Endocrine Abstracts

Introduction: In the UK, the North West of England is one of the worst affected regions by COVID 19, with over 275 cases/100,000. We retrospectively looked at the diabetes characteristics of consecutive patients at our trust admitted with COVID 19 and had known diabetes, and assessed whether there was a correlation with the outcome, Clinical Frailty Score (CFS) and age.Methods: 88 continuous patients with a prior diagnosis of diabetes and COVID 19 swab p...

A 56 year old lady was diagnosed with cancer of unknown primary after the discovery of liver metastases. Prior to the commencement of EOX chemotherapy (epirubicin, oxaliplatin and capecitabine) she was given a dose of 4 mg zolendronic acid for hypercalcaemia of malignancy. Three weeks later she presented to our hospital with a history of rapid decline and reduced oral intake, with associated diarrhoea. She had reduced GCS and hypotension. Initial investigations revealed an acu...

Case 1: A 32 year old fit and well female presented with symptoms of thyrotoxicosis and goitre. Her initial investigations revealed fT4 45 pmol/l (10–20) and fT3 26 pmol/l (3.5–6.5), with undetectable TSH. TSH receptor antibodies were positive. She was commenced on beta blockers and carbimazole and increased to 60 mg daily, with the fT4 improving only to 34.4 and fT3 to 13.8. Cholestyramine was commenced and titrated to a dose of 4 g twice daily, with resultant norma...

We present a case of discordant pituitary biochemistry which resolved after discontinuing a commercially available combination vitamin supplement. A 35 year-old man presented following an episode of headache and dizziness, preceding collapse and possible seizure activity. Investigations revealed deranged pituitary function: TSH 0.02 mU/l (0.35-5.50), fT4 3.6 pmol/l (10.0-20.0), 9 am cortisol 18 nmol/l (200-500), testosterone >52 nmol/l (8.4-28.7), FSH <0.3 U/l (1.0-18....

A 29-year-old man presented with an 18-month history of reduced libido and lethargy. His symptoms started after cessation of anabolic steroids for three years. His childhood and development history were unremarkable with normal onset of puberty and development of secondary sexual characteristics. He had no past medical or family history of note. Clinical examination demonstrated normal BMI, musculature, distribution of body hair, testicular volume, and genital size. Biochemica...

Background: Glucocorticoids are used medium and long-term for a variety of inflammatory and autoimmune conditions, with increasing use in the UK. The management of their potential side effects, however, remains suboptimal, and guidelines are not comprehensive. Our institute has had cases of patients presenting with hyperglycaemic emergencies due to steroid induced diabetes.Aims: 1) To obtain an estimate of the frequency of the use of medium and long term...

Immunotherapy targeting the CTLA-4 and PD-1pathways has revolutionised the treatment of several cancer types, and is under investigation in many others. However, its use is associated with a variety of side effects, many of which associated with immune system activation. In metastatic melanoma, the combination of ipilimumab (an anti-CTLA-4 antibody) and nivolumab (an anti-PD-1 antibody) has been shown to have greater efficacy than either drug as monotherapy, though as expected...

A 65 yo gentleman was referred to the endocrinology department with thyrotoxicosis. He had a history of IHD and recurrent VT necessitating amiodarone for 8 years. Routine TFTs had shown TSH undetectable, fT4 34.1, fT3 8.7. There were no symptoms or signs of thyrotoxicosis or cardiovascular compromise. He had been treated with carbimazole by his GP for the previous 3 weeks, this was discontinued at the initial evaluation due to recurrent vomiting. TPO anti...

HHS is a rare hyperglycaemic emergency, typically precipitated by infection in people with T2DM. There are few recorded cases of COVID induced pure HHS. We here by report 2 further cases, including the first known reported case in a person with T1DM.Case 1: 81yo male with T1DM (on glargine and aspart insulin, HbA1c 57 mmol/mol) presentedwith lethargy, general deterioration and a fall.Therewere no new symptoms offever/cough/breathlessness or change in tas...

Opioids –Yet another Cause for Adrenal Insufficiency. Opioid prescriptions have almost doubled in the last decade in the UK. Opioid related hypogonadotropic hypogonadism is a well-recognised clinical entity. Opioid therapy as a cause of adrenal insufficiency is an under-recognised endocrinopathy with potentially lifethreatening adverse effects. We present the case of a 57 year old lady referred to the endocrine clinic with symptoms of generalised fatigue and weakness. Her...