Endocrine Abstracts

Case history: A 49-year-old male was readmitted with asymptomatic hypercalcaemia and renal impairment following a recent admission where he was diagnosed and commenced on treatment for miliary tuberculosis. He was on month 6 of standard anti-tuberculous therapy (ATT) and one month off glucocorticoids commenced for CNS-involvement. High dose cholecalciferol was started on initial admission when he was found to be normocalcaemic but vitamin-D deficient, and continued. The clinic...

Case history: A 69-year-old female was referred acutely from the community with 4 weeks of progressive breathlessness. Initially exertional, she was now also breathless at rest with orthopnoea and paroxysmal nocturnal dyspnoea. She had a background of antibody-positive thyrotoxicosis diagnosed 33 years ago, managed solely in primary care on carbimazole 20 mg, with good compliance. On examination, she was dyspnoeic with an irregularly-irregular tachycardia and fine tremor to th...

Background: Gynaecomastia results from the raised oestrogen-to-testosterone ratio caused by relative oestrogen excess or testosterone deficiency. Alterations to androgen sensitivity causes a relative testosterone deficiency that can present in a spectrum, from significant, to subtle alterations of secondary sexual characteristics. Mild androgen insensitivity syndrome (MAIS) should be considered in the differential for those presenting with gynaecomastia with elevated gonadotro...

Case presentation: A 40-year-old Caribbean woman presented with sudden onset palpitations. She described 3 months of progressive shortness of breath, non-productive cough and 7kg weight loss. She denied chest pain, fevers or night sweats, but reported increased stool frequency, gritty eyes, and occasional visual blurring. She appeared cachectic and had a fine tremor, left eye proptosis and a visible pulsatile goitre. She was afebrile, tachypnoeic, hypoxic, hypotensive with fas...

A 43-year-old Bangladeshi lady was seen in the endocrinology clinic after recent admission to hospital with vomiting and headaches. Her past medical history included Type 2 diabetes, hypertension, ischaemic heart disease and goitre. During admission, a diagnosis of euglycaemic diabetic ketoacidosis (DKA) was made (pH 7.31, bicarbonate 18.3, glucose 7.8 and ketones 6.1) secondary to SGLT-2 inhibitor. This was managed with a fixed rate insulin infusion, intravenous fluid hydrati...

Section 1: Case history : A 49 year old South Asian gentleman was admitted to the emergency department after monitoring blood tests showed hypercalcaemia (corrected calcium of 3.67mmol/l) and acute kidney injury. He had a recent admission with a new diagnosis of miliary tuberculosis and superadded bacterial infection, complicated by a long and complex ITU admission after initiation of treatment. He was discharged home on colecalciferol 4000 units daily in addition to his anti-...

Case History: A 23-year-old Bengali woman with a 2-year history of Graves’ disease presented to the endocrine day unit with a widespread, pruritic, vasculitic-looking rash. She was treated with Carbimazole since diagnosis but was poorly compliant. One month prior to presentation, her Carbimazole dose was increased from 20 mg daily to 60 mg daily, as she remained biochemically thyrotoxic (Free T4 79.9 pmol/l, T3 34.8 pmol/l and TSH < 0.01 mU/l). The rash started on her lower...

Case history: A 35-year-old woman with known hypertriglyceridaemia presented with a one day history of abdominal pain, vomiting and fever. She was 14 weeks pregnant having conceived spontaneously following a period of infertility. She had discontinued her lipid-lowering medication and was managed with diet alone. On examination, she was pyrexial, tachycardic (HR=100 bpm), normotensive (BP=111/71 mmHg), oxygen saturation was 96% on air and she had a tender distended abdomen. A ...

Background: Endocrine emergencies such as hyponatraemia and hypercalcaemia commonly present during unselected medical on-call. However, in our hospital a questionnaire survey of trainees revealed lack of confidence and preparedness in managing endocrine emergencies. 18 trainees responded (12 Foundation Year 1 (FY1), 1 Foundation Year 2 (FY2), 5 Core Medical trainees (CT1) reporting lack of confidence and preparedness in managing endocrine emergencies. 76.92% of FY1 doctors fel...

Background: Patients taking hydrocortisone replacement for primary or secondary adrenal failure require individual adjustment of their dose. Previous observations in our department suggest that total serum cortisol levels achieved following an afternoon or evening dose of 5 mg hydrocortisone are almost as high as those that result from a 10 mg dose in the early morning; and that the ‘area under the cortisol curve’ (AUC) generated by an evening 5 mg dose is broader th...