Endocrine Abstracts

A 34-year old female with type 1 diabetes presented to the antenatal clinic complaining of polydipsia, polyuria and nocturia. She was 12 weeks pregnant with adequate glycaemic control on a basal-bolus insulin regime. She reported new onset headaches but no deterioration in vision. On examination, her visual fields were full to confrontation with red pin. She was eunatraemic (Na 138 mmol/l), had an early morning cortisol of 332 nmol/l and normal thyroid function tests (FT4 16 p...

A three year old boy was referred for surgical correction of an undescended right testis. Intra-operatively he was found to have a hyperplastic right gonad which was in continuation with a unilateral fallopian tube, prompting analysis of his karyotype. This showed 46XX/XY mosaicism with 88% of the cells being XX and 12% XY. The post-operative histology confirmed mixed testicular and ovarian tissue in the right gonad. He appeared phenotypically male and had blaschko lines consi...

A 49 year old Russian lady was found to have an elevated testosterone level (9 nmol/l) when investigated for hair loss. This was first detected some years ago when she apparently was given a provisional diagnosis of polycystic ovarian syndrome. When assessed in her local endocrine unit she did not report any excessive body hair growth or symptoms of virilisation. She claimed to reach the menopause aged 45 years and reported a family history of early menopause. Initial blood te...

A 60 year old gentleman with a history of renal stones presented 5 years ago with left sided flank pain. A CT of his renal tract showed an unexpected metastatic deposit in the left iliac crest. Cross-sectional whole body imaging, performed to locate the primary, also identified an expansile soft tissue mass in the T8 vertebral body and a predominantly cystic looking left sided thyroid nodule. He proceeded to have an iliac crest biopsy which was consistent with metastatic folli...

The amount of radioactivity given to patients undergoing ablation for remnant tissue in thyroid cancer at our centre has been greatly reduced to 1100 MBq I-131 in recent years, prompting a review of practice. An extensive risk assessment, focusing particularly on radiation exposure to the public during the patient’s commute home was conducted and found patients could now be discharged safely on the day of treatment. Owing to these findings and audit showing 86% of patient...

Case: A 46-years-old anaesthetist presented with 2 weeks history of general malaise, sore throat, and fever. Symptoms started while on holiday. A diagnosis of subacute thyroiditis was made overseas based on presentation and suppressed TSH level. He was started on betamethasone 4mg and ibuprofen for 2 weeks with rapid symptomatic improvement. He felt well enough to travel back to UK. He then presented to our hospital with recurrent symptoms as above.Inves...

Insulinomas are rare neuroendocrine tumours that classically present with a combination of symptomatic hypoglycaemia, low serum glucose values and resolution of symptoms post glucose ingestion.We describe a 65-year-old lady who repeatedly presented over several years with recurrent infections, predominantly of the urinary tract, nausea and diarrhoea, necessitating frequent hospital admissions. Despite extensive investigations, no clear cause for her symp...

Introduction: Regimens for pre-operative α and β-blockade for patients with secretory phaeochromocytomas/paragangliomas vary widely between centres. The worldwide lack of availability of intravenous phenoxybenzamine (Goldshield) has removed a useful tool in the management of phaeochromocytoma crisis and has necessitated a change in our institution’s routine pre-operative strategy. We compare pre, peri and post-operative surrogate measures of blockade in a cohort...

A 42-year-old woman presented to her GP with episodes of feeling ‘shaky’ exacerbated by physical exercise and prolonged fast. She was previously diagnosed with an insulinoma in 2006 (serum glucose 1.6 mmol/l, serum insulin 3.1 mIU/l and serum C-peptide <165 pmol/l). CT abdomen /transabdominal ultrasound revealed a 1 cm insulinoma in the uncinate process of the pancreas and the patient later underwent pancreatic enucleation in 2006. Post pancreatic enucleation, 72...

A previously fit and well 27 year old Ghanaian male was brought to hospital by his cousin due to new behavioural changes. The patient was described by his cousin as a normally reserved, self-sufficient man who had become a polar opposite ‘irritable’ personality that ‘spent extravagantly’. He repeatedly claimed to be ‘God’s protection’ and responded aggressively to visual hallucinations. This had resulted in social exclusion and loss of employ...