Endocrine Abstracts

Insulin Autoimmune Syndrome (IAS)/Hirata disease is a very rare condition in which anti-insulin antibodies result in accumulation of high circulating concentrations of insulin in complexes. Hypoglycaemia in IAS occurs when insulin is released from the antibodies during fasting. We present two contrasting cases of Hirata disease. Both patients presented with symptomatic hypoglycaemia. Patient-A is a 52-year old obese Thai female, with acanthosis nigricans and a strong family hi...

Case history: A 73-year-old gentleman was admitted for evaluation of recurrent hypoglycaemia. He has had type 1 diabetes mellitus for 60 years, which was well controlled on a basal-bolus regime with carbohydrate counting. He had frequent hypoglycaemic episodes for 5 months despite drastic reduction in insulin dosage. His insulin was completely stopped on admission. He did not develop ketosis and continued to have hypoglycaemia. He did not have end-organ complications from T1DM...

Case history: A 43-year-old man was admitted to Intensive care with life-threatening pneumonia, along with acute hypertension and hypokalaemia. There were several Cushingoid clinical features, therefore ectopic ACTH syndrome was suspected.Investigations: The diagnosis of severe ACTH-dependent Cushing’s syndrome was confirmed with unsuppressed cortisol after low dose dexamethasone (763 nmol/l with ACTH 131 ng/l, 24-h urinary cortisol levels (x2) of >...

Case history: A 41 year old female was admitted following development of severe hypertension (226/146 mmHg), complicated by heart failure and acute kidney injury. She otherwise had no relevant past medical history. On clinical examination she was obese (BMI 51.94 kg/m2). As part of her cardiac investigations, she underwent a cardiac magnetic resonance imaging (MRI) which detected a 3 cm right sided adrenal nodule. An adrenal biochemical screen identified an elevated...

Case history: A 53-year-old male with melanoma who had a previous surgical excision of his skin lesion in December 2018 was being treated with adjuvant pembrolizumab. In June 2019 his treatment changed to combination immune checkpoint inhibitor therapy (ICPi) with ipilimumab and nivolumab due to radiological recurrence.Investigations: There were no pre-ICPi endocrine investigations available. In July 2019, thyroid function tests (TFTs) showed thyroid-sti...

Section 1: Case history: A 52 years old gentleman initially presented with visual field defect and headache due to a large multi-lobulated pituitary adenoma and underwent an endoscopic transsphenoidal sub-total resection in March 2018. Histology revealed a non-functioning adenoma with mitotic index Ki-67 of 3%–5%. His visual field defects resolved post-operatively and he was monitored with serial imaging. A year later he suffered a collapse at his GP surgery and was found...

Section 1: Case history: A 66-year-old man, with a history of hypertension controlled on 3 anti-hypertensives and diet-controlled Type 2 Diabetes, presented to a community-based musculoskeletal clinic to have an intra-articular Triamcinolone injection for a frozen shoulder. 30 min after the injection, he developed dyspnoea, widespread urticaria and facial angioedema. He was initially treated for suspected anaphylaxis with adrenaline, antihistamine and Hydrocortisone at the GP ...

Introduction: We present a challenging case of central diabetes insipidus secondary to hypothalamic large B cell lymphoma. These are rare tumors accounting for less than 1% of lymphomas. Conventional treatment involves the MATRIX regime (methotrexate, rituximab, thiotepa, cytarabine) chemotherapy, coupled with intensive intravenous fluid therapy to avoid methotrexate toxicity. The main challenges in the management of this case were maintaining fluid and electrolyte balance in ...

Section 1: Case history: Adrenal haemorrhage in pregnancy is rare but life threatening. We present the case of a 23-year-old woman who developed idiopathic spontaneous bilateral adrenal haemorrhages during pregnancy. The patient, without significant past medical history, presented at 35 weeks of gestation with right sided lower thoracic and abdominal pain which was thought to be musculoskeletal in nature; she was discharged home once the pain settled. She represented at 37 wee...

We describe a 40-year-old female who presented with fine tremors, weight loss, dyspnea and hemoptysis. On examination she appeared diaphoretic and tachycardic without goiter or thyroid eye disease. Thyroid function tests confirmed biochemical hyperthyroidism: [fT4 >100 pmol/l (NR: 12–22), TSH <0.005 mu/l (NR: 0.270–4.200)]. Chest X-ray showed numerous metastatic pulmonary nodules bilaterally. CT chest confirmed multiple large pulmonary metastases throughout both ...

We are a presenting a 57 year old male victim of recurrent metastatic melanoma who was treated surgically in 2015 by wide local excision together with right axillary dissection for axillary nodal spread. He re-presented to dermatology clinic in December 2018 with skin lesion that was histologically proven to be a BRAF-mutant malignant melanoma. CT scans at that time showed spread to mediastinal and hilar nodes. Oncology team decided to commence Iplimumab/Nivolumab combination ...

Case history: A 30-year-old Ugandan male, now living in UK, presented to A&E with confusion and agitation. Capillary blood glucose was 0.9 mmol/l and he was commenced on intravenous Dextrose. During blood donor screening in Uganda, he was told that he had a blood-borne infection. He had gross hepatomegaly on examination. During admission, he experienced repeated episodes of hypoglycaemia despite increased dietary intake of carbohydrates and continuous infusions of 5%-10% D...

Section 1: Case history: A case of a 23-year-old lady with a known history of Perthes disease, pulmonary stenosis, bronchial asthma, primary hypothyroidism on levothyroxine and newly diagnosed hypertension on amlodipine, who presented to Accident and Emergency with symptoms of generalised lethargy, weakness of the upper and lower limbs, rapid onset of weight gain for 6 months, increasing abdominal girth and recurrent genital thrush.Section 2: Investigati...

Case history: A 54-year-old man was admitted with a history of syncopal episodes. Orthostatic hypotension led to an endocrine referral and subsequent diagnosis of pan-anterior hypopituitarism but with no evidence of posterior pituitary involvement. Although an initial aetiological diagnosis remained elusive, further work-up (see below) led to a histology-confirmed diagnosis of ACE-negative neurosarcoidosis. This diagnostic conundrum could have been contributed by a prior neuro...

Section 1: Case history: A 57-year-old female shop assistant presented with a four week history of increasing thirst and lethargy. The patient also reported non-specific pain in her shoulders, ribs and hips. She was otherwise well with no past medical history. Systemic enquiry was unremarkable. On examination nothing abnormal was noted. Specifically there were no rashes, lymphadenopathy or hepatosplenomegaly. Joint examination was normal and there was no muscle tenderness or w...

Case history: Adrenal masses are often a diagnostic challenge and can present with unusual symptoms. We describe a case of a 37-year-old male with a background of ulcerative colitis, who presented with bilateral gynecomastia in the breast clinic of, worsening over last one year. He had marked breast tenderness, a decline in his libido but no erectile dysfunction. There was no history of recreational drug use.Investigations: His serum biochemistry showed ...

A 70 year-old male with a long standing history of IgG kappa paraproteinemia presented with sudden onset of confusional state. His friend had noticed short term memory lapses, behavioural changes, increased aggression and agitation for the last 3 months. He had developed proximal muscle weakness and pain. He was admitted to the hospital. He had no history of alcohol abuse, smoking or illicit drug use. He was not on any medication. He was under haematology surveillance for his ...

Section 1: Case history: A 69-year-old female with a past history of treated hypertension and Graves’ disease presented to the emergency department with a two-day history of headaches, vomiting, confusion and difficulty swallowing following a recent holiday in Spain. She had clinical meningism and a diagnosis of meningitis was made.Section 2: Investigations: After an initial CT scan of her head was reported as unremarkable, a lumbar puncture was per...

Section 1: Case history: 75 year old female diagnosed with Grade 1 pNET (Ki-67 index 70%) in 2018. Treated with subtotal pancreatectomy but 8 months post-surgery a follow up scan showed new liver metastases, at which point she was commenced on lanreotide. 3 months later she presented with an 8 week history of episodic weakness, sweating and confusion consistent with hypoglycaemia. These episodes initially improved with eating but had become more severe and unresponsive to carb...

Case history: A 65 year-old Caucasian gentleman was admitted with out-of-hospital VF arrest at work place. ROSC was achieved after shock by paramedics but developed multiple in-hospital arrests requiring (>100 shocks in 24 h) with incessant polymorphic ventricular tachycardia which was resistant to anti-arrhythmic therapy including drugs and pacing. Investigations revealed hypercalcemia and newly diagnosed high PTH with no change in mild LV dysfunction from previous myocardial...

We present a 24 year old gentleman with Multiple endocrine neoplasia type 1 with a truncating mutation in the Menin gene arising denovo. He has a past medical history of optic atrophy, pituitary macroprolactinoma in 2007 with ommaya reservoir in situ, hyperparathyroidism with subsequent parathyroidectomy (3 glands removal) and spinal osteoporosis. He had a laparoscopic pancreatic nodule enucleation for pancreatic tumours (×2 in tail of pancreas) in 2017 with his ...

Section 1: Case history: A 58 year old lady presented to the Emergency Department with a two week history of general lethargy, weight loss, increased thirst and polyuria as well as muscle cramps in her legs. Aside from sinus tachycardia, her observations and physical examination were unremarkable on admission. She had a background of hypertension on Indapamide as well as idiopathic hypoparathyroidism on Alfacalcidol. The latter had been diagnosed nine years prior following adm...

Case history: A 65 year old unresponsive female, admitted as a stroke call, was found to have myxoedema crisis with admission TSH level of >100 mIU/l and T4 of 0.7 pmol/l. She was known hypothyroid with poor medication compliance. ITU admission for intubation and ventilation, CVVH (renal filtration) and vasopressors was required. Total length of ITU stay was 62 days, prolonged by cardiac complications during correction. There was no known cardiac history. On Day 7 of admission...

Case history: A 20-year-old male presented with a one-year history of reduced libido, headache and slowly progressive blindness. His symptoms (particularly the visual deterioration) had a great impact on his daily life, leading to dismissal from work. Examination showed decreased visual acuity (12/6 bilaterally), reduced colour vision and a dense bitemporal visual field loss. Testes measured 15 mls bilaterally. He had no clinical stigmata of acromegaly, nor Cushing’s dise...

Section 1: Case history: A 46-year-old woman was referred to the Endocrinology clinic for evaluation of persistently elevated parathyroid hormone levels despite correction of previous vitamin D deficiency. She had a history of calcific tendinitis of the left shoulder and iris pigment dispersion syndrome. Notably, her mother had undergone two parathyroid surgeries for primary hyperparathyroidism with removal of three parathyroid glands, revealing multiple parathyroid adenomas a...

Case history: The patient was a 17-year old lady who was referred to us by her primary care provider for hyperprolactinaemia and primary amenorrhoea. She was of short stature (0.4th centile for height and minus 2 centile spaces of the mid-parental height) and in the 9th–25th centile range for weight. There was no history of galactorrhoea. Her breast development was Tanner stage 3–4, and pubic hair 2–3, with no axillary hair. There was no evidence of any intellec...

Case History: A 53 year old woman presented with a 12-month history of progressive hirsutism and deepening of her voice. Her symptoms coincided with the onset of the menopause. On clinical examination she had evidence of virilisation with muscle hypertrophy.Investigations: Biochemical tests revealed a serum testosterone (serT) of 30 nmol/l, a DHEA-Sulphate of 1.5 umol/l (1.0–12.0), an androstenedione of 3.2 nmol/l (0.0–6.0), a post-overnight de...

Case history: A 47 year old male presented to his GP with non-specific symptoms of fatigue and weight gain. Thyroid function tests revealed elevated TSH (28.4 mU/l) with normal Free T4 (14.3 pmol/l). Anti-TPO antibodies were undetectable. A presumptive diagnosis of subclinical hypothyroidism was made and he was commenced on Levothyroxine which was titrated over 9 months to 150 mcg/d given a persistently elevated TSH. The patient was unable to tolerate this dose due to the deve...

Case history: A 16 month old boy was referred to Community Paediatrics with developmental delay. Bloods taken as part of a developmental delay screen, revealed a raised calcium, with an inappropriately normal parathyroid hormone (PTH) and a normal vitamin D. There was no family history of hypercalcaemia. Blood tests in the boy’s mother and grandmother also showed hypercalcaemia.Investigations: Calcium was raised at 3.46 mmol/l. A urinary calcium cre...

Section 1: Case history: An 18 year old young man with a background of several years’ ADHD (Attention Deficit Hyperactivity Disorder) and moderate learning disability presented generally unwell, with recent weight loss, abdominal pain, vomiting and poor oral intake in May 2019. He had been unsettled for some time with his mother convinced that his current condition warranted further investigation. When blood tests were done, severe hyponatraemia and hyperkalaemia were fou...

Introduction: Hyperprolactinaemia, amenorrhoea with ophthalmoplegia and radiological abnormalities in suprasellar region usually suggest a pituitary tumour. We present a case of carotico-cavernous sinus fistula causing pituitary engorgement (CCF) mimicking pituitary tumour.Case history: 45 year old female with background history of long term amenorrhea, migraine admitted under Neurology with worsening headache, nausea, vomiting and blurred vision. There ...

Case history: Twenty-one year-old female with Di-George syndrome, genetically confirmed at the age of 6 years, was on 1-alfacalcidol for chronic hypoparathyroidism. Her initial presentation was with Seizures in childhood. She has been seizure free with treatment of hypocalcaemia. Her serum calcium levels have been fluctuating with intermittent hypercalcaemia over the years.Investigations: Initial results on 1.5 mcg of 1-alfacalcidol OD:<p class="abst...

Case history: 73-year-old male was seen in breast clinic for right breast lump which was noted 6 weeks back with no nipple discharge. Mammogram and ultrasound confirmed bilateral gynaecomastia more on right side. Referred to endocrine clinic with abnormal hormone profile. He is a retired builder. He was a heavy smoker for 50 years and has stopped smoking 1 year back. He drinks socially and has never used illicit drugs. His only past medical history was GORD for which he takes ...

Our endocrinology department had been looking after a patient with Graves’ disease since 2007. At this time, she was 17 years old (TSH <0.03 mIU/l, T4 62.6 pmol/l). Carbimazole was prescribed but she was non-compliant with medications and clinic appointments. Her background history included DiGeorge Syndrome (22q11 deletion) manifesting with a bicuspid aortic valve, primary hypoparathyroidism and chronic constipation. She was seen in October 2011 and carbimazole incre...

Case history: A 41-year-old lady referred to diabetes clinic due to chronic diarrhoea on Metformin and for consideration of any injectable treatment. HbA1c was 41 and BMI is 35. In 2007, OGTT during pregnancy showed fasting glucose of 4.1 mmol/l and 2 h glucose of 7.8 mmol/l. In 2013 her fasting glucose was 7.5 and HbA1c was elevated at 53 mmol/mol. Since July 2013 she has been diagnosed as type 2 DM and started on Metformin. In October 2013 HbA1c fell to 49. Over the succeedi...

Case report: Von Hippel-Lindau Disease (VHL) is an autosomal-dominant disease with almost complete penetrance, characterized by the development of several types of neoplasia. Non-functioning pancreatic neuroendocrine tumours (pNETs) are part of the syndrome in up to 16% of the patients. A 36 year old female with a known diagnosis of VHL (Mutation exon 3) was under surveillance. She had previous surgeries twice for haemangioblastomas, and an adrenalectomy for phaeochromocytoma ...

Case history: 73-year-old woman recently commenced on oral diuretics for peripheral oedema was admitted with severe hypokalaemia and refractory hypertension. Conn’s syndrome was initially considered but admission of regular liquorice consumption made a diagnosis of hypokalaemic hypertension (pseudoaldosteronism) secondary to liquorice over-indulgence more likely. She went on to develop cardiomyopathy and had haematemesis from a bleeding duodenal ulcer (DU). Endocrine test...

Section 1: Case history: We present the case of a 35-year-old gentleman referred by his GP to Endocrinology clinic for loss of libido and testosterone deficiency. His co-morbidities included obesity (BMI 59 kg/m2), hypertension and obstructive sleep apnoea (OSA) requiring overnight continuous positive airways pressure (CPAP) therapy. Routine pituitary profile showed luteinising hormone 4.8 IU/l (1–8), testosterone 7.1 nmol/l (8–25), prolactin 232 mU/l (86&...

Section 1&2: Case history and investigations: Primary hyperparathyroidism is a rare condition in pregnancy. The occurrence rate is about 1 % and up to 80 % of the patients are asymptomatic. Clinical symptoms are nonspecific. However, severe maternal, foetal and neonatal complications including neonatal death have been reported in literature. 27 years old Asian lady presented to Emergency Department with abdominal pain in July 2019. She was found to have raised calcium at l...

Case history: A 75-year-old lady presented with sudden central chest discomfort to Emergency Department. The chest pain was preceded by palpitations. She had a background of Hypertension. She was non-smoker and otherwise fit and well. She mentioned receiving a steroid injection one day ago for joint pain. Her B.P on presentation was 226/106. Her physical examination was otherwise normal.Investigations: Her ECG on admission revealed atrial tachycardia and...

Case history: A previously asymptomatic 58-year-old gentleman presented following an out-of-hospital cardiac arrest, precipitated by multiple, bilateral pulmonary emboli.Investigations: In the course of investigation, a 35 mm, MIBG-negative, right adrenal lesion was discovered. Functional adrenal tests revealed significantly elevated normetanephrine and 3-methoxytyramine levels. Severe hypertension and type 2 diabetes were concurrently diagnosed.<p c...

History: A 54 years old gentleman was admitted to the hospital after being found unconscious at home by his wife with a tongue bite and urinary incontinence. He had perineal approach biopsy 2 days ago for prostate cancer. Since biopsy, he had poor urine output with clots and dribbling. He also gave 2 days history of constipation. Wife was a doctor and mentioned that she palpated a distended bladder the night before. On examination, he was haemodynamically stable although he di...

Section 1: Case history: A 38 year old man with no significant past medical history presented to the emergency department with a sudden onset, severe frontal headache. He had been experiencing peripheral visual disturbance for six days prior to this. Routine observations including blood pressure were normal on arrival. Neurological examination of the upper and lower limbs revealed no abnormalities. Bedside visual field test demonstrated significant loss of peripheral vision bi...

Introduction: Lymphocytic Hypophysitis (LH) is an autoimmune endocrinopathy characterised by extensive infiltration of the anterior pituitary gland with chronic inflammatory cells, thus causing pituitary expansion and a variable degree of hypopituitarism closely mimicking the features noted in pituitary adenoma and seen most frequently in women. The aetiology has a general preponderance of occurring at the end of gestation or during the early postpartum period.<p class="ab...

Case history: We present a 44 year old female with persistent severe burning itchy rash over the face, scalp and upper body for ten months. She was reviewed in multiple dermatology clinics and a diagnosis of chronic urticaria was made. Despite various treatments including antihistamines and steroids, symptoms persisted affecting her quality of life significantly.Investigations and diagnosis: Routine blood investigations revealed mild persistent elevated ...

Case: 55 year old male presented with severe sharp and burning pain at anterior aspect of both legs (radiating from groin to feet), worse at night, unable to keep bed sheets lying on legs due to pain (allodynia). Patient reported weight loss of 3 stones in last 1 year including a recent 1 stone weight loss in 2 months. Patient is a type II DM for the last 3 years. He was intolerant to Metformin and is on Gliclazide 160 mg BD. Alcohol intake around 40 units per week. Initial in...

Case history: A 35-year-old female presented to a district general hospital with convulsive status epilepticus. In the two weeks preceding the seizure, she complained of migrainous-type headaches, transient aphasia and ataxia. Her general practitioner organised a confusion screen, revealing hypothyroidism and commenced levothyroxine 50 μg. She had no other medical history and denied illicit drug use or alcohol-excess. Examination revealed mild pyrexia (38.2°C), clonu...

Case history: A 74-year old gentleman was referred from Urology clinic for hypercalcemia after being treated for left vesico-ureteric calculus causing mild hydronephrosis. Past medical history included asthma, eczema and hypertension. He had been taking calcium supplements for 5 years, but stopped 2 months prior to clinic. He was asymptomatic and quite well with no recent fracture.Investigations: Adjusted Ca ranged from 2.62 to 2.78 mmol/l, PTH from 2.6 ...

Case presentation: A 66 year old male presented to the clinical physiology department for a routine ECHO. He was found to be hemodynamically unstable with fast Atrial fibrillation and was referred to ED for immediate management. He was subsequently admitted in CCU under Cardiology. He presented with a 3 month history of shortness of breath, palpitations, persistent tremors, unintentional weight loss and generalised fatigue. No previous thyroid problems. He had a longstanding h...

A 17-year-old young lady presented with tiredness, weight loss, palpitations, hot flushes and irregular menstruation in April 2016 and her initial TFTs showed TSH <0.03 mU/l with a fT4 of 48.2 pmol/l. She was treated with carbimazole 40 mg daily and further investigation confirmed she had had Graves’ disease as TSH receptor antibodies (2.10 U/l), TPO antibodies (>1300 IU/ml), thyroid ultrasound scan demonstrated mildly enlarged and thyroiditis. She had only six period...

Introduction: Adrenal myelolipomas are rare benign tumours consisting of fat and haematopoietic elements. We present an adult male patient with congenital adrenal hyperplasia (CAH) with an incidental diagnosis of bilateral adrenal myelolipomas, resulting in an improvement in adherence to treatment, but uncertainty regarding his future management.Case history: 53 year old man with known CAH was referred into the endocrine clinic, historically requiring la...

Case history: A 67 year-old male was referred from GP to Endocrine clinic due to incidental high Calcium level in a routine bone profile. Adjusted Serum Calcium was 2.69 mmol/l. In Endocrine clinic, a detailed history was taken. The patient denied all symptoms of hypercalcemia.Past medical history: Alcohol-related cirrhosis (complicated with Varices banded by OGD), Diverticular disease, Type 2 diabetes mellitus, Hypertension, Hyperlipidemia.<p class=...

Case history: A 43-year-old Syrian woman presented with severe right thigh pain following a fall from standing height. Progressive hip and back pain in the preceding 18 months resulted in her mobilizing with crutches. Past medical history included a reported bony tumour resected from her wrist three years earlier, clavicle fracture and previous renal calculi. She took no regular medications.Investigations: Pelvic radiograph showed a right proximal femora...

Case history: A fifteen year old female was seen in general paediatric clinic after multiple GP attendances based upon persistent maternal concerns for short stature (height below 0.4th centile). She was otherwise healthy, had achieved menarche at age 14, and had no dysmorphic features. She had been reviewed by endocrinology age ten and discharged with a diagnosis of familial short stature. Her mother’s height was on the 0.4th centile and her father’s on the 75th, re...

Case history: A 33 year old gentleman presented with a 4 month history of an evolving rash. This initially appeared on the extensor surfaces of the knees bilaterally and progressed to involve both arms and the trunk. This rash was not associated with fever, pain, pruritis or any other symptoms. These lesions were diffuse erythematous crops of yellow papules visible over the knees, arms and trunk. The patient was initially diagnosed with folliculitis and treated with oral flucl...

Case history: 29 year old lady presented to A&E with UTI. She had a history of emotionally unstable personality disorder and was an elective inpatient in a psychiatric hospital at the time of her presentation. Blood tests done on admission showed that she was hypercalcaemic. She was treated for UTI and referred to endocrinology. Biochemistry tests were in keeping with familial hypocalciuric hypercalcaemia (FHH). It transpired that her father and sister also had hypercalcae...

Case history: A previous healthy 69 year-old female was brought into the ED by her worried husband after he noticed worsening confusion. She developed seizures post arrival to the ED and was admitted under ITU for further care. Retrospective history from the husband indicated she had started feeling unwell around Christmas with a feeling of malaise. She self-medicated with amoxicillin which she had access to as a nurse practitioner. Over the next 2 days she developed headaches...

Section 1: A 57 year old gentleman was referred to the endocrinology clinic with hyponatraemia. His past medical history included hip dislocation and Peyronie’s disease. He was very anxious. He did not smoke or drink alcohol, and he was taking Ibuprofen, paracetamol and amitriptyline 75 mg ON. He had raised urinary sodium and was diagnosed with SIADH. As part of a routine workup he was found to have a raised morning cortisol. The patient had a BMI of 21 and had no abdomin...

Case history: 20 year old male with Asperger's and OCD was admitted as a psychiatric inpatient and started on aripiprazole and subsequently quetiapine. His symptoms were well controlled, however his creatine kinase rose significantly over the subsequent 3 months. He had no symptoms of neuroleptic malignant syndrome and despite other parameters being investigated, no other causes were found. For this reason, advice from endocrinologists was sought for advice on management of a ...

Case history: A 61-year-old gentleman first presented to A&E following a collapse at work. After missing lunch, he became combative towards his colleagues and was found to be hypoglycaemic with capillary blood glucose of 2.5 mmol/l. Symptoms rapidly improved after oral glucose intake. The patient reported similar episodes in the past, usually occurring before meals and mainly if missing or delaying a meal. The patient did not have any past medical history of note, did not ...

Section 1: Case history: A sixty-three-year-old Caucasian male presented with a six-week history of lethargy, emotional lability, polydipsia, polyuria, increased appetite and weight gain. He also reported changes in his facial features and widening of the gaps between his teeth. He has a background of hypertension, obstructive sleep apnoea and benign prostatic hyperplasia. On examination, the patient appeared plethoric, had coarsened facial features, mild prognathism and evide...

Section 1: Case history: A 38 year old female was identified as carrying a heterozygous pathogenic MEN1 variant (c.13404delG) through predictive testing, following a diagnosis of familial hyperparathyroidism.Section 2: Investigations: Routine screening for hyperparathyroidism and pituitary disease was negative. However, a CT thorax–abdomen–pelvis revealed a 41 mm pancreatic tail mass. Biopsy via endoscopic ultrasound confirmed a well-d...

A 30 year-old Caucasian male presented for a routine check-up. He was known to have abnormal thyroid function tests since the age of 23 years of unclear nature/aetiology. He reported occasional palpitations and anxiety. There were no other symptoms on systems’ review. He did not take regular medication, was an ex-smoker and consumed alcohol socially. His mother had hypothyroidism and his maternal aunt’s thyroid nodules. He was euthyroid. A palpable isthmic nodule &#7...

A 58 year old male diagnosed with ‘Parkinson's Disease’ in 2016 following symptoms of Parkinsonism and a DaTscan, was admitted with seizures. He was given Benzodiazepines in the A&E which helped control the seizures. A CT scan of his head revealed Bilateral Basal Ganglia calcification. This was the first time he had seizures, but he did complain of having on and off facial twitching and muscle spasms. There was no history of trauma to the head, fevers, or change ...

Adrenal lesions are commonly detected incidentally during cross-sectional imaging examinations, and the majority are benign adrenal adenomas. A 52 year old gentleman with a history of hypertension and paroxysmal atrial fibrillation was referred to our service following a fall in which he fractured several ribs. Subsequent abdominal CT revealed an incidental finding of bilateral adrenal masses, reported as approximately 5 cm and 4 cm on the right and left side respectively with...

Introduction: Paragangliomas are neuroendocrine tumours, usually found from the base of the skull to pelvis. They are extremely rare in the sellar and parasellar region which normally lacks paraganglion cells. We report a rare case of an incidental sellar paraganglioma.Case: A 66 years old female had progressive retinopathy and maculopathy of unclear cause since 2011. Lung nodules were seen on CT performed to exclude paraneoplastic retinopathy. 18F-FDG P...

Introduction: Hyponatremia in patients with pituitary tumours are common due to many reasons including secondary hypoadrenalism and secondary hypothyroidism. When these causes are treated with the background of hyponatremia, serum sodium should be regularly monitored as it could get corrected too rapidly leading to ODS.Case report: 34 Year old patient presented to a tertiary care hospital with headache. His MRI brain revealed a large suprasellar lesion s...

Case history: Cyclical Cushing’s is a very rare disease with rhythmic fluctuations in cortisol production with or without phenotypic features. It is a very challenging entity to diagnose. The low index of clinical suspicion is key for timely diagnosis and prevention of long-term complications. A 66 years old male presented with intermittent, episodic bilateral leg swelling and reversible weight gain of ˜6 kg following these episodes. Background history entailed femor...

Case history: We present a rare case of Langerhans cell histiocytosis (LCH) of pituitary stalk and hypothalamus in a 40 year old lady. She presented with 9 weeks history of a sudden onset of polyuria and polydipsia. She had extreme thirst even during night which led to significant nocturia and tiredness. She denied headache, blurring of vision, galactorrhoea or menstrual irregularity. She had no significant past medical history and was not on any medications. Physical examinat...

Case history: 49 year old female with learning disabilities who was being treated as epilepsy for 2 years and attended the GP surgery for routine bloods. Patient had a seizure like activity and fell onto both knees. X ray which showed a distal femur fracture which was undisplaced and was extra-articular and patellar fracture. Patient was found to be hypoglycaemic on the ward and she was treated with 10% dextrose infusions. She underwent Left knee exploration and repair of medi...

Case history: A 70 year old man presented with a six month history of sore throat and dysphagia. His past medical history included Type 2 diabetes and dysarthria due to tracheomalacia following tracheostomy at the age of 40 when he was involved in a road traffic collision. Initially he was diagnosed with gastroesophageal reflux, but symptoms did not settle with proton pump inhibitor medication. He as therefore referred to the ENT team for further evaluation.<p class="abste...

Section 1: Case history: 23 Year old Caribbean gentleman attended A&E with several month history of non-specific headaches, changes in memory/mood and joint pains. Since the age of 5 he had been medically treated for renal stones, He had a past medical history of sickle cell trait and was not on any regular medications. There was no significant family history apart from sickle cell disease. He had initial bloods which showed serum adjusted calcium level 3.7 mmol/l and PTH ...