Endocrine Abstracts

Graves’ disease (GD) is the most common cause of hyperthyroidism1 and is caused by stimulating autoantibodies to the TSH receptor (TRAb).2 TRAb assays have 98% sensitivity and 99% specificity 3 for GD and are recommended as the first-line cost-effective investigation to diagnosis the aetiology of hyperthyroidism and determine the risk of thyroid eye disease.4,5 In TRAb antibody negative patients, radionuclide imaging may be help...

A 45 year old female civil servant presented to primary care for a routine evaluation of her lipid profile. When questioned, she described a history of lethargy and low mood. The patient’s GP noted features of agitation and sweating and organised a range investigations including thyroid function tests. Past medical history included systemic lupus erythematosus, a diagnosis that the patient had experienced difficulty accepting, requiring an extended period of counselling.<...

A 24-year-old female make-up artist presented with a 6 months history of emotional lability, heat intolerance, weight loss and shaking of the hands. She described a deteriorating relationship with her spouse and increasing difficulties performing her professional role. On examination, she demonstrated marked agitation, tremor, sweating and tachycardia. Biochemistry confirmed severe thyrotoxicosis (fT4 84 pmol/l, TSH<0.01 mU/l). Subsequent clinic attendance and c...

Inappropriately low circulating PTH levels following thyroid surgery, is the most common cause of iatrogenic hypocalcaemia. Standard treatment of hypoparathyroidism has comprised vitamin D analogue and calcium supplementation. However some patients remain hypocalcaemic despite use of maximal titrated and tolerated therapy. Teriparatide is recombinant formulation of endogenous PTH, containing 34 amino acid sequence which is identical to the N-terminal portion of this hormone. W...

Background and aims: The use of serum calcitonin to screen patients with nodular thyroid disease for medullary thyroid cancer (MTC) remains controversial due to conflicting data regarding its sensitivity, specificity and cost effectiveness. Currently, the use of calcitonin is recommended by the European consensus group but not the American Thyroid Association. We aimed to formally evaluate the utility of calcitonin as a screening tool for MTC in patients presenting to the thyr...

Pituitary sarcoidosis is a rare form of neurosarcoid, commonly associated with multisystemic sarcoidosis. The most common intracranial site of sarcoidosis leading to endocrine involvement is the hypothalamus and the pituitary gland. The prevalence of hypothalamic–pituitary involvement in multisystemic sarcoiosis is reported to be around 5%.Granulomatous infiltration of the hypothalamus and the pituitary gland always results in endocrine disorder, GH...

A 30-year-old Eritrean female presented with a 1 month history of nausea and vomiting, with 15 kg weight loss but no bowel disturbance. Past medical history included an open cholecystectomy. There was no family history of mineral or bone disorders. She denied any prescribed/over-counter medication and abstained from alcohol. Examination revealed marked cachexia (BMI 16.1 kg/m2). ECG revealed ST depression and T wave inversion.Investigations in...

Background: Metyrapone is commonly used in medical management of Cushing’s syndrome. It inhibits 11-β hydroxylase, which catalyses the conversion of 11-deoxycortisol to cortisol. The adequacy of metyrapone blockade can be assessed either clinically or biochemically using a target mean serum cortisol 150–300 nmol/l. Cortisol is normally measured by immunoassay.Case report: A 21-year-old female presented with clinical and biochemical feature...

Background: Differentiated thyroid cancers are reported to present with synchronous distant metastases in 1–9% of cases. The most common single sites of synchronous metastases are lung (45%) and bone (39%) with dual site involvement (12%). Other single sites of metastases are rare (4%). Pleural metastases are very unusual, accounting for < 0.6% of cases.Case: A 55-year-old male smoker presented with cough, weight loss and thoracic back pain. Exa...

A 70-year-old female with known schizophrenia presented in hyperthyroid crisis. Examination revealed muscle wasting, tremor, sweating, low-grade fever, and sinus tachycardia. Biochemistry confirmed the diagnosis (TSH <0.1 mlU/l, thyroxine 41 pmol/l (9–25), tri-iodothyronine 25 pmol/l (3.5–6.5)). The patient was commenced on i.v. esmolol and carbimazole (40 mg) crushed into warm milk.However, lacking mental capacity, and refusing to take all...