Endocrine Abstracts

A 30 year old female presented with recurrent episodes of collapse with hypotension. She had been taking tramadol 100 mg four times daily for pain due to endometriosis. A random cortisol of 110 nmol/L led to suspicion of opiate induced adrenal insufficiency and further investigations were undertaken. Results 09:00 hours ACTH 3.2 ng/L, cortisol 109 nmol/L, fT4 12.3 pmol/L, fT3 3.7 pmol/L, TSH 1.18 mU/L, FSH 6.8 IU/L, LH 12.1 IU/L, prolactin 438 mU/L a...

A 30 year old female presented with recurrent episodes of collapse with hypotension. She had been taking tramadol 100 mg four times daily for pain due to endometriosis. A random cortisol of 110 nmol/L led to suspicion of opiate induced adrenal insufficiency and further investigations were undertaken. Results 09:00 hours ACTH 3.2 ng/L, cortisol 109 nmol/L, fT4 12.3 pmol/L, fT3 3.7 pmol/L, TSH 1.18 mU/L, FSH 6.8 IU/L, LH 12.1 IU/L, prolactin 438 mU/L a...

A 32 year old female presented with recurrent episodes of severe hypoglycaemia. Type 1 diabetes had been diagnosed 10 years earlier and she had undergone subtotal colectomy/ileostomy 20 months earlier for chronic diarrhoea. Histology suggestive of eosinophilic colitis. High stoma output (>4 litres per 24 hours) was causing stomal incontinence with disruption of normal lifestyle. Treatment with combinations of loperamide, codeine, omeprazole and octreotide were ineffective....

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) occurs in 10-45% of patients and secretion of ectopic adrenocorticotrophic hormone (EAS) in 2.5% of patients with small cell lung cancer (SCLC). Simultaneous secretion of ADH and ACTH is rare with only 10 cases being reported. The varying biochemical data leads to misdiagnosis as this case demonstrates. A 67 year old male presented with a 2 week history of falls attributed to alcohol abuse. Physical signs ...

Gitelman’s syndrome (GS) is an autosomal recessive renal tubular disorder caused by mutations of the SLC12A3 gene coding for the thiazide-sensitive sodium chloride co-transporter (NCCT). Hypokalaemia, hypomagnesaemia, hypocalciuria and metabolic alkalosis are consequent. Sjorgren’s syndrome (SS) is a connective tissue disorder primarily affecting lacrimal and salivary glands resulting in sicca complex. The coincidental presence of both syndromes is rare. A 28 year ol...

Primary thyroid lymphoma accounts for <5% of thyroid malignancies. The most common (up to 70%) and clinically aggressive sub-type is non-Hodgkin’s B-cell lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma is less common (up to 30%) and clinically more indolent. Females are more frequently affected than males (4-8:1) with onset in 6th and 7th decades. A strong association with Hashimoto’s disease (>90%) is recognised. A 66 year old male presented with...

Graves’ disease (GD) is the most common cause of hyperthyroidism with incidence rates of 20-50 cases per 100,000. Genetic predisposition and environmental factors are known to play a role in its pathogenesis. After perceiving an increase in the number of cases presenting to our thyroid clinic we confirmed a rise in the incidence of GD in North West Wales since the start of the COVID-19 pandemic. The annual incidence of GD was calculated using the number of positive thyroi...

A 73 year old female presented with a 5-year history of fatigue, anorexia and weight loss of 15 kg. Her primary care physician recorded a 09:00 h cortisol of 163 nmol/l. Previous medical history was one of abdominal diffuse B-cell lymphoma 9 years earlier treated with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin and prednisolone) followed by CT-guided radiotherapy. Medications were transcutaneous buprenorphine 20 mg/hour, aspirin 75 mg od and omeprazole 20 mg o...

Opiate use is a well-recognised cause of hypogonadotrophic hypogonadism. Adrenocorticotrophic hormone and growth hormone deficiencies are much rarer.A 56-year-old female presented with weight loss, lethargy, and nausea of ~3 years duration. She had received treatment with morphine sulphate 100 mg twice daily for ~15 years for back pain due to disc prolapse and osteoarthritis. A 0900 h cortisol of 110 nmol/l requested by her general practitioner had resul...

The classic episodic triad of headache, sweating and palpitations facilitates the diagnosis of phaeochromocytoma. The absence of these symptoms can lead to misdiagnosis in patients with uncommon symptoms attributable to phaeochromocytoma. We present such a case.Case report: A 64 year old man was referred to endocrinology having been coincidentally found to have a right adrenal mass with features of a phaeochromocytoma. He was asymptomatic and engaged in ...