Endocrine Abstracts

Introduction: Macrohormones are complexes of monomeric hormone molecules with IgG leading to formation of macrocomplexes. They are usually immunoreactive, but biologically inactive. The higher molecular weight results in reduced renal clearance and therefore accumulation in the blood. We present two cases of unusual macrohormones.Case 1: A 55-year-old male had his thyroid function checked as part of investigation for chest pain, and was started on thyrox...

Pneumocystis jirovecii pneumonia (PJP) is well recognised in HIV infected and transplant recipient populations and prophylaxis is standard practice. PJP may also occur in rarer cases of immunodeficiency. We report 2 cases of Cushing’s syndrome complicated by PJP. Patient 1 was a 30 year old Indian male who presented with 2 weeks of bloody diarrhoea, abdominal pain and lethargy. He was cushingoid and investigations showed severe hypercortisolism (urinary cortisol >266,...

We report the case of a 37-year-old woman with a 9-month history of intermittent and variable symptoms of anorexia, nausea & vomiting, muscular weakness and pain in association with recurrent hypoglycaemic episodes. The patient stated that she had episodes of myalgia with generalised weakness affecting mobility and a history of significant weight loss as a result of anorexia and nausea & vomiting. The patient had two previous hospital admissions with similar symptoms a...

Background: CYP3A4 is the most prevalent cytochrome P450 (CYP) enzyme in the liver, and is used by the majority of medications for their metabolism and elimination from the body. The inhibition of CYP3A4 can result in the accumulation of drug concentrations increasing the risk for possible toxicity. We report a case of iatrogenic Cushings’s syndrome secondary to impaired CYP3A4 metabolism of triamcinolone by coadministration of darunavir/cobicistat, with resultant seconda...

Introduction: Galactorrhea is a common symptom of raised prolactin irrespective of cause of hyperprolactinemia. Whereas pituitary prolactinoma is the commonest cause, there are many other causes of increased prolactin including chest wall injuries or chest surgery. Galactorrhea without prolactin increase has been reported as well. We describe a case of galactorrhea following thoracoscopic resection of schwannoma from apex of left hemithorax.Clinical Case...

A 53-year old male presented to his optician with blurring of vision on the right and was diagnosed to have branch retinal vein occlusion. Over the next 6 weeks he manifested further visual impairment, initially due to right central retinal venous occlusion (CRVO) and after another 3 months left CRVO. He received intravitreal Ranibizumab injections and timolol-dorzolamide eye drops in both eyes. Soon after this, he had a hospital admission for infected submandibular gland and ...

Spindle Cell Oncocytoma (SCO) is a neoplasm of the adenohypophysis, often pre-operatively misdiagnosed as pituitary macroadenoma due to its rarity. First described in 2002, 28 cases have been described. It is a benign tumour manifesting in adults with no sex predilection, classified as WHO Grade I. A 71-year-old woman presented with bitemporal hemianopia, secondary hypoadrenalism, hypothyroidism and hypogonadotrophic hypogonadism. Imaging in October 2017 confirmed a 18.0×...

Fifty-three year old male presented to gastroenterologist with retrosternal pain and dysphagia. On gastroscopy a 2 cm soft sub-pedunculated polypoid mass in the lower oesophagus was identified and on biopsy it was confirmed as adenocarcinoma. CT scan confirmed the finding but additionally identified 20mm right adrenal “incidentaloma” with mild calcification and reassuring imaging characteristics, further supported by a low uptake on 18-FDG PET-CT. He underwent Ivor L...

Background: Hyperinsulinemic hypoglycaemia refers to inappropriate secretion of insulin in the presence of low plasma glucose levels. One day old male infant 3.6kg, born to non-consanguineous parents referred for symptomatic hypoglycaemia. APGAR score was 8/10 and 9/10 at 1 and 5 minutes. There was no history of gestational diabetes mellitus in the mother. General physical examination was unremarkable. Glycemic monitoring revealed persistent hypoglycemia with low plasma glucos...

Introduction: Localising the aetiology of Cushing’s syndrome can be challenging, especially when investigations utilised are limited in their sensitivities and specificities. We present a case whereby the reliabilities of laboratory and radiological investigations are tested to their limits.Case Presentation: A 70 year old female presented with a one year history of fatigue, weight gain and headaches. She had proximal myopathy, cheek telangiectasia ...

Adrenal insufficiency is not commonly associated with a finding of bilateral enlarged adrenal gland when diagnosed in late adulthood. Various cases in the literature to date seem to indicate that the combination of these two findings may be suggestive of adrenal lymphoma. Our patient was initially referred to Gastroenterology with weight loss, nausea and early satiety from where he was referred for a whole body computed-tomography (CT) scan as part of a screen for malignancy. ...

Background: Hyperhidrosis is a debilitating disease that has a significant impact on quality of life. There is limited research and gudelines on the investigations and management of hyperhidrosis.Aims: To assess if investigations and treatment of hyperhidrosis meets NICE CKS July 2013 guidelines.Method: The term ‘hyperhidrosis’ was used as a keyword search on an electronic patient record. Letters were restricted to those ...

Background: The management of Cushing’s disease can be challenging especially when patients can present with sepsis and severely immunocompromised with limited oral medications to achieve cortisol control. We review a case of Cushing’s disease and the medical management of Cushing’s disease.Case Report: A 54 year old female presented with symptomatic hyperglycaemia with truncal obesity, proximal muscle weakness, right posterior thorax haem...

Thirty-eight years gentleman presented with DKA as the first presentation of his diabetes. His HbA1c was 12%. On exam, he showed features of Acromegaly and normal BMI. His Growth hormone and IGF-1 were very high in confirming the diagnosis of Acromegaly. His Anti GAD and Anti Islet cell antibodies are negative. MRI dedicated pituitary showed pituitary macroadenoma. Treatment of his DKA was difficult. He was discharged on insulin. Later, the patient was seen in the endocrine cl...

Background: Self-administration of anabolic steroids among bodybuilders is an underestimated problem, often not admitted by patients.Case presentaation: A 19 year old male (planning to study medicine!) presented with gynaecomastia, general malaise and erectile problems. Investigations revealed acute hepatitis: ALT 2125 U/L [Ref. range (RR)<45] and hypogonadotropic hypogonadism: LH – 1.6 IU/L [RR: 1.5-9.3], testosterone 0.214 ng/mL [RR: 2.49-8.36...

Craniopharyngioma is a rare and benign type of tumour derived from squamous cell nests of the primitive Rathke’s pouch of the pituitary gland. Commonly present in childhood, it is also found in adults in their 50s and 60s. People may initially present with vision disturbance, usually bitemporal inferior quadrantanopia, progressing to bitemporal hemianopsia as the tumour grows and compresses on the optic chiasm. Although a slow-growing tumour, both the disorder and therapy...

We present a rare case of a 50 years old lady who presented with new onset hirsutism and hoarseness of voice since 2 years. Investigations showed high serum testosterone, androstendione and free androgen index. All other systemic and endocrinology evaluation for hirsutism did not reveal any abnormality. CT scan of her abdomen showed a right ovarian mass which was confirmed as a Sertoli-Leydig cell tumour (stage Ia) on surgical staging and completely cured after bilateral salpi...

A 57-year-old woman with poorly controlled type 2 diabetes (HbA1c 148 mmol/mol) presented acutely with lower back pain, in the absence of trauma. Her WHO performance status score was 2. 18 months earlier she had developed a left fifth toe ulcer, resulting in left forefoot amputation six months later which had not healed. She had also developed a neuropathic ulcer in her right hallux, complicated by osteomyelitis. Despite excellent peripheral vasculature, conservative therapy w...

Introduction: Primary hyperparathyroidism is a common endocrine disorder. Symptoms at onset are often non-specific, thus the diagnosis tends to be overlooked.Objective: To highlight varying modes of presentation in primary hyperparathyroidism, the need for early recognition and treatment to prevent complications.Case Presentation: A 51-year old woman presented with complaints of back and lower limb pains of 7-year duration. She als...

Introduction: The diagnosis of hereditary hemorrhagic telangiectasia (HHT) is definite if 3 of the following criteria are present, possible or suspected if 2 are present and unlikely if fewer than 2 are present:• Epistaxis.• Telangiectasias.• Visceral lesions: gastrointestinal, pulmonary, hepatic, cerebral and spinal).• Family history: a first-degree relative with HH...

Introduction: Pituitary adenomas are not uncommon presentations in our clinical practice but the challenge with management becomes more daunting as the size of the tumour gets bigger as seen in this woman we present herein with a macroadenoma. The combination of factors militating against accessing the best of health care available is unconnected with the usual problems affecting health care delivery in Sub-Saharan Africa, including out-of-pocket payments for health services a...

Over the last few years, there has been an increase in the demand on the National Health Service, with patients presenting to hospital with multiple co-morbidities and increasingly complex needs. The type of endocrine referrals received can vary both in complexity and also between clinicians. The Royal College of physician has published a ‘Referring wisely’ report in June 2017 which aims to improve and streamline the quality of referrals received in each speciality. ...