Endocrine Abstracts

Familial Hypophosphatemia is an inherited disorder of bone metabolism that affects 1 in 20 000 new-borns. The X-linked dominant form of the disease results from a genetic mutation of the PHEX gene. This leads to disordered regulation of fibroblast growth factor 23 resulting in reduced phosphate renal reabsorption and vitamin 1α Hydroxylation. Clinical features include short stature, rickets, craniosynostosis and dental abnormalities.Case: A 29 year ...

Armour thyroid is desiccated porcine extract which is a historical treatment for hypothyroidism. It contains both L-thyroxine and liothyronine. Each grain (60 mg) contains 38 μg of L-thyroxine and 9 μg liothyronine. Since the 1960’s its use has been superseded by L-thyroxine. Due to limited clinical effectiveness studies, it is not licensed for use in the United Kingdom. We present a case of Armour thyroid use in preg...

Background: A 23-year-old woman diagnosed with Dunnigan-type familial partial lipodystrophy (FPLD) attended the joint Antenatal/Endocrine Clinic at 13 weeks of gestation. She was diagnosed at age 7 and subsequently developed type 2 diabetes at age 11 years. She was managed initially with metformin followed by addition of insulin. It was an unplanned pregnancy and her booking HbA1c was 8.4% (IFCC 68 mmol/mol).Prior to pregnancy, she was on a basal bolus r...

Introduction: Hypoglycaemia remains the major barrier to tight glycaemic control in diabetes. Oral hypoglycaemic agents such as sulphonylureas (SU) remain one of the main options for managing type 2 diabetes mellitus (T2DM), but the glucose independent action is associated with an increased risk of hypoglycaemia. We present a retrospective audit of patients attending the A&E Department with severe hypoglycaemia at a large acute trust serving a population of 450 000.<p ...

We present two thyroid antibody positive euthyroid women with history of recurrent miscarriage who had successful pregnancy outcome when treated with levothyroxine.A 31-year-old Caucasian lady was referred to our endocrine services with a history of three previous miscarriages. She had strongly positive thyroid peroxidise antibodies (TPO) with normal thyroid function tests.We commenced her on 25 μg of levothyroxine. Within two...

Introduction: Cushing’s syndrome can impair the gonadotrophic axis in women of child bearing age if left untreated. Furthermore undergoing endoscopic transphenoidal surgery can render patients hypogonadal, thereby reducing the chances of spontaneous conception. In such cases, pregnancy is usually achieved by assisted contraceptive techniques. We present a case of spontaneous pregnancy following transphenoidal surgery and bilateral adrenalectomy.Case...

Background: Immunotherapy with checkpoint inhibitors (CPI) {CTLA4 and PD-1 inhibitors} have significantly improved outcomes and survival rates in patients with a number of cancers. In the UK, Ipilimumab and Nivolumab are approved for the treatment of advanced malignant melanoma. These are often long term therapies and are associated with immune mediated endocrinopathies.Case: A 70 year old male presented to the Medical Admissions Unit with a history of l...

Case history: A 22-year-old lady was referred to the thyroid eye clinic with bilateral proptosis following a routine visit to the opticians. She had a 2-year history of thyrotoxic symptoms, which had been getting worse over the past 4 months.She had signs of severe thyrotoxicosis and was clinically in atrial fibrillation (AF) with a central heart rate of 195 beats/min. Neck palpation revealed a moderate-sized smooth and symmetrical goitre with no bruits ...