Endocrine Abstracts

We are presenting a common case of diagnostic dilemma with hypercalcemia.This 66 year female patient was referred to Endocrine clinic with hypercalcemia. She was asymptomatic with blood tests showing C.Calcium of 2.73 mmol/l. This was followed by investigations to rule out primary or tertiary hyperparathyroidism.Blood tests revealed high PTH of 12.2 pmol/l with low 25OH Vitamin D of 37 nmol/l, suggesting a diagnosis of tertiary hyp...

Myxoedema coma or severe decompensated hypothyroidism is rare but has high mortality; appropriate early recognition and treatment is essential. We present a case of severe hypothyroidism with multi organ failure. A 58-year-old lady with several months’ history of loss of appetite, tiredness and hair loss presented with progressive lethargy, sleepiness and abdominal distension for 1 week. On admission she was very drowsy, had a doughy dry skin and facial puffiness. Large a...

We present here a case of diagnostic dilemma in a 34-year female presenting with Amenorrhoea. She was recently married and saw GP for infertility and history of hot flushes, melasma and migraine. Clinic history revealed primary amenorrhoea diagnosed in Brazil at age 15. Patient was told she was born without ovaries and was started on Premarin (oetrogen). She had normal female secondary sexual charcteristics, functional female genitalia and growth. On examination, she had a nor...

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) partic...

Introduction: The thyroxine absorption test (TAT) is well established to investigate persistently raised TSH in patients on L-thyroxine. We review our experience with this test.Method: Blood was taken for baseline FT4, FT3, TSH measurements and malabsorption screen. A week’s supply of L-thyroxine (1.6 mcg/kg×7) was administered orally under direct supervision and FT4 and TSH measured 2 h later. Patients continued o...

Aim: To investigate the relationship between baseline and stimulated cortisol responses in relation to the habitual time of rising and time of test.Method: The self-reported habitual rising time and time of cortisol testing were recorded in 63 consecutive patients (47F, 17M, age 18–94) undergoing standard stimulation testing with tetracosactide (SynActhen) 250 μg i.v. In total, 75 tests were analysed. A normal response was defined as a 30 min p...

Introduction: Hyponatraemia is not uncommon in primary care and its management can be complex. It is vital that initial assessment is carried out properly as mismanagement can have serious consequences.Aim: To investigate general practitioners’ views and perceptions on the management of hyponatraemia encountered in primary care.Method: Local general practitioners were surveyed with a questionnaire via email and at local postgr...

Introduction: Hyperthyroidism may mimic many conditions, and there is potential for under-diagnosis if testing is considered only in patients presenting with classical symptoms.Aim: To describe the range of presentations in patients found to have hyperthyroidism and referred from primary care.Method: Consecutive patients diagnosed with hyperthyroidism and referred to the endocrine clinic between Jan 2009 and Nov 2009 were studied. ...

Introduction: Hypocalcaemia is a rare presentation of thyrotoxicosis. We describe a patient with severe life-threatening hypocalcaemia and suggest pathogenic mechanisms.Case report: A 66-year old lady with long-standing insulin-treated type 2 diabetes presented acutely with generalised weakness and a collapse at home. Prior to admission, she had been treated for an infected neuro-ischaemic plantar ulcer with broad-spectrum antibiotics. She had developed ...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...