Endocrine Abstracts (2019) 65 P78 | DOI: 10.1530/endoabs.65.P78

The frustration of endocrine practice in a resource poor, developing country

Akinyele Akinlade

General Hospital Odan, Lagos, Nigeria

Background: The practice of endocrinology requires the support of good laboratory services in order to make accurate diagnosis of many endocrine disease. Many endocrine disorders appear rare in our country because of lack of reliable laboratory services. The following cases illustrate this frustration.

Case 1: A 39-year old caterer, known hypertensive but diagnosed diabetic recently when she developed a non-healing left foot ulcer and subsequent gangrene following a pedicure treatment 2 weeks earlier, for which she had an amputation. She had clinical features of Cushing’s syndrome. Her urinary free cortisol was 965.2 (100–379) ug/day. Night (2300 h) serum cortisol was 249.59 (240–618) nmol/l while an overnight 1mg dexamethasone suppression test cortisol was 64.53 (240–618) nmol/l. Confusion came when we got another serum cortisol (‘after dexamethasone’) result that was neither requested for nor the sample sent) as 111.62 (<276 nmol/l)! This unsolicited result could not be satisfactorily explained by the lab, leaving us confused and frustrated as to the veracity of the results and how to proceed with the case.

Case 2: A 35-year old lady being managed for secondary adrenal insufficiency (and vitamin D deficiency) following prolonged use of steroids for suspected connective tissue disease. Her initial serum cortisol done a few days before her consultation with me was 1.47 (8.7–22.4) ug/dl. As she was symptomatic, she was started on 20 mg of hydrocortisone tablet while she repeated the serum cortisol for confirmation. The serum cortisol done 4 days after commencement of the hydrocortisone was reported to be 659 (171–536) nmol/l by another lab, that insisted after a doubt was raised that the rerun result was about the same (726.9). A recheck 2 days later at one of the initial labs showed 13.7 nmol/l. These inconsistent results were expensive and paid out-of-pocket by the patient.

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