Endocrine Abstracts

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...

Case history: 48-years old man, with no comorbidities, presented to A&E due to global headache of 20 days duration, with associated intermittent vomiting, but no photophobia, cranial nerve impairment, neck pain or visual disturbance. The first head-scan (CT, computed tomography) was unremarkable, hence was discharged with safety advises. One week later, he represented to A&E with similar complaints. On enquiries, he mentioned to be reviewed by an optician 6 months ago,...

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...

Insulin Autoimmune Syndrome (IAS)/Hirata disease is a very rare condition in which anti-insulin antibodies result in accumulation of high circulating concentrations of insulin in complexes. Hypoglycaemia in IAS occurs when insulin is released from the antibodies during fasting. We present two contrasting cases of Hirata disease. Both patients presented with symptomatic hypoglycaemia. Patient-A is a 52-year old obese Thai female, with acanthosis nigricans and a strong family hi...