Endocrine Abstracts

43-year-old lady with a history of rheumatoid arthritis (On Sulfasalazine and Infliximab IV every 8/52), was brought in to our hospital following a collapse. She had had acute onset of headache 6 weeks prior to admission with nausea, vomiting and blurred vision but her symptoms had gradually resolved. Her GCS on arrival was 5. Subsequent CT scan brain showed acute right-sided subdural haematoma and subarachnoid haemorrhage and was indicative of coning. She was taken to theatre...

A 49 year old gentleman was diagnosed with a pituitary macroprolactinoma at Leicester Royal Infirmary (LRI) (Baseline prolactin 8000 mU/l). He was treated with Cabergoline 0.5 mg twice/week. He developed CSF rhinorrhoea shortly after treatment was commenced and was listed for repair under the neurosurgical team at Queen’s Medical Centre (QMC). Six weeks later, while visiting Wales, he was admitted to Bangor hospital with headaches and vomiting. CSF cultures were positive ...

A 52 year old lady presented with a history of weight loss, tachycardia and tremor. She was diagnosed with primary hyperthyroidism; TFTs were TSH <0.02 mU/l and FT4 >100 pmol/l, LFTs were mildly deranged (ALT 79 u/l, ALP 101 u/l). TSH receptor antibodies were positive, suggestive of Graves’ disease.The patient was started on carbimazole, initially at 10 mg TDS which was titrated down to 5 mg TDS. Repeat LFT showed ALP at 219 u/l and a fluctu...

Introduction: Patients with diabetes mellitus require insulin with disease progression to attain or maintain glycaemic targets. Patients and physicians work together to balance the advantages of improved glycaemic control with the risk of hypoglycaemia and increasing regimen complexity. Insulin Degludec (Tresiba) is an ultra-long-acting insulin analogue launched in the UK in March 2013 and is available in two strengths, 100 and 200 units/ml.Method: Retro...

Xerostomia can be classified into two different types. One type is associated with severely reduced salivary secretion. The other involves normal salivary function yet reduced viscosity of saliva or reduced mucin concentration within the saliva, a common finding in elderly people. Studies show that xerostomia is the most common oral side-effect of cardiovascular medication. Statins are common cardiovascular drugs used to treat hypercholesterolemia. A 55-year-old Asian lady, no...

Introduction: Turner Syndrome is a chromosomal disorder that is characterized by short stature and gonadal dysgenesis, affecting 1 in 2500 female live births. It is associated with a wide variety of conditions that could lead to significant morbidity and mortality if not followed up and managed appropriately. A multidisciplinary approach is important in the management of these patients. This audit aims to review the current practice of a specialist Turners Syndrome clinic in a...

Acromegaly prevalence is 2.8–13.7 cases per 100,000. Diagnosis at the early stages can be quite challenging and management is complex involving various specialties to achieve remission of the condition. September 2013, 49 year old lady presented to optometry with few months of bumping into things. She was later found to have superior bitemporal hemianopia. She later described having to change her wedding rings multiple times over the past year with increase in size of sho...

Introduction: In 2003, the UK National Institute for Clinical Excellence (NICE) established guidelines on the use of GH in adults. These guidelines state that recombinant GH should be used only for adults with a severe GH deficiency that severely affects their quality of life. To assess current practice in relation to these guidelines, a review of patients receiving GH treatment was performed. The aims were to assess if adults with GH deficiency met NICE criteria for GH therap...

A 57-year-old gentleman presented with bilateral painless submandibular swelling, and flu like symptoms. A biopsy from the enlarged submandibular gland showed chronic sclerosing sialadenitis with lymphocytic infiltration. Immunohistochemistry showed plasma cells positive for CD79a and IgG4, and a combination of CD4 and CD8 positive lymphocytes. IgG4 levels were significantly raised (3.16 g/l, NR <1.3 g/l). A diagnosis of IgG4 syndrome was made. Chest and abdominal CT imagi...

Aim: To evaluate the use of Denosumab in accordance to the UK National Institute of Health and Care Excellence (NICE) technology appraisal guidelines TA204 – Denosumab indicated for the prevention of osteoporotic fractures in post-menopausal women.Methods: A retrospective audit involving 129 patients prescribed Denosumab for osteoporosis between October 2011 and March 2015 at Nottingham University Hospitals, UK. Denosumab prescription data was obtai...