Endocrine Abstracts

Autoimmune Hypothyroidism is a common clinical condition with a suggested prevalence of up to 12% of the population. The subsequent enlargement of the thyroid gland caused by circulating thyroid antibodies can cause neck discomfort warranting a referral to the thyroid ultrasound (USG) clinic. The USG characteristics of autoimmune hypothyroidism can be challenging to grade and the atypical appearances often makes it difficult to exclude a mitotic lesion. We have set forward few...

26year old Human rights activist being evaluated for left hip and thigh pain over the preceding 7 months, was referred to our services in November 2015 with headache, secondary amenorrhoea and raised prolactin levels. The headache which was mainly frontal started a few months ago and coincided with the amenorrhoea. She did not report visual disturbances or lactation. She also described the feeling of increased thirst and increased urinary frequency over this period. Apart from...

A 40-year-old female was referred for further management of thyrotoxicosis to GSTT. She worked as a nanny and had Graves’ thyrotoxicosis since October 2019. Her presenting symptoms were weight gain, hair loss, insomnia, and increasing anxiety. She had a large palpable goitre on examination with no eye disease. Ultrasound of the thyroid showed a diffusely enlarged thyroid with a normal echotexture, reflectivity and vascular flow. Benign subcentimeter nodules were seen in e...

A 56 year old lady underwent laparoscopic adrenalectomy for an incidental right adrenal mass. Plasma metanephrines were elevated pre-op and histology revealed PCC with a PASS score of 0/20 with SDHB immunostaining +. She remained asymptomatic until 9 years later when she presented with palpitations and worsening hypertension. Plasma metanephrines were 3-4 times above reference range. She was also found to have goitre and USG/FNA revealed THY4 lesion for which she underwent tot...

We present here a case of 70 year old female, seen in endocrine clinic for Hypothalamic-Pituitary-Adrenal (HPA) axis suppression after prolonged glucocorticoid use. History revealed that she had prolonged use of prednisolone for her asthma in the past. In 2011, Prednisolone was stopped but she had to be started on Hydrocortisone replacement due to HPA axis suppression. She was taking Hydrocortisone 20 mg BD. Trials to wean her off Hydrocortisone failed due to ongoing tiredness...

In the current era of multi-modal imaging being performed for various pathologies, incidental non-functioning pituitary microadenomas (NFPAs) are being increasingly identified. The available literature and guidance is limited on the long-term surveillance and monitoring and hence there is a wide variation in clinical practice across the UK. We conducted a retrospective study in our institution to compare the outcome in our cohort to the current literature.<p class="abstext...

Pathogenic variants in the SDHx genes are responsible for ~20% of familial Phaeochromocytoma/Paraganglioma (PPGL) tumours. Metastatic disease is lower in SDHD in comparison to SDHA, B and C mutations. Although the genotype-phenotype relationship is not well established it is considered that truncating SDHD pathogenic variants have a higher risk of causing disease in comparison to missense variants. We present two cases of metastatic paraganglioma in patients with heterozygous ...

68 years old female initially referred to endocrine clinic in November 2016 for assessment of fluctuating thyroid function. She had a history of long standing primary hypothyroidism, stable on treatment with 100 mcg Levothyroxine. In last one year, Levothyroxine was tapered and stopped due to persistent suppression of TSH and high normal Free T4. Last tests showed TSH of <0.01mIU/l and Free T4 of 27.1 pmol/l. She had ongoing complaints of feeling increasingly tired and gen...

A 50-year-old female with complex chronic hypoxic congenital heart disease was incidentally identified with a 2 cm extra-vesicular nodule of the bladder during a surveillance ultrasound scan. Suspicious of a bladder carcinoma she uneventfully underwent open partial cystectomy. Histology confirmed a bladder paraganglioma with local lymph node invasion. Post-operative biochemical work-up disclosed raised plasma metanephrine”s: normetadrenaline 7073 pmol/l (120-1180 pmol/l),...

A 71 year old gentleman, known to have Renal Cell Carcinoma with metastasis to lung, mediastinum, spine and liver, was transferred to our services for management of T2/T3 Spinal root impingement. On admission he was noted to have severe hypercalcemia of 3.33mmol/l, mild hypophosphatemia 0.8mmol/land an ongoing acute kidney injury. He had appropriate initial management with intravenous fluids, and was started on dexamethasone 8 mg with PPI cover for the spinal metastasis. His i...