Endocrine Abstracts

Background: Diabetes is the commonest cause of ketoacidosis, with alcoholic and starvation ketoacidosis encountered less frequently. We present a case of high anion gap metabolic acidosis whose features were not categorigal for usual causes.Case presentation: A 42-year-old female patient was admitted with a 3 day history of nausea, vomiting and abdominal pain, that begun 1 day after binge alcohol intake, on the background of alcohol excess. AKI, transami...

Vitamin D deficiency is common and various supplementations regimens are in use. The purpose of this audit was to compare the efficacy of two short-term colecalciferol loading regimens in treating Vitamin D deficiency. Sixty-four consecutive patients with serum 25OH VitaminD ≤30 nmol/L were assigned to 12 or 16 weeks treatment with 40,000 IU colecalciferol orally once a week. The main endpoint was to identify which duration of treatment is adequate for achievement of suf...

A 45-year-old man was found wandering in the streets by the Ambulance Service. He complained of productive cough with haemoptysis. On examination he was cachectic with clubbing, and he was confused (abbreviated mental test score 1/10). Chest XR showed left hilar and perihilar air space shadowing. He was treated for a community acquired pneumonia. A CT scan of the head showed a mass lesion in the pituitary fossa, confirmed on an MRI scan.Assessment of his...

A 75-year old gentleman presented with symptoms of increasing lethargy, loss of appetite associated with weight loss and constant micturition. A CT scan showed extensive peritoneal mass in the lower abdomen and pelvis with disseminated intraperitoneal malignancy. A CT guided biopsy confirmed a poorly differentiated tumour. Immunohistochemistry showed that all the cytokeratin markers were negative, but vimentin was positive and CD117 (c-kit) was strongly positive, indicating th...

Background: Androgen-deprivation therapy (ADT) is commonly used in the management of advanced prostate cancer. ADT can be achieved through bilateral orchidectomy, by administration of GnRH receptor agonists, or by using by the newer GnRH receptor antagonist Degarelix. The classical desired biochemical goal is to achieve a serum testosterone of <1.7 nmol/l.Case Presentation: A man with metastatic prostate cancer on androgen deprivation therapy and ser...

Background: Current UK guidelines for the Use of Thyroid Function Tests provide specific recommendations for the use of thyroid function tests in inpatients. Isolated alterations in TSH occur in 15% of inpatients and <2% will have underlying thyroid disorder. Thyroid function should be repeated every 4–6 weeks when changing thyroxine replacement dose or when commencing thionamides.Aim: To identify the indications and frequency of thyroid tests i...

Background: Following pituitary surgery, dynamic testing with insulin tolerance (ITT) or glucagon stimulation testing (GST) is used to identify patients with secondary hypocortisolism who require glucocorticoids. High glucocorticoid replacement doses are associated with adverse effects, and the optimal replacement dose is unknown.Aim: We aimed to assess the interpretation of dynamic testing post pituitary surgery in clinical practice and its relation wit...

Background: After pituitary surgery patients require HPA axis assessment, that is achieved with postoperative cortisol measurements and, in selected patients whose post-operative cortisol measurements are inconclusive, with the insulin tolerance test (ITT) and the glucagon stimulation test (GST).Aim: We aimed to assess the performance of the day 2/3 post-operative cortisol in predicting the HPA axis sufficiency as assessed by the ITT and the GST.<p c...

Adrenal incidentalomas are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in a number of investigations usually conducted in the Endocrinology clinic.In 2011 we audited the prevalence and management of adrenal incidentalomas identified on abdominal CT imaging over one calendar month in our centre. Consequently, a decision pathway for new adrenal lesions was introduced in the Radi...

Adrenal masses discovered incidentally during imaging (adrenal incidentalomas) are common and constitute a common reason for referral in the Endocrinology clinic. Our aim was to audit the prevalence of adrenal masses discovered in all computerised tomography (CT) abdominal imaging done over one calendar month in our centre. A secondary aim was to identify the underlying diagnosis and fate of the discovered adrenal nodules. All 690 CT scans done in March 2011 in our centre that...