Endocrine Abstracts

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fevers and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Stre...

Case history: A 44-year-old gentleman presented to A&E with a 2-week history of fevers and rigors. He gave a background history of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. A vegetation identified on the mitral valve led to an unexpected diagnosis of infective endocarditis. Antibiotic treatment for infective endocarditi...

A 54-year-old man with a recurrent non-functioning pituitary gonadotroph adenoma previously treated with transphenoidal surgery (TSS) in 2015, presented to Charing Cross hospital for repeat transsphenoidal surgery in May 2022. Since his initial surgery, he remained on Levothyroxine 50 μg once daily only. There was no evidence of adrenal insufficiency (0900 h cortisol 333 nmol/l at day 6 following initial TSS). In February 2022, his electrolytes, FSH, LH, testosterone, pro...

Case History: A 54 year old man with type 2 diabetes mellitus was referred in 2014 to our multi-disciplinary foot care service for the management of ulcers. One year previously he had undergone a left hallux amputation due to underlying osteomyelitis. Over the period 2015 through 2021, he required multiple admissions for management of limb threatening foot sepsis with exposed necrotic mid and hind foot bone. In 2016 he suffered a cerebrovascular infarct and in 2019 an episode ...

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

Monogenic diabetes is estimated to account for 1-2% of all diabetes cases diagnosed before the age of 45. It is caused by mutations in genes encoding for beta cell development, function and regulation. We present three cases of monogenic diabetes in pregnancy.Case 1: Age 30, Para 3, White ethnicity. This individual was screened for a GCK mutation at 18 weeks gestation (third pregnancy) on the basis of family history. She required metformin and insulin to...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Case history: A 25-year-old woman presented with secondary amenorrhoea present since aged 18yrs. She had spontaneous albeit late menarche aged 16yrs and five menstrual periods over the subsequent two-years, before complete menstrual cessation. She denied other medical history, psychological stress, excessive exercise, or regular medications. Notably, she reported normal sense of smell via her right nostril, but anosmia via her left nostril. Family history included a diagnosis ...

Case history: Our patient presented with primary amenorrhoea and incomplete puberty aged 15 yrs. Based on BMI >40 kg/m2 from early adolescence, clinical hyperandrogenism, family history of polycystic ovary syndrome (PCOS), and insulin resistance, she was diagnosed with PCOS and commenced on a combined oral contraceptive (COC), achieving breast development. Aged 21yrs, she was reassessed for amenorrhoea of COC. Biochemical assessment revealed hypogonadotrophic hy...

Background: Polycystic Ovary Syndrome (PCOS) and Functional Hypothalamic Amenorrhoea (FHA) are the two commonest causes of menstrual disturbance in pre-menopausal women. In practice, differentiating these two common reproductive disorders can be challenging. A fundamental abnormality that underpins both conditions is altered gonadotrophin releasing hormone (GnRH) pulsatility, being increased in PCOS but reduced in FHA. Likewise, congenital (e.g. congenital hypogonadotropic hyp...