Additional Cases

ea0091cb1 | Additional Cases | SFEEU2023

Non-classical presentation of Graves’ disease during the postpartal period with idiopathic intracranial hypertension (IIH): A cause or a red herring

Graves disease relapse is a common occurrence during the postpartum period which is due to resurgence of immune system after pregnancy. In most cases, overt clinical symptoms are seen and the timing of its occurrence varies from 4 to 8 months. This is a case of a 33 year old lady referred after an MTOP with bilateral pappiloedema and subsequently diagnosed with Graves relapse. She had a background of Graves disease 7 years ago initially treated medically and had tw...

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ea0091cb2 | Additional Cases | SFEEU2023

Subclinical hyperthyroidism in pregnancy

Hope David

33 year old female who is 5 months pregnant, referred to Endocrinology clinic with TFTs in keeping with sub clinical hyperthyroidism. Previously also had thyroid USS showing large 5 cm nodules both lobes, both indeterminate in appearance (U3) which preceded pregnancy. Symptomatic with sweating and palpitations. No family history of thyroid disease and no red flag symptoms. Clinical examination showed palpable thyroid nodules with no evidence of thyrotoxicosis...

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ea0091cb3 | Additional Cases | SFEEU2023

A case of Graves’ disease relapse with high immunologic activity and recurrent refractory course precipitated by poor drug compliance - influence of carbimazole compliance on immunogenic activity

Olaogun Idowu

Graves disease is a very common cause of thyrotoxicosis and it runs a relapsing remitting course due to varying immunogenicity of the pathogenic autoantibodies. Medical treatment is the preferred means of treatment by patients especially in the uncomplicated and non relapsing cases. Few studies have established the additional benefit of thionamides on immunogenic characteristics in Gravess disease. This is a case of a 30 year old lady diagnosed with Graves di...

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ea0091cb4 | Additional Cases | SFEEU2023

Amiodarone-Induced Thyrotoxicosis: Case Report

Anizor Chinedu , Kumar Jesse

Introduction: Amiodarone is a widely used antiarrhythmic drug for refractory atrial or ventricular tachyarrhythmias. Amiodarone-induced thyrotoxicosis (AIT) occurs in up to 6% of patients taking this medication in iodine-sufficient areas of the world and in up to 10% in iodine deficient areas. AIT is of two types: type 1 is a form of iodine-induced hyperthyroidism whereas type 2 is a drug-induced destructive thyroiditis. Type 1 AIT tends to occur in patients with underlying th...

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ea0091cb5 | Additional Cases | SFEEU2023

Thyrotoxic crisis presenting with hypoglycaemia, pancytopenia and intrahepatic cholestasis

Gamage Kavinga , Pathmanathan Sivatharshya , Sumanatilleke Manilka

Background: Thyrotoxic crisis is a rare and life threatening condition requiring urgent medical intervention. Intrahepatic cholestasis, hypoglycaemia and pancytopenia are known but uncommon presentations in thyrotoxic crisis.Case presentation: A 71 year old Sri Lankan female with a background history of diabetes presented to a tertiary care centre with severe hypoglycaemic episodes despite being off oral hypoglycaemic agents, weight loss of 6 kg, palpita...

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ea0091cb6 | Additional Cases | SFEEU2023

Type 2 Amiodarone-induced Thyrotoxicosis

Cilia Kyle

A 72-year-old man with a past medical history of hypertension, atrial fibrillation and ischemic heart disease presented to cardiology outpatients for his routine visit. His regular medications included atorvastatin 80 mg daily, enalaparil 5 mg daily, amlodipine 5 mg daily, aspirin 75 mg daily and amiodarone 200 mg daily. Endocrinologists were involved after noticing abnormal thyroid function tests (TFTs) on his routine check. TFTs showed a suppressed thyroid stimulating hormon...

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ea0091cb7 | Additional Cases | SFEEU2023

Hyperthyroidism in a women of child bearing age

Patil Aashutosh

Patient a 30 year old female was referred to Endocrinology from ED. Patient had presented to ED with palpitations and anxiety. Was having these symptoms for last month and had no other medical illness, not on any regular medications. In ED had ECG done which showed sinus tachycardia, had Bloods done which showed picture of Hyperthyroidism so was referred to Endocrinology. She was started on oral propranolol for symptomatic relief and the TRAB antibodies, TPO antibodies were re...

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ea0091cb8 | Additional Cases | SFEEU2023

Amiodarone; A tale of 2 thyroiditis

Irfan Aisha

2 cases of Amiodarone induced thyroiditis. 1. 60 years old gentleman on haemodialysis, secondary to diabetes related kidney failure, on Insulin for diabetes, also on treatment for active pulmonary tuberculosis and on amiodarone for non-sustained VTs for one year and had left ventricular systolic dysfunction. He went into atrial fibrillation during a dialysis session and his thyroid function tests were done along with other blood tests. He was discussed with cardiology who advi...

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ea0091cb9 | Additional Cases | SFEEU2023

A case of Thyroid Hormones resistance causing symptoms in a young woman

Nizami Atif , Khan Asra , Nizamuddin Khwaja

This case reports describes a 26-year-old presented with having regular shakes, including tremulous arms, feeling hot and cold, mood swings, increased sweating, constantly feeling hungry, being itching all the time and having stomach-ache. She felt easily bloated with certain types of food. She was investigated and found to have thyroid hormone dysfunction. Symptoms were suggestive of Thyrotoxicosis with Biochemical evidence of Thyrotoxicosis. She had further investigations in...

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ea0091cb10 | Additional Cases | SFEEU2023

Relapse of Graves’ Disease

Gatt Arlene , Vella Sandro

A 23-year-old female presented with a three-month history of palpitations, tremors and recent anxiety. This was associated with hot flushes in the morning, heat intolerance and increase in appetite. Otherwise, bowel habits were normal and the patient suffered from long-standing menorrhagia with regular menstrual cycles. She denied a recent viral illness, neck pain or swelling, dysphagia, shortness of breath or dysphonia. She denied thyroid eye disease symptoms. She denied a pa...

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ea0091cb11 | Additional Cases | SFEEU2023

Late Onset Amiodarone Induced Thyrotoxicosis

Bramble Delanos , Hamdan Sawsan , Ghieth Sherif

A 60-year-old engineer was reviewed in the Endocrinology clinic on 07/05/2021. He reported weight loss, palpitations, disturbed sleep, and fatigue over the previous four (4) months. He denied any neck pain or swelling. There were no symptoms consistent with thyroid eye disease. He had no pre-existing history of thyroid disease. TFTs in March 2021 confirmed primary hyperthyroidism (TSH < 0.004 (0.35- 4.94 miu/l), FT4 19.8 (9-19 pmol/l), FT3 7.4 (2.9- 4.9 pmol/...

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ea0091cb12 | Additional Cases | SFEEU2023

Graves’ Disease and Cerebral Vasculopathy

Subbiah Kasi , Perumal Samundeeshwari , Gilbert Jacqueline

A 20-year-old lady of Vietnamese origin presented with increasing frequency of headaches and worsening right sided weakness over 4 days. There was no other significant past medical illness, and she was not on any regular medication. She was not a smoker, and there was a history of thyrotoxicosis in her mother. Her heart rate was 110 beats per minute, and she was in sinus rhythm. On examination there was right sided weakness (MRC grade 4/5), expressive dysphasia, tremor of her ...

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ea0091cb13 | Additional Cases | SFEEU2023

Persistent Hyperthyroidism Secondary to Ectopic Autonomous Thyroid Tissue

Subbiah Kasi , Khalilova Samira , Sathyanarayan Sheela , Dimitriadis Georgios

A 28 year old lady presented with a 4 month history of anxiety, palpitations, weight loss and a pressure sensation in the neck. On examination she had fine tremor of her outstretched fingers and no palpable goitre with a regular heart rate. FT4 was 22 pmol/l(10.3-24.5), FT3 7.9 pmol/l(3.5-6.5), TSH 0.02 mIU/l(0.3-5.5), TSH receptor antibodies (TRAb) <0.9 U/l(0-1.75) and TPO antibodies <4 IU/ml (0-35). She was started on Carbimazole 20 mg daily and after being well cont...

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ea0091cb14 | Additional Cases | SFEEU2023

Familial dysalbuminemic hyperthyroxinemia (FDH)

Shamsaldeen Mohammed , Panicker Janki

Introduction: Familial dysalbuminemic hyperthyroxinemia (FDH) is a familial autosomal dominant condition that was first reported in 1979. It is caused by a mutant albumin molecule with an increased affinity for serum thyroxine (T4), despite the serum albumin level being normal. FDH causes increase in total T4 and T3 level with normal TSH level. As FDH patients are clinically euthyroid and asymptomatic, they do not require treatment.Case report: 68-year-o...

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ea0091cb15 | Additional Cases | SFEEU2023

Thymic hyperplasia in Grave’s Disease – a not so uncommon occurrence

Chagger Herpreet

Thymic hyperplasia (TH) in Graves Disease (GD) is not uncommon. It was first described in 1914 by William Halstead, however incidence has been difficult to establish as most patients remain asymptomatic from the TH and do not routinely undergo chest imaging when managing GD. We present a 49-year-old female with a background of rheumatoid arthritis and hypothyroidism, who presented to Rheumatology with proximal and distal muscle weakness, absent reflexes and weight loss. ...

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ea0091cb16 | Additional Cases | SFEEU2023

Abstract Withdrawn...

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ea0091cb17 | Additional Cases | SFEEU2023

Thyrotoxicosis presenting as Stroke

Yee Phang Soo

We have been seeing an 82 year old lady in endocrine clinic since 2017. She was initially admitted via ED in September 2017 with sudden onset confusion and left sided weakness. MRI confirmed ischaemic stroke with evidence of an acute right sided posterior cerebral artery infarct affecting right occipital and superior cerebellar regions. She was also noted to be in atrial fibrillation, and was also found to have significant thyrotoxicosis with a supressed TSH, FT4 60, FT3 30. T...

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ea0091cb18 | Additional Cases | SFEEU2023

Grave’s Disease

Khan Hamza

A 29 year old lady with a background Hx of asthma came to the Ambulatory clinic with palpitations in the mid of Dec 2022. She was found to have an elevated heart rate of 120/min, regular and EKG showed Sinus Tachycardia. BP was Normal and weight was stable. She was also complaining of loose Bowls for the last few months. She denied any eye signs. She was a smoker and was not pregnant (She was not planning pregnancy in the near future). Her Bloods were Normal with stable U&...

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ea0091cb19 | Additional Cases | SFEEU2023

A case of Amiodarone induced thyrotoxicosis Type 1

Humayun Khan Huma

Introduction: Amiodarone, a drug with high iodine content, is commonly associated with thyroid dysfunction. There are two well-recognized forms of amiodarone induced thyrotoxicosis. Thyrotoxicosis due to iodine excess leading to increased thyroid hormone synthesis is referred to as Amiodarone induced thyrotoxicosis type 1 (AIT type 1) whilst thyrotoxicosis due to direct toxic effect (thyroiditis) is known is amiodarone induced thyrotoxicosis Type 2 (AIT type 2). The aim in bot...

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ea0091cb20 | Additional Cases | SFEEU2023

Stimulating and Blocking Thyroid-Stimulating Hormone (TSH) Receptor Autoantibodies from Patients with Graves’ Disease

Thin Khine May

Background: Autoimmune thyroid conditions such as Hashimotos thyroiditis and Graves disease are more common in women than men. Both conditions are characterized by symptoms and signs on the opposite spectrum of the scale. Although cases of conversion from hyperthyroidism to hypothyroidism are often encountered in clinical practice, the exact incidence of this conversion is not known -it is possible that such conversion may be due to development of blocking and stim...

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ea0091cb21 | Additional Cases | SFEEU2023

The Swinging Sixties: Drug-fuelled Highs and Lows

Ying Khor Xiao , Syed Akheel

A man in his sixties, with no previous history of thyroid dysfunction (Table 1), was commenced on Amiodarone for atrial fibrillation at the age of 64 years. 24 months after starting on Amiodarone, the patient was found to have a low TSH with markedly elevated fT4 but normal free T3 (fT3). He was asymptomatic, there was no goitre, thyroperoxidase and TSH-receptor antibodies were negative. The thyroid dysfunction was managed by non-interventional observation with gradual resolut...

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ea0091cb22 | Additional Cases | SFEEU2023

Recurrence of Graves’ disease in remnant Thyroid Tissue after Total Thyroidectomy

Zeeshan Amna , AhmedMohamed Isra

Case Report: We reported a case of 54 year old lady who presented with symptomatic hyperthyroidism 11 years after total Thyroidectomy. She remained well controlled on average 100 mg of Levothyroxine until presented with persistently supressed TSH despite weaning off and later withdrawal of levothyroxine (T4 16 pmol/land TSH <0.03 pmol/l) and elevated Thyroid Stimulating Antibodies (TSI) (>40 iu/l). Her Thyroid ultrasonography showed remnants of thyroid tissue in the th...

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ea0091cb23 | Additional Cases | SFEEU2023

A story of resistance: When Graves’ disease isn’t just Graves’ disease

Aslam Aisha , Lewis Alexander

A 32-year-old female was referred with abnormal thyroid function tests after investigation for nonspecific joint symptoms and exhaustion in 2010. Initial biochemistry showed TSH 0.03 mU/l(0.2-5), Free T4 75 pmol/l(9-24). At her endocrine appointment she reported loose stools, tremors, exertional dyspnea and a peculiar sensation in neck in keeping with thyrotoxicosis. Since puberty, she had problems acquiring weight. Repeat thyroid function demonstrated TSH <0.01 mU/land Fr...

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ea0091cb24 | Additional Cases | SFEEU2023

Acute decompensated heart failure in a patient with longstanding uncontrolled Graves’ thyrotoxicosis

Anandhakrishnan Ananthi , Gunganah Kirun

Case history: A 69-year-old female was referred acutely from the community with 4 weeks of progressive breathlessness. Initially exertional, she was now also breathless at rest with orthopnoea and paroxysmal nocturnal dyspnoea. She had a background of antibody-positive thyrotoxicosis diagnosed 33 years ago, managed solely in primary care on carbimazole 20 mg, with good compliance. On examination, she was dyspnoeic with an irregularly-irregular tachycardia and fine tremor to th...

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ea0091cb25 | Additional Cases | SFEEU2023

Thyrotoxicosis

Dhevi Krishnasamy Ganapathy Kavitha , Basu Ansu

38 year female presented to the endocrine clinic with palpitations. On further questioning she reported weight loss, diarrhoea but normal menstrual cycles. She was diagnosed in September 2022 with thyrotoxicosis in a country outside UK and was commenced on carbimazole 20 mg once daily. Blood investigations in September 2022- TSH 0.02 serum FT4 31.0 FT3 8.17). Bloods repeated by GP 4 months later after arrival in UK, showed the following: Serum TSH 23.45, serum T4 1.20, serum T...

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ea0091cb26 | Additional Cases | SFEEU2023

Amiodarone induced thyrotoxicosis

Salari Syeda

50yrs old male with AF diagnosed in 2018. Had a failed ablation. Started on amiodarone from June 2021 to July 202 that was stopped and started on diltiazem for rate control. No history of previous thyroid disease or family history of thyroid no goiter. GP picked up thyrotoxicosis in August 2022 in bloods, started him on carbimazole and referred to endocrine. In terms of thyroid there was weight loss, tremulousness and sob. TRAB was negative. Prednisolone started given history ...

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ea0091cb27 | Additional Cases | SFEEU2023

Iatrogenic Graves’ disease - A case of severe Graves’ disease and Graves’ orbitopathy occuring after radioiodine therapy for toxic nodular goitre

Olaremi Japhet

Radio-active iodine (RAI) therapy is effective in managing hyperthyroidism due to solitary toxic thyroid nodule, in which 90% efficacy is observed. The most common side effects of RAI include hypothyroidism, transient neck pain and dry mouth and eyes. Occasionally, transient worsening of hyperthyroidism or the development of new-onset Graves orbitopathy (GO) has been reported in patients with GD after RAI therapy. However, there is scant literature regarding the risk of ...

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ea0091cb28 | Additional Cases | SFEEU2023

Thyroid function and Self Help

Bonanos Stathis , Mullan Karen , J Hunter Steven , Wallace Helen

A 60 year old nurse presented to the emergency department with palpitations, itchy skin, shortness of breath, diarrhoea, insomnia, weight loss and feeling hot /clammy. She felt her symptoms were in keeping with the menopause although she had been amenorrhoeic for six years. Thyroid function tests revealed fT4 73 pmol/land TSH <0.01 mIU/lhaving been normal six months previously. She was started on carbimazole 40 mg/day and was seen urgently in clinic. She reported to feelin...

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ea0091cb29 | Additional Cases | SFEEU2023

A case of persistent grade II subclinical hyperthyroidism without any overt complications

Akbar Shahzad , Taqi Muhammad , Mongolu Shiva

Introduction: Hyperthyroidism is a pathological state characterized by increased synthesis and secretion of thyroid hormones (thyroxine (T4) and triiodothyronine (T3)) by the thyroid gland. Subclinical hyperthyroidism a milder form is defined as a low or suppressed TSH (<0.4 mIU/l), but serum free T4 (FT4) and free T3 (FT3) within the reference interval.Case: 76 years old lady seen in endocrine clinic. She was referred by GP because of ...

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ea0091cb30 | Additional Cases | SFEEU2023

A presentation of Graves’ thyrotoxicosis

Sheikh Abdur-Raoof

A female patient in her early forties was referred to the endocrine clinic. She initially presented to her general practitioner with symptoms of leg cramps and feeling lethargic. As part of initial investigation, thyroid function tests were performed which revealed Free T4 >100 pmol/lwith a TSH suppressed <0.02mU/l. She was promptly commenced on carbimazole for thyrotoxicosis. On retrospective questioning, there was history of weight loss greater than one stone, over t...

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ea0091cb31 | Additional Cases | SFEEU2023

Graves’ disease in ITU- Thyroid Storm vs Thyrotoxicosis

Ajit Rajan Thirupathirajan Vikram , Hamdan Sawsan , Bramble Delanos , Patel Nishchil , Dimitropoulos Ioannis

A 28-year-old female presented to ED with one week history of flu-like symptoms, palpitations, increasing breathlessness, and productive cough with copious sputum, of two days duration. There was h/o some weight loss over the last year, with episodic palpitations over the last 8-10 years that increased in frequency over the last one year. She had a family history of hyperthyroidism paternally and maternally. On examination, there was mild lid-lag and proptosis. She was tachypn...

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ea0091cb32 | Additional Cases | SFEEU2023

Medical and surgical management of thyrotoxicosis

Zaki Beenish , Carroll Paul

A 25-year lady was referred to GSTT for further management of thyrotoxicosis as she had relocated to London. The patient developed thyrotoxicosis during her pregnancy at the age of 23. During her pregnancy, she had significant weight loss. Her thyroid function test in September 2020 showed TSH 0.04 mU/lwith FT4 of 24.1 pmo/land TSH receptor antibody of 1.35 U/l. Hence she was started on propylthiouracil (PTU) during pregnancy. PTU was titrated down based on biochemical respons...

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ea0091cb33 | Additional Cases | SFEEU2023

Management of thyrotoxicosis complicated by neutropenia

Zaki Beenish , Velusamy Anand

A 40-year-old female was referred for further management of thyrotoxicosis to GSTT. She worked as a nanny and had Graves thyrotoxicosis since October 2019. Her presenting symptoms were weight gain, hair loss, insomnia, and increasing anxiety. She had a large palpable goitre on examination with no eye disease. Ultrasound of the thyroid showed a diffusely enlarged thyroid with a normal echotexture, reflectivity and vascular flow. Benign subcentimeter nodules were seen in e...

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ea0091cb34 | Additional Cases | SFEEU2023

Immunotherapy induced Thyrotoxicosis and adrenal insufficiency

Awadelkareem Abuzar , Khan Irfan , Hnin Thanda , Shekar Nitin , Asam Muhammad , Masinghe Sanjana

Introduction: Immune-checkpoint inhibitors are used in patients with advanced cancers. They are associated with a wide array of side effects known as immune-related adverse events (irAEs). These can affect skin, gastrointestinal tract, multiple endocrine glands, liver and other systems. We report a 69-year-old male with a past medical history of Chronic Obstructive Pulmonary Disease and Lung cancer who was referred by the oncology team with a clinical and biochemical picture o...

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ea0091cb35 | Additional Cases | SFEEU2023

A Case of Thyrotoxicosis refractory to medical management

Subramanian Venkatram , Bell Richard

38 year old lady with history of thyrotoxicosis managed since 2012. She works as a bus driver and is a single mother. She had no evidence of thyroid eye disease and her clinical activity score was 0. She has a smooth goitre which is non compressive. She was previously treated with propylthiouracil and she went into remission but then she relapsed in 2018. She has been on treatment but due to being a single mother and also her work schedules, she struggles with her medications ...

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ea0091cb36 | Additional Cases | SFEEU2023

Hashitoxicosis in A Young Patient: Uncommon Presentation of Autoimmune Thyroid Disease

Ali Mudassir , Abouglila Kamal

A 39-year-old lady with background history of autoimmune hypothyroidism diagnosed over 10 years ago, established on Levothyroxine 100 mg once daily, was referred by the GP with unusual sweating, palpitations, tiredness, anxiety, tremors and weight loss of around one stone over last few months. The thyroid function tests were suggestive of thyrotoxicosis with TSH of less than 0.05 mu/land FT4 60 pmol/l, hence the dose of levothyroxine was gradually reduced and ultimately stoppe...

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ea0091cb37 | Additional Cases | SFEEU2023

A case of severe hypothyroidism in an elderly patient with Hashimoto’s Disease

White Margaret

85 yo presenting with collapse, found to be hypothermic, bradycardic, hypotensive and hypoglycaemic, decreased GCS, on admission. TSH 135, T4 unrecordable. Prescribed IV liothyronine and hydrocortisone as per guidelines. Managed in Medical HDU. Careful management of hypothermia to avoid vasodilation and hypotension- blankets rather than active warming. Close management of blood sugars for hypoglycaemia. Pt responded well to therapy. Oral levothyroxine started once pt alert and...

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ea0091cb38 | Additional Cases | SFEEU2023

A Rare Occurrence of Solitary Pheochromocytoma in an Adolescent Presenting with Cholestatic Liver Derangement

Pillai Gopalakrishnan Prethivan , Ming Yong , Sert Khim Khoo Serena

A 16-year-old male, previously well, presented with 3 days history of non-specific body ache and headache. His blood pressure was 194/127mmHg, heart rate 115 beats/minute but had normal examination findings otherwise. His BP was high throughout his admission and his BMI was 20 kg/m2. Drug history was unremarkable. We noted he had transaminitis with predominantly elevated alkaline phosphatase (ALP). His ALP was 397U/l(40-105 U/l), Alanine transaminase (ALT) 124U/l(0-50 U/l), As...

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ea0091cb39 | Additional Cases | SFEEU2023

Case of Adrenocortical Tumour

Sharma Sangita

Background: Mrs X had experienced severe right sided abdominal pain. Brought to hospital by ambulance from the residential home. In Accident and Emergency, she was confused and the accuracy of her history was difficult to confirm. Mrs X had a CT abdomen and pelvis with contrast. This had reported a 3.8 cm enhancing, well defined left adrenal mass, this needed to be assessed with adrenal protocol CT. Referred to Nurse-Led Adrenal Incidentaloma clinic for investigations.<p c...

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ea0091cb40 | Additional Cases | SFEEU2023

Adrenocortical Carcinoma Presenting with flank pain: A Case Report

Dhar Mili

A 52-year-old female presented with acute left flank pain after experiencing intermittent pain, weight gain, mood disturbances and hirsutism for six months. A CT scan of the abdomen and pelvis revealed a large heterogeneous 10x7x15 cm mass in the left adrenal gland with local invasion. The patient had a past medical history of right invasive ductal carcinoma and had undergone a wide local excision. She was referred to the Endocrine team.Biochemic...

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ea0091cb41 | Additional Cases | SFEEU2023

Oncocytic Adrenocortical Carcinoma - a rare variant

Poe Poe Han Htwe Nang , Abbas Afroze , Fraser Sheila , Anthoney Alan

A 59-year-old male patient, who is fit and well, presented with abdominal discomfort, night sweats, back pain and lower urinary tract symptoms. The CT scan, organised by the GP, demonstrated a 17 cm heterogenous mass with central necrosis and scattered calcification in right side of abdomen, possibly right adrenal origin or liver or kidney. He was referred to Adrenal MDT. Baseline functional testing showed unsuppressed cortisol level in an overnight dexamethasone, high DHEA su...

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ea0091cb42 | Additional Cases | SFEEU2023

A case of Pheochromocytoma crisis precipitated by biliary sepsis

Elsayed Mohamed Ali Nihad

Background: Pheochromocytoma is a rare tumour that arise from chromaffin cells in the adrenal medulla and produces signs and symptoms due to excessive catecholamine secretion from tumour. Presenting symptoms can vary but often they classically present with headaches, sweating and palpitations in the setting of paroxysmal hypertension. Pheochromocytoma crisis results from the sudden release of large quantities of catecholamines and leads to progressive multiple organ dysfunctio...

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ea0091cb43 | Additional Cases | SFEEU2023

Cushing’s Syndrome of Unknown Aetiology

Win Wutyee

72 year old male has an incidental left adrenal lesion which was picked up by the ultrasound scan in 2014 for the flank pain. His medical background includes type2 Diabetes-Mellitus, hypertension, aortic stenosis, hypogonadotropic hypogonadism, well controlled asthma and sleep apnoea using CPAP. His Adrenal CT (late 2014) has shown pre-contrast of 4HU, portal-phase 20HU, and delayed-phase-18HU. His MRI adrenals showed fat rich left side 3 cm adrenal adenoma with stable appeara...

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ea0091cb44 | Additional Cases | SFEEU2023

Severe Cushing’s Syndrome in a 24 year old female

Sloan Gordon , Macinerney Ruth , Pillai Anita , Robinson Robert , Pallai Shillo , Shahbuddin Ibrahim

A 24 year old female presented to her general practitioner with general malaise. She had a genetic diagnosis of hereditary non-polyposis colorectal cancer (Lynch syndrome), with no colonic lesions detected on screening. Routine biochemistry revealed a potassium of 2.1mmol/l, requiring admission for urgent investigation and intravenous replacement. Further clinical assessment found a past history of severe acute thoracic back pain (3-months prior to presentation), weight gain a...

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ea0091cb45 | Additional Cases | SFEEU2023

Ectopic ACTH Dependent Cushing’s Syndrome

Sadaf Shaikh

History: 57yrs old gentleman presented with c/o-Shortness of breath confusion weakness Tired Having poor appetite Poor mobility generally unwell.P/M/H: Diagnosed with Medullary Thyroid Carcinoma as a part of MEN2A at the age of 32 yrs had a thyroidectomy and lymph node clearance in 1997 followed by a few months later by sternotomy and mediastinal node resection. Bony metastasis. Residual Horners syndrome. Developed Renal, liver and Bone metastasis ...

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ea0091cb46 | Additional Cases | SFEEU2023

A case of Adrenal Hypercortisolism: A timeline

Tulsi Dooshyant , Bano Gul , Triantafyllou Christina

A 69 year old lady was initially seen in clinic in August 2020 for a right adrenal incidentaloma which was discovered after she had a CT abdomen for diverticulitis related symptoms. She subsequently had a dedicated CT Adrenal in January 2019 before she was seen in clinic which showed a 25 x 32 mm right adrenal adenoma labelled as lipid poor with an absolute & relative washout of 67% and 47% respectively. Her past medical history included hypertension and anxiety disorder. ...

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ea0091cb47 | Additional Cases | SFEEU2023

ACTH-dependent Cushing with low ACTH levels: a diagnostic conundrum

Ali Rashid Razan , Napier Catherine , Pearce Simon , Mamoojee Yaasir

Background: Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessments. Biochemical evidence of endogenous steroid excess is demonstrated through overnight dexamethasone suppression test (ODST), low dose dexamethasone suppression test and/or 24-hour urinary free cortisol estimation (UFC). Once endogenous steroid excess is confirmed, random serum ACTH measurement is key in determining the suspected source of steroid exce...

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ea0091cb48 | Additional Cases | SFEEU2023

Hunting for the source of ACTH

Yang Lisa , Wernig Florian

A 64 year old female presented to A&E with a 3 month history of general decline, low mood and 8 kg weight loss. On examination there was facial plethora, thin skin with generalised bruising and peripheral oedema. Initial blood tests showed raised inflammatory markers, low potassium (2.6 mmol/l) and deranged liver function tests. A CT chest/abdomen/pelvis found a 2 cm lesion in the left lung with extensive liver metastases but no nodal deposits in the abdomen so this was fe...

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ea0091cb49 | Additional Cases | SFEEU2023

Cushing’s Disease during the COVID Lockdown

Gilroy Michael

A 36-year-old female was referred to Endocrinology by her GP in August 2019 with polycythaemia, obesity, hypertension, type 2 diabetes, asthma, right shoulder and bilateral ankle pain [on 6-monthly steroid injections], easy bruising, hirsutism, PCOS and raised testosterone. Haematology had excluded likely causes of polycythaemia [JAK 2 negative]. The GP noted previous review by Endocrinology in another hospital [December 2012] regarding possible PCOS but was lost to follow up ...

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ea0091cb50 | Additional Cases | SFEEU2023

Cushing’s syndrome due to ectopic ACTH secretion

Faheem Muhammad , Malhotra Gaurav , Aziz Umaira

Ectopic ACTH is an infrequent cause of Cushings syndrome which can be severe in its presentation and needs immediate management to in order to prevent the complications associated with severe hypercortisolism. This case of ectopic ACTH secretion is being reported who presented clinically as Cushings syndrome and later diagnosed to have small cell carcinoma of lung. A 62-year-old previously normally fit and well lady presented with 1-month history of feeling unwell,...

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ea0091cb51 | Additional Cases | SFEEU2023

A case of Cushing’s secondary to ectopic ACTH secreting neuroendocrine tumour

Osman Shaima

A retired 73 year old teacher, who had 2 sons and lived independently alone and stayed active playing tennis 3 times per week. She is an ex-smoker and drinks alcohol occasionally. Past medical history: right breast cancer T1N0 post wide local excision/radiotherapy in remission, type 2 diabetes on Linagliptin. Large cell neuroendocrine tumour of the lung with liver metastasis, on palliative chemotherapy with Octreotide injections. Admitted with generalised body weakness started...

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ea0091cb52 | Additional Cases | SFEEU2023

Cyclical Cushing’s disease – challenges in diagnosis and management

Sawhney Natasha , Abraham Prakash

Background: The case is a 64 year old patient referred by the GP who noticed she looked cushingoid. She gave an approximately 4 year history of a change in facial complexion, central weight gain, unsteadiness and poor wound healing. There was a history of depression, essential hypertension and previous back surgery. On examination she was plethoric, had pedal oedema, thin skin and central obesity (BMI 32).Investigations: Initial overnight dex...

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ea0091cb53 | Additional Cases | SFEEU2023

Co-existence of an adrenal mass and Cushing’s disease: a diagnostic challenge

Al Radhi Balqees , Mamoojee Yaasir , Al-Sharefi Ahmed

Introduction: Adrenal tumors are commonly discovered incidentally on cross-sectional abdominal imaging. The Incidence of adrenal tumors increased 10-fold in the past 2 decades, with most diagnosed in older adults. In any patient with a newly discovered adrenal mass, determining whether it is functioning adenoma or non-functioning and identifying whether it is ACTH dependent or not is crucial to avoid missing the real underlying pathology.Clinical case: A...

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ea0091cb54 | Additional Cases | SFEEU2023

Complexities in the diagnosing of Cushing’s syndrome

Wellala Vindya , Ranganatha Rao , Kumarathunga Dineesha , Thadani Puja , Georgios Giovos

Diagnosis of Cushings syndrome is challenging in the absence of cardinal features. But still, they have the same metabolic risk due to the presence of biochemical hypercortisolism. A 35-year lady was referred to the tertiary care endocrine unit following an incidental finding of high cortisol levels while on treatment for covid in 2021. She also had some weight gain, slow healing of wounds, and easy bruising. She did not have any features of hyperandrogenism and hyperten...

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ea0091cb55 | Additional Cases | SFEEU2023

A complex case of Cushing’s disease from an evasive source

Sattar Nosheen , Debono Miguel

Diagnosis of Cushings disease can be a difficult and lengthy process with repeated and dynamic testing required to ensure the correct diagnosis is made prior to invasive intervention such as surgery. This case demonstrates that even with meticulous investigation the underlying cause of the disease can still be evasive. A 43-year-old female presented with a history of hypertension since age 20, managed with Amlodipine (10 mg) and Ramipril (10 mg). She was investigated for...

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A journey through Cushing’s Syndrome -- "From Discovery till Recovery"

Zafar Sadia , Bhagi Ridhi , Roy Chowdhury Sharmistha

Background: Cushings syndrome (10-15/million people diagnosed/year) is quite rare with Cushings disease accounting for >70% of cases in adults. Spinal epidural lipomatosis (SEl) secondary to endogenous Cushings syndrome is even more rare condition (8 reported cases so far) of which 3 cases are secondary to Cushings disease. Here, we highlight a case of ACTH-dependent Cushing disease with resultant spinal epidural lipomatosis (SEl) that was treated w...

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ea0091cb57 | Additional Cases | SFEEU2023

Can serum ACTH level be reliably interpreted in the diagnostic work-up for Cushing in adrenal incidentalomas?

Ali Mudassir , Ramsingh Jason , Mamoojee Yaasir

Background: Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessments. Biochemical evidence of endogenous steroid excess is demonstrated through overnight dexamethasone suppression test (ODST), low dose dexamethasone suppression test and/or 24-hour urinary free cortisol estimation (UFC). Once endogenous steroid excess is confirmed, random serum ACTH measurement is key in determining the suspected source of steroid exce...

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ea0091cb58 | Additional Cases | SFEEU2023

Hypercalcaemia in a young female patient

Tsoutsouki Jovanna , North Matthew , Tebbs Daniel , Tharakan Goerge , Behary Preeshila , Cox Jeremy , N Comninos Alexander

A 35 year old lady presented with a one week history of back pain, myalgia, fatigue, epigastric pain, and persistent vomiting. She reported a four week history of reduced appetite and 4 kg weight loss. She had recently recovered from an uncomplicated COVID-19 infection. Past medical history included a previous eating disorder (anorexia and bulimia), and subsequent chronic gastritis. Drug history included Omeprazole 20 mg daily, Laxido 2 sachets daily and antacids (Rennies 4-8 ...

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An interesting case of severe symptomatic hypercalcaemia – primary hyperparathyroidism, tertiary hyperparathyroidism or PTH carcinoma until proven otherwise?

Triantafyllou Christina , Tulsi Dooshyant , Bano Gul

A 79-year-old female was admitted with general decline, polydipsia, polyuria, decreased appetite and constipation. Her family reported mobility decline over past six months and confusion over past few days with weight loss. She had hypertension on Amlodipine and renal impairment was only detected when she recently moved to UK from Jamaica. An incidental finding of hypercalcaemia was found with an adjusted calcium of 3.03, PTH 79.8, vitamin D 33 and phosphate 0.41. The initial ...

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Familial Hypocalciuric Hypercalcemia: the importance of taking detailed family history when assessing patients

Hanson Petra , Harrold Christopher

54 year south Asian woman was found to have mild hypercalcaemia of 2.64mmol/l, vitamin D of 21 nmol/land PTH of 4.9 pmol/lin 2013. She had a DEXA scan showing osteopenia of the fourth lumbar vertebrae. She did not have any symptoms suggestive of hypercalcaemia but reported generalised aches and pains. She had a past medical history of hysterectomy, right oophorectomy, dyspepsia and asthma. She was initially treated with vitamin D. Repeat calcium, vitamin D and PTH normalised a...

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Asymptomatic hypercalcemia with Hip fracture- Primary Hyperparathyroidism

Irfan Aisha

78 years old lady admitted with fall and right hip fracture under the orthopaedic team was referred to endocrinology with high calcium levels (2.84 mmol/l). Patient was mobile and independent, had a mechanical fall, no preceding symptoms. She had no symptoms of hypercalcemia. She had background history of osteoarthritis and previous history of removal of skin cancer. She was taking calcium supplements, but they were stopped at the time of admission. She was an ex-smoker. Her m...

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Diagnosis and Management of Primary Hyperparathyroidism

Gatt Arlene , Vella Sandro

A 57-year-old gentleman presented with severe hypercalcaemia (Corrected Calcium 3.48 mmol/l) associated with polyuria and polydipsia. He denied pruritus, nausea, vomiting, abdominal pain, constipation or other aches and pains. He denied syncope, seizures, haematuria or recent urinary tract infections. He had a past history of bilateral urolithiasis as well as right pyelonephritis and hydronephrosis requiring nephrostomy, Crohns Disease and Diverticular Disease. Drug Hist...

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ea0091cb63 | Additional Cases | SFEEU2023

A Young Woman with Symptomatic Primary Hyperparathyroidism and a Renal Stone

Khan Shaila , Palazzo Fausto , Haboosh Sara , Behary Presheela , Wernig Florian , Cox Jeremy , Comninos Alexander

A 27-year old Caucasian woman was referred to the Endocrine Bone Clinic after investigations for general malaise revealed hypercalaemia and elevated parathyroid hormone levels. She had no history of constipation, abdominal pain, bone pain, or other related symptoms. She had no history of renal stones or fractures and no change in weight. Her past medical history included asthma and she took a salbutamol inhaler as required. She had no family history of endocrine pathology. Gen...

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An atypical case of hyperparathyroidism

Eyadeh Ahmad , Seejore Khyatisha

A 70-year old female patient was referred to the Endocrine clinic after incidental finding of significant hypercalcaemia (3.19 mmol/l, NR: 2.20-2.60 mmol/l) during work-up for cognitive decline. She had a known background of T2DM, hyperlipidaemia, osteoarthritis with a previous right total hip replacement and a laparoscopic cholecystectomy. She was first reviewed in clinic in June 2022 and was almost asymptomatic, except for memory issues. She denied previous history of renal ...

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The familial hypocalcuric hypercalcaemic mask

Busti Stefano

Background: Primary hyperparathyroidism is a relatively common endocrine disorder. Familial hypocalciuric hypercalcaemia is an important differential diagnosis but is much less prevalent. We examine a case of hypercalcaemia where there was some initial diagnostic uncertainty.Case report: a 55-year-old lady was referred from primary care with mild hypercalcaemia, low mood, constipation and urinary frequency. She had a previous history of renal stones at t...

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Primary hyperparathyroidism vs Familial hypocalciuric hypercalcaemia

Chin-Harty Lisa

A 61-year-old male was referred for hypercalcaemia. He was experiencing generalized fatigue and underwent several investigations which included serum calcium. He had recently been treated for two episodes of chest infections. At that time, he was also experiencing weight loss and night sweats. His symptoms have since resolved. He had no symptoms of hypercalcaemia- polyuria, polydipsia, abdominal pain, constipation, bone pain, or headaches. He was not taking calcium supplements...

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Recurrent primary hyperparathyroidism

Ahmed Faroug

Introduction: - Primary hyperparathyroidism is a relatively common disorder affecting 1 in 500 women and 1 in 2000 men aged over 40 years. - Diagnosis of primary hyperparathyroidism is confirmed biochemically with synchronous elevation of serum calcium and inappropriate elevation of parathyroid hormone. - Parathyroid adenomas are the most common aetiology. Around 80% are a single, benign adenoma, which in most cases is sporadic. Multiple adenomas and hypertrophy of all 4 gland...

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A pt bed bound diabetic patient presents with unexplained drowsiness

Kyaw Moe , Banerjee Amit

A 71 year lady, who has past history of acute ischaemic stroke ( now bed bound and can only get out of bed with the help of a hoist) , Type 2 diabetes melitus, HTN, CKD and high lipid. She is on Metformin 1 gm twice daily, Ramipril 5 mg at night, Clopidogrel 75 mg od, Atorvastatin 80 mg od. She was brought to hospital by unexplained drowsiness and poor oral intake. Her blood sugar was 72, ketone 5.2, Ph: 7.21, Na: 165, Urea 14 and calculated osmolality of 412. Her chest xray a...

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‘Changing faces’- A new diagnosis of acromegaly presenting with euglycaemic DKA

Osman Nadia , Patel Henna , Gunganah Kirun

A 43-year-old Bangladeshi lady was seen in the endocrinology clinic after recent admission to hospital with vomiting and headaches. Her past medical history included Type 2 diabetes, hypertension, ischaemic heart disease and goitre. During admission, a diagnosis of euglycaemic diabetic ketoacidosis (DKA) was made (pH 7.31, bicarbonate 18.3, glucose 7.8 and ketones 6.1) secondary to SGLT-2 inhibitor. This was managed with a fixed rate insulin infusion, intravenous fluid hydrati...

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Society for Endocrinology Endocrine Update 2023

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