Endocrine Abstracts

Pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone may be lifesaving. Apoplexy is often the first manifestation of an underlying pituitary adenoma. We report a case of apoplexy in a patient with an undiagnosed pituitary adenoma who presented with sudden onset headache and subtle neurology in the form of minor left ptosis. A 64-year-old male with a background of hypertension, asthma-COPD overlap syndrome and bronchiectasis presented to A&E w...

Case 1: A 73-year-old woman underwent two separate major abdominal surgeries, one month apart, for the management of ovarian endometrioid adenocarcinoma. She had hypotensive crises about 30 minutes into each of the procedures, requiring metaraminol and noradrenaline infusions. Cortisol levels post-surgeries were 99 nmol/l and 23 nmol/l, respectively. Further questioning revealed exogenous steroid use, including high dose inhaled steroids (Fostair-800mcg/daily) and IM steroid i...

Introduction: The RECOVERY trial2 reported patients with Covid-19 receiving requiring invasive mechanical ventilation or oxygen that the use of dexamethasone (6 mg for 10 days) resulted in lower 28-day mortality. Adrenal insufficiency (AI) from hypothalamic-pituitary-adrenal (HPA) axis suppression3 is a serious, potentially life-threatening side effect of glucocorticoids treatment.Objective: We aimed to investigate the effects of Co...

Pheochromocytoma crises are uncommon but have high mortality. We describe herein a case where multidisciplinary team management was crucial in safely carrying the patient through such a crisis. The patient was a 63 year old lady with a background of neurofibromatosis type 1 (NF-1), and previous renal artery stenosis bypass surgery. She was admitted via A&E with increasingly frequent episodes of sweating, headache, dyspnoea and palpitations. Her troponin was raised at admis...

IntroductionWe are currently mid Covid-19 pandemic. In the last year there have been 116, 135, 492 confirmed Covid-19 cases worldwide, with an estimated 2, 581, 976 deaths.The RECOVERY trial reported for patients hospitalized with Covid-19, the use of dexamethasone (6 mg for 10 days) resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomisation. Adrenal ins...

Introduction: Ectopic ACTH syndrome is rare but is frequently severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. It should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment (1). Etomidate, an imidazole-derivative anesthetic a...

A 30 year-old Caucasian male presented for a routine check-up. He was known to have abnormal thyroid function tests since the age of 23 years of unclear nature/aetiology. He reported occasional palpitations and anxiety. There were no other symptoms on systems’ review. He did not take regular medication, was an ex-smoker and consumed alcohol socially. His mother had hypothyroidism and his maternal aunt’s thyroid nodules. He was euthyroid. A palpable isthmic nodule &#7...

Summary: 59-year-old female diagnosed at the age of 41 in 2004 with pseudohypoparathyroidism (PHP) initially presenting with raised PTH 152 pmol/l (1.6-6.9), Phosphate 1.91 mmol/l (0.87-1.45), adjusted calcium 1.90 mmol/l (2.20-2.60), raised ALP 600 units/l (0-129) and low vitamin D 29 nmol/l. Since diagnosis started on alfacalcidol 1 mg daily and Calcichew-D3. Investigations by hepatology team in the view of persistently raised ALP showed normal liver ultrasound, Fibroscan an...

Introduction: Pituitary metastasis (PM) is a rare condition and associated with a reduced life-span. The most common primary sites are breast and lung, followed by thyroid and renal cell carcinoma. Patients with PM are mostly asymptomatic and incidentally discovered during neuroimaging. Characteristic symptoms are reported in <20% and most commonly include visual involvement, diabetes insipidus, and panhypopituitarism. We here describe a case with malignant melanoma (MM) w...

Case history: Cyclical Cushing’s is a very rare disease with rhythmic fluctuations in cortisol production with or without phenotypic features. It is a very challenging entity to diagnose. The low index of clinical suspicion is key for timely diagnosis and prevention of long-term complications. A 66 years old male presented with intermittent, episodic bilateral leg swelling and reversible weight gain of ˜6 kg following these episodes. Background history entailed femor...