Endocrine Abstracts

Introduction: Non-diabetic hypoglycaemia (NDH) has many causes including insulinoma, non-insulin producing cancers and gastric bypass surgery but medications like fluoxetine are rarely reported.Case history: 55 years female, university lecturer, history of Roux-en-Y gastric bypass in 2015 and depression, referred for recurrent symptomatic hypoglycaemia 1 to 2 hours post-meal (reactive hypoglycaemia) with recorded capillary blood glucose up to 1.6 mmol/l ...

Introduction: With increasing prevalence of hypogonadism, testosterone replacement therapy (TRT) remains the mainstay of treatment for male hypogonadism. Polycythaemia, the commonest reported side effect of TRT is often claimed to be less with transdermal preparations than intramuscular.Case history: A 48 years gentleman, initially presented in primary care with reduced libido, erectile dysfunction(ED), low energy levels. Early morning testosterone level...

Introduction: DKA is often seen in people with Diabetes Mellitus I and seldom in Diabetes Mellitus II but rarely seen in Maturity Onset Diabetes of Young (MODY) and even more rare in association with SGLT2i.Case history: 44 years female, genetically confirmed Hepatocyte Nuclear Factor 1 alpha (HNF1A) MODY since 2004 initially treated with maximum doses of metformin and gliclazide and then lost to follow-up. GP initiated Empagliflozin a year before presen...

Introduction: Osteoporosis can be associated with Cushing syndrome or hyperthyroidism but is an unusual finding in a patient with primary adrenal insufficiency (with physiological dose of steroid replacement) and concurrent autoimmune hypothyroidism without any other secondary causes of osteoporosis. We present a case of severe osteoporosis in a postmenopausal female in whom we could not establish a verifiable cause. Case: A 60-year-old postmenopausal wo...

Introduction: Parkinson’s disease is considered as a second most common neurodegenerative disorder but rarely associated with the Graves’ disease. Case report: A 44-year-old female diagnosed as Graves’ disease having classical features of hyperthyroidism i.e. tremors of hands, palpitations, weight loss despite of good appetite and biochemical evidence of thyroid function tests (TFTs) i.e. raised free T4, low TSH and positive antibodies. She was given car...

Introduction: NF1 or Von-Recklinghausen’s disease, an autosomal dominant neuro-cutaneous disorder results from NF1 (a tumour-suppressor gene) mutation, predisposing to neoplasms mainly affecting eye, skin and nervous system but rarely pheochromocytoma (0.1-5.7%). The incidence increases to 20-50% if NF1 is associated with hypertension.Case history: 30 years female, known NF1 since 2005 and multiple laparotomies for intra-abdominal neurofibromas pres...

Introduction: Commonest causes of pancreatitis are alcohol and gallstones but less common causes like hypertriglyceridemia should also be considered as management may differ.Case history: 47 years old gentleman with history of pancreatitis and hyperlipidaemia type1 taking atorvastatin and bezafibrate, admitted with severe abdominal pain and vomiting. He was non-smoker and non-drinker. No history of cholelithiasis or medications causing pancreatitis. He w...

Introduction: Immobilization hypercalcemia is uncommon condition associated with limited movements following brain and spinal cord lesions. Immobilization results in stimulation of osteoclastic bone resorption hypercalciuria and hypercalcemia.Case report: 57 year female, Background of Breast Cancer (Treated with Skin sparing mastectomy and adjuvant radiotherapy) admitted following large subdural hematoma leading to craniotomy and evacuation of hematoma. ...

Introduction: Denosumab, a human monoclonal antibody used in osteoporosis and second line treatment option for hypercalcaemia, can cause profound hypocalcaemia especially in Vitamin-D depleted and cancer patients.Case history: 56 years female, with diabetes, hypertension on metformin, empagliflozin, amlodipine and ramipril, presented with 3 months history of backache, no red flag signs, clinically and hemodynamically stable except mild confusion and spin...

Thyroid storm is rare and life threatening manifestation of thyroid hormone excess. It has high mortality rate with delayed treatment. As early intervention is associated with improved patient outcome, prompt diagnosis based on clinical grounds is of paramount importance. We present a case of thyroid storm which was different in terms of absence of fever on presentation, presence of thrombocytopenia and deranged cholestatic LFTs which resolved after treatment of thyroid storm....