Endocrine Abstracts

Forty-four-year-old transgender – female to male who underwent surgery for gender reassignment including hysterectomy, oophrectomy and mastectomy.He has been on testosterone replacement since 2003, initially oral, then sustanon 250 mg IM injection 2 weekly which was self-administered. He was keen on long-acting testosterone injections (Nebido) so was referred to our endocrine service, as his GP was reluctant to prescribe testosterone replacement, as...

A 72 year old, non-diabetic, woman was referred with recurrent severe hypoglycaemia. Twenty-one years ago she was investigated for hypoglycaemia when inappropriate hyperinsulinaemia had been confirmed. Although a CT of her abdomen could not demonstrate an insulinoma she underwent a distal pancreatectomy and subsequent histology showed islet cell hyperplasia. She was managed with dietary intervention and diazoxide. At the time of the current referral she was suffering daily sev...

The insulin stress test (IST) continues to be considered a potent test for assessing ACTH and GH reserve. The test has been shown to be safe when performed in an experienced unit. Many endocrine nurse specialists independently perform IST's using appropriate protocols. We audited all consecutive IST's performed by an individual endocrine specialist nurse in our unit. IST was not performed if patients had a history of seizure, ischaemic heart disease or were > 60 yrs. All pa...

Although treatment of osteomalacia is cheap and effective, there are few data on the long-term outcomes. Studies suggest that a minority of patients fail to normalise parathyroid hormone (PTH), due to autonomous parathyroid activity and primary hyperparathyroidism is sometimes 'unmasked' during therapy. This study examined the impact of a recommended oral regimen of calcium 1000 milligrams and vitamin D3 800 international units (20 micrograms) daily, on PTH levels. ...

We have previously shown that the current guidelines for monitoring thyroid function post radioiodine (RI), may not detect hypothyroidism until it has become severe, in a significant proportion of cases (J Endocrinol Invest 2012 35 82–86). An alternative more intense follow-up strategy was used whereby patients had TSH and FT4 measured at 4-week intervals post RI for 6 months. Endocrine specialist nurse-led telephone and nurse-led out-...

There are at least 60 reports of pregnancy and acromegaly. The maternal and foetal morbidity relates to associated diabetes mellitus and hypertension rather than maternal growth hormone excess. A 32-year-old Asian female who spoke no English, was noted to have acromegalic features during a hospital admission for pneumonia. She was 6 weeks pregnant and had been recently diagnosed with type 2 diabetes mellitus. Acromegaly was confirmed with GH nadir 105 mU/l during 75 g OGTT and...

We present two cases where, without measurement of cortisol binding globulin (CBG), interpretation of their 250mcg short synacthen test (SST) would have falsely suggested inadequate pituitary-adrenal reserve.A 62yr old woman was referred with an incidental finding of a pituitary adenoma. Pituitary function tests confirmed gonadotrophin and growth hormone deficiency. Initial and subsequent SSTs were normal (30min cortisol reater than 600nmol/L). Follow up...