Endocrine Abstracts

Neuroleptic-induced hyperprolactinaemia (NIHP) is a recognised complication of neuroleptic drug therapy.Pituitary tumours however may exist co-incidentally in patients on neuroleptic medications and contribute to hyperprolactinaemia. A potential pitfall is to attribute the elevated prolactin level to drug therapy alone particularly when treatment with neuroleptics has been longstanding.A 35 year old woman with bipolar affective disorder was referred with...

Secondary causes of diabetes are uncommon. As 50-80% of patients with diabetes have co-existing hypertension, a high index of suspicion is required to exclude a secondary cause in patients presenting with both conditions. Atypical presentations may delay the diagnosis.A 49 year old man presented with a one year history of polydipsia, polyuria and fatigue. Diabetes was diagnosed with a random blood glucose (RBG) of 12 mmol/l. Hypertension diagnosed 15 yea...

Primary adrenal tumours are responsible for about 10% of cases of Cushing's syndrome. Adrenocortical carcinomas are rare with an incidence of 2 per million per year. Both adrenocortical adenomas and carcinomas occur more commonly in women.A 46 year old previously fit woman presented with a short history of hirsutism, facial plethora, amenorrhoea, acne and progressive weight gain. Hypertension and glucose intolerance had been diagnosed recently. There was...

Background: The absorption kinetics of soluble insulin are complex. Soluble insulin is absorbed after a delay as the hexameric form dissociates before being absorbed as the dimer.Patients using soluble insulin are instructed to inject 15-30 minutes before meals.In practice few patients comply with these recommendations.The aims of this study were to identify the proportion of patients injecting at the recommended time and to assess any association between injection timing and ...

Hyperthyroidism is diagnosed in pregnancy in about 0.1 - 0.4% of patients. Graves' disease is the commonest cause of thyrotoxicosis in pregnant women. The natural course of Graves' disease in pregnancy is characterised by an exacerbation of symptoms in the first trimester and during the post partum period. Symptoms usually tend to improve in the second half of pregnancy.We describe a patient who was diagnosed with Graves' disease in the third trimester of pregnancy. A 32 y...

Introduction: We present a case of probable cyclical Cushing’s syndrome (CS) masquerading as polycystic ovarian syndrome (PCOS) which went undetected for almost a decade. Our case highlights the subtleties and complexities of interpreting diagnostic tests in patients with cyclical endogenous hypercorticolism.Case: A 33-year old female with presumed PCOS presented with a seven year history of persistent hirsutism and acne. However there was no menstr...

Introduction: Giant prolactinomas are uncommon tumours and typically exceed 40 mm. These tumours are locally invasive but still respond to dopamine agonist therapy. The medical management of cystic giant prolactinomas with dopamine agonists is controversial as the non-solid components of these aggressive tumours are believed to respond poorly to drug therapy. We present a case of a giant cystic invasive prolactinoma masquerading as a multilobular schwannoma that was successful...

Case History: A 60 year old female presented with anxiety and weight loss. Serum free T4 was 50 pmol/l (normal 12-23). Despite restoring T4 to normal, symptoms persisted and included flushing attacks. Urine 5-HIAA was elevated (182 micro moles/24 hrs; normal 0-40).Tests were done to locate the primary and secondary carcinoid tumour.Investigations: CT of thorax and abdomen, and ultrasound of abdomen were negative. Routine biochemistry and haematology were...

The porphyrias encompass a group of disorders characterized by inherited or acquired derangements in the biosynthesis of heme.Porphyria cutanea tarda is the most common form and is characterized by chronic skin lesions and hepatic disease.It may rarely be complicated by hepatocellular carcinoma. We present a 67 year old man who presented with hepatocellular carcinoma on a background of previous porphyria cutanea tarda.The patient was diagnosed with Type ...

Introduction: Graves’ thyrotoxicosis and Addison’s disease are disorders with a strong auto-immune basis. Primary hypothyroidism and Addison’s disease are recognised components of polyglandular autoimmune syndrome type II (PGA-II). Despite its autoimmune etiology, Graves disease is not commonly associated with PGA-II. We present a case of a patient with newly diagnosed Graves’ disease presenting in incipient adrenal crisis due to unrecognized Addison’s...