Endocrine Abstracts

A 37 year old woman presented to A&E with symptoms of hyperemesis gravidarum. She was 9 weeks pregnant, in her third pregnancy. It was noted that her calcium level was 3.13mmol/l, PTH 12.1 pmol/l, vitamin D 42nmol/l. She was treated with IV fluids and discharged with endocrine follow up. The endocrine and obstretric teams arranged for an urgent review on the antenatal ward the next week. Calcium was still raised at 3mmol/l. She was admitted overnight for antiemetics and IV...

Hyperthyroidism commonly affects women of child-bearing age. Use of carbimazole in the first trimester of pregnancy has been shown to be associated with certain congenital abnormalities, such as aplasia cutis, choanal atresia, dysmorphic facial features, abdominal wall and gastrointestinal tract defects, in up to 2% of cases. The MHRA issued a Drug Safety Alert in February 2019, recommending to strengthen the advice on contraception given to women of child-bearing age who need...

Section 1: Case history: A 39-year-old Asian lady at 18 weeks of gestation, after in vitro fertilisation pregnancy, was found to have an adjusted calcium level of 3.08 (range 2.20-2.60 mmol/l) on routine blood tests. She was asymptomatic. Her Parathyroid hormone (PTH) was 14.1 (1.1-6.9pmol/l) and 25 hydroxy vitamin D 16 (15-174 nmol/l). She had insulin treated diabetes following an episode of pancreatitis for which no cause was identified. She was treated as an inpati...

Case History: 41-year-old female presented with a 3-day history of fever, cough, and breathlessness. She had palpitations, diarrhoea and weight loss of 4-5 kg over 1 month. Graves” disease had been diagnosed 5 years prior to this episode and she had been treated with carbimazole but was not in remission. On this occasion, she was febrile and had atrial fibrillation. She also had right pleural effusion and bilateral pedal oedema.Investigations: Blood...

Malignancy-related hypercalcaemia occurs in over 20% of cancer patients. Most cases are due to enhanced production of parathyroid hormone-related peptide (PTHrP) by tumours and carry a poor prognosis of survival of weeks to months. A 74 year old man with a history of prostate cancer treated with radical radiotherapy in 2013 and androgen blockade until 2015 underwent CT and PET/CT scans in 2017, which showed liver and spleen abnormalities, suggestive of metastases, but unlikely...

Case History: 17 year old boy presented with a six week history of polyuria, polydipsia, headaches and easy fatiguability. Further investigations confirmed hypopituitarism with low early morning urine osmolality. MRI brain revealed soft tissue mass arising from tectal plate extending into cerebral aqueduct resulting in hydrocephalus with normal pituitary gland. Hydrocortisone, Levothyroxine and Desmopressin were started and urgent in-patient transfer to Neurosurgical unit in t...

Case History: A 35-year-old was referred to surgery with a confirmed diagnosis of symptomatic acromegaly. Her GH failed to suppress during an oral glucose tolerance test (OGTT), her IGF-1 and prolactin was high. The histology and immunocytochemistry suggested pituitary hyperplasia. We started to look for conditions associated with pituitary hyperplasia resulting in GHRH production, including the genetic tests for inherited conditions. A solitary nodule was noted in her neck du...

Case History: 29 year old lady presented with profuse diarrhoea, lethargy and hypokalaemia in 2010. CT scan confirmed mass lesion in tail of pancreas. Chromogranin A and 24 hour urinary 5HIAA were normal. Fasting Gut hormone level showed elevated level of Vasoactive Intestinal Peptide (VIP), suggesting diagnosis of VIPoma. Further investigations confirmed hyperparathyroidism and microprolactinoma. Investigations: Adjusted calcium 2.98 mmol/l (<2.55), ...