Endocrine Abstracts

Background: Demeclocycline is a well-known treatment for syndrome of inappropriate ADH secretion (SIADH). We studied the use of demeclocycline for treatment of SIADH in our hospital to assess its efficacy and safety.Materials and methods: A search was performed for all discharge summaries containing demeclocycline over period of 1 year. 40 results obtained of which five were excluded as demeclocycline was mentioned but not actually used. 35 admission epi...

Background: It is well documented that some patients with hypothyroidism continue to be symptomatic despite normalisation of TSH levels with T4 mono-therapy. The Royal College of Physicians 2008 statement recommends that T4 alone should be used for the treatment of hypothyroidism with no recommendation for additional T3 therapy. However, the Internet has many reports of symptomatic benefit on combination therapy and patients may present to the outpatient clinic requesting T3 t...

A 77-year-old lady presented with reduced conscious state, dysphasia and profound confusion on a background of behavioural change and anorexia over the previous 10 days. She was previously independent with history of hypertension controlled on atenolol (100 mg). She was significantly hypertensive 200/100. Her serum calcium was elevated at 4.01 mmol/l (2.05–2.60). The serum parathyroid hormone (PTH) was also significantly elevated at 26 pmol/l (0.5–6.4) consistent wit...

Background: Postprandial hyperinsulinemic hypoglycaemia due to nesidioblastosis is a significant and debilitating complication after Roux-en-Y gastric bypass surgery (RYGB). There is growing evidence suggesting this is due to increased incretin hormones secretion. Nesidioblastosis can be difficult to manage with variable response to different pharmacological therapies and some requiring partial/total pancreatectomy or revision of bypass surgery pouch. We present a patient who ...

We present a case of 76-year-old male who attended acute medical unit with 3 week history of confusion, slurred speech and reduced mobility. One month prior to his admission he was diagnosed with severe hypothyroidism with TSH of 100 mU/l and T4 of 1.9 pmol/l and significantly positive anti-peroxidase antibodies (561 IU/ml) and was started on 100 μg of levothyroxine by his GP. During his admission his confusion persisted despite antibiotics for presumed chest i...

Background: Dopamine agonists (DA) are used as the first-line trearment in patients with macroprolactinomas. Late resistant to DA(cabergoline) therapy may occur. Patient with resistant macroprolactinoma may end up receiving a relative high dose of DA. These patients should be advised to take up radiotherapy option as earlier as possible to avoid the need of high dose dopamine agonist. We present a 63-year-old man who presented in 1999 with visual loss,due to giant macroprolact...

Background: A recent study by the author suggests up to 73% of growth hormone (GH) secreting pituitary adenomas produce multiple hormones on histological analysis and 16% immunostain positive for TSH. We report the case of an acromegalic patient with a plurihormonal adenoma where diagnosis of thyrotoxicosis was made several years post-hypophysectomyCase history: Mr JT was diagnosed with acromegaly at the age of 59 having been noted to have acromegalic ph...

Objective: The rate of surgical cure of acromegaly with transphenoidal hypophysectomy varies greatly. Factors that have been previously noted to affect outcome include tumour size and level of growth hormone (GH). We evaluated clinical factors associated with surgical outcome in our patient series.Method: Retrospective study of clinical data and surgical outcome of patients who underwent transphenoidal hypophysectomy for acromegaly by a single surgeon at...

BackgroundPancytopenia due to hypopituitarism has been reported previously in the literature. Most of these case reports relate to hypopituitarism secondary to Sheehan’s syndrome. We report a case of isolated ACTH deficiency causing pancytopenia which was successfully treated with hydrocortisone replacement.Case history: A 71-year-old lady with a known history of treated hypothyroidism and learning disabilities was referred to...

Background: Metabolic surgery has been hailed as a potential new treatment (‘magic bullet’) for obese patients with type2 diabetes. Several studies have shown that metabolic surgery for morbid obese patients with type2 diabetes can lead to considerable weight loss and also has positive impact on the incidence of type2 diabetes, in some cases leading to elimination of the disease in up to 80% of patients. But metabolic surgery do not seem to induce similar ‘magic...