Endocrine Abstracts

A 26-year-old man with known CAH (21-hydroxylase deficiency) presented with infertility. Investigations revealed azoospermia and USS showed bilateral grossly abnormal testes replaced to a large extent by multiple mixed echogenic, ill defined nodules with flecks of calcification. Clinically, given the bilateral lesions and his poorly controlled CAH, the testicular lesions were felt to be ACTH-dependent testicular adrenal rest tumours (TART). Owing to overproduction of adrenal a...

We report a 32-year-old primigravida with type 2 diabetes and large uterine fibroid who was found to have incidental, asymptomatic, non-PTH driven hypercalcaemia of 2.67 mmol/l (NR 2.2-2.60 mmol/l) at 7 weeks gestation. Investigations revealed no evidence of malignancy. Interestingly, following initial blood test, her calcium normalised but with persistent complete suppression of PTH until 19 weeks gestation, when her calcium rose to 3.25 mmol/l. Her 1,25-dihydroxy Vitamin D w...

A 51-year-old asymptomatic man presented in 1998 with elevated thyroid stimulating hormone (TSH) 6.34 mIU/l (0.34–5.6 mIU/l), FT4 54.1 pmol/l (7.5–21.1 pmol/l), FT3 20.1 pmol/l (3.0–5.0 pmol/l) and TSH-α subunits 3.6 mcg/l (<2.0 mcg/l). After the first visit, he was lost to follow-up.He presented 10 years later in 2008 with 1-week history of symptoms of heart failure and hyperthyroidism. Clinically he was thy...

Introduction: The common causes of thyrotoxicosis are Graves’ disease, toxic multinodular goitre and toxic adenoma which account for >90% of cases of this condition. Iodine-induced thyrotoxicosis (Jod-Basedow syndrome) is infrequently considered as a cause of thyrotoxicosis. This case describes a lesser known cause of iodinated contrast-induced thyrotoxicosis.Case Report: A 47 year old man with known alcoholic liver disease and recurrent pancrea...

Objective: We present this case to emphasize the need to consider the uncommon causes of hypercalcaemia and the importance of history taking.Case report: A 79 year old man with multiple sclerosis was admitted with hypercalcaemia of 3.41 mmol/L, a suppressed PTH and AKI. He was investigated for non-PTH mediated hypercalcemia, having a whole host of investigation. He had normal serum ACE, with no radiological evidence of granulomatou...

Objective: We present this case to emphasize the need to consider the uncommon causes of hypercalcaemia and the importance of history taking.Case report: A 79 year old man with multiple sclerosis was admitted with hypercalcaemia of 3.41 mmol/L, a suppressed PTH and AKI. He was investigated for non-PTH mediated hypercalcemia, having a whole host of investigation. He had normal serum ACE, with no radiological evidence of granulomatou...

Introduction: Hyponatraemia is a common electrolyte abnormality seen among hospitalised patients. We describe below, an inpatient seen with severe hyponatraemia.Case description: 71yr old gentleman with no co-morbidities, admitted with acute confusion and slurred speech. Physical examination: Observations: Temperature 35C, heart rate 53/min, otherwise stable. GCS 15/15, no focal neurolo...

Introduction: Syndrome of inappropriate anti-diuretic hormone (SIADH) is the one of the most common causes of hyponatraemia encountered in hospitalised patients. However, there are very few reported cases of SIADH in pregnancy. This case describes such an entity.Case Report: A 21 year old lady who was seven weeks pregnant presented to hospital following episode of new onset seizure. She was involved in a road traffic accident seven months prior with asso...

Introduction: Short synacthan test is a first line endocrine test for diagnosing adrenal insufficiency except in situations like Pituitary surgery or Pituitary apoplexy within the last 2 weeks when this may give a false positive result and this is well known in literature. Here we discuss lesser reported clinical situations seen in two of our patients having good adrenal response to SST with only GST identifying adrenal insufficiency.Case Report: Two pat...

Introduction: Carbimazole is a first line antithyroid drug for thyrotoxicosis management in UK. Its main but rare complications include allergic reaction and risk of neutropenia. Here we discuss the lesser reported situation in which a thyrotoxic patient who is in a remission from Aplastic anaemia was treated with Carbimazole.Case Report: Out patient was seen in Ambulatory care with symptoms of heart failure along with tachycardia. Thyroid blood test sho...