Endocrine Abstracts

We present the case of a 49 year old Caucasian lady who was referred for urgent evaluation to rule out Cushing’s syndrome. She had progressive increase in bulk of her shoulders and upper arms over several months. She had a history of asthma, hypertension, and alcohol excess. She had inadvertently been using fostair (steroid inhaler) as a reliever up to 10 times a day. She denied anabolic steroid or drug use. She had no clinical features of Cushing’s syndrome. There w...

Case: We present an interesting case of pituitary hypophysitis following ipilimumab therapy. A 66 year old lady previously diagnosed with left ocular melanoma in 2006 was under oncology follow up, when routine surveillance scan showed recurrence in segment six of the liver. She underwent laparoscopy and was found to have multiple liver metastases following which she was commenced on ipilimumab. Four weeks after completing her second cycle of ipilimumab, she developed severe he...

Introduction: Lifelong corticosteroid replacement is the treatment for patients with Addison’s disease. Steroid therapy need to be altered in the event of illness such as infection, accident or any other major stress. Patients need to be advised on sick day rules and this information should be reiterated at every time of patient contact.We conducted an online survey among doctors across all specialties in the Countess of Chester hospital to assess t...

A 56-year-old gentleman diagnosed with galactosemia by open liver biopsy at the age of one was referred by GP with longstanding complaints of increasing lethargy, low mood and chronic anaemia. Initial investigations revealed normocytic anemia with a normal renal function, ESR, haematinics, calcium and myeloma screen. Endocrine tests revealed anterior hypopituitarism (TSH: 4.4, FreeT4: 4.5, LH: 0.5, FSH: 2, testosterone: <0.1, prolactin: 27, IgF-1: <3.3, random cortisol...

Case: We present the case of a previously fit and well 53-year-old lady who presented with persistent hypokalaemia (1.9 mmol). She was cushingoid and testing confirmed Cushing’s syndrome with random cortisol of >1750 nmol/l, ACTH 838 ng/l and non-suppressed cortisol (1099 nmol/l) after low dose dexamethasone suppression test. MRI pituitary was normal. Abdominal CT scan showed bilateral adrenal hyperplasia and large (>10 cm) mass with necrotic centre replacing the ...

Primary hypothyroidism and hypoadrenalism may occur concomitantly as part of autoimmune endocrine syndromes. Thyroxine replacement without steroid replacement can precipitate fatal adrenal crisis in this subgroup of patients. We report two patients with autoimmune primary hypothyroidism presenting with acute adrenal crises after commencing thyroxine replacement.Case 1: A 36-year-old patient with type 1 diabetes for 15 years was admitted with vomiting, ab...