Endocrine Abstracts

A 56 year old man was admitted to hospital with a two day history of nausea and vomiting. Admission calcium was 4.1 mmol/l with a PTH of 146.5 pmol/l and creatinine of 227 umol/l. Primary hyperparathyroidism was diagnosed 4 months earlier with a calcium of 3.22 mmol/l and PTH of 24.4 pmol/l. He had prior outpatient treatment with intravenous disodium pamidronate and cinacalcet. He was waiting SPECT CT due to indeterminant imaging. Past history included right tonsillar carcinom...

Background: Patients with adrenal insufficiency sometimes complain of excessive weight gain or feeling unwell on standard hydrocortisone despite dose optimisation. Prednisolone can be used in adrenal insufficiency but has a more prolonged duration of action and blood tests to monitor prednisolone levels are not readily available. Conventional glucocorticoid replacement can lead to over-replacement particularly in the evening which is thought to increase the risk of obesity. Pl...

A 63 year old man was admitted with headache, nausea, vomiting and BP of 247/155 mmHg. He had a 4 month history of headache. Past medical history of depression, back pain and 40 pack year smoking history. There was no history of chest pain, palpitation or neurological disturbance. ECG: sinus rhythm, Rate 110, LVH. Cholesterol 6.1 mmol/l. Creatinine 118umol/l. CT head unremarkable. He was commenced on amlodipine. Tramadol and pregabalin were stopped due to possible serotonin sy...

A 71 year old lady presented to MAU with a recent onset of generalised weakness and a history of facial and periorbital swelling developing over seven years. She had also noticed hoarsening of her voice, cold intolerance, weight gain, constipation and reduced appetite. Admission blood tests showed marked hyponatremia of 113 mmol/l with severe hypothyroidism (TSH 45.24 mIU/l, fT4 1.1 pmol/l and TPO antibody 358 IU/ml). Subsequent tests confirmed SIADH (serum osmolali...

A 20-year-old man with a 5-year history of poorly controlled type 1 diabetes presented with epigastric pain, bloating and weight loss. He had attended DAFNE recently and had been commenced on an insulin Pump resulting in improvement of HbA1C from 114 to 76 mmol/mol over a 4-month period. Blood pressure was elevated (157/108 mmHg) with a resting tachycardia of 110. Haemoglobin was elevated at 18.7 g/dl. 24 h blood pressure monitoring revealed an average diastolic blood pressure...

An 82-year-old man presented with weight loss and lethargy. Thyroid function tests showed a fT4 7.6 pmol/l and TSH 0.08 mU/l. Short synacthen test confirmed hypoadrenalism with baseline cortisol of 34 nmol/l and 30 min sample 156 nmol/l. He had low gonadotrphin levels and Prolactin was 551 μ/l. He was commenced on hydrocortisone and levothyroxine treatment with symptomatic improvement. An urgent CT scan revealed multiple enlarged lymph nodes above and below the diaphragm ...

Background: Following vaccination for SARS-CoV-2 a significant proportion of individuals experience moderate to severe symptoms. In patients with adrenal insufficiency (AI) this has been reported to translate in to need for increased glucocorticoids and incipient or frank adrenal crises. We assessed occurrence of symptoms, need for glucocorticoid dose adjustment and crises in a large cohort of patients with AI following vaccination for SARS-CoV-2.Methods...