Endocrine Abstracts

Adrenal suppression and iatrogenic Cushing’s secondary to concomitant inhaled steroid and itraconazole is a potentially common and serious drug interaction. A 55 year old patient with bronchiectasis and asthma developed an exacerbation of allergic bronchopulmonary aspergillosis (ABPA). He had been on inhaled fluticasone for over 2 years. He was commenced on itraconazole. The patient was on holiday 6 weeks after itraconazole was commenced when he noted that his face had be...

Paragangliomas are rare tumours that arise from extra-adrenal chromaffin cells within the sympathetic paraganglionic axis. While neoplasms of the adrenal medulla, (phaeochromocytomas) are normally characterized by catecholamine (CA) hypersecretion, paragangliomas can be nonfunctional. We report our findings from 5 patients (4 males, 1 female) with paragangliomas. In 4 out of 5 patients the initial presentation was related to the space-occupying effect of the tumour. Episodic s...

Thyroid associated orbitopathy affects approximately a third of patients with Graves’ disease. It is responsible for significant symptoms, poor quality of life, and if neglected can cause blindness. Early diagnosis of Graves’ ophthalmopathy is paramount as is early detection of sight-threatening disease. All but the mildest cases are best referred to centres who provide multidisciplinary care and have the experience and expertise on managing this condition. Treatment...

The majority of patients with thyroid eye disease (TED) improve spontaneously without any specific intervention. Some have acute sight-threatening complications and most are left with significant disfigurement. Numerous medical treatments have been tried and most do not work. Steroids and orbital irradiation are helpful in some cases, but neither has a major impact on appearance. All patients with TED deserve consideration for rehabilitative reconstructive surgery. The role of...

Permanent hypoparathyroidism is rare after total thyroidectomy. However, our experience is that often patients remain on alfacalcidol and calcium supplements long-term after thyroidectomy.A study was initiated in our centre in 2004, whereby all patients on alfacalcidol or calcium supplements post thyroidectomy underwent a gradual alfacalcidol and calcium reduction programme. Of 57 patients thus enrolled, we report on 22 who were initially on alfacalcidol...

Thyroid nodule is a potential thyroid cancer and hence prompt assessment of all cases is mandatory. Fine needle aspiration (FNA) is a simple and reliable test in the management of thyroid nodule.This is a prospective audit of all new patients with thyroid nodules referred to our endocrine unit in the period between November 2000 to March 2002. 64 patients were identified, 57(89%) of which were females. The mean average age was 49. Thyroid function test w...

IntroductionMilk-Alkali Syndrome is defined by the triad of hypercalcaemia, acute renal failure and metabolic alkalosis. It was first described by Sippy in 1915 after people were treated with the Sippy regimen for peptic ulcer disease.Case reportA 76 year old woman was referred to the Endocrinology Clinic after she was initially presented to the Gastroenterolgy team with altered bowel habits, hypercalcaemia (...

High dose steroids are effective in treating active thyroid-associated ophthalmopathy (TAO), however the side effects are considerable. This study aimed to establish whether long term response to intravenous methylprednisolone can be predicted by a detailed ophthalmological assessment 1 to 2 weeks after the first dose of steroid.45 patients with moderate to severe, active TAO (including 31 with optic neuropathy), treated with intravenous methylprednisolo...

Acromegaly and thyroid-associated ophthalmopathy(TAO) are uncommon diseases with different pathogenetic mechanisms.We report two patients with acromegaly and TAO and speculate on a possible association.A 54 year old man with subclinical hypothyroidism and strongly positive thyroid microsomal antibodies presented with features of TAO.MRI of his orbits confirmed the diagnosis.Clinical examination also revealed features suggestive of acromegaly,which was co...

A recognised complication of small cell lung cancer is adrenocorticotrophic hormone hypersecretion (ACTH). The profound biochemical derangement and subsequent symptomatology can be resistant to established medical therapeutic interventions. Our case illustrates the role of low risk palliative laparascopic surgery for resistant disease.Mr SR, a 47yr ex-smoker presented with breathlessness and haemoptysis of 3 months duration, there was no past medical or ...