Endocrine Abstracts

A 22-year old lady was referred with a history of fatigue, generalised aches and pains. Investigations revealed persistently low potassium on few occasions. There was no history of diarrhoea or vomiting. No laxative, diuretic or liquorice abuse. PMH: treated hypothyroidism and Idiopathic thrombocytopenic purpura. She weighed 46 kg and her BP was 115/63. Further investigations: sodium 140 mmol/l, potassium 2.6 mmol/l (3.5–5.0), bicarbonate 28 mmol/l (22–28), magnesium...

We report a 51-year old lady presenting to hospital with a 3 week history of abdominal and peripheral swelling. Mentation was slow and noted to be pale on admission. She also reported feeling cold, lethargic, reduced exercise tolerance and constipation. She had no prior medical problems, no regular medications and working till the day prior to admission in a garden centre. She was an ex-smoker, teetotal and there was a family history of hypothyroidism. Physical assessment reve...

A 68-year-old previously well man was referred to the endocrinology department in April 2007 with generalised tiredness and dizziness following a recent viral upper respiratory illness. He had no symptoms to suggest pituitary dysfunction. He was normotensive and lacked clinical features of hypopituitarism or dysthyroidism. Visual fields were normal to confrontation. Testicular volumes were normal. Initial baseline pituitary function tests (reference ranges in brackets): FT<sub...

A 62-year-old woman was referred to the endocrine clinic with new onset thyrotoxicosis. She had previously had two other conditions affecting her thyroid gland. In 1977, she underwent a right thyroid lobectomy for a non-functioning thyroid adenoma. In 2002, she presented with a rapidly enlarging left sided goitre, which proved to be thyroid B-cell lymphoma on core biopsy. She was treated with chemotherapy alone and remains under regular haematology follow up. Serial thyroid fu...

A 30-year-old woman with long standing type 1 diabetes presented with recurrent severe hypoglycaemia. One month earlier she had given birth to her first child. Before pregnancy her HbA1c had been 7.8 to 9.2 percent (RR 3.1 to 5.0 percent) but improved by the third trimester to 6.8 percent. Before pregnancy her total daily insulin dose was 50 units and by the third trimester it had only increased by 25 percent to 60 units. The pregnancy and birth were uneventful with no hypogly...

A 22 years old woman presented with a few days history of nausea, vomiting and general lethargy. She was not on any treatment except the oral contraceptive pill (OCP). She was apyrexial, tachycardic at 140/min with a regular pulse and her blood pressure was 110/70. She was not pigmented. Her plasma sodium was 131 mmol/l, with normal potassium, creatinine and urea. Her arterial blood gas analysis showed a pH of 7.22 and bicarbonate of 12mmol/L. Her TFTs showed a thyrotoxic pict...

A 61 year old woman presented with a six months history of nausea, vomiting and lethargy. She is a non-smoker and drinks little alcohol. She was on 100mcg of Thyroxine following partial thyroidectomy. Physical examination was unremarkable apart from postural hypotension (BP 140/80mmHg laying, 105/75mmHg standing). Blood tests showed plasma sodium of 121mmol/L with normal potassium, urea, creatinine, FBC, random glucose and TFTs. A short synacthen test (1mcg) was normal with a ...

A 34-year-old woman was referred by her GP in 2000 with thyrotoxicosis (TSH undetectable, free T4 36.4 pica moles per litre, reference range 10-25). She had no ophthalmic symptoms or signs and no goitre. There was no family history of thyroid disease. Her thyroid peroxidase antibodies were undetectable but thyrotropin-binding inhibitory immunoglobulin was 30 (Reference range 0-15) confirming Graves' disease. Carbimazole was initiated but changed to propylthiouracil after a pre...

A 54-year-old man with long standing coeliac disease and moderate dietary compliance was admitted with lethargy and feeling unwell. His blood pressure was 129 mmHg systolic, 91mmHg diastolic and serum sodium 112 millimoles per litre (RR 136 to 145). He was otherwise well with normal visual fields. A 250-microgram Synacthen test demonstrated a basal cortisol of 630 nanomoles per litre rising to 983 nanomoles per litre after 30 minutes. His TSH was undetectable, Ft4 9.6 picomole...

A 77 year old man developed a severe progressive polyneuropathy associated with significant disability. He was also found to have type 2 diabetes mellitus and antibody-negative primary hypothyroidism and was treated with gliclazide and thyroxine to good effect. Nerve conduction studies showed a demyelinating type neuropathy that was not typical of diabetic neuropathy. Two years later he was admitted with an episode of severe hypoglycaemia accompanied by low blood pressure, hyp...