Endocrine Abstracts

Consultants have all done research and got publications, and juniors always seem to be too busy to do either. However, without direct experience, you have little chance of understanding research papers, let alone generating your own, and somehow you have to fill in that gap on your CV. There comes a time then, at which a clinical research fellowship suddenly seems rather attractive.The benefits of a period in research are obvious. A fellowship allows you...

We present two cases, with apparently confirmed Cushing’s. Detailed clinical evaluation did not support the diagnosis, and carbamezepine interference was finally confirmed in both patients.Case 1: A 44-year-old man presented to a nephrologist with malignant hypertension. Routine investigation for secondary causes revealed hyperreninaemia with marked disparity of kidney size suggestive of renal infarction. 24 h urinary free cortisols (UFCs) were also...

A 69-year-old woman was referred with a 2 year history of frontal balding, deepening voice and weight loss. Past medical history included primary hypothyroidism, osteoarthritis, varicose veins and menopause at age of 50 years. Current medications included levothyroxine. She was otherwise very well and enjoyed heightened physical endurance – regularly cycling >60 miles with a group of male friends. On examination she was virilised with male pattern alopecia, marked fac...

Introduction: Amiodarone induced thyrotoxicosis (AIT) remains a diagnostic and therapeutic challenge. Broadly, AIT is classified as type 1 (underlying latent thyroid disorder) or type 2 (destructive thyroiditis). Despite being an on-going clinical conundrum, there is no U.K. wide guidance on management of AIT. We report a retrospective review of recent cases treated within our department as AIT.Methods: Data was collected for all patients referred to our...

Background: Addison’s disease is characterised by immune mediated destruction of the adrenal glands. This process is widely deemed to be irreversible. We present a case of confirmed Addison’s disease where adrenal function appears to have spontaneously recovered.Case report: A 37-year-old presented in 1997 with classical Addison’s disease: pigmentation, dizziness, weight loss, and nausea. There was no relevant family history. Random cortis...

Background: Cushing’s syndrome derived from paraneoplastic ectopic ACTH production can present in dramatic fashion. We describe such a case that presented with severe hypokalaemia, involving significant diagnostic and management challenges.The case: A 66-year-old female was referred acutely to hospital by her GP after feeling weak and lethargic. She had profound hypokalaemia of 1.5 mmol/l (3.5–5.3) with normal renal function and had been normok...

The low dose dexamethasone suppression test (LDDT) is used routinely to exclude Cushings. This test can also be used to exclude androgen secreting tumours in females with elevated testosterone levels through normalisation of, or >40% suppression of serum levels.We have audited the use of the LDDT to assess its value in investigating women with raised androgens, to ascertain whether it reduced the need for other investigations and to identify any prob...

A 52-year-old gentleman was referred for the evaluation of hypercalcaemia. He gave a four week history of feeling generally unwell with dizziness, abdominal discomfort, weight loss, nausea and vomiting. He was an ex-heavy smoker and was on Lithium for about 20 years for bipolar disorder. He had had a recent admission to hospital with sepsis, secondary to chest infection, with a brief ITU stay and was discharged only 3 weeks prior to the onset of current illness.<p class="a...

A 33-year-old male presented with headache and visual loss in May 2003. MRI pituitary showed a large tumor arising from pituitary fossa extending to suprasellar cistern compressing the optic chiasm with features recent infarction. He subsequently underwent urgent trans-sphenoidal decompression and a necrotic prolactinoma was excised with full recovery of his vision. His prolactin level remained elevated and so he was treated with cabergoline. Further questioning revealed that ...

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...