Endocrine Abstracts

Case history & Management: A 36-year old lady of Lithuanian descent first presented in 2011 with secondary infertility due to hyperprolactinaemia of 1554 (N=0–500). Her MRI was normal and was started on Cabergoline which was stopped 5 months later when she became pregnant. She delivered normally but was thereafter lost to follow-up. She was referred back in 2014 with galactorrhoea and hyperprolactinaemia (6856) and MRI this time showed a 0.7 mm microprolactin...

Introduction: Hypothyroidism (HypoT)-related polyneuropathy is reported to range between 42 to 72%. However, there is paucity of information regarding the prevalence and clinical course of small fibre neuropathy in HypoT. This prospective study examines small fibre function (SFF) – using the Laser doppler imager flare (LDIFLARE) technique – and structure (SFS) using in-vitro corneal confocal microscopy (IVCCM) in a cohort of HypoT subjects before ...

Prepubertal gynaecomastia may be due to increased oestrogen resulting from excessive aromatase activity in extra glandular tissues. CYP19A1 gene on chromosome 15q21.2 encodes aromatase, the key enzyme for oestrogen biosynthesis. Tissue-specific promoters regulating the expression of aromatase activity have been demonstrated in placenta, ovary, testes, brain, skin fibroblasts and adipocytes. Mutations involving aromatase cytochrome P450 (P450arom) have been reported ...

A 37-year healthy man initially presented to primary care with weight loss and palpitations and diagnosed to have thyrotoxicosis based on thyroid function tests (TFT) – TSH (< 0.05; n = 0.27-4.20μIU/l), FT4 (59.8; n = 12-22 pmol/l), and FT3 (32; n = 3.1-6.8pmol/l) . CBZ was started and 4-weeks later was seen in the Endocrine clinic where Graves’ disease was confirmed based on a goitre and positive antiTSH receptor antibody. However...

Aims: The short synacthen test (SST) is considered as the gold standard test to assess the viability of the hypothalamic-pituitary-adrenal axis. This study explores the appropriateness of its clinical use in a district general hospital. Furthermore, it assesses the effectiveness of the alternate use of 9AM cortisol in excluding hypoadrenalism and the cost-effectiveness of sampling both 30 and 60 minutes serum cortisol in SST.Me...

Aims: The short synacthen test (SST) is considered as the gold standard test to assess the viability of the hypothalamic-pituitary-adrenal axis. This study explores the appropriateness of its clinical use in a district general hospital. Furthermore, it assesses the effectiveness of the alternate use of 9AM cortisol in excluding hypoadrenalism and the cost-effectiveness of sampling both 30 and 60 minutes serum cortisol in SST.Me...

Factitious hypoglycaemia is characterised by high insulin levels but accompanied with low Proinsulin and C-peptide levels and a negative sulfonylurea screenWe present a 54-year-old woman who was initially diagnosed with type 2 diabetes in 2002 and by 2004, she was converted to insulin treatment due to poor tolerance to Metformin. She also had a previous history of Manic depressive psychosis and treated with lithium.In the months pr...

Case history: A 54-year-old man was admitted with a history of syncopal episodes. Orthostatic hypotension led to an endocrine referral and subsequent diagnosis of pan-anterior hypopituitarism but with no evidence of posterior pituitary involvement. Although an initial aetiological diagnosis remained elusive, further work-up (see below) led to a histology-confirmed diagnosis of ACE-negative neurosarcoidosis. This diagnostic conundrum could have been contributed by a prior neuro...

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is regarded as a precursor to the development of carcinoid tumorlets. It is confined to the neuroendocrine cell of the airway mucosa without penetration through the basement membrane and appears in a diffuse pattern, typically in association with obliterative bronchiolar fibrosis. DIPNECH belongs to the preinvasive lesions defined by the 1999 World Health Organization classification, along with atypical ade...

TSH secreting tumours (TSH-omas) are uncommon, accounting for less than 2% of pituitary tumours. Typically, patients with such tumours demonstrate hyperthyroidism with detectable or elevated TSH levels, and show little response to TRH stimulation. Treatment is controversial: typically surgery, radiotherapy or somatostatin analogues.We present a 22 year-old man who was found to be tachycardic on joining a gym in 2003. There were no other symptoms or signs...