Endocrine Abstracts

Tuberculosis involving the thyroid gland is known to be rare with 76 cases being reported as of 2006, and may vary in their presentation*. We present a case of a previously well 67-year-old male who consulted for decreased sensorium, jaundice and hypotension, all attributed to sepsis. Patient exhibited no hyper-or hypothyroid symptoms and physical examination did not reveal clues to an underlying thyroid disease. Cultures of the blood, urine and sputum were inconclusive and de...

Background: Self-management of Type 1 diabetes (T1DM) is difficult and complex, particularly so during the transition period. Deterioration in glycaemic control is common, in part due to psychosocial and environmental changes (going to college or university), poor adherence to insulin regimens, risk-taking behaviours and family stressors. Transition to adult diabetes services can be a traumatic period for young people with diabetes, who commonly fall between services and are l...

Case: A 10-year-old girl with panhypopituitarism and cerebral palsy secondary to Group B streptococcal meningitis as a neonate had full hormonal replacement therapy (hydrocortisone, thyroxine, DDAVP) since infancy. GH was started at 3 years of age. Sodium levels were always stable in the high normal range. She became epileptic aged seven and was started on sodium valproate. Recurrent chest infections occurred from age eight and she became colonised with Pseudomonas an...

Case: A 14 year-old boy was found semiconscious by his mother following difficulty in sleeping overnight as he felt intermittently hot and cold. He had intentionally tried to lose weight (about 25 kg over 6 weeks). Presenting weight was 81 kg. Following prolonged resuscitation at home, GCS was 12 on arrival to hospital, 8 when intensive care team arrived. pH was <6.9 throughout. First venous glucose was 80 mmol/l (unrecordable on gas and glucometer), first plasma Sodium 11...

Background: Neuroglycopenic symptoms in insulinoma could persist for years before localising the source of endogenous hyperinsulinaemia. 90% of insulinomas are sporadic, solitary and < 2 cm in diameter, and can be associated with multiple endocrine neoplasia-1 (MEN-1). Insulinoma is an emerging clinical entity with a huge diagnostic challenge as tumour growth varies from months to years before tumour localisation.<p class="abstext...

Background: Neuroglycopenic symptoms in insulinoma could persist for years before localising the source of endogenous hyperinsulinaemia. 90% of insulinomas are sporadic, solitary and < 2 cm in diameter, and can be associated with multiple endocrine neoplasia-1 (MEN-1). Insulinoma is an emerging clinical entity with a huge diagnostic challenge as tumour growth varies from months to years before tumour localisation.<p class="abstext...

Ventricular tachycardia may occur in the setting of primary hyperthyroidism despite the absence of typical hyperthyroid symptoms. The case is a 40-year old female coming in for epigastric pain and vomiting who was incidentally found to have monomorphic ventricular tachycardia. Despite this she was in no respiratory distress, and exhibited no symptoms of heart failure. Other than agitation, physical examination showed no signs of hyperthyroidism. Initial management included num...

Cardiomyopathy can occur due to hypothyroidism or hypocalcemia but often resolves with judicious treatment with levothyroxine and correcting calcium levels to acceptable levels. We discuss a case of a 37-year-old woman presenting with acute cardiogenic shock and a history of total thyroidectomy 6 years prior for papillary thyroid carcinoma stage 1 (T2N1aM0). Patient was non-compliant to levothyroxine treatment and developed easy fatigability and exertional dyspnea 5 months bef...

Case History: A 76 year old woman presented to the Accident & Emergency Department with persistent hypokalaemia, hypertension and metabolic alkalosis. She complained of ongoing muscle fatigue and tiredness and denied any headaches or vision problems. On examination, she had evidence of centripetal obesity, proximal myopathy, pink striae and bruises on her abdomen. No visual field deficit on confrontation and neurological examination was normal. She had a past medical histo...

Background: Gastric reduction duodenal switch involves restrictive and mal-absorptive aspect, removing approximately 70% of stomach and most of the duodenum. Surgical alteration leading to malabsorption of macronutrients is achieved with varying results of weight loss but resulting nutritional side effects are under-recognised. Issues in nutritional complication leading to neurological complications like peripheral neuropathy are increasingly recognised. We discuss a case of s...