Endocrine Abstracts

Background: It is well documented that some patients with hypothyroidism continue to be symptomatic despite normalisation of TSH levels with T4 mono-therapy. The Royal College of Physicians 2008 statement recommends that T4 alone should be used for the treatment of hypothyroidism with no recommendation for additional T3 therapy. However, the Internet has many reports of symptomatic benefit on combination therapy and patients may present to the outpatient clinic requesting T3 t...

We present a 65-year-old lady initially diagnosed and treated for epilepsy who was subsequently referred 10 years later for the investigation of underlying spontaneous hypoglycaemia. Laboratory plasma glucose concentrations of 2.0 and 1.7 mmol/l were recorded prior to referral and subsequently a fasting challenge provoked hypoglycaemia associated with a plasma glucose of 0.8 mmol/l, C-peptide 371 pmol/l (NR 120–600) and insulin 7.4 mU/l (NR 0–10). CT and MRI imaging ...

An 88 year old female presented with gradually worsening stridor and dysphagia. Her past medical history was complex and included included ischaemic heart disease and atrial fibrillation treated with warfarin. She had been initially referred for enlargement of her lonstanding goitre 6 years ago (2012) with investigations demonstrating a suppressed TSH and a normal FNA cytology. Respiratory function tests did not show any significant extra thoracic compression, but her CT scan ...

Aim: To determine whether the ratio of T3 to TRAB (TSH Receptor Antibody levels) could be used to identify those patients with Graves’ thyrotoxicosis who cannot be controlled with antithyroid drug (ATD) therapy and those who will relapse within 2 years of discontinuation of ATD therapy.Method: Retrospective analysis of 22 patients with Graves’ disease and their relapse at 2 years after discontinuation of ATD therapy. Patients were diagnosed wit...

Phaeochromocytomas show a positive correlation between tumour size, metanephrines level and symptoms. Small tumours (<1 cm) are usually asymptomatic and are picked up through hereditary screening or surveillance of previous tumours. We present a 72-year-old gentleman who was referred to the Endocrinology service with symptoms of palpitations, sweating, dizziness and hypertension for several years. He was investigated for palpitations but no cardiac arrhythmias were present...

Langerhans Cell Histiocytosis is an inflammatory myeloid neoplasia caused by mutations of several genes in the MAPKinase (MAPK) pathway which can present in single or multiple sites. Our patient presented to her GP with several months of amenorrhoea, thirst, tiredness and 3 stone weight loss. She was previously fit and well, working, and married with children. Blood tests revealed panhypopituitarism with low 9am cortisol 117 nmol/l (133-537). Oestrogen and gonadotrophins were ...

Anabolic androgenic steroids (AAS) are class C drugs with adverse effects on health. Prevalence is increasing, often with a lack of awareness of the dangers. We present the case of a 33 year-old male with dilated cardiomyopathy and polycythaemia apparently due to AAS abuse over three years. The patient presented with five weeks of increasing breathlessness and chest tightness. Examination revealed evidence of congestive cardiac failure. Chest radiograph showed evidence of pulm...

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...

A frail, long-term surgical inpatient, was under-nourished on TPN. He had a tendency towards hypocalcaemia and was under regular review by the surgical and nutrition team. It was noted on his routine monitoring that his Ca had fallen to 1.78 mmol/l (2.2-2.6 mmol/l). He was reviewed out-of-hours and prescribed 10mls of 10% Calcium Gluconate infused over 10 minutes, as per the hospital guidance for the treatment of hypocalcaemia. A further prescription of calcium gluconate 10% i...