Endocrine Abstracts

Background: Letrozole is a potent aromatase inhibitor licensed for use in women with breast cancer. It is also used by body builders for reduction of gynecomastia when taking anabolic steroids. Supply for this unlicensed use is readily available through internet. Testosterone production is regulated by negative feedback of estrogen on the pituitary. The use of letrozole can therefore cause supraphysiological levels of testosterone in men. We present such a case.<p class="a...

Background: Primary Hyperparathyroidism is mainly produced by an adenoma and it is mostly a benign condition. Most of the patients are asymptomatic. We present a case of ectopic parathyroid cyst presenting with this condition.Case: A 76 yr female presented with new onset confusion, abdominal pain, vomiting, diarrhoea and dehydration. She was currently being treated for a urinary tract infection. Investigations showed acute kidney injury with creatinine 3...

Objectives: Increasing use of scanning has led to a significant increase in detection of adrenal incidentalomas. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons have issued guidelines for evaluation of adrenal incidentalomas in 2009. We audited our current practice at Royal Shrewsbury Hospital against the 2009 guidelines.Method: Retrospective audit of patients found to have adrenal masses on imaging st...

Background: Primary hypoadrenalism with bilateral adrenal enlargement is a relatively rare condition. We present four such patients. Case 1: 60 year old male presented with malaise, weight loss and hyponatremia. Short synacthen test was abnormal and ACTH was raised (309 ng/L). CT adrenals showed bilateral adrenal enlargement with uniform texture and low attenuation with no change in repeat CT. FNAC of adrenal gland showed infarcts. Further tests confirmed antiphospholipid anti...

Cushing’s syndrome can occur as a consequence of prolonged exposure to excessive amounts of circulating free cortisol and the various causes can be broken down into exogenous causes, such as from steroid treatment for chronic illnesses, or endogenous as in this case. Cushing’s syndrome can be further classified into ACTH-dependent and ACTH-independent1, for which the latter accounts for 15–20% of all cases. This report highlights the case of a 35 year old female...

Background: There has been conflicting evidence on the use of strict dietary iodine restriction prior to Radioiodine (RAI) administration for the management of hyperthyroidism and varying level of restrictions have been used. More recently the Medical Physics team in our institute implemented strict dietary iodine restrictions for 2 weeks pre-RAI administration. Significant inconvenience was reported by patients, which in some instances led to their reluctance to receive a sec...

Background: Post menopausal hirsutism should raise suspicion of androgen secreting tumors. We present a case due to bilateral ovarian hyperthecosis with an adrenal incidentaloma.Case history: 57 year old female patient was referred to us with history of new onset hirsutism over the past 2 years. She went through menopause 6 years back. On examination she had hirsutism affecting all her body, no evidence of virilization and no organomegaly on abdominal ex...

Proton pump inhibitors (PPI) are widely prescribed. PPI-induced diarrhoea and hypomagnesaemia are well-documented in literature. Hypomagnesaemia is well-known to cause functional hypoparathyroidism. We describe a patient who had transient profound hypoparathyroidism which improved on discontinuing PPI and normalising severe hypomagnesaemia.A 72-year-old male, who was on oral anti-diabetic medications, calcium/vitamin D3 supplements and PPI, presented wit...

Autoimmune encephalitides are being increasingly recognised as important and potentially reversible non-infectious causes of the encephalitic syndrome. Myriad of clinical presentation and lack of symptom specificity leads to a wide differential diagnosis. Failure to diagnose the correct aetiology of an encephalitic syndrome can lead to significant morbidity and mortality. A 57 years old right handed female with no significant medical problems initially presented with left side...

Background: The success of Minimally Invasive Parathyroidectomy (MIP) is closely linked to accurate preoperative localisation of a solitary parathyroid adenoma. Sestamibi/SPECT scan (SS) and ultrasonography (US) are the preferred imaging modalities although their accuracy varies considerably between different centres.Aim: To assess the efficacy of SS and US in identifying a solitary parathyroid adenoma in patients with primary hyperparathyroidism (PHPT) ...