Endocrine Abstracts

Introduction: Hypophysitis has been recognised as a frequent endocrine related side effect of immunotherapy with the CLTA-4 inhibitor Ipilimumab, with a prevalence of upto 17.4%. The most common symptoms of hypophysitis are headache and signs/symptoms of hypopituitarism. Whilst some patients have an enlarged pituitary on MRI, this is frequently normal. ACTH and TSH deficiencies are most common, but all anterior and posterior pituitary hormonal axis may be affected. Hypopituita...

Case history: Case 1: 18-year-old female referred with asymptomatic hypercalcaemia (adjusted calcium 2.69 mmol/l), phosphate 0.96 mmol/l, parathyroid hormone 2.6 pmol/l and total 25 hydroxyvitamin D 37 nmol/l. No evidence of end organ damage. Initial calcium: creatinine clearance ratio 0.0033 but the patient had a vitamin D 24 nmol/l. Case 2: A 53-year-old female referred with asymptomatic incidental hypercalcaemia (adjusted calcium 2.73–2.87 mmol/l), raised parathyroid h...

A 46-year-old lady was referred to endocrinology with thyrotoxicosis. She was diagnosed with Graves’ disease by her GP in October 2016 when presenting with classical symptoms and investigations [TSH<0.01 mIU/L (NR 0.3–4.2), fT4=34.3 pmol/L (NR 9–23), TSHrAb>30 u/mL (NR<0.4), and increased iodine uptake]. She was therefore started on carbimazole 15 mg/day. She returned to her GP in December 2016 reporting resolved symptoms, however, she ...

A 46-year-old lady was referred to endocrinology with thyrotoxicosis. She was diagnosed with Graves’ disease by her GP in October 2016 when presenting with classical symptoms and investigations [TSH<0.01 mIU/L (NR 0.3–4.2), fT4=34.3 pmol/L (NR 9–23), TSHrAb>30 u/mL (NR<0.4), and increased iodine uptake]. She was therefore started on carbimazole 15 mg/day. She returned to her GP in December 2016 reporting resolved symptoms, however, she ...

A 49-year-old female was admitted to with diabetic ketoacidosis (DKA) and newly diagnosed diabetes. Her only significant medical problem was malignant hypertension with poorly controlled blood pressure (BP) on four antihypertensive agents. She reported no exogenous glucocorticoid or liquorice ingestion. She also complained of a 6-month history of lethargy, weight gain, and a two-month history of easy bruising, lower-limb weakness, increasing polyuria and polydipsia. There was ...

A 49-year-old female was admitted to medical HDU with diabetes ketoacidosis (DKA) and newly diagnosed diabetes. Six months previously she was diagnosed with malignant hypertension. She had poorly controlled blood pressure despite treatment with four anti-hypertensives, which were her only regular medication. She had never used any medications or creams containing glucocorticoids. She had no history of hypokalaemia and reported no use of liquorice. She recently attended an outp...

A key component of androgen synthesis is the availability of the pro-hormone DHEA, which is either converted to active androgens or inactivated to its sulfate ester DHEAS by DHEA sulfotransferase (SULT2A1). The latter reaction requires provision of the universal sulfate donor 3′-phosphoadenosine-5′-phosphosulfate, PAPS. In humans, PAPS is generated by the PAPS synthase isoforms PAPSS1 and PAPSS2. Recently, inactivating PAPSS2 mutations have been identified i...

Hyponatraemia is the commonest electrolyte disturbance in clinical practice and accounts for 15–20% of emergency admissions to hospital. It is thought that up to 30% of hospitalized patients develop a degree of hyponatraemia at some point during their admission. It is therefore an important problem. Management of inpatients with hyponatraemia remains problematic and an audit of our practice at St Mary’s Hospital, Imperial College Healthcare NHS Trust, has confirmed t...

A 58-year old previously independent man with background of poorly-controlled hypothyroidism, T2DM, hypertension, ischaemic cardiomyopathy, and CKD presented to hospital feeling generally unwell, with a dry cough. His regular medications included anti-hypertensives, L-thyroxine 50 μg daily, linagliptin, insulin, aspirin, atorvastatin, and thiamine. On admission, the TSH was 83 mIU/l, free T4 6.5 pmol/l and free T3 was 1.9 pmol/l; four months earlier, the TS...

Case history: A 55 year-old female presented to A&E with left iliac fossa pain and vomiting, 8 days following her first dose of the AstraZeneca COVID-19 vaccine. She had a background of hypothyroidism, hypertension and hysterectomy for menorrhagia at age 25 – no prior thrombotic history. She underwent emergency laparoscopy for suspected torsion, which was converted to laparotomy for ovarian necrosis secondary to left ovarian vein thrombosis. Post-operatively, isolated...