Endocrine Abstracts

Background: Following the RECOVERY study, dexamethasone is prescribed for patients requiring inpatient treatment of Covid. Cases of new and atypical diabetes have been reported during this pandemic. The risk of steroid induced hyperglycaemia is well recognised but other metabolic sequelae less so. We present a patient who developed severe hypernatraemia following commencement of dexamethasone.Case Report: A 44-year-old man (unvaccinated) was diagnosed wi...

Flash glucose monitoring has increased dramatically in patients with diabetes since the introduction of the FreeStyle libre 2 (FSL) incorporating hypoglycaemia predictive features and an alarm system. A 31-year-old lady, gravida 2, para 1 presented at 26 weeks’ gestation following a car accident where she fractured clavicle and navicular. She reported blurred vision and subsequent collapse whilst driving (with her daughter as a passenger) prior to the accident. Paramedics...

We describe the use of plasmapheresis for pre-operative stabilisation in a case of refractory Grave’s thyrotoxicosis. Our case is a 21 year woman with 12 month history of severe Grave’s disease. Her serum freeT4 was >100 pmol/L (ref.range 11–24) and TSH <0.014 mU/L at diagnosis, had no goitre and negative thyroid peroxidase antibodies. Thyroid uptake scan confirmed Grave’s disease. She was treated with carbimazole 60 mg daily and propranolol. She re...

Background: The incidence of gestational diabetes appears to be rising, likely related to the increasing prevalence of overweight/obesity in the general population, and the trend of increasing maternal age. However, it must be remembered that some women newly diagnosed with diabetes in pregnancy have latent type 1 diabetes; GAD (glutamic acid decarboxylase) antibody measurement may be useful in cases with atypical features. We present two such cases.Case...

The differential diagnosis of diabetes insipidus includes psychogenic polydipsia and a water deprivation test is sometimes difficult to perform due to patient’s confusion, compliance or extreme thirst. We present a simple, cost effective alternative to the water deprivation test.67-year-old male was admitted with a 3 week history of polyuria, polydipsia and extreme thirst. On systemic enquiry he complained of left sided pleuritic chest pain for few ...

Patients with significant hypercalcaemia unrelated to primary hyperparathyroidism have suppressed or undetectable levels of Parathyroid Hormone (PTH). We present a case where the hypercalcaemia was not due to primary hyperparathyroidism yet the PTH was elevated.82 year old male was admitted with 2 weeks history of lethargy, vomiting, increased frequency of micturiton, light headedness and confusional state. Past medical history included Type 2 diabetes, ...

We present a complex case of basal skull prolactinoma presenting with CSF rhinorrhoea and without elevated prolactin. Our case is a 41 year woman who presented 2 years ago with streptococcal meningitis and CSF rhinorrhoea. Initial imaging suggested right sphenoid tumour eroding the skull base involving structures in anterior and middle cranial fossa. After the tumour was biopsied by ENT team, she developed signs of recurrent meningitis, therefore referred to neurosurgery. She ...

Background: Adrenal incidentalomas are discovered unexpectedly and with increasing frequency on cross-sectional imaging acquired for reasons unrelated to adrenal dysfunction. Whilst the majority are non-functioning, literature suggests there is an increased risk of malignancy for adrenal incidentalomas above 4 cm. American guidelines advising resection of all incidentalomas above 4 cm were established without strong evidence whilst European guidelines adopt a more pragmatic ap...

Morvan’s syndrome is a rare autoimmune disease characterised by peripheral nerve hyper excitability, CNS symptoms and autonomic dysfunction which can mimic other endocrine presentations with symptoms including hyperhidrosis, weight loss, neuromyotonia and insomnia. Morvan’s is associated with malignancy, in particular thymomas, suggesting paraneoplastic aetiology. This case is the first to associate Morvan’s with renal carcinoma and proposes insulin like growth ...

Morvan’s syndrome is a rare autoimmune disease characterised by peripheral nerve hyper excitability, central nervous system symptoms and autonomic dysfunction which can mimic other endocrine presentations with symptoms including hyperhidrosis, weight loss, neuromyotonia and insomnia. Morvan’s is associated with malignancy, in particular thymomas, suggesting a paraneoplastic aetiology. This case is the first to associate Morvan’s with renal carcinoma and proposes...