Endocrine Abstracts

A 74-year-old male presented to hospital following an episode of brief loss of consciousness and several hours of post ictal confusion. There was no witnessed seizure activity, tongue biting, or incontinence. His past medical history included SCC right scalp, TIA and primary hypothyroidism. He had been commenced on Cemiplimab (immunotherapy) for metastatic SCC seven months before. On assessment, he appeared well and general examination including neurological examination was no...

Grave’s disease is an auto-immune disorder which responds well to medication and up to half of the patients who take anti-thyroid drugs go into remission. We present a patient with Graves’ disease, who developed acute hepatitis associated with Carbimazole and, re-challenged with Carbimazole when she represented with in fast atrial fibrillation (AF) with relapse of hepatitis. A 75 year-old lady admitted with palpitation and chest tightness. She had a background of par...

Common non-specific symptoms like fatigue can occasionally point towards a rare significant pathology. We report a similar case in which investigations for subtle symptoms revealed a serious unexpected diagnosis. A 76 year-old man presented to his GP for new onset mild fatigue. He had an underlying prostate cancer with no known metastases, treated only with hormonal therapy. This was under surveillance with urology team. GP sent off blood tests which showed a very low random s...

A 63-year-old female with cardiovascular risk factors presented with tremor, sweating, lower back discomfort, nausea and dyspnoea. ECG showed sinus tachycardia with lateral ST-depression. High-sensitivity troponin was dynamically elevated (72 ng/l to 112ng/l on one-hour repeat). Computed tomography aortogram ruled out aortic dissection but identified a 6.6cm lesion in the left adrenal gland. Ventricular tachycardia was detected on cardiac monitoring. Differential diagnoses inc...

A pituitary hormonal profile and MRI pituitary was requested revealing eupituitary hormonal status with an incidental finding of 4 mm microadenoma. The case was discussed in local MDT and the outcome was to continue conservative management of PHPTH with cinacalcet until pheochromocytoma has been ruled out completely. Both MEN-1 and MEN-2 are associated with PHPTH. If a patient is having episodic adrenergic crises with inconclusive metanephrines analysis then excluding pheochro...

The commonest cause of hypercalcaemia is primary hyperparathyroidism (PHPTH). The diagnostic work up includes paired blood samples for serum corrected calcium, parathyroid hormone (PTH) and vitamin D levels. But in young patients, rare genetic conditions could be contributing towards hypercalcaemia and hence could produce a diagnostic challenge. We report hypercalcaemia work up in two young females where genetic tests were required.Case 1<p class="ab...

Hypercalcaemia due to primary hyperparathyroidism (PHPTH) is fully curable by parathyroidectomy. Occasionally recurrent hypercalcemia presents as a results of either residual adenoma, recurrent disease or an ectopic parathyroid gland. The most challenging cases are those with ectopic glands which are not identified on usual surgical neck exploration. We present a similar case that went through multiple surgeries for recurrent hypercalcemia. A 79-year-old lady initially was dia...

The incidence of recurrent primary hyperparathyroidism (PHPTH) (> 6 months from initial exploration) has been reported to be between 1–10%. Repeated neck explorations could be challenging for surgeons and ensuring normalised biochemistry is vital for peri-operative safety. Recurrent parathyroid adenomas can present with aggressive hypercalcaemia which can be challenging to control prior to surgery. We report a similar case below. A 72 year old lady had her first prese...

A 41 year old lady presented to emergency department with tremors and palpitations. Her examination and routine bloods were normal but ECG showed sinus tachycardia (heart rate = 141 bpm). She was treated with propranolol and discharged. She was readmitted in emergency department with ongoing palpitations, lethargy and tremors. On examination, she had a diffuse goitre but no signs of Graves’ eye disease. The blood tests showed overt thyrotoxicosis (TSH<0.01 mU/l, FT4 =...