Endocrine Abstracts

Introduction: Malignancies and hyperparathyroidism account for over 90% of cases of hypercalcaemia. When presenting with suppressed PTH, malignancy is its commonest cause. We present a case of PTH-independent hypercalcaemia of immobilisation responding to bisphosphonate therapy.Case summary: A 57-year-old Caucasian male presented with significant weight loss and severe back pain. He consumed 50 units of alcohol a week, had stopped smoking 20 years earlie...

We present two cases where, without measurement of cortisol binding globulin (CBG), interpretation of their 250mcg short synacthen test (SST) would have falsely suggested inadequate pituitary-adrenal reserve.A 62yr old woman was referred with an incidental finding of a pituitary adenoma. Pituitary function tests confirmed gonadotrophin and growth hormone deficiency. Initial and subsequent SSTs were normal (30min cortisol reater than 600nmol/L). Follow up...

A 30-year-old woman with long standing type 1 diabetes presented with recurrent severe hypoglycaemia. One month earlier she had given birth to her first child. Before pregnancy her HbA1c had been 7.8 to 9.2 percent (RR 3.1 to 5.0 percent) but improved by the third trimester to 6.8 percent. Before pregnancy her total daily insulin dose was 50 units and by the third trimester it had only increased by 25 percent to 60 units. The pregnancy and birth were uneventful with no hypogly...

A 34-year-old woman was referred by her GP in 2000 with thyrotoxicosis (TSH undetectable, free T4 36.4 pica moles per litre, reference range 10-25). She had no ophthalmic symptoms or signs and no goitre. There was no family history of thyroid disease. Her thyroid peroxidase antibodies were undetectable but thyrotropin-binding inhibitory immunoglobulin was 30 (Reference range 0-15) confirming Graves' disease. Carbimazole was initiated but changed to propylthiouracil after a pre...

A 54-year-old man with long standing coeliac disease and moderate dietary compliance was admitted with lethargy and feeling unwell. His blood pressure was 129 mmHg systolic, 91mmHg diastolic and serum sodium 112 millimoles per litre (RR 136 to 145). He was otherwise well with normal visual fields. A 250-microgram Synacthen test demonstrated a basal cortisol of 630 nanomoles per litre rising to 983 nanomoles per litre after 30 minutes. His TSH was undetectable, Ft4 9.6 picomole...