Endocrine Abstracts

A 31-year-old female presented with menstrual irregularities, weight gain and hirsutism.She was recently diagnosed with type 2 diabetes requiring Metformin therapy.Investigations: Serum cortisol levels failed to suppress on overnight dexamethasone suppression test (ODST) and low dose dexamethasone suppression tests (LDDST) (ODST: unsuppressed cortisol at 343 nmol/l, LDDST 48 h post dexamethasone cortisol of 397 nmol/l). The serum c...

Klinefelter syndrome is the most common genetic cause of primary hypogonadism in men. Upto 80% have karyotype 47 XXY. It can present with a wide range of phenotypical and biochemical abnormalities. It is also known to be associated with certain autoimmune diseases. We describe a rare case of Klinefelter syndrome with partial hypopituitarism and suggest screening with full pituitary profile plus dynamics tests at first presentation if clinical suspicion is high. A 36 year old m...

Case 1: A 17-year-old female was referred to the endocrinology outpatients due to abnormal thyroid function tests (TFTs) (as below) detected on routine monitoring for Thyroxine replacement therapy. Following exclusion of pregnancy, possibilities of assay interference due to heterophilic antibodies as well as thyroid hormone resistance were considered. Repeat analysis was arranged at two laboratories using different methods. Results were concordant, excluding assay interference...

Background: Functional hypothalamic amenorrhoea (FHA) is a common cause of secondary amenorrhoea and is related to a combination of weight-loss, exercise and psychological stressors. These factors lead to suppression of pulsatile GnRH secretion. Diminished LH and FSH concentrations result in a hypoestrogenic state. We present an archetypal case of FHA that clearly demonstrates the ‘hypothalamic set-point’ for the body composition of a young woman below which...

Introduction: Amiodarone induced thyrotoxicosis (AIT) remains a diagnostic and therapeutic challenge. Broadly, AIT is classified as type 1 (underlying latent thyroid disorder) or type 2 (destructive thyroiditis). Despite being an on-going clinical conundrum, there is no U.K. wide guidance on management of AIT. We report a retrospective review of recent cases treated within our department as AIT.Methods: Data was collected for all patients referred to our...

Introduction: Neuroendocrine tumors (NET) are very rare and often present a diagnostic challenge. They are often misdiagnosed due to non-specific symptoms. We report a rare case of NET presenting to a non endocrine unit.Case: A 72-year-old Caucasian female was referred for refractory diarrhoea with hypokalaemia. In addition, there was history of significant weight loss over few months.She had past medical history of diabetes, hyper...

Background: The suitability of serum insulin-like growth factor 1 (IGF-1) reference ranges (RR) used locally (manufacturer-derived), were raised as a clinical concern. IGF-1 levels above the RR were reported in patients displaying no clinical signs or symptoms of acromegaly, and in whom growth hormone suppression tests were negative. No analytical issue was evident, and quality performance indicators were satisfactory.Methods: A review of all serum IGF-1...

Introduction: Hypokalaemia is a common biochemical abnormality seen in inpatients; it is usually mild and iatrogenic. We report a rare case of muscle paralysis due to severe unprovoked hypokalaemia, presenting on acute medical take.Case: The patient presented with a two week history of epigastric pain, nausea, vomiting, muscle spasms and dizziness. Past medical history included asthma, vitiligo, pernicious anaemia as well as long standing history of unex...

Background: We report a case of a 35-year-old male presenting with pituitary dysfunction secondary to an optochiasmal cavernoma.The gentleman was initially referred with gynaecomastia and biochemical tests consistent with secondary hypogonadism. On further questioning he also reported extremely lethargy, difficulties with weight loss and poor libido. Examination was consistent with features of hypogonadism with reduced body hair, bilateral gynaecomastia ...

Backgound: We report a case of a 63-year-old postmenopausal female diagnosed with ovarian hyperthecosis masked by concurrent use of an aromatase inhibitor.Following diagnosis of breast cancer in 2009, requiring mastectomy with adjunctive chemotherapy, she was commenced on anastrozole. Later she noted gradual onset of frontal balding and hirsutism. Biochemistry revealed elevated serum levels of testosterone 13.2 nmol/l (range: <1.9 nmol/l) and androst...