Endocrine Abstracts

Decrum’s disease or adiposis dolorasa is a rare progressive syndrome of unknown aetiology. It is characterised by painful fatty deposits, general obesity, weakness and unexplained emotional disturbance.1We describe a case of a 55-year-old man who presented with pneumonia. On examination he was noted to be overweight and have multiple skin nodules. His chest X-ray was abnormal; he underwent further workup with a CT thorax/abdomen/pelvis. T...

Follicular thyroid cancer is the second most common cause of thyroid carcinoma. Metastasis occurs in 10–15% of cases. Typical sites of metastasis include bone and lungs, scalp metastasis are rare, with <50 cases reported. We describe two such cases.A retrospective chart review was performed on these patients, examining presentation, treatment and subsequent outcomes.Patient 1. An abnormal lesion was noted on a routine ches...

Case history: A 42 year old male teacher presented to the emergency department with an acute right MCA infarct, on a background of paroxysmal atrial fibrillation/flutter and recurrent supraventricular tachycardia. He had chronic palpitations, with previous failed cardiac ablation. He had no other medical history, specifically, no history of ear infections or learning difficulties. There was no known family history of thyroid dysfunction. Previous TSH levels (no FT4 measurement...

Idiopathic Isolated ATCH deficiency (IIAD) is a rare cause of secondary adrenal insufficiency characterised by ACTH deficiency with otherwise intact pituitary function. Our objective was to describe the presentation, the autoimmune associations and diagnostic findings observed in IIAD. We present a case series of 19 cases of idiopathic Isolated ACTH deficiency which were identified from the National Pituitary Register in Ireland. A chart and biochemical review was performed to...

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of poli...

Diabetes insipidus is characterised clinically by the inappropriate production of large volumes of dilute urine, even in the presence of clinical dehydration or depravation of water. DI occurs either due to deficiency or insufficiency of arginine vasopressin (AVP) hormone production. The gold standard test remains the water deprivation test. Hereditary DI accounts for <10% of all cases.We present a family with a known heterozygous missense mutation, ...

Background: Adrenal insufficiency remains a potentially life-threatening condition, necessitating adequate glucocorticoid replacement and appropriate stress-related adjustment to avoid crisis. Flu-like illness is a key precipitant of adrenal crisis. While some authorities recommend annual influenza vaccination for such patients, uptake rates in this population are unknown. Additionally, while seasonal vaccines may lead to minor symptoms in the general population, there are no ...

Context: The syndrome of inappropriate antidiuresis(SIAD) is the commonest cause of hyponatraemia. Data on the aetiology of SIAD is mainly derived from retrospective studies, often with poor ascertainment of minimum criteria for correct diagnosis. Although central adrenal insufficiency(CAI) is known to cause euvolaemic hyponatraemia, the incidence of undiagnosed CAI in SIAD is unknown.Objective: To establish the incidence of CAI in SIAD.<p class="abs...

Acute hyponatraemia is a medical emergency with high mortality. Recent expert guidelines advocate treatment with intravenous boluses of 3% saline with the aim to reduce cerebral oedema more rapidly than traditional slow intravenous infusion, but there is a poor evidence base for this policy change. We retrospectively audited treatment of symptomatic hyponatraemia due to SIAD (n=57, age 22–76 year), comparing low dose (20 ml/h) and bolus infusion of 3% saline. Bol...

IgG4 related hypophysitis is a recently described entity belonging to the IgG4 related diseases. It is characterised by markedly elevated serum IGG4 levels and tissue infiltration by IgG4 positive plasma cells. To date, 34 cases of IgG4 related hypophysitis have been described but only a handful were in women or biopsy proven. We describe a case of a 58 year old woman who presented with transient headache. She also complained of polyuria and nocturia. She had a thyroidectomy f...