Endocrine Abstracts

42-year-old female with relapsing Graves’ disease treated with propylthiouracil (PTU) presented to the Emergency Department with a two-week history of fevers, night sweats, transient rash, arthralgia and fatigue. Five years previously she presented with Graves’ disease, TSH <0.02 mIU/l, FT4 of 39.8 pmol/l (9–16 pmol/l) and TSH receptor antibody positive with a titre of 11.3 IU/l. Initially treated with carbimazole therapy but developed an urticarial rash, lo...

The Insulin tolerance test (ITT) is regarded as the gold-standard for diagnosing ACTH deficiency but some normal subjects do not exhibit an adequate cortisol response to hypoglycaemia. Identification of false fail cases in pituitary patients is important so as to avoid unnecessary treatment with glucocorticoids. Two hundred consecutive ITTs in pituitary patients were analysed. Twenty six (13 males) failed the ITT and subsequently have a Short Synacthen test (SST). 20 patients ...

Case presentation: A 35-year-old man presented to the emergency department (ED) in a confused and agitated state. His past medical history was significant for poorly controlled type 1 diabetes, complicated by background diabetic retinopathy. He was taking basal/bolus insulin and had a history of diabetic ketoacidosis (DKA) eleven years prior. He also had multiple sclerosis however disengaged with neurology services and was non-compliant with interferon therapy. Prior to admiss...

Case presentation: A 35-year-old man presented to the emergency department (ED) in a confused and agitated state. His past medical history was significant for poorly controlled type 1 diabetes, complicated by background diabetic retinopathy. He was taking basal/bolus insulin and had a history of diabetic ketoacidosis (DKA) eleven years prior. He also had multiple sclerosis however disengaged with neurology services and was non-compliant with interferon therapy. Prior to admiss...

Introduction: Cushing’s disease (CD) is very rare in children and is invariably caused by a corticotroph adenoma. However, corticotroph cell hyperplasia has only been convincingly shown in two previous cases of paediatric Cushing’s disease. We report the case of a 7-year-old boy with Cushing’s disease caused by coticotroph cell hyperplasia.Case report: Our patient presented with a 10-month history of obesity, hirsutism and growth retardati...

Section 1: Case History: We present the case of a 52-year-old found female found collapsed at home with a three-week history of polyuria, polydipsia and lassitude on a background of primary hypothyroidism and non-insulin-dependent diabetes. On examination, she was hypothermic at 32°C, hypotensive (blood pressure 90/60 mmHg), newly oliguric, and had a Glasgow coma scale (GCS) of 9/15. A diagnosis of severe diabetic ketoacidosis (DKA) was made on admission. <p class="ab...

Primary CNS lymphoma (PCNSL) accounts for 0.85% - 2.0% of primary brain tumours. PCNSL arises in periventricular regions of the corpus callosum, with hypothalamic involvement less commonly. While cases have been reported in the literature, cranial diabetes insipidus (CDI) secondary to PCNSL is a rare phenomenon. We present this case series of three patients from our institution diagnosed with CDI and panhypopituitarism in the context of PCNSL.Cases: 1. 3...

Ectopic ACTH syndrome is a rare condition occurring in five to ten percent of ACTH dependent hypercortisolism. We present the case of a fifty eight year old gentleman who presented with severe hyperosmolar hyperglycaemic state (blood glucose fifty seven mmol/l) and acute decompensated heart failure associated with elevated liver enzymes. Liver ultrasound followed by computed tomography of thorax abdomen and pelvis showed a lung tumour with liver metastases. Clinical suspicion ...

Transsphenoidal surgery (TSS) to resect a corticotroph adenoma is the first-line treatment for Cushing’s disease (CD); remission rates of up to 80% have been reported in cases of microadenomas. Endocrine Society guidelines define post-operative biochemical remission as morning serum cortisol <138 nmol/L within seven days of surgery. Our practice is to use a cut-off of <50 nmol/L at day 3 post-op to indicate biochemical remission. If serum cortisol on day 3 is 50&#...

Differentiation between non functioning pituitary macroadenomas (NFPA) and prolactinomas may be difficult as hyperprolactinaemia can also be present at diagnosis in NFPA cases due to pituitary stalk compression (disconnection hyperprolactinaemia). Some authors suggested that prolactin >2,000 mIU/l is almost diagnostic of a prolactinoma, while others use a higher cut-off of >5000 mIU/l. Our aim was to identify the level of prolactin above which a prolactinoma was more l...