Endocrine Abstracts

Pheochromocytoma is an uncommon tumour found in the adrenal gland medulla. It is identified by the excessive release of catecholamines. The typical symptoms include paroxysms of high blood pressure and adrenergic symptoms like headaches, sweating, breathlessness, and palpitation. In severe instances, patients may experience hypertensive crises and cardiomyopathy. We describe a case where intestinal pseudo-obstruction, a rare complication of pheochromocytoma, was only resolved ...

A 59 year old female patient presented with fall and Syncopal episode to Emergency Department. She had a few days history of increasing thirst, polyuria and diffuse abdominal discomfort. These symptoms were ongoing for weeks prior to her syncopal episode. Her past medical history of Endometriosis, Type 2 diabetes mellitus, epilepsy, ex-IVDU user with hep B in remission and self-neglect. She suffered with frequent episodes of heart burns and self-treated this with over counter ...

Here we present a 49 year-old-male patient with known T1DM, hypothyroidism on Levothyroxine, with previous history of poor compliance with his Levothyroxine. He was admitted with 3 days history of bilateral feet swelling and foot droop. Following the improvement of his leg swellings, his bilateral foot droop became more prominent. He was diagnosed with Hashimoto hypothyroidism with anti TPO ab levels of 279 IU/Ml (reference range: <34 IU/ml) in 2012. His regular medication...

Case: 60 year old male presented to his GP with symptoms of polydipsia, polyuria, reduced appetite and weight loss of about 1 stone over 6-7 weeks. Routine bloods showed abnormal blood film with left shift in neutrophils, moderate thrombocytopenia (61), basophilia and occasional blasts (1%). Morphology was suggestive of Chronic Myeloid Leukaemia (CML). He was referred to haematology for further management and had specialist bloods and a bone marrow examination. Due to ongoing ...

83-year-old lady presented to emergency department with intermittent confusion. Detailed history revealed that she had a background of recent posterior circulation ischemic stroke 3 weeks prior. She was then referred from her rehabilitation center to us for episodic unresponsiveness with associated low capillary glucose, improving with intravenous dextrose. Prior to her stroke, she had episodes of intermittent dizziness, usually mid-morning, which resolved with snacks. Past me...

Case History: An 83-year-old male patient was admitted with coffee ground vomiting. He had no associated melaena, abdominal pain or previous episodes of vomiting. He was on apixaban and bisoprolol for his hypertension and atrial fibrillation. He did not smoke and only drank alcohol occasionally. The patient underwent endoscopy and was found to have variceal bleeding and had band ligation. He was started on terlipressin and pantoprazole. He was referred to endocrine for ongoing...

Case History: A 39 year old female who was trying to conceive was referred with a raised T4 and non-suppressed TSH, on a background of a miscarriage after embryo transfer one month earlier. She reported no symptoms, however, on specific questioning she had palpitations, a mild tremor and later showed mild tachycardia on holter monitoring. There were no childhood features of Resistance to Thyroid Hormone β (RTHb). There was a family history of primary hypothyroidism only. ...

Section 1: Case History: A case of 51 year old female who was referred to us by GP due to increase in size of previously known adrenal adenoma that was picked up on the abdominal ultrasound requested by GP for her deranged liver function test. She had previous investigations in 2017 by endocrinologist in another hospital for a left benign adrenal incidentiloma and it was found non-functional at that stage. She had hypertension 3 years ago and was started on Ramipril by GP. She...

Case History: We present a case of a 52-year-old female with a history of right adrenalectomy at age 30, insulin-dependent Type 2 diabetes, and atypical clinical manifestations mimicking acromegaly. The patient presented with a five-year history of worsening facial appearance, blurry vision, and a noticeable hunch in the back. Notably, she had undergone right adrenalectomy for an adenoma in the past and had never received steroid therapy post-surgery. Despite presenting with f...

Case History: A 73-year-old gentleman with no prior comorbidities, presented with 2-month history of decreased appetite, weight loss and lethargy. He denied experiencing paroxysmal symptoms of headache/sweating/palpitations, abdominal pain, fever, night sweats or chronic cough. Clinically, he was cachexic, dehydrated (blood pressure 98/82 mmHg; heart rate 125 beats per minute) with a vague mass palpable over the right lumbar. There were no palpable lymphadenopathy or features ...

Case History: A 56-year-old woman initially sought evaluation at an endocrine clinic in 2018 due to the discovery of an adrenal incidentaloma (AI). She complained of chest pain and underwent coronary computed tomography angiography, which revealed no significant coronary artery disease but incidentally detected a lung nodule. Subsequent interval assessment of the lung nodule via HRCT unveiled a well-defined 25 × 20 mm left adrenal mass. Further examination indicated a 30 ...

Introduction: Thyrotoxicosis, characterized by excessive production of thyroid hormones, can precipitate a spectrum of cardiovascular complications, including heart failure and valvulopathy. This case study highlights a case where effective management of thyrotoxicosis precipitated the reversal of heart failure and valvulopathy. Case Presentation: A 44-year-old woman presented at the emergency department with complaints of dyspnea, palpitations, and fati...

KPD remains poorly understood. It is characterised by unprovoked hyperglycaemia with ketoacidosis at diagnosis, in the context of brief history of hyperosmolar symptoms and weight loss in individuals with no prior history of diabetes. The initiation of insulin therapy in these patients is accompanied by insulin-free periods, during which oral hypoglycaemic medications and diet achieve normoglycaemia. KPD has been reported predominantly in Africans, African Americans, Hispanics...

Case history: A 67-year-old-lady was first seen in the endocrinology clinic in December 2015 for management of her osteoporosis-deemed to be secondary to menopause with alcohol excess as an additive factor. This had been confirmed on the bone densitometry scan. She had previously been on Alendronate from July 2012 to April 2015, but discontinued this due to intolerance. Considering her latest bone mineral densitometry (BMD) values (in g/cm2) of 0.766 (T-score of -2....

Case history: We present the case of a 59-year-old gentleman admitted to our hospital in February 2023 with severe hypercalcaemia. He had a background of mild intermittent hypercalcaemia since 2018 (highest 2.73 mmol/l), chronic kidney disease, hypertension, and a recently climbing prostate-specific antigen that had warranted a 2-week-wait Urology referral. On admission, his only symptom was constipation, without weight loss or constitutional symptoms. His parathyroid hormone ...

Case history: A 31-year-old-lady was referred to the antenatal clinic at 6 weeks gestation. She had a background of a Craniopharyngioma and underwent transsphenoidal surgery (TSS) at age 9 years. She subsequently developed post-operative hypopituitarism which required supplementation with Growth hormone (GH), Levothyroxine and hormone replacement therapy (HRT). She also developed cranial diabetes insipidus (CDI) requiring supplementation with desmopressin. She had never been s...

Case History with Investigations: A 65-year-old female, with no previous thyroid abnormalities, was originally referred to ENT with goitre. She was clinically and biochemically euthyroid, and following ultrasound with fine needle aspiration for right-sided nodules with benign cytology, was discharged. She was subsequently referred to Endocrinology with persistent lethargy and hair loss despite normal thyroid function. She described gritty eyes and swollen eyelids for 2 years, ...

Case History: 49 year old female presented to emergency with severe shortness of breath with non-productive cough, of 5 days duration. There was no h/o flu like symptoms nor GI symptoms. She did not have a significant past medical history but consumed alcohol in excess and was a heavy smoker. On examination, the patient was of normal build, with blood pressure of 150/90 mm Hg and pulse rate of 160/min, irregular. There were fine hand tremors, with sweaty palms and forearms. Th...

Case history: We discuss a 40-year-old man with an unusual presentation of newly diagnosed Adrenoleukodystrophy following a family genetic screening test that was performed when his nephew aged 8 years was diagnosed with the same condition. He was struggling to articulate his thoughts and occasionally developed slurring of speech and these changes were noted over a period of 3 years preceding the diagnosis. The patient also reported symptoms of fatigue, clumsy gait and muscle ...

Case history: A 30-year-old female was investigated and treated for hypercalcaemia during the third trimester of pregnancy. She has a background of rheumatoid arthritis on hydroxychloroquine and was reviewed by the rheumatologists during her pregnancy due to worsening limb and back pain. She had multiple calcium levels monitored during her pregnancy. Her calcium had been elevated since 2022 but had increased further during the pregnancy and it wasn’t until she was referre...

Case history: Our patient presented with primary amenorrhoea and incomplete puberty aged 15 yrs. Based on BMI >40 kg/m2 from early adolescence, clinical hyperandrogenism, family history of polycystic ovary syndrome (PCOS), and insulin resistance, she was diagnosed with PCOS and commenced on a combined oral contraceptive (COC), achieving breast development. Aged 21yrs, she was reassessed for amenorrhoea of COC. Biochemical assessment revealed hypogonadotrophic hy...

The case describes a 49-year-old woman with a history of previous biliopancreatic diversion and duodenal switch procedure carried out in 2010. She was known to the local bariatric service with multiple micronutrient deficiencies and had no prior history of liver disease. She was admitted to hospital in 2023 with a widespread rash, proximal myopathy, multiple nutrient deficiencies, acute kidney injury, and spontaneous bleeding into the psoas muscle. She was seen by a dietitian ...

Section 1: Case history: A 42-year-old man was referred with a five-year history of hypertension and multiple hospital admissions for hypokalaemia. His blood pressure was 164/104 mmHg on three drugs.Section 2: Investigations: A diagnosis of primary aldosteronism (PA) was confirmed on a saline suppression test: aldosterone 554 pmol/l at baseline, 240 pmol/l post saline infusion (normal <170). A CT adrenal revealed a 13 mm left-sided adrenal nodule. Th...

A 40 year old male presented to his general practitioner with numbness in his fingertips, especially at night. Since his screening for peripheral neuropathy was unremarkable, he was called in for an in-person appointment to look for carpel tunnel syndrome. At the surgery he was noticed to have enlarged hands but he did not have any other complaints at that time. He missed his further appointments, until after 2 years when he presented with dental problems, protrusion of his lo...

A 54 year old gentleman with a background of treated B cell lymphoma presented to his practitioner with symptoms of thyrotoxicosis. His thyroid work up confirmed positive thyroid receptor antibodies, and hence treated as Graves’ disease. He was started on carbimazole by his practitioner. After two weeks of initiation of treatment with carbimazole, he presented to his GP with yellowish discoloration of skin, nausea, vomiting and passing dark coloured urine. He was found to...

A 63 year old male presented with sudden onset severe chest pain which clinically seemed cardiac in nature. A diagnosis of Non-ST Elevation MI was made and was managed conservatively. Later, after 6 months he again presented with chest pain. On this occasion, CT aorta and CT Thorax, Abdomen and Pelvis was done to rule out aortic aneurysmal rupture, and to look for post-infarct changes in the myocardium, cardiac MRI was done. Cardiac MRI and CTTAP both showed an incidental find...

Section 1: History: Myxoedema coma is a rare, emergency presentation of extreme hypothyroidism, but without robust evidence to base management recommendations on. We present the case of a woman in her seventies who was admitted following a fall. Collateral history revealed five days of worsening mobility, drowsiness, and confusion with poor oral intake. This progressed to slurred, incoherent speech, and brief vacant episodes. Her background included glaucoma, mastectomy, and i...

Case History: Patient 1: A 44 years old gentleman with BMI of 44.7 was referred to the weight management clinic for the management of obesity. His weight was in obesity range since childhood and he reported excessive tiredness and lethargy. He also had history of anxiety and depression. Examination showed lack of body hair, reduced muscle mass and small testes. Patient 2: A 48 years old lady was referred to the endocrinology clinic for incidental adrenal adenoma. She reported ...

Case History: A 49 year old man was referred from primary care with clinical features of thyrotoxicosis, including weight loss, anxiety and palpitations, over the previous four months. The patient had a 20 year history of abnormal thyroid function, characterised by elevated fT3 and fT4 with normal TSH. He had been previously assessed by the regional thyroid service 12 years prior and diagnosed with thyroid hormone resistance syndrome (RTH). This was based on clinical and bioch...

Case History: We present the case of a 77 year old female, who presented to the cardiology team with progressive shortness of breath and signs of heart failure. Echocardiogram showed pulmonary hypertension, tricuspid, pulmonary and aortic regurgitation and atrial septal defect with a bidirectional shunt. She also reported a 5 year long history of diarrhoea, flushing and wheezing. The Echocardiographic features together with the chronic symptoms raised suspicion for carcinoid s...

Case history: A 64-year-old man was diagnosed with sporadic medullary thyroid cancer in 2018 after presenting with diarrhoea and a neck mass. He underwent a total thyroidectomy, neck dissection and post-operative radiotherapy, for extensive T4N1bM0 disease involving the tracheal wall and oesophagus. He was left with hypoparathyroidism, taking 1-alfacalcidol 1 mg OD. He also had T2DM on Gliclazide. In 2023 his calcitonin had risen to 12,220 pmol/l, with recurrent severe diarrho...

Introduction: Gestational diabetes insipidus (GDI) is a rare complication of pregnancy thought to be due to increased vasopressin produced by the placenta. It usually occurs at the end of the second or in the third trimester. Case Description: We report the case of a 28-year-old female patient, a primigravida with a previous history of Right hemi-anomalous pulmonary venous drainage into IVC with an initial baffle operation in October 2019. She had diet-c...

Background: Transient thyroiditis following parathyroidectomy, although uncommonly documented, can arise from various etiologies such as autoimmune disorder, infections and other post inflammatory states, commonly with Immunotherapy. Post-surgical thyroiditis, including cases post-parathyroidectomy, is not fully elucidated in terms of its mechanisms. Herein, we present two cases of transient thyroiditis post-parathyroidectomy, highlighting the divergent outcomes and thereby th...

A 48-year-old woman with complex cyanotic congenital heart disease due to dextrocardia was found to have a urachal remnant during routine ultrasound as part of her cardiac monitoring. Unexpected, excision via partial cystectomy without any hypertensive crisis identified 12 mm bladder paraganglioma [PGL], with local metastases to bladder (distinct from primary lesion) and lymph nodes (pT2b N1). Post operatively (following histopathology diagnosis), biochemistry demonstrated mar...

Case history: A 41-year-old female presenting with abdominal pain and melaena, was found to have a left adrenal incidentaloma on her abdominal CT. Her past medical history included polycystic ovaries, menstrual irregularity, fibromyalgia and gallstones. Medications on presentation were lansoprazole and dihydrocodeine only. On further questioning, she was experiencing hair loss, proximal muscle weakness, bruising and striae, weight changes and low mood.In...

Case history : Dopamine agonists are effective and safe first line therapy for prolactinomas. We report an intriguing effect of dopamine agonist therapy in a 68-year-old man commenced on cabergoline treatment for a macroprolactinoma. At review, he reported new nail growth on the tip of a previously partially amputated finger which had been devoid of a fingernail for over four decades. This patient was incidentally diagnosed with a pituitary tumour on a CT brain scan performed ...

Case history: A 39-year-old gentleman was referred to the Endocrine clinic with a 5-year history of hypertension and intermittent hypokalaemia. He had been seen in the hypertension clinic, screened for secondary causes, and found to have an aldosterone of 604 pmol/l, renin <0.2 nmol/l/hr and potassium 3.7 mmo/l (off interfering medication), in-keeping with a diagnosis of Primary Aldosteronism (PA). His blood pressure was 126/82 mmHg on Ramipril 10 mg, Amlodipine 5 mg OD an...

Primary aldosteronism (PA) is a highly prevalent syndrome which is often missed even in those that present classically due to poor awareness. The commonest initial presentation is varied degree of hypertension with hypokalaemia in only 37%. The presence of hypokalaemia could be a good pointer to the diagnosis of PA but it is not a common initial presentation in normotensive patients. We present a 22-year-old man who presented initially with refractory normotensive hypokalaemic...

Background: Phosphate plays an important role in bone mineralisation. Hypophosphataemia is a common electrolyte abnormality which can result from poor intestinal absorption, increased renal loses (secondary to renal disease, alcohol abuse or drugs) or intracellular phosphate shift (often secondary to septicaemia or glucose or insulin treatment). This case showcases the importance of identifying the underlying cause of hypophosphataemia to guide subsequent treatment.<p clas...

Case History: A 60-year-old female presented to the outpatient clinic with lethargy and proximal muscle weakness. She had a recent hospital admission with osmotic symptoms leading to a diagnosis of ketosis-prone diabetes and was started on insulin. Eight months prior, she was diagnosed with a pancreatic neuroendocrine tumour (p-NET) with hepatic metastases; immunopositivity staining strongly for synaptophysin, focal chromogranin and patchy CD56, with low Ki-67 index of <1%...

Case history: A 64-year-old male was admitted to our hospital in January 2024 following a road traffic accident. The patient was not wearing a seatbelt, and airbags did not deploy due to low speed, resulting in the patient’s head hitting the windscreen. A subsequent CT trauma series showed a large destructive expansile lesion within the clivus and sphenoid bone extending superiorly into the hypothalamus with findings typical of a chordoma. Appearance on non-contrast MRI w...

We present a 43 year old gentleman of Bangladeshi origin, who was referred to us by his GP with increased sweating, palpitations and anxiety for the last few years and abnormal thyroid functions. He complained of headaches, tremors, weight loss, increased appetite and sleep disturbances in addition to the above symptoms. He had no other significant past, family or social history. On examination in the clinic, he was found to have a raised blood pressure. He had phenotypical fe...

A 52-year-old woman presented in 1998 at age 26 with hirsutism, obesity, and purple striae. She had history of learning difficulties and hyperphagia since age7. Physical examination revealed a supraclavicular pad of fat and hypertension. Biochemical analysis indicated a non-suppressed low-dose dexamethasone suppression test and an ACTH level of 55 ng/l, with all other pituitary hormones normal. MRI findings showed a midline hypodense area anterior to the posterior lobe, with d...

Case history: A 53 year old lady was admitted with aggressive behaviour and confusion. Past medical history: Treated breast cancer 2017, no recurrence on mammogram 2021. Lifelong smoker. Initial investigations: persistent hypokalaemia with metabolic alkalosis, negative septic screen, unremarkable CT and MRI brain, failed lumbar puncture. Hypokalaemia only corrected with SandoK and spironolactone. She was empirically treated for encephalitis. CT TAP (septic screen): extensive m...

A 24-year-old, Bengali female presented to her GP with fatigue. Blood tests demonstrated she was pregnant and had elevated thyroid hormones (Free T4 50.4 pmol/l, NR 10.5-24.5; Free T3 19.9 pmol/l, NR 3.1-6.8) with an inappropriately normal TSH (4.04 mU/l, NR 0.27-4.2), prompting referral to our endocrine unit. Her TFTs were repeated on a different platform which excluded assay interference. She reported a 5-year history of a goitre, associated with symptoms of hyperthyroidism ...

I present a case of a 32 year old woman who presented in September 2023 with abdominal pain and vomiting. Her blood tests showed; Hb 151 g/l, WCC 18.3, Na 130 mmol/l, K 1.8 mmol/l, Ur 4.7 mmol/l, Creatinine 91 umol/l, Corrected Calcium 2.93 mmol/l, Phosphate 0.54 mmol/l, Lipase 191 unilts/l. Venous Blood Gases showed pH 7.25, Bicarbonate 15.6, Lactate 1.9, pCO2 4.5, Glucose 7.0 mmol/l. She had a background of treated TB aged 25, recent diagnosis of H. Pylori gastritis, and gav...

Case history: 41-year-old lady with background of T1DM (1993), previous DKA (2017), and treated thyrotoxicosis (2017-2019) presented with 3 day history of vomiting, diarrhoea, poor oral intake, and shortness of breath. She was anxious, though not agitated. She denied palpitation though remained tachycardic. She denies abdominal pain, jaundice, or oedema legs. Her only medication was basal-bolus regimen to which she was compliant. She does not smoke, drink or use illicit drugs....

A 76-year-old lady was admitted to a Spanish Hospital with vertigo and dizziness. Investigations revealed hypercalcaemia and a right adrenal mass on an MRI abdomen. On returning to the UK, she was referred to endocrinology. Additional symptoms included fatigue, memory loss and some leg weakness over the preceding months. She was noted to be hypertensive, controlled on Amlodipine 5 mg od. Investigations revealed an elevated serum corrected calcium of 2.85 mmol/l and serum PTH r...

A 73-year-old gentleman due to undergo prostatectomy for adenocarcinoma was found to have biochemical secondary hyperthyroidism at a preoperative assessment. His thyroid stimulating hormone (TSH) was 5.08 µIU/ml and free T4 (fT4) was 22.7 pmol/l. He was clinically euthyroid and did not have a goitre. His past medical history was of subclinical hypothyroidism, atrial fibrillation, and hypertension. Subclinical hypothyroidism was diagnosed in 2020 based on findings of TSH 1...

Case History: A 5-year-old South Asian female patient was born at term with very low birth weight (-3.8 SDS). She exhibited short stature (height -3.9 SDS), feeding difficulties (BMI -3.0 SDS) and microcephaly (HC -4.9 SDS). Maternal height was reduced (-3.5 SDS), paternal height was normal (-0.2 SDS). The girl had characteristic syndromic features including triangular face, high-pitched voice, and high-arched palate. She displayed developmental delay manifesting as inattentio...

Clinical case: A 23-year-old woman with genetically confirmed pseudohypoparathyroidism type 1b (PHP1b) reported a one-month history of progressive bilateral cervical lymphadenopathy at her most recent outpatient visit. This was associated with night sweats and a dry cough, but no weight loss, haemoptysis or recent foreign travel. Clinical examination revealed widespread non-tender cervical and inguinal lymphadenopathy with no hepatosplenomegaly. An expedited ultrasound guided ...

Case history: A 64 year old male attended the Emergency Department with palpitations on 02/11/2023. He had previous extensive cardiovascular disease: Ventricular Tachycardia (VT) - ICD (2021) and 2 ablations (2022, 2023); Myocardial Infarctions (2005, 2021); and moderate Left Ventricular Systolic Dysfunction (LVSD). He was treated with amiodarone from July 2021 which was stopped after his second ablation in August 2023. Interrogation of his pacemaker showed new atrial fibrilla...

Case History: We present a very interesting and challenging case of a 71-year-old male, with a significant medical history including Bipolar affective disorder, drug-induced parkinsonism, benign prostatic hyperplasia (BPH), and hypothyroidism. The admission was prompted by a catheter-associated urinary tract infection and subsequent hypernatremia secondary to lithium induced Diabetes Incipidus. Despite initial therapeutic interventions, such as amiloride therapy, the patient c...