Endocrine Abstracts

• In healthy adults, hyperinsulinaemic hypoglycaemia is rare and therefore needs further investigation. Such a state invariably indicates endogenous insulin secretion after a careful history has ruled out Sulphonylurea abuse. Optimal diagnostic and management strategies remain a challenge. A recent observational study in a tertiary Centre in Cambridge has identified 29 cases over a 13-year period and has found great value of the 48-h fast in diagnosing insulinoma a...

Lithium-induced Nephrogenic Diabetes Insipidus is the commonest type of Nephrogenic Diabetes Insipidus. Management remains challenging even when Lithium is discontinued as non-reversibility of Diabetes Insipidus can be irreversible. Possible treatment options include Hydrochlorothiazide, Amiloride or Acetazolamide. We report a case of possible Nephrogenic Diabetes Insipidus 1 year after discontinuation of Lithium. Our patient is an 85-year old lady who was referred for an Endo...

Secondary causes for Hypertension account for 5% of hypertension cases. Renal Artery Stenosis due to Fibromuscular Dysplasia is an uncommon cause of Secondary Hypertension. This is a case of a 35-year old lady who presented with headache and vomiting and was found to have malignant hypertension with resultant acute left caudate nucleus infarct in the brain. A mild hypokalaemia on admission prompted measurement of renin and aldosterone which were both elevated. She also had ele...

Patients with Familial Hypercholesterolaemia (FH) have premature Cardiovascular disease and have a standardised mortality ratio nine times greater than normal. FH must therefore be correctly diagnosed and treated aggressively. Referral for FH is based on fulfilling the Simon Broome’s (SB) Criteria. We aimed to evaluate practice at Queen Alexandra Hospital with regards to referral for FH genetic mutation. We set out to see whether SB’s criteria were being fulfilled wh...

Background: Severe hyponatremia can be associated with oxytocin infusion. The incidence of hyponatraemia after oxytocin is around 5%. There are reported cases of serious neurological complications including seizures, coma and maternal death.Case report: A 37-year-old female with known partial central diabetes insipidus following a head injury was established on Desmopressin nasal spray 10 mg twice a day. She had an uneventful pregnancy on the same dose. ...

Thyrotoxicosis is a relatively common condition affecting 1–2% of women and 0.1–0.2% of men. Common symptoms are usually straightforward and easily identified. Rarer presenting features such as confusion and headache have been published in the literature as case reports. We hereby report two cases of Graves Thyrotoxicosis presenting unusually and therefore misleading the initial diagnostic pathway. The first case is a 45-year-old female with a 4-day history of headac...

Case History: This is a 73 year old lady with known Type 2 Diabetes Mellitus who presented to Acute Medicine with a 2-week history of diarrhoea and acute confusion on a background of a 4-month history of gradual cognitive and functional decline. She was treated for low-respiratory tract infection with acute kidney injury on a background of age-related functional decline. CT brain was organised.Investigations: CT Brain: Large enhancing soft tissue dense l...

Background: Transsphenoidal surgery is the primary therapy in majority of Acromegaly patients with GH-secreting somatotroph adenomas. Reported outcomes of surgery show an initial remission rate of 40–50% for macroadenomas and >85% for microadenomas. Rates of hypopituitarism following endoscopic pituitary decompression vary between 5 and 25%. Invasion of cavernous sinus indicates the tumour is unlikely to be resectable.Methods: We audited the res...

Sertoli-Leydig cell tumours are rare comprising 0.2–1.2% of all primary ovarian cancers. Virilisation is seen in 30–50% of cases. Heterologous Sertoli-Leydig cell tumours with dominant cystic component are even rarer and mainly affect females aged 20 to 30 years. A 66-year-old lady was referred to the Endocrine Department with a one year history of rapid severe hirsutism involving the limbs, abdomen, chest, face and thinning of hair on the scalp. Blood pressure of 15...

Case History: A 61-year-old Caucasian female from Ukraine presented with severe hypercalcaemia following routine blood tests performed by the GP. She reported symptoms of back pain and joint pains. She had renal stones 10 years prior. No history of thiazide or lithium use. No red flags; no change in appetite or weight loss. There was no familial history of Multiple Endocrine Neoplasia (MEN). Examination of her neck, cardiorespiratory, abdomen and breasts were normal. <p cl...