Endocrine Abstracts

Primary Aldosteronism (PA) is caused by autonomous aldosterone production from the adrenal cortex (due to hyperplasia, adenoma or rarely carcinoma) and diagnosis is confirmed by elevated plasma aldosterone level with suppressed renin activity and localized further by CT scan of the adrenal glands and selective adrenal venous sampling (AVS) if required. On the other hand, Addison disease (also known as primary adrenal insufficiency) which represents the other face of the coin i...

Introduction: Non-diabetic hypoglycaemia (NDH) has many causes including insulinoma, non-insulin producing cancers and gastric bypass surgery but medications like fluoxetine are rarely reported.Case history: 55 years female, university lecturer, history of Roux-en-Y gastric bypass in 2015 and depression, referred for recurrent symptomatic hypoglycaemia 1 to 2 hours post-meal (reactive hypoglycaemia) with recorded capillary blood glucose up to 1.6 mmol/l ...

A 32-year-old gentleman, of South-Asian origin was admitted with a 4-week history of abdominal pain, nausea and vomiting. He also had history of polyuria, polydipsia and weight loss over 6 weeks. Just prior to these symptoms he had been started on colecalciferol 20 000 units weekly by his GP for Vitamin D deficiency (25(OH) Vitamin D – 10.3 nmol/l (48–145)). On admission he had adjusted calcium of 4.52 mmol/l and acute kidney injury with his eGFR being 38 ml/min per ...

A 37-year-old gentleman was admitted following a GP referral for asymptomatic hypercalcaemia. His adjusted calcium was raised at 3.27 mmol/l while phosphate level was normal. The only past medical history was borderline hypertension which was being monitored in primary care. His PTH level was suppressed at 0.43 pmol/l l (1.1–5.5) while 25(OH) Vitamin D was normal at 71.6 nmol/l (48–145). Twenty-four hours urinary metadrenalines were normal. His full blood counts were...

Background: Glucokinase (GCK) is a gene which plays an important role in recognising how high the blood glucose is in the body. It acts as the glucose sensor for the pancreas. Changes in the GCK gene can lead to increases in blood glucose and affected people may be diagnosed with diabetes although this rise in blood glucose is mild and does not need treatment. Glucokinase diabetes is one of familial diabetes types that called MODY (maturity onset diabetes of the young). We rep...

Introduction: DKA is often seen in people with Diabetes Mellitus I and seldom in Diabetes Mellitus II but rarely seen in Maturity Onset Diabetes of Young (MODY) and even more rare in association with SGLT2i.Case history: 44 years female, genetically confirmed Hepatocyte Nuclear Factor 1 alpha (HNF1A) MODY since 2004 initially treated with maximum doses of metformin and gliclazide and then lost to follow-up. GP initiated Empagliflozin a year before presen...

Multiple parathyroid tumors causing hyperparathyroidism are the most common manifestation of multiple endocrine neoplasia type 1 (MEN1), displaying almost 100 percent penetrance by age 40–50 years. In most cases, it is the initial manifestation of MEN1.We report a case of young lady presented to hospital with diarrhoea and vomiting and diagnosed to have multiple peptic ulcers with severe oesophagitis. Her other biochemistry was consistent with prima...

Introduction: Vitamin D deficiency occurs more frequently in patients with primary hyperparathyroidism compared to general population, and is usually associated with an aggravated form of the disease. Current guidelines recommend measurement of vitamin D level in all patients with primary hyperparathyroidism, and their repletion if the levels are <50 nmol/l.Case report: We present a 56 years old Caucasian lady who underwent right parathyroidectomy &#...

A 37 year old gentleman with no significant past medical history presented with 2 day history of acute onset headache, nausea, vomiting, photophobia and fever. He was pyrexial. He had no focal neurological deficit but marked neck stiffness. His inflammatory markers were raised. CT head showed large pituitary tumour. He was started on Dexamethasone and IV Ceftriaxone and transferred to tertiary centre. MRI brain showed large pituitary macroadenoma projecting into right cavernou...

Gonadotroph pituitary adenomas are common but majority of them are classified as non-functional as they do not lead to features of hormonal excess. Functional gonadotroph adenomas are rare and there are only few small series or individual case reports about these.Case report: 45-year-old gentleman presented with headaches, progressive visual failure and complaint of excessive tiredness. He had normal libido and had an 8-year-old child. On examination, he...