Endocrine Abstracts

Primary hyperaldosteronism (PHA) is increasing common since the use of aldosterone to rein ratio (ARR) as a screening test. It occurs up to 10% patients with hypertension. Indentifying PHA is important as hypertension can either be cured by unilateral adrenalectomy or controlled by targeted medical therapy with mineralocorticoid receptor agonist in bilateral disease. Familiarising with the different assays and unit is crucial on interpreting ARR. Plasma aldosterone concentrati...

Background: Resistant Hypertension is defined as uncontrolled high BP despite treatment with at least three antihypertensive agents. The underlying cause is usually found to be phaeochromocytoma, Conn’s or renal artery stenosis (RAS). We would like to present two cases with difficult control of hypertension which did not fall into these categories.Case 1: History: 68 year old gentleman presented 2012 with >10 year history of hypertension. BP 200...

Background: Post-operative hypoparathyroidism is a known complication of total thyroidectomy. It can either be transient or long-term requiring lifelong treatment. Delayed presentation of hypoparathyroidism occurring after several years of surgery is rare, with only a few cases reported in literature but can be life-threatening.Presentation: We report a case of a 70-year-old female presenting with features of hypocalcaemia (tinnitus and tingling in her f...

Introduction: Symptomatic hypogonadism affects 5–6% of men aged 30–79 years and is associated with increased morbidity and mortality. There are currently no trust guidelines for the diagnostic workup of these patients.Methods: Retrospective analysis was performed of diagnosis and assessment of adult men with low serum total testosterone (TT) and compared with clinical practice guidelines of The Endocrine Society. We identified all patients with...

Background: Neurofibromatosis type 1 (NF1) related Phaeochromocytoma is a rare endocrine disorder and diagnosis is frequently delayed. NF1 is frequently associated with gastro-intestinal stromal tumour but also reported with adenocarcinoma (rare genetic MLH1 mutation). We presented a case where diagnosis of phaeochromocytoma was delayed 5 years after initial symptoms and only incidentally found on scanning at the time of his presentation with colonic...

Background: Neurofibromatosis type 1 (NF1) related Phaeochromocytoma is a rare endocrine disorder and diagnosis is frequently delayed. NF1 is frequently associated with gastro-intestinal stromal tumour but also reported with adenocarcinoma (rare genetic MLH1 mutation). We presented a case where diagnosis of phaeochromocytoma was delayed 5 years after initial symptoms and only incidentally found on scanning at the time of his presentation with colonic...

Introduction: We present a challenging case of central diabetes insipidus secondary to hypothalamic large B cell lymphoma. These are rare tumors accounting for less than 1% of lymphomas. Conventional treatment involves the MATRIX regime (methotrexate, rituximab, thiotepa, cytarabine) chemotherapy, coupled with intensive intravenous fluid therapy to avoid methotrexate toxicity. The main challenges in the management of this case were maintaining fluid and electrolyte balance in ...

Case history: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant disorder caused by heterozygous pathogenic variants in the FLCN gene encoding folliculin on chromosome 17p11, first described clinically in 1975. It is a ‘hamartomatous’ disorder usually manifesting with pulmonary cysts, benign cutaneous tumours and conferring a high risk of renal malignancy. A 43 year old man had a 34 x 22 mm right adrenal nodule discov...

Background: Hypogonadotropic hypogonadism (HH) is commonly associated with morbidly obesity. Gynaecomastia is associated feature of hypogonadism and can be deteriorated by testosterone therapy.History: A 49-year-old gentleman with a BMI of 53.2 kg/m2 was referred for management of obesity. He has two children (age 18 and 22). He had obesity associated comorbidities including obstructive sleep apnoea and impaired fasting glucose. He reported le...

Introduction: Hyponatraemia is the commonest electrolyte disturbance occurring in 15–20% of inpatients (1), with significant clinical implications if mismanaged. We conducted a retrospective audit of our current management of hyponatraemia in our 1000 bedded trust.Method: Data of patients with severe hyponatraemia (Na<125 mmol/l) admitted to hospital over 4 weeks (Aug 2011) was collected. Twenty randomly selected cases were reviewed focusing on ...