 69-year-old retired pharmacist was referred to our endocrine clinic with an incidental finding of hypokalaemia noted during recent spinal fusion surgery. He has been hypertensive for 6 years. His blood pressure was well controlled on Diltiazem 240 mg and Doxazosin 4 mg, but required 8 tablets of SandoK daily to maintain normokalaemia. His past medical history includes type 2 diabetes, diabetic retinopathy, chronic kidney disease, hypercholesterolaemia and benign prostatic hy...

ea0055we7 | Workshop E: Disorders of the adrenal gland | SFEEU2018

A hypertensive emergency post massive phaeochromocytoma resection: catecholamines not to blame

O'Toole Sam , Rathore Ali , Brown Morris , Akker Scott

Case history: A 26 year-old lady was admitted from clinic with severe hypertension and bilateral papilloedema. Six weeks prior to admission she had undergone resection of a massive right upper quadrant lesion that was felt to be of hepatic origin. Histological analysis of the lesion revealed it to be an adrenal phaeochromocytoma and she was thus referred to the endocrine service. Pre-operative biochemical assessment had not been performed but there was no evidence of any blood...

ea0055we8 | Workshop E: Disorders of the adrenal gland | SFEEU2018

A pressing diagnosis in an adolescent

O'Toole Sam , Tufton Nicola , Arnez Lorena , Parvanta Laila , Akker Scott

Case history: A 17 year old previously healthy male presented to his local emergency department with a generalised tonic seizure associated with severe hypertension (systolic blood pressure 240 mmHg) and tachycardia. He was intubated and admitted to the Intensive Care Unit. Antimicrobials to cover meningoencephalitis were commenced and his hypertension was managed with intravenous labetalol. He was extubated the following day. He had experienced headaches on a monthly basis fo...

ea0055we9 | Workshop E: Disorders of the adrenal gland | SFEEU2018

The case of a young man who originallypresented with severely derranged electrolyes aged four days

Jacob Peter , Drake William

We would like to present the case of a twenty-six year old gentleman whose first presentation to hospital was aged 4 days old. At that time he was thought to be generally unwell with poor feeding and excessively somnolent. During his resuscitation he was found to have extremely deranged serum electrolytes with sodium 122 mmol/l and potassium 14 mmol/l. His electrocardiogram (ECG) was initially noted to be bizarre, with no clear rhythm. After resuscitation with IV fluid, glucos...

ea0055we10 | Workshop E: Disorders of the adrenal gland | SFEEU2018

A case of mineralocorticoid hypertension with low postoperative cortisol

Zia-ul-Hussnain Hafiz Muhammad

66 year old man who had hypertension treated with Amlodipine 5 mg, Perindopril 10 mg, Nebivolol 5 mg, Doxazosin 8 mg and a Thiazide diuretic from the age of 45 with previous history of subarachnoid haemorrhage and DVT presented to emergency department with episode of weakness, nausea and dizziness. His serum potassium at initial presentation was 2.3 mmol/l. After stopping thiazide diuretic and beta blocker for 4 weeks and being commenced on Amlodipine 5 mg, Doxazosin XL 12 mg ...

ea0055we11 | Workshop E: Disorders of the adrenal gland | SFEEU2018

You can lead a patient to hospital, but you can’t make him have an adrenalectomy

Thurtell Craig , Mackie Alasdair

A 42 year old man was referred to the acute medical unit with accelerated hypertension in March 2015. He presented with headache and blurred vision due to hypertensive retinopathy. Pre-treatment BP was 186/131 mmHg. Initial treatment included amlodipine, bendroflumethiazide and losartan. Prior to discharge, a 24 hour urine collection showed a significantly elevated urinary noradrenaline level (3091 nmol/d, reference 0–473). Referral was made to the cardiovascular risk cli...

ea0055we12 | Workshop E: Disorders of the adrenal gland | SFEEU2018

The octagenarian with a phaeochromocytoma: a new management dilemma

Glyn Tessa , Thomas Julia

Increased use of abdominal imaging has resulted in vast numbers of adrenal incidentalomas being identified (Bovio et al., 2006). Guidelines exist for identifying hormone excess and diagnosing malignancy but there is little evidence about how to manage phaeochromocytoma in patients who are poor surgical candidates. We present the case of a frail 88 year-old lady who was found to have a right adrenal incidentaloma during assessment for abdominal pain. Mrs R is able to m...

ea0055we13 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Primary hyperaldosteronism presenting following a miscarriage

Thurston Layla , Qureshi Sheharyar , Martineau Marcus

Case history: A 35-year-old female was found to be significantly hypertensive (181/91 mmHg) following a first trimester miscarriage (at 8 weeks gestation) during her first pregnancy.Investigations: Blood tests demonstrated moderate hypokalaemia (2.6 mmol/l) with a normal serum sodium (140 mmol/l) and eGFR (>90 ml/min). ECG showed hypokalaemic changes with prolongation of the PR interval and T wave flattening. To avoid potential misinterpretation, add...

ea0055we14 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Hyporeninaemic hypoaldosteronism in surgically cured Conn’s syndrome

Pittaway James , Coppack Simon , Carpenter Rob , Drake William

A 53 year old gentleman from Ghana was referred to our clinic for further management of his Conn’s syndrome. This had been diagnosed at another hospital 3 years previously when he presented with hypertension and hypokalaemia on the back of 14 years of poorly controlled hypertension. Serum aldosterone was raised at 3178 pmol/l and serum renin mass was 3.9 mU/l. MRI revealed a 5 mm nodule in the medial limb of the right adrenal gland. He was initially commenced on medical t...

ea0055we15 | Workshop E: Disorders of the adrenal gland | SFEEU2018

A case of hypertension and palpitations with a suspicious adrenal mass

Stiles Craig E , Sze Candy

A 41 year old man was referred to the endocrine service at St Barts hospital. He had previously had a GP check-up and was found to be hypertensive, this led to him having an ultrasound KUB, an abnormality was detected which resulted in a CT abdomen being performed. The CT abdomen showed a 38×33 mm well defined right adrenal lesion and the patient was referred to endocrinology. Upon review, the patient had been having palpitations for the past year - particularly when stra...

ea0055we16 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Challenging case of recurrent phaeochromocytoma and metastatic paraganglioma

Klepacki Jan , Dymott Jane , Abraham Prakash

Background: A 59 year old woman presented with recurrent symptoms of catecholamine excess (episodic headache and sweating). She was initially diagnosed in another centre to have a right adrenal phaeochromocytoma in 2002. She had suggestive symptoms, elevated urine catecholamines and a right adrenal mass on CT Adrenals. MIBG was however negative and they had proceeded with a right adrenalectomy and histology confirmed a phaeochromocytoma. She also had type 2 DM, anxiety and deg...

ea0055we17 | Workshop E: Disorders of the adrenal gland | SFEEU2018

Back to the basics!

Hasan Faisal , Johnson Andrew

A 42 year old lady initially presented in Poland with haematuria while she was on holiday over Christmas. She had some tests including an ultrasound of the kidney which showed a mass adjacent to the left kidney. The haematuria had settled and she was feeling well apart from non-specific back ache. She worked in a cake factory which she continued to do here in the UK. Her GP requested another ultrasound of her kidneys which showed a solid mass adjacent to the left kidney and a ...