Endocrine Abstracts

Obesity surgery is not a scalable solution for obesity and diabetes. Options for pharmacotherapy are sorely required because there will be patients who cannot and will not have surgery, or perhaps will require a ‘bridge’ to surgery. Although oral agents such as Orlistat and Bupropion/Naltrexone are marketed in Europe, these treatments suffer from considerable side effects that limit their appeal and efficacy. Gut hormone treatments, exemplified by high-dose Liragluti...

Bariatric or metabolic surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy are becoming increasingly prevalent as these treatments are now recommended as treatment choices for obesity and type 2 diabetes. Post-bariatric hypoglycaemia (PBH), typically a post-prandial hyperinsulinaemic hypoglycaemia occurring 1-3 hr after ingestion of food, is now more commonly encountered in practice, presenting either to endocrine/metabolic outpatient clinics or during medical on-...

Very low calorie diets (VLCD) have been a time-honored means of losing weight for many decades. The DiRECT trial has put VLCD back in the limelight and now NHS England and Scotland have committed resources to piloting VLCD as an intervention for Type 2 diabetes. Is this premature, or is it the solution for the tsunami of Type 2 diabetes that we face? Prof Tricia Tan and Dr Abd Tahrani will debate the utility of VLCD in the treatment paradigm of Type 2 diabetes....

Post–bariatric surgery hypoglycaemia (PBH) is a metabolic complication of bariatric surgery. Symptoms of post-bariatric hyperinsulinaemic hypoglycaemia may develop from 6 months to years after surgery, and typically present 1 to 3 hours after a meal. The incidence of post bariatric hypoglycaemia is estimated to be 0.2–11%,1,4 but the actual incidence is unknown due to the vague symptoms and lack of diagnostic criteria for the diagnosis of post-bariatric hy...

Objective: To describe a patient with an unusual course of primary hyperparathyroidism (PHPT) due to parathyroid adenoma in 2004, who developed recurrent hyperparathyroidism due to parathyroid carcinoma in 2010, and a subsequent adenoma in 2011.To our knowledge, this sequential occurrence has not been previously reported in literature.Case: A 57-year old male was operated on for a parathyroid adenoma in the right inferior gland in 2004. He was asymptomat...

Synopsis: Thyroid cancer with concomitant thyrotoxicosis is variably reported to be rare. Malignancy occurs as postoperative incidental finding of a small malignant focus in Graves’ disease, as part of a toxic multinodular or a toxic adenoma. We report two cases of large toxic multinodular goiters with metastasis diagnosed preoperatively as follicular neoplasm and confirmed postoperatively as differentiated thyroid cancer. Review of literature, pathophysiology and treatme...

Introduction: The commonest complications post trans-sphenoidal surgery is diabetes insipidus and the development of anterior pituitary hormone deficiencies. Other complications include meningitis, CSF leak, visual deterioration, haemorrhages and transient hyponatremia. We present a case of pituitary abscess 6 months post pituitary surgery who presented with viral meningitis and panhypopituitarism.Case report: A 55-year-old lady presented with a 3 weeks ...

Introduction: The incidence of agranulocytosis with thionamide therapy is uncommon, ranging between 0.2 and 0.5 percent. Most reports document agranulocytosis after short duration of high dose Carbimazole in older patients. We report a 32-year-old lady with Graves’ disease who developed neutropaenic sepsis secondary to Carbimazole therapy on 5 mg daily and on treatment for the last 13 months.Case report: Our patient was diagnosed with Graves’s ...

Case report: A 40-year old male with a background history of autism, severe learning difficulties and childhood Hirschsprung’s disease had been on long-term lithium carbonate therapy, without any history of polyuria or polydipsia. During admission he underwent a subtotal colectomy for malignant colonic polyps. Pre-operative serum urea and electrolytes, glucose and lithium levels were normal. Pre-operative fluid balance was normal. The post-operative period was turbulent; ...

The glucocorticoid receptor is constitutively expressed and fundamental to life. Activity of GR is partially governed by interacting partners whose actions skew the frequency with which GR produces meaningful transcriptional outcomes. Moreover, the tissue-specific actions of GR are themselves defined, with binding patterns being distinct in various tissue types. These features mean full molecular understanding of this steroid hormone receptor remains incomplete. As glucocortic...