Endocrine Abstracts

Hypercalcaemia is one of the common cases seen in Endocrine clinics. We report another challenging case of hypercalcaemia. A 43 old Asian man was referred by GP initially in 2011 with asymptomatic hypercalcaemia of 2.87 mmol/L. His past medical history included chronic plaque psoriasis with arthropathy, hypertension, stage 3 CKD, Fatty liver with mild fibrotic change secondary to methotrexate and learning difficulties. Hypercalcamia was thought to be contributed by Dovonex (Ca...

Diabetes education plays a vital role especially in newly diagnosed patients to prevent long-term complications and hospital admissions. We present a 68-year old female who was admitted with nausea, vomiting and poor oral intake. She was discharged two weeks ago after having complete pancreatectomy, splenectomy and left adrenalectomy for pancreatic cancer and a left adrenal mass. She did not have past medical history of diabetes and was commenced on basal bolus insulin after s...

Aims and objectives: Variable rate insulin infusion (VRII) is commonly used to achieve normoglycaemia in hospitalised patients. Joint British Diabetes Society (JBDS) produced guidelines on VRIII in 2014 to minimise complications related to inpatient VRII use. Local guidance along with a new VRII chart was introduced in 2017 at the West Suffolk NHS Foundation Trust and staff training provided. We performed an audit to review compliance to national and local VRII guidance.<p...

A 49-year-old lady was referred to the endocrine clinic for hypophosphataemia. Apart from tiredness, she had no other symptoms. Past medical history was significant for bronchiectasis, obstructive sleeps apnoea, caudaequina syndrome, migraine and anxiety. She had frequent hospitalisations due to bronchiectasis exacerbations requiring systemic steroids. Usual medications included azithromycin, gabapentin, omeprazole, antacids, laxatives, carbocisteine, fluoxetine, montelukast, ...

Background: The treatment of choice for primary hyperparathyroidism (PHPT) is surgical parathyroidectomy. Cinacalcet is the first calcimimetic approved by European Medicines Agency (EMA) in 2008 for use in patients with PHPT who are not fit for surgery or refuse surgery. British National Formulary (BNF) recommends it for hypercalcaemia in PHPT where parathyroidectomy is inappropriate. The main aim of treatment with cinacalcet is to keep calcium levels at safe levels.<p cla...

Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised patients. It is an independent risk factor for mortality and is associated with increased length of hospital stay.Method: The objective of audit was to review practice of investigations and management of hyponatraemia in adults at Bedford hospital in line with evidence based guidelines including European Society of Endocrinology 2014 clinical practice guidance. An observ...

We present a 60-year-old man who was referred to endocrine clinic with fatigue and a random cortisol of 136nmol/l . He had clear renal cell carcinoma and had right radical nephrectomy 7 years ago. Surveillance scans revealed involvement of mediastinal lymph nodes, pancreas and small bowel and he has pancreatic and small bowel resection in four years ago. He had recurrence a year ago and received Ipilimumab and Nivolumab. Biochemistry revealed low fT4 and inappropriately normal...

A 56 year old man was admitted from psychiatry ward after episode of symptomatic hypoglycaemia with capillary blood glucose of 2.5 mmol/L. His background included CKD on thrice weekly haemodialysis, IHD, stroke, hypertension and paranoid psychosis but not diabetes. He denied taking hypoglycaemics, his oral intake was normal and weight was stable. He had another symptomatic hypoglycamia after 22 hours with venous glucose of 1.5 mmol/L, Insulin 320 mU/L (3.0–17.0) and C-pep...

Aims and objectives: Continuous subcutaneous insulin infusion (CSII) has been in clinical practice since 1970s. NICE guidance (2008) recommends CSII in adults with type 1 diabetes (T1DM) if attempts to achieve target HbA1c with multiple daily injections (MDIs) result in disabling hypoglycaemia or HbA1c levels remain above 69 mmol/mol. The aim of our audit was to check compliance of our service against NICE guidance, and to see if CSII improved glycaemic control and/or hypoglyc...

A 49 year old lady presented to the hospital unconscious with severe hypoglycaemia. She had type 1 diabetes for 24 years and coeliac disease. She was hypo-unaware and had multiple admissions with DKA and hypoglycaemia over the years. She did not engage in the self-management of diabetes, therefore, insulin was being injected by the carers in the community and by nurses in the hospital. Her erratic and unpredictable glycaemic control was attributed to non-compliance. She admitt...