Endocrine Abstracts

Introduction: Long term treatment with corticosteroids has been widely used, due to the well documented immunosuppressive and anti-inflammatory activity. Corticosteroids are among the most widely prescribed drugs in oncology and post-transplant patients. However, long-term treatment with a dose of corticosteroids, which equals prednisolone 5mg/day for at least 4 weeks, is very likely to result in suppressed function of the hypothalamic pituitary adrenal (HPA) axis, a condition...

Pheochromocytoma crises are uncommon but have high mortality. We describe herein a case where multidisciplinary team management was crucial in safely carrying the patient through such a crisis. The patient was a 63 year old lady with a background of neurofibromatosis type 1 (NF-1), and previous renal artery stenosis bypass surgery. She was admitted via A&E with increasingly frequent episodes of sweating, headache, dyspnoea and palpitations. Her troponin was raised at admis...

Background: Resection of the adrenal gland is a challenging intervention that requires close endocrinological supervision for the correct assessment of hormones to minimise complications peri-operatively (peri-op) and post-operatively (post-op).Objectives: This study assessed the function of the hypothalamus–pituitary–adrenal axis and the related management according to underlying adrenal disorders.Methods: We reviewed 16...

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,...

Introduction: Pituitary metastasis (PM) is a rare condition and associated with a reduced life-span. The most common primary sites are breast and lung, followed by thyroid and renal cell carcinoma. Patients with PM are mostly asymptomatic and incidentally discovered during neuroimaging. Characteristic symptoms are reported in <20% and most commonly include visual involvement, diabetes insipidus, and panhypopituitarism. We here describe a case with malignant melanoma (MM) w...

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...

IAS is a very rare condition in which anti-insulin antibodies carry high concentrations of insulin in suspension in circulation. Hypoglycaemia occurs when insulin is released from the antibodies during fasting or post-prandially.We present two cases. Patient-A is a 52-year old Thai obese female, with acanthosis nigricans and a strong family history of T2DM. Patient-B is a 28 year-old normal- BMI Caucasian female with an unremarkable history. None of the ...