Endocrine Abstracts

Lawyers need doctors. When the work of the legal profession leads into areas of clinical medicine it is important that expert clinicians are there to explain and advise on the clinical issues. A good clinician can give valuable advice to the parties involved, and can also assist the courts in reaching a just and equitable conclusion.In endocrinology an expert is most commonly asked to advise in matters relating to an allegation of clinical negligence. So...

Lawyers need doctors. When the work of the legal profession leads into areas of clinical medicine it is important that expert clinicians are there to explain and advise on the clinical issues. A good clinician can give valuable advice to the parties involved, and can also assist the courts in reaching a just and equitable conclusion.In endocrinology an expert is most commonly asked to advise in matters relating to an allegation of clinical negligence. So...

Many patients taking medical therapy for a prolactinoma may assume that they need treatment for life. In reality it is often possible to stop treatment after a while.In considering whether to stop treatment of a prolactinoma, it is helpful first to review the diagnosis and clarify whether the patient has a prolactinoma. Hyperprolactinaemia has many causes, and some patients are treated without a secure diagnosis of prolactinoma.For...

Radiation to the neck is known to be associated with the later development of hypothyroidism. The possibility of acute radiation-induced thyrotoxicosis is not generally recognised. We report here a case of acute hyperthyroidism shortly after radiotherapy.A 57-year-old man with poorly differentiated adenocarcinoma of the left parotid underwent parotidectomy with radical neck dissection followed by radiotherapy. He received 65 Gy by intensity modulated rad...

NICE guidelines (2008) recommend that patients with gestational diabetes (GDM) should no longer have post-partum review with glucose tolerance test (GTT), but that fasting blood glucose is sufficient. We have undertaken a retrospective study of post-partum GTT in patients with GDM, to examine whether the 2 hour glucose value adds useful additional information. Notes of 208 patients with GDM in 2003–2008 were reviewed, and the results of post-partum GTT were collected. 175...

Discordant thyroid function is common; differential diagnosis includes assay interference, familial dysalbuminaemic hyperthyroxinaemia, thyroid hormone resistance (RTH) and TSHoma. We present four TSHomas, demonstrating the diversity of clinical course. All had assay interference and RTH excluded. Case 1: A 64-year-old lady with thyrotoxic symptoms and no family history. TSH 6.36 mU/l, with fT4 32.6 pmol/l and raised SHBG. Pituitary MRI showed a 7 mM lesion. She was unresponsi...

Optimal management of familial medullary thyroid cancer (MTC) involves early genetic diagnosis of affected individuals and prophylactic thyroidectomy. Patients diagnosed later may have biochemical evidence of metastases which are clinically silent. We report a family which illustrates the management difficulties which may arise with this approach. SC, a healthy 25-year-old man, presented for assessment for MTC. His mother had had a total thyroidectomy for MTC with no clinical ...

Hypothyroidism is a recognised late complication of radiotherapy to the neck. However, radiation-induced thyrotoxicosis is not generally considered, and may not be diagnosed. We report a case of transient thyrotoxicosis following radiotherapy to the neck. A 71-year-old man with supraglottic squamous cell carcinoma was treated with 65Gy radiotherapy, delivered by volumetric arc therapy in 38 fractions. During radiotherapy he became confused. Three days af...

Pituitary MRI is widely used in endocrine practice, and is regarded as entirely safe. We report here a life-threatening outcome from a routine pituitary MRI scan.A 23-year-old female with a 3-year history of microprolactinoma confirmed by MRI underwent a routine repeat MRI scan with gadolinium. During injection of Gadovist she experienced minimal chest tightness which rapidly resolved. Four hours after the injection she rapidly became very breathless. On...

A 79-year-old lady presented with a 6 months history of confusion and slurred speech and was found to have recurrent spontaneous hypoglycaemia (plasma glucose 1.3, 1.8 and 2.6 mmol/l). Pituitary and adrenal function were normal, and raised insulin (102 pmol/l) and C-peptide (630 pmol/l) levels confirmed the diagnosis of insulinoma, which was identified as a solitary 2 cm mass in the head of pancreas. Treatment with diazoxide 100–150 mg tds led to normalisation of g...