Endocrine Abstracts

Introduction: Parathyroid hormone (PTH) starts to rise very early in the course of kidney disease. As kidney disease progresses, plasma levels of vitamin D and calcium begin to decline, thus contributing to greater secretion of PTH. In addition, the retention of phosphate further increases PTH secretion independent of calcium and vitamin D levels. Continued stimulation of PTH secretion leads to irreversible parathyroid gland hyperplasia.Objectives: To me...

Introduction: In Endocrinology, subclinical disorders meet certain diagnostic laboratory thresholds, but are by definition asymptomatic. Subthreshold disorders in Endocrinology have not been defined. We describe two cases of cortisol deficiency, primary and secondary, with normal baseline cortisol, which were by presentation clinical, but could be characterized as subthreshold by biochemical cut-off criteria.Case 1: A 47-year-old woman was referred for a...

Introduction: rhPTH(1-84) replacement is the treatment of choice in adults with hypoparathyroidism not adequately controlled on standard therapy. Although increased bone turnover markers have consistently been reported in trials of safety and efficacy, marked elevations coupled with significant symptoms have been rare. We describe a case of increased treatment-induced bone turnover, necessitating significant therapeutic adjustments and monitoring.Case re...

Introduction: Nelson’s syndrome is a rare complication of Cushing’s disease treated with bilateral adrenalectomy. There is no effective medical treatment yet. Nelson’s patients respond to hypothalamic stimuli distinctly from patients with Cushing’s disease and those with Addison’s disease. We describe the responses to standard ACTH stimulation tests in a patient with Nelson’s syndrome.Case report: A 42-year-old woman present...

Introduction: Neuroendocrine tumors (NETs) are a heterogeneous group of rare neoplasms that originate from endocrine cells with the ability to secrete amines and hormonal polypeptides. Pancreatic neuroendocrine tumors (PNETs) can be functional or non-functional. Functional PNETs secrete common hormones such as gastrin, insulin and glucagon and much less frequent hormones such as vasoactive intestinal peptide (VIP). Their clinical characteristics depend on the peptide secreted....

Introduction: Medullary thyroid carcinoma (MTC) accounts for 1-5% of all thyroid cancers. It is a neuroendocrine tumor arising from the calcitonin-secreting parafollicular cells of the thyroid. In rare cases, the neoplastic cells additionally secrete other substances, such as histamine, serotonin, ACTH, CRF etc, leading to paraneoplastic syndromes.Case report: An 80 year old male presented to our Department with an already diagnosed metastatic MTC. Three...

The Royal College of Physicians (RCP) published a report called Referring Wisely in June 2017. The report asked specialty physicians for a short list of conditions they felt would benefit from specialist input in the context of acute inpatient management (recommended referrals). It also asked for a list of conditions which need not be referred (avoid referrals).Methods: We retrospectively audited inpatient referrals from our electronic inpatient referral...

The Royal College of Physicians (RCP) published a report called Referring Wisely in June 2017. The report asked specialty physicians for a short list of conditions they felt would benefit from specialist input in the context of acute inpatient management (recommended referrals). It also asked for a list of conditions which need not be referred (avoid referrals).Methods: We retrospectively audited inpatient referrals from our electronic inpatient referral...

Background: MTC tends to metastasize early in the course of the disease affecting usually regional lymph nodes; in 7–23% of patients distant metastases may be present at diagnosis (common metastatic sites:liver, lungs, bone). We present two MTC cases with unusual metastases to the breast, pancreas and mandible.Case presentation: Patient No 1: a 48-year-old female was diagnosed with MTC in 1990. Total thyroidectomy was performed followed by neck diss...

Introduction: With the advent of modern imaging, up to 30% of adrenal pheochromocytomas are discovered incidentally in asymptomatic patients. Smaller tumors may be ‘pre-biochemical’ in their secretory capacity, but truly nonfunctioning tumors over 3 cm are exceedingly rare. We describe a case of a clinically and biochemically silent pheochromocytoma.Case report: A 65-year-old woman was found to have a left adrenal incidentaloma on an abdominal ...