Endocrine Abstracts

A 41-year-old woman with primary ovarian failure secondary to Turner syndrome presented in December 2020 with heavy vaginal bleeding. She had not attended appointments during the Covid-19 epidemic because of concerns around contracting the virus. She was anaemic with haemoglobin 47g/dl. Ultrasound showed grossly thickened and heterogenous endometrium (60 mm). Cross sectional imaging and hysteroscopy confirmed locally advanced endometrial carcinoma (Stage 3). She proceeded to hysterectomy in June 2021. She did not wish to have chemotherapy and a palliative approach was taken. She sadly died in February 2022. Our patient had been on unopposed oestrogen, a known risk factor for endometrial hyperplasia and dysplasia. She had taken premarin from age 16 to 38 years and had not wanted to change her HRT regimen having experienced progestin side effects. An ultrasound scan 2 years earlier was reported as reassuring. A request to change her to a combined oestrogen-progestin patch had been made but she had not presented to her GP to collect the prescription. This young woman had firm beliefs about her hormone replacement regimen, but at the time of her presentation said that the risks of unopposed oestrogen had not been explained to her in a way which she understood. At a serious untoward incident meeting we felt that although the risks had been discussed, earlier discussion with a gynaecologist would have been helpful. Because it is unusual for endocrinologists to manage women who are not taking a progestin, there was less experience of the significance of her bleeding pattern. Hence, we are particularly keen to share the details of this tragic case to raise awareness amongst our colleagues and trainees. Contributory factors to our patient’s outcome were the Covid-19 epidemic, and an historical difficulty knowing what medications were being prescribed in primary care.