Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology Endocrine Update 2022

Society for Endocrinology Clinical Update 2022

Workshop D: Disorders of the adrenal gland

ea0082wd1 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Iatrogenic Cushing’s syndrome with secondary adrenal insufficiency due to concomitant use of chronic intranasal steroids and fluconazole - a dangerous combination

Mansukhbhai Shekhda Kalyan , Anthony Karen , Rossi Michela

Background: Intranasal steroids are commonly used for allergic rhinitis, rhinosinusitis and nasal polyps as they are considered safe in terms of long-term adverse effects profile due to favourable pharmacokinetic characteristics as compared to other oral and inhaled steroids. Some are also available over the counter without prescription.Case: We report a patient with iatrogenic Cushing”s syndrome and secondary adrenal insufficiency due to chronic in...

ea0082wd2 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Addison”s disease in individual living with HIV: is Covid-19 the culprit?

Soo Choi Ji , Mital Dushyant , H Ahmed Mohamed , Mansoor Raza Mohamed

Introduction: There are emerging reports showing the relationship between human immunodeficiency virus (HIV), Covid-19 and adrenal insufficiency. This was attributed to thrombotic events and necrosis, leading to hypoadrenalism. The HIV virus can also lead to Addison”s disease due to destruction of adrenal gland. Prevalence of adrenal infarction with COVID-19 was found to be 23% and 88% this was shown to be affecting both adrenal glands. Case report:...

ea0082wd3 | Workshop D: Disorders of the adrenal gland | SFEEU2022

A rare case of hypocortisolism in hypercoagulable state

Htet Aung Htet , Zeeshan Amna , Dimitriy Chernov , Damani Nazar , Tauni Rahat , Kostoula Melina

We report a case of 39-year-old woman presenting with sudden severe abdominal pain and vomiting. She had a past medical history of anti-phospholipid antibody syndrome (APLS) diagnosed in the United States (US) 20 years ago. She had multiple episodes of vomiting over the last 10 years and was diagnosed with cyclical vomiting as investigations including CT abdomen and endoscopy did not reveal a structural cause. She was taking warfarin for APLS. She was haemodynamically stable a...

ea0082wd4 | Workshop D: Disorders of the adrenal gland | SFEEU2022

An Atypical Presentation of Addison”s Disease

Mathew Susan , Jude Edward

History: A 52-year-old woman was referred by her GP for colonoscopy in view of 7 months” history of unexplained weight loss of nearly 2.5 stones, constipation and recently detected normocytic anaemia. Her past medical history was unremarkable except for bronchial asthma that was managed with albuterol. However, on the day of the scheduled colonoscopy, she was noted to be hypotensive (BP- 63/38 mm Hg, heart rate 93 bpm) and was hence admitted for fluid resuscitation. Follo...

ea0082wd5 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Optimising the biochemical control in a young patient with classical Congenital Adrenal Hyperplasia (CAH) and history of azoospermia, resulted in spermatogenesis

Ali Mudassir , Cheetham Tim , Mitchell Anna

A male with classical salt-wasting congenital adrenal hyperplasia (CAH; 21-hydroxylase deficiency) who was diagnosed in infancy and had normal pubertal growth and development attended the endocrine department for routine follow up in June 2019 (age 26). His current daily medications are hydrocortisone 10 mg on waking, 5 mg at 4 pm and fludrocortisone 200 mg once daily. He also has injectable hydrocortisone sodium phosphate 100mg for emergency use. Over recent years, he reports...

ea0082wd6 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Acute presentations of 4 patients with spontaneous adrenal haemorrhage

Ganawa Shawg , Ensah Grace , Keevil Brian , Issa Basil

: We report on 4 patients who acutely presented to our unit and diagnosed with adrenal haemorrhage.Case 1: A 72 year old man presented with generalised abdominal pain, fever and raised CRP a week after hip replacement surgery. CT abdomen showed non-enhancing bilateral adrenal lesions consistent with adrenal haemorrhage. He was taking Apixaban for DVT following hip replacement. SST was performed which confirmed suboptimal cortisol response. Hence, Treated...

ea0082wd7 | Workshop D: Disorders of the adrenal gland | SFEEU2022

A rare endocrine complication of immunotherapy in lung cancer

Virgo Elena , Joseph Stonny

Lung cancer is the second most common cancer in the world with the leading position as a cause of oncological fatality. The immunotherapy is applied as the second line of chemotherapy, and seems a breakthrough therapy, promising a better quality of life to patients in the late stages of cancer. Pembrolizumab (also, known as MK-3475 or Keyruda) is a humanised antibody PD-1 receptor or antibody to programmed death ligand one. Side effects considered as acceptable and mostly pres...

ea0082wd8 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Atypical late presentation of congenital adrenal hyperplasia with adrenal myelolipomas

Idris Izan , Basavaraju Navya , Moulik Probal , Rangan Srinivasan , Singh Prashant

64 y/o male was being investigated for raised PSA. Following an MRI and biopsy, he was diagnosed with high grade prostatic intraepithelial neoplasia requiring close PSA surveillance. Incidentally, he was found to have bilateral adrenal lesions, measuring 6.4 cm on the left and 4 cm on the right. Prior to review in endocrine clinic, adrenal workup and CT adrenals were performed. CT showed both adrenal masses contain fat and calcification and are thought to be bilateral adrenal ...

ea0082wd9 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Journey with classical adrenal hyperplasia. Expectations and reality of treatment

Aslam Aisha , Ahmad Shiraz

27-year-old male presented to the outpatient adult Endocrine team with Classical Salt wasting CAH due to 21 -Hydroxylase Deficiency. He has 659 A/C G splice mutation. There was no prior family history of CAH. The diagnosis was made at birth and he was commenced on hydrocortisone and Fludrocortisone. Further confirmatory tests were done at the age of one month. He was regularly followed up in the pediatric endocrine clinic. There have always been issues with compliance. He had ...

ea0082wd10 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Cushing”s crises arising from a neuroendocrine tumour treated with etomidate infusion

Islam Quazi , Eltayeb Randa , Eldigair Hiba , Khoo Bernard , Yousseif Ahmed , Karra Efthimia , Patel Dipesh

Introduction: Ectopic ACTH syndrome is rare but is frequently severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. It should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment (1). Etomidate, an imidazole-derivative anesthetic a...

ea0082wd11 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Gabapentin induced low cortisol

Wahid Alam , Srinivasan Ramalingam

A 56 year old man with history of Hypertension, “Pre-diabetes” and Osteoarthritis was noted to have a low morning Cortisol of 31 nmol/l at 0912 hrs and <28 nmol/l at 0741 hrs on the first and 4th postoperative days respectively following a left total knee replacement. His regular medications were Amlodipine 5mg OD, Ramipril 5mg OD, Bisoprolol 3.75mg OD, Atorvastatin 20mg HS, Gabapentin 100mg TDS. Post operatively he was also given Zomorph 10mg BD with Oramorph PR...

ea0082wd12 | Workshop D: Disorders of the adrenal gland | SFEEU2022

A danger of treating hypothyroidism

Wood Kirsty , Abraham Prakash

This 46 year old lady with no significant past medical history was referred urgently to the Endocrine Investigation Unit with a 9 month history of increasing lethargy and gradual weight loss of around 5 kg. Two months prior, she had been diagnosed with subclinical hypothyroidism and after commencing Levothyroxine, quickly lost another 5 kg in weight over a period of 6 weeks and had postural dizziness with systolic BP readings between 80 and 90 mmHg. She was having a normal men...

ea0082wd13 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Male infertility in CAH – a balance of risk?

Naeem Ammara , Srirangalingam Umasuthan

26 year old gentleman with classic salt-wasting CAH due to 21-hydroxylase deficiency was maintained on hydrocortisone 7.5mg+7.5mg+5mg along with fludrocortisone 100 mg OD. Due to inadequate biochemical control, his hydrocortisone was increased to 10mg+10mg+5mg initially, which was subsequently switched to prednisolone 5mg+2.5mg. His 17-OH progesterone continued to remain high (300-400 nmol/l) with suppressed gonadotrophins and a high normal testosterone suggestive of mostly ad...

ea0082wd14 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Adrenal insufficiency after unilateral adrenalectomy for Cushing”s Syndrome

Subramaniam Yuvanaa , Akker Scott

We present a 38-year-old patient who had adrenal insufficiency following laparoscopic removal of 3.2 cm cortisol-secreting right adrenal tumour. His biopsy showed adrenocortical adenoma in keeping with Cushing’s syndrome. He had a history of hypertension with suboptimal control despite being on 3 anti-hypertensives. His early morning cortisol (by GP to investigate secondary causes) were elevated and this prompted Endocrine referral. Clinical history and examination were ...

ea0082wd15 | Workshop D: Disorders of the adrenal gland | SFEEU2022

ACTH secreting Pancreatic NET - an unusual presentation – A Case report

Nagarajah Kalyani

Neuroendocrine tumours are heterogenous group of diseases that can originate from any part of the gastrointestinal tract, bronchi, Thyroid and Pancreas. Tumours that arise from the endocrine Pancreas, on the islet of Pancreas, are called Pancreatic NET. Pancreatic NETs have an incidence of < 0.1 % per one million person and can lead to secretion of ectopic ACTH (1). Ectopic ACTH secretion accounts for 5-10 % of all patients presenting with ACTH dependent hypercortisolism: ...

ea0082wd16 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Non-classic congenital adrenal hyperplasia (NCCAH)

Ranasinghe Beatrice , Chhina Navpreet

Case history: 30-year-old female presented with subfertility for a year. She has had menarche at the age of 13 and regular periods for 2 years prior to commencing on hormonal contraception (initially COCP and then implant). Off contraception her menstrual cycles resumed after 6 weeks with a regular cycle length of 24 days. She has also suffered from generalised excessive body hair since young.Investigations: Treatment and follow up: Foll...

ea0082wd17 | Workshop D: Disorders of the adrenal gland | SFEEU2022

Cushing syndrome during pregnancy: A case presentation

Zia Rao Komal , Tulsi Dooshyant , Falinska Agnieszka , Bawlchchim Zosanglura , Russell-Jones David

: A 26 year old 22 weeks pregnant woman was referred to the Endocrine team after she presented with high blood pressure without evidence of proteinuria. She had no past medical history and was newly diagnosed with gestational diabetes. On clinical examination, she had some clinical features consistent with hypercortisolism such as very prominent large purplish striae over her abdomen, bad facial acne, multiple superficial ecchymoses due to easy skin bruisability and excessive ...