Endocrine Abstracts

A 41 year old female presented to the haematologists with a coincidental finding of polycythaemia: haemoglobin 198 g/L, white blood cell count 8×109/L, platelets 236×109/L, haematocrit 0.57 L/L and red blood cell count 6.16×1012/L. Six years earlier haemoglobin 151 g/L, white blood cell count 7.7×109/L, platelets 297×109/L, haematocrit 0.4 L/L and red blood cell count 4.53×1012/L. S...

Introduction: Testicular adrenal rest tumours (TARTs) are a complication of congenital adrenal hyperplasia (CAH), stimulated by hyper-secretion of adrenocorticotropic hormone (ACTH). They are the main reason for fertility problems in men with CAH owing to compression of the seminiferous tubules, obstructive azoospermia and potentially permanent testicular damage. These lesions are benign and, in most patients present bilaterally. TARTs are treatable, but they can be misdiagnos...

We present the case of a 28-year old woman who presented with menstrual irregularity and hirsutism since menarche at age 11. She had been diagnosed with polycystic ovarian syndrome and treated with the oral contraceptive pill for 12 years, despite BMI of 21 kg/m2. Blood pressure was 101/66 mmHg. Baseline electrolytes showed sodium 140 mmol/L, potassium 3.6 mmol/L. Short synachthen test confirmed the biochemical diagnosis of congenital adrenal hyperplasia (CAH) [cort...

Background: Adrenal lymphomas are rare and often present with hypoadrenalism in the context of bilateral adrenal masses. We report a patient with unilateral adrenal mass and hypoadrenalism at presentation before evolving rapidly to bilateral masses proven to be a large B cell lymphoma. We discuss mechanisms of hypoadrenalism in adrenal lymphoma.Case history: A 79 year gentleman with no signifanct past medical history admitted with a 6 week history of bei...

A 62-year-old Asian British female presented with increasing tiredness. She had multiple co-morbidities and was prescribed steroid inhalers for suspected asthma. Her type 2 diabetes mellitus, previously well controlled on metformin, had worsened over a short period of time (48 to 85 mmol/mol). On examination, she was obese (weight 82 kg, BMI 43 kg/m2), hypertensive (155/78 mmHg); rest of the examination was unremarkable. The blood test revealed undetectable cortisol...

Background: Birth control is widely encouraged to prevent unwanted pregnancies and around two-third of women use contraception. Prescribed contraceptives may result in amenorrhoea or withdrawal bleeds which can mask the initial symptoms of many endocrine disorders delaying diagnosis and treatment.Case Summary: A 43-year old Filipino female nurse was referred for headache, uncontrolled hypertension, weight gain, hirsutism and acne with raised serum testos...

Patient is a seventy year old Egyptian female with past medical history of coronary artery disease, systolic heart failure, chronic kidney disease stage 3, and a benign pheochromocytoma previously worked up at a neighboring hospital, who was admitted for dyspnea and subjective fever intermittently for the past two weeks. Chest x-ray revealed bilateral pulmonary infiltrates. She was treated for community acquired pneumonia. Four days after admission patient has worsening respir...

Background: Adrenocortical carcinomas (ACC) are rare malignant tumours with an incidence of 1 to 2 per million per year.Case Report: A 70 year old lady was admitted with a one month history of new onset hypertension, hypergylcaemia, hirsutism and generalised weakness. On examination she was cushingoid with facial plethora, severe hirsutism, central obesity and severe proximal myopathy. A CT trunk showed a large, lobulated, inhomogeneous, solid left adren...

Background: We present a case in which a diagnosis of Addison’s disease was missed due to misinterpretation of short synacthen test (SST). This patient was also found to have Polyglandular Syndrome Type 2 (APS-2) after further tests were performed.Clinical case: A normally fit and well 28-year-old Caucasian man presented to hospital with a few days history of general malaise and a syncopal episode. On admission, patient was hypotensive and tachycard...

Introduction: Pheochromocytoma is a rare tumor originating from the embryonic neural crest and secreting high levels of catecholamines. The average pheochromocytoma size is 7 cm in the previous publications (1). Sometimes these tumors may be bigger. In this abstract, a case of pheochromocytoma with a huge size presented with unusual presentation.Case study: Fifty-six year-lady presented with an incidental finding of suprarenal mass 14.5 cm after an inves...

Introduction: Short synacthan test is a first line endocrine test for diagnosing adrenal insufficiency except in situations like Pituitary surgery or Pituitary apoplexy within the last 2 weeks when this may give a false positive result and this is well known in literature. Here we discuss lesser reported clinical situations seen in two of our patients having good adrenal response to SST with only GST identifying adrenal insufficiency.Case Report: Two pat...

A 32 year old female presented with recurrent episodes of severe hypoglycaemia. Type 1 diabetes had been diagnosed 10 years earlier and she had undergone subtotal colectomy/ileostomy 20 months earlier for chronic diarrhoea. Histology suggestive of eosinophilic colitis. High stoma output (>4 litres per 24 hours) was causing stomal incontinence with disruption of normal lifestyle. Treatment with combinations of loperamide, codeine, omeprazole and octreotide were ineffective....

Adrenal gland anomalies are common incidental findings when imaging tests are performed for other reasons, but are usually unilateral. We present a case where bilaterally abnormal adrenal glands held the key to a rare diagnosis. A 79 year old female ex-smoker with a background of Type 2 Diabetes Mellitus and hypertension presented to our emergency department with a four month history of falls and progressive decline in mobility. Examination revealed evidence of weight loss, wi...

Background: PBMAH is a rare cause of adrenal Cushing’s syndrome, frequently due to aberrant adrenal expression of hormonal receptors.Aim: To describe 6 patients with PBMAH.Methods: Clinical, hormonal and imagistic evaluation.Results: Age at diagnosis of patients (4M/2F) was 50–79 years. One asymptomatic patient was incidentally diagnosed on abdominal CT, two patients had overt Cushing’s (centra...

Background: Primary aldosteronism (PA) accounts for 5–10% of all patients with hypertension, and an even greater proportion of those with refractory hypertension. Accurate assessment of PA is important both for rationalisation of medical therapy and to identify those patients with unilateral disease who may benefit from surgery. Single timepoint testing may miss patients with intermittent (‘cyclical/periodic’) disease, a phenomenon seen in other endocrine hypers...

Addison’s disease rarely newly presents during pregnancy. We highlight two cases diagnosed within 3 months. A 41-year-old with mild depression on Sertraline, presented at 11-weeks’ gestation with an 8-week history of fatigue, weight loss, dizziness and vomiting. Persistent hyponatraemia was noted (Na 122–127 mmol/l). Random cortisols were 298–428 nmol/l. Sertraline withdrawal and fluid restriction at another centre did not improve her hyponatraemia, the use...

A 50 year old man was admitted in September 2017 with left sided thoracic pain. A chest radiograph revealed a left-sided hilar mass. CT of thorax demonstrated a large, left-sided, anterior mediastinal mass with associated lymphadenopathy and sclerotic bone metastases. A CT-guided biopsy was performed and pathology was consistent with carcinoid tumour. The patient was referred to clinical oncology. An NM octreotide scan confirmed a left-sided avid lesion within the thorax. Gut ...

We present a case of a 53 year-old lady with HIV, who was referred to the endocrine service with a random cortisol of <20 nmol/l. She complained of fatigue, appetite loss and 13 kg weight loss. She had a history of brain histoplasmosis, which had been successfully treated >5 years previously. At that time she required a short course of steroid therapy acutely. Short synachthen test revealed inadequate response (cortisol at 0 min: 378 nmol/l, 30 min: 481 nmol/l, 60 min:...

25% of Cushing’s syndrome cases are caused by cortisol producing tumours of the adrenal glands. Adrenalectomy is standard treatment followed by glucocorticoid replacement therapy until the hypothalamic-pituitary-adrenal axis recovers. We present a challenging case of adrenal insufficiency after unilateral adrenalectomy for Cushing’s syndrome. A 38 year-old woman was referred with hyperlipidaemia and uncontrolled hypertension diagnosed 4 years previously. Examination ...