Endocrine Abstracts

TSH receptor antibody (TRAb) assays are highly sensitive and specific for the diagnosis of Graves’ disease. TRAb can minimise need for additional radiological modalities such as ultrasound and isotope scan in excluding other causes of hyperthyroidism. The relapse rates of hyperthyroidism following a course of anti- thyroid drugs (ATDs) remains disappointingly high at between 50-70%. TRAb levels at diagnosis and at the completion of a course of ATDs can be useful in predic...

This 46 year old lady with no significant past medical history was referred urgently to the Endocrine Investigation Unit with a 9 month history of increasing lethargy and gradual weight loss of around 5 kg. Two months prior, she had been diagnosed with subclinical hypothyroidism and after commencing Levothyroxine, quickly lost another 5 kg in weight over a period of 6 weeks and had postural dizziness with systolic BP readings between 80 and 90 mmHg. She was having a normal men...

Identifying the cause of hypercortisolism is vital in ensuring the correct treatment plan for a patient. I present the case of a patient in whom the desmopressin test, as an adjunct to the CRH test, proved helpful in determining the cause. A 27 year old man who initially presented with weight gain, abdominal striae and sweating was admitted with low mood, anxiety and suicidal ideation. Tests showed elevated 24 hour urinary cortisol (highest 1446 nmol/24 hours), random cortisol...

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...

Case: A 73 year old man was seen in eye clinic with 5 month history of visual problems. He was diagnosed with bilateral glaucoma and early Cataracts. His vision was not improving despite eye drops and new glasses thus cranial imaging was requested. He also complained of feeling off balance and tiredness. He denied headache or galactorrhoea. Examination: Bitemporal hemianopia (L>R). Investigations: CT head scan – Pituitary Macroadenoma 3.6×3.1×3.8 cm, with di...

A 16 year old boy presented to his GP with a two month history of polyuria and polydipsia. He was reviewed by his GP and diabetes mellitus was ruled out. At the time of presentation three months later, he had a three week history of headache and vomiting. His glasses prescription had changed and he had increasing diplopia. The optician found bilateral papilloedema and he was referred to the eye clinic for further assessment. Due to abnormal gaze palsies, he was admitted to the...

Background: A 59 year old man was referred to Endocrinology from Neurology with a 2 year history of hypertension, and a 1 year history of mild hypernatraemia (146–148 mmol/l) and hypokalaemia (3.2–3.4 mmol/l). He had a past history of a cerebral aneurysm and superficial siderosis. His main complaints were severe fatigue, poor balance and tinnitus. His medications at diagnosis were Amlodipine 5 mg and Sertraline 50 mg.Investigations: Blood press...

Background: A 59 year old woman presented with recurrent symptoms of catecholamine excess (episodic headache and sweating). She was initially diagnosed in another centre to have a right adrenal phaeochromocytoma in 2002. She had suggestive symptoms, elevated urine catecholamines and a right adrenal mass on CT Adrenals. MIBG was however negative and they had proceeded with a right adrenalectomy and histology confirmed a phaeochromocytoma. She also had type 2 DM, anxiety and deg...

Background: Conventional management for thyrotoxicosis includes anti-thyroid medications, radioactive iodine and/or surgery. However, in some cases patients are resistant to first line drugs and need second line treatment to normalize thyroid function tests (TFTs) before considering definitive therapy. We present a case of Grave’s disease where patient didn’t respond to first line anti-thyroid medications and required Lithium and Cholestyramine to achieve euthyroid s...

A 45 year old man was referred to endocrinology with increasing weakness, lethargy, loss of libido and erectile dysfunction. Initial investigations showed hypogonadotrophic hypogonadism with testosterone 0.8 nmol/l (8.2–32.2), FSH <1 U/l, LH<1 U/l, SHBG 93 nmol/l and secondary hypothyroidism with TSH 1.65 mU/l, FT3 2.1 pmol/l FT4 9 pmol/l, prolactin 180 mU/l, IGF-1 12.5 nmol/l. Short synACTHen test showed normal adrenal response (692 to 1014 nmol/l) with a higher ...