Endocrine Abstracts

Disorders of calcium metabolism are common in Sarcoidosis. The frequency of hypercalciuria and hypercalcaemia has been reported as 30–50% and 10–20% respectively. The underlying mechanism is enhanced PTH independent extra-renal production of 1,25-Dihydroxy Vitamin D (Calcitriol) which increase absorption of Calcium from the gut causing hypercalcaemia.A 79 year old lady was admitted with fever, cough and night sweats and was treated for pneumoni...

As the SGLT-2i class gains popularity for management of type 2 diabetes (T2DM), the risk of diabetic ketoacidosis (DKA) has been recognised as a potential adverse event. However, all the reported cases of DKA associated with SGLT-2 inhibitors seem to have some additional predisposition to this condition and been exposed to alternative precipitants. We report a root-cause analysis of five locally presenting cases of DKA associated with dapagliflozin followed by a literature rev...

Thyrotoxic period paralysis is a rare endocrine emergency associated with hyperthyroidism that needs urgent treatment. We present a case of a 19-year-old Chinese student who was admitted with progressive weakness in his lower limbs developing overnight. He was resident at the students’ hostel and went to sleep after ignoring mild leg weakness overnight but could not even get up from his bed in the morning. Luckily his friend called the ambulance and brought him in hospita...

Hashimoto’s encephalopathy (HE) is a very rare neuropsychiatric condition associated with autoimmune thyroid disorders which shows a remarkable response to steroid therapy and hence is also called steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT). We report a case of 44 year old lady presenting twice with psycho-affective symptoms but not receiving the diagnosis on first presentation. She initially presented with 3 wee...

: A family with generalised resistance to thyroid hormone secondary to a missense point mutation in thyroid hormone receptor β (TR-β) gene corresponding to substitution of arginine to histidine at amino acid 438 (R438H) is described in three successive generations.Case 1: (Index case) A 43 year old lady presented with thyrotoxicosis and was initially treated with carbimazole followed by radio-iodine ablation of the thyroid. Thyroxine was commen...

Common non-specific symptoms like fatigue can occasionally point towards a rare significant pathology. We report a similar case in which investigations for subtle symptoms revealed a serious unexpected diagnosis. A 76 year-old man presented to his GP for new onset mild fatigue. He had an underlying prostate cancer with no known metastases, treated only with hormonal therapy. This was under surveillance with urology team. GP sent off blood tests which showed a very low random s...

A pituitary hormonal profile and MRI pituitary was requested revealing eupituitary hormonal status with an incidental finding of 4 mm microadenoma. The case was discussed in local MDT and the outcome was to continue conservative management of PHPTH with cinacalcet until pheochromocytoma has been ruled out completely. Both MEN-1 and MEN-2 are associated with PHPTH. If a patient is having episodic adrenergic crises with inconclusive metanephrines analysis then excluding pheochro...

Hypoparathyroidism post-thyroidectomy is a recognised complication and treated with calcium supplements, vitamin D, and rather recently with recombinant human parathyroid hormone therapy (teriparatide). We report a case of a 68-year-old female who developed refractory hypocalcaemia and hypomagnesaemia following thyroidectomy for a multinodular goitre. Her management was complicated by inflammatory bowel disease, surgically treated with an ileostomy in situ. Post-opera...

The commonest cause of hypercalcaemia is primary hyperparathyroidism (PHPTH). The diagnostic work up includes paired blood samples for serum corrected calcium, parathyroid hormone (PTH) and vitamin D levels. But in young patients, rare genetic conditions could be contributing towards hypercalcaemia and hence could produce a diagnostic challenge. We report hypercalcaemia work up in two young females where genetic tests were required.Case 1<p class="ab...

Hypercalcaemia due to primary hyperparathyroidism (PHPTH) is fully curable by parathyroidectomy. Occasionally recurrent hypercalcemia presents as a results of either residual adenoma, recurrent disease or an ectopic parathyroid gland. The most challenging cases are those with ectopic glands which are not identified on usual surgical neck exploration. We present a similar case that went through multiple surgeries for recurrent hypercalcemia. A 79-year-old lady initially was dia...