Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2021

Edinburgh, United Kingdom
08 Nov 2021 - 10 Nov 2021

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Join us in Edinburgh for the flagship event of the Society for Endocrinology

Poster Presentations

Bone and Calcium

ea0077p24 | Bone and Calcium | SFEBES2021

Hyperparathyroid service evaluation at the Royal Cornwall Hospital Trust from 2013 to 2021

Beck Adele , Looker Jack , Reddy Venkat , Rock Ben , Browne Duncan

Introduction: Primary hyperparathyroidism affects 0.3% of the general population1. 90% are due to single parathyroid adenoma1. Surgical treatment is the only definitive cure2. Improvements in imaging permit radiologists to better identify parathyroid adenomas1, enabling more targeted surgery1, thus shortening general anaesthesia, as well as lowering post-operative complication rates. Neck ultrasound (US) and parathyroid sc...

ea0077p25 | Bone and Calcium | SFEBES2021

Seasonal variations in circulating vitamin D appear gender dependent and may highlight a novel health inequality

Laing Ian , Allcock Rebecca , Aitchison Michael , Perkins Karen , Wignall Paul

Vitamin D is a pleotropic hormone with important actions in a wide variety of cell types. Whilst its role in the endocrine control of calcium metabolism via the active circulating metabolite 1,25- dihydroxy cholecalciferol is widely appreciated, other actions in a range of cells and tissues depend on activation of circulating 25-hydroxy vitamin D by intracrine mechanisms and paracrine actions which may be locally controlled. Of particular interest are the roles of vitamin D pe...

ea0077p26 | Bone and Calcium | SFEBES2021

Pre-antiresorptive therapy dental screening (PADS): a successful intervention against medication related osteonecrosis of the jaws (MRONJ)

White Gillian , Hughes Caitlin , Burnside Lesley , Munro Robin , Chong Zhuo Min

Introduction: MRONJ is defined as exposed bone in the maxillofacial region that persists after eight weeks in patients treated with antiresorptive or anti-angiogenic drugs, without previous radiotherapy. The estimated United Kingdom incidence of MRONJ in osteoporosis patients is 0.01-0.1% (1). MRONJ can cause severe disfigurement, speech and feeding difficulties. We aim to investigate MRONJ incidence and utility of dental screening in patients receiving Zoledronate ...

ea0077p27 | Bone and Calcium | SFEBES2021

An Audit into the Diagnosis and management of primary hyperparathyroidism

Zafar Muhammad , Singh Rajiv , Ogunko Arthur , Manghat Padmini , Abedo Itopa

Background: Primary Hyperparathyroidism is a leading cause of hypercalcaemia and is frequently asymptomatic. Due to its long-term complications, early diagnosis and management is essential. NICE published guidelines on diagnosis and management of Primary Hyperparathyroidism in May 2019. The aim of this audit was to compare our existing practices against NICE guidance.Methods: We conducted retrospective data collection by identifying patients diagnosed wi...

ea0077p28 | Bone and Calcium | SFEBES2021

Case Report: Asymptomatic hypercalcaemia in a patient with TB re-activation

Chaudhury Nadia , Thadani Puja , Ladher Ramesh , Cajic Vjeran , Gholap Nitin

Background: Vitamin D is important for calcium homeostasis. In granulomatous diseases including tuberculosis (TB), hypercalcaemia may be seen. Suspected mechanisms include elevated vitamin D sensitivity and increased extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)2D] by alveolar macrophages within granulomas. Prevalence of hypercalcaemia in TB patients vary worldwide, yet is rare in the UK. We present a case of hypercalcaemia in a patient with TB reactivat...

ea0077p29 | Bone and Calcium | SFEBES2021

Comparison of local cinacalcet prescribing trends with NICE guidelines

Dewdney Charlotte , Adamu Laura-Ikeme , Macfarlane David

Introduction: Cinacalcet is an allosteric modulator of the calcium sensing receptor which lowers parathyroid hormone (PTH) secretion. However, it is expensive and there is limited evidence of benefit in reducing complications of primary hyperparathyroidism (PHPT). In 2019 the National Institute for Health and Care Excellence (NICE) guidelines suggested that cinacalcet could be considered in individuals with PHPT if surgery has been unsuccessful or is unsuitable and if adjCa<su...

ea0077p30 | Bone and Calcium | SFEBES2021

Pregnancy and Lactation Associated Osteoporosis (PLO)- Case Report

Outas Mariana Costache

The partum period can be seen as a transient condition of “menopause” due to the physiological decline to a baseline of the high estrogens found during pregnancy, and bone metabolism is likely to alter. Moreover, high calcium requirements for fetal growth and during breastfeeding are covered in the maternal metabolism from enhanced intestinal absorption in a Calcitriol dependent pathway, and maternal bone reabsorption under control of parathyroid hormone (PTH) parath...

ea0077p31 | Bone and Calcium | SFEBES2021

Recombinant PTH 1-84 (Natpar) treatment in a case of refractory hypocalcaemia secondary to surgical hypoparathyroidism and malabsorption post-gastric bypass

Sagar Rebecca , Cooke Heather , Maguire Deidre , Abbas Afroze

We report the case of a 63-year-old lady with refractory hypocalcaemia due to surgical hypoparathyroidism, decompensated by malabsorption following gastric bypass, successfully treated with recombinant human parathyroid hormone 1-84 (rhPTH), Natpar. She initially presented with medullary thyroid cancer aged 33 and was found to have MEN2A. She underwent thyroidectomy and developed post-surgical hypoparathyroidism. She was managed for over 20 years with alfacalcidol and oral cal...

ea0077p32 | Bone and Calcium | SFEBES2021

Bendroflumethiazide-induced hypocalciuria in a patient with hypercalcaemia and unsuppressed parathyroid hormone levels

Htun Kyaw , Oyibo Samson , Rajkanna Jeyanthy

Introduction: There are reports of patients having co-existing primary hyperparathyroidism and familial hypocalciuric hypercalcaemia (FHH). The combination of relative hypocalciuria, hypercalcaemia and slightly elevated serum parathyroid hormone (PTH) could indicate FHH. Medications such as, lithium and bendroflumethiazide can reduce renal excretion of calcium. We report a case highlighting the importance of being aware of drug-induced hypocalciuria during the investigation of...

ea0077p33 | Bone and Calcium | SFEBES2021

Severe Hypercalcemia in a Patient with Milk Alkali Syndrome

Wasserman Evan , Gadela Vaishnavi , Perosevic Nikola

Introduction: Hypercalcemia has a broad differential, including primary hyperparathyroidism, non-parathyroid hormone-mediated hypercalcemia, including humoral hypercalcemia of malignancy, or medication mediated. We report a case of severe hypercalcemia attributable to milk-alkali syndrome due to excessive calcium carbonate use.Case: A 71 year-old female with a history of hypertension presented after a fall without loss of consciousness. She endorsed epis...

ea0077p34 | Bone and Calcium | SFEBES2021

Vitamin D deficiency and inflammation in IBD patients

Soare Iulia , Sirbu Anca , Diculescu Mircea , Mateescu Bogdan Radu , Tieranu Cristian , Cima Luminita , Fica Simona

Introduction: Vitamin D is a potential immune modulator and low levels are common in inflammatory bowel disease (IBD) patients. The aim of the study was to determine the association between deficient vitamin D and inflammatory profile.Methods: Intestinal (fecal calprotectin) and blood inflammatory profile [erythrocytes sedimentation rate (ESR), protein C reactive, fibrinogen], were performed to all patients. In addition, level of 25 hydroxy vitamin D was...

ea0077p156 | Bone and Calcium | SFEBES2021

Primary Cinacalcet therapy is safe and effective as alternative or bridging modality in Primary Hyperparathyroidism

Nge Nge Nyein , Malik Mohamed

Purpose: To evaluate long-term safety and efficacy of cinacalcet in management of primary hyperparathyroidism (PHPT).Material/Methods: We retrospectively studied all patients on cinacalcet for primary hyperparathyroidism over 3 year’s period. Data was collected and analyzed for indication, daily maintenance dose, tolerability, biochemical effect at 3, 6 and 12 months, effect on bone mineral density and renal stone disease. This study excluded those ...

ea0077p157 | Bone and Calcium | SFEBES2021

A case of familial hyperparathyroidism with an uncommon mutation

Quader Monzoor , Buch Harit , George Arun

A 29 year-old nursing student, was incidentally detected to have high serum calcium 3.43 mmol/l (2.2-2.6) whilst being treated for community acquired pneumonia. She had no symptoms of hypercalcaemia. Her uncle had been operated for primary hyperparathyroidism (PHPT) although only limited details were available. PTH of 28 pmol/l (1.6-7.2) confirmed the diagnosis of PHPT. She had vitamin D deficiency, normal liver and renal function. She was offered parathyroidectomy and preoper...

ea0077p158 | Bone and Calcium | SFEBES2021

Immobilization induced hypercalcemia

Khan Irfan Iqbal , Ahmad Waqar , Tahir Chohan Muhammad , Aung Aung , Dhakshinamoorthy Barkavi , Nag Satyajit

Introduction: Immobilization hypercalcemia is uncommon condition associated with limited movements following brain and spinal cord lesions. Immobilization results in stimulation of osteoclastic bone resorption hypercalciuria and hypercalcemia.Case report: 57 year female, Background of Breast Cancer (Treated with Skin sparing mastectomy and adjuvant radiotherapy) admitted following large subdural hematoma leading to craniotomy and evacuation of hematoma. ...

ea0077p159 | Bone and Calcium | SFEBES2021

Hypercalcaemia as an isolated manifestation of Sarcoid Myositis: A rare case report

Baitule Sudhanshu , Dolan Lauren , Kasavkar Ganesh , Gholap Nitin

Background, case-history: Hypercalcaemia secondary to parathyroid hormone (PTH) independent mechanisms is well known, with differentials including Sarcoidosis. We describe a case of Sarcoid Myositis presenting with symptomatic hypercalcaemia (adjusted serum calcium levels of 3.12 mmol/l) but no muscle weakness in a 39-year-old lady with a background of Type 1 Diabetes Mellitus, Hyperthyroidism, and Rheumatoid Arthritis.Investigations: Laboratory investig...

ea0077p160 | Bone and Calcium | SFEBES2021

An interesting case of Turner syndrome and Parathyroid Carcinoma with recurrent mild asymptomatic hypercalcemia

Naeem Ammara , La Rosa Clementina

Introduction: Primary parathyroid carcinoma accounts for less than 1% of the parathyroid gland tumours and almost always presents as primary hyperparathyroidism. Very few Turner syndrome patients have been reported so far to present with primary hyperparathyroidism secondary to parathyroid adenoma. We report a case of parathyroid carcinoma in a 59 years old lady with Turner syndrome who is presenting with recurrent mild hypercalcemia.Case presentation: A...

ea0077p161 | Bone and Calcium | SFEBES2021

Autoimmune Polyglandular syndrome presenting with multiple Endocrinopathies

Awala Orighomisan , Machenahalli Pratiba , Sankar Sailesh , Randeeva Harpal , Weickert Martin

Background: Autoimmune polyglandular syndrome type 1 (APS-1) is an autoimmune inherited disorder, a potentially underdiagnosed clinical entity, caused by mutations in the autoimmune regulatory gene that can present with varying symptomatology as it affects various organs, posing both a diagnostic and management hurdle. We report a case to highlight this complexity.Case report: Case details involves a female who first presented in childhood with rash, eye...

ea0077p162 | Bone and Calcium | SFEBES2021

Undiagnosed probable genetic primary hyperparathyroidism presenting with brown tumors and deafness

Sharma Bhavna , Qureshi Asjid , Rahman Mushtaqar , Tolley Neil , Thakker Rajesh , Hui Elaine , Seechurn Shivshankar , Remedios Denis , Seetho Ian , Deore Mahesh , Mantega Michele , Mateen Abdul

A 25 year old Afghan male presented with a 4 day history of worsening left-sided loin pain. He had a past history of deafness since birth, speech problems and development delay. Bilateral renal calculi and widespread multiple well defined lytic lesions (likely brown tumours) were seen on CT-KUB. The corrected calcium was 3.21 mmols/l, PTH 80 pmol/l, Vitamin D 25 nmol/l, phosphate 0.49 mmols/l, ALP 960 IU/l and fractional calcium excretion was 0.16. His skull X Ray/OPG, done du...

ea0077p163 | Bone and Calcium | SFEBES2021

Symptomatic primary hyperparathyroidism in the first trimester of unplanned pregnancy

Beck Adele , Reddy Venkat , Sulkin Tom , Browne Duncan

Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. Its prevalence in pregnancy is reported to be between 0.15% and 1.4%[i][ii]. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and foetus (foetal death, congenital malformations, neonatal severe hypocalcaemia induced tetany)[iii][iv]. However, there is a lack of clear guidance on management of primary hyperparathyroidism in pregnancy. We describe the ...

ea0077p164 | Bone and Calcium | SFEBES2021

Resolution of primary hyperparathyroidism following parathyroid adenoma infarction on treatment with cinacalcet

Elford Jane , Head Simeon , Wood Ffion , Williams Elin , Tellier Genevieve , Kraus Alex , Wilton Anthony

Spontaneous resolution of primary hyperparathyroidism following infarction for parathyroid adenomas is rare with infarction on treatment with cinacalcet being even rarer. A 53 year old female who presented to primary care with malaise was found to have biochemical evidence of primary hyperparathyroidism with adjusted calcium 3.31 mmol/l and parathyroid hormone 28.8 pmol/l. Previous medical history was unremarkable. Following discussion with endocrinology, treatment with cinaca...

ea0077p165 | Bone and Calcium | SFEBES2021

Hypercalcemia secondary to Hypervitaminosis D caused by over the counter consumption of vitamin D

Shaikh Sheeba , Omer Maria , Wahab Furat , Irshad Shadman

Introduction: Vitamin D toxicity (VDT) is quite an uncommon condition which results from misperception between dosage regimens of vitamin D supplementation. VDT is diagnosed when Serum 25-hydroxyvitamin D levels are higher than 375 nmol/l (150 ng/ml). Vitamin D supplementation is easily accessible as over-counter medication and online. This report describes a patient who presented with severe hypercalcemia and acute kidney injury (AKI). Further assessment revealed that patient...

ea0077p166 | Bone and Calcium | SFEBES2021

Systematic review of cardiovascular morbidity and mortality associated with primary hyperparathyroidism; does early surgical intervention improve the outcome?

Azad Fatima

Introduction: Primary hyperparathyroidism is associated with numerous cardiovascular complications including hypertension, left ventricular hypertrophy and calcification of cardiac valves. However NICE have not included cardiovascular complications as an indication of parathyroidectomy. This literature review will be focused on benefits of parathyroidectomy on cardiovascular complications of primary hyperparathyroidism.Methodology: Literature search done...