Endocrine Abstracts

Case history: A 44-year-old gentleman presented to A&E with a 2-week history of fevers and rigors. He gave a background history of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. A vegetation identified on the mitral valve led to an unexpected diagnosis of infective endocarditis. Antibiotic treatment for infective endocarditi...

We present a family of a 45-year-old patient who presented to hospital acutely unwell with metastatic paragangliomas. Unfortunately due to rapidity of his presentation, no genetic testing was performed. He was found to have 5 cm right carotid body tumour. His urine collections confirmed raised (seven times normal) 24 h urine metanephrines 24.55 μmol (normal <3.47 μmol). Shortly after the initial diagnosis he was found to have extensive vertebral body metastases i...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fevers and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Stre...

A 48-year-old male presented with headache, cough and recurrent nose bleeds. Clinical examination showed saddle shape nose deformity. His past medical history included primary hypothyroidism diagnosed at the age of 10 years, was taking levothyroxine. His brother had a Rathke’s cleft cyst, surgically removed. His blood test were as follows: Sodium 125mmol/l, TSH 0.10mU/l, free T4 10.2pmol/l, freeT3 2.6pmol/l, cortisol < 28nmol/l, prolactin 240mU/l, FSH 1.8U/l, LH 0.3U/...

A 45-year-old female presented with secondary amenorrhea. Since menarche, her period has been irregular, which she initially managed with oral pills, which were discontinued in 2009. Subsequently, she does have complete secondary amenorrhoea. She has hirsutism at the age of 20. Which was initially well controlled with oral contraceptive pills but has been getting worse over the years. Ferriman-Gallwey’s score was high. She also stated that her weight had been steadily inc...

A 36-year-old lady (gravida 2 para 0) presented with subfertility, dysmenorrhoea and mild hyperprolactinaemia (prolactin of 881 mU/l no macroprolactin). She was also found to be hypercalcaemic whilst on calcium supplements. Despite a negative home pregnancy test, her β-HCG was elevated at 1471 IU/l confirming she was pregnant.She remained hypercalcaemic despite stopping calcium supplements and starting colecalciferol. At 9 weeks into her pregnancy, ...

A 64-year-old gentleman was referred with persistent hypercalcaemia following two previous parathyroidectomies from an external hospital. He was found to be hypercalcaemic incidentally by his GP in 2011. Prior to surgery in January 2011, his corrected calcium (cCa) was 2.83 mmol/l, PTH 1.9 pmol/l, vitamin D 38 nmol/l, 24 h urine calcium creatinine clearance ratio (24 h UCCR) was 0.0135. Histology from his 1st neck exploration revealed one hyperplastic parathyroid gland. A furt...

We present a case of 50-year-old female who presented to a local hospital with sudden onset severe sharp left flank pain. Urgent CT revealed a mass in the left adrenal gland which was thought to be a supra-renal bleed. It measured 6 cm at this point. She was discharged with paracetamol and re-assured. As she was not feeling well, she had an US kidney in private sector 1 month later revealing static appearance of presumed haematoma. Following the period of observation to allow ...

A 43-year-old gentleman was referred from a local hospital with biochemical and radiological suspicion of pheochromocytoma. He admitted to a 10-year history of palpitations, flushing, sweating, and tremors. He was intermittently feeling stressed, anxious and angry with mood swings. He had difficulty sleeping and suffered from headaches. He was treated for hypertension and 10 years prior he was admitted to the local hospital with malignant hypertension. He was drinking up to 40...

A 68-year-old patient was noted to have prognathism, broad fingers and toes and coarse facial features during her admission for a hip replacement 2 years ago. Her family noted change to her facial features and she admitted to increase in her shoe size over 10 years. Her past medical history included treated hypertension only. Her oral glucose tolerance test (OGTT) confirmed paradoxical rise of GH with peak 6.23 μg/l. Her initial IGF1 was raised at 131 nmol/l (6–30 nm...