Endocrine Abstracts

We report a case of a 45-year-old gentleman who was seen in the Endocrine Clinic with confirmed phaeochromocytoma. He had a background of obesity; he weighed 123 kg and at a height of 169 cm, his BMI was 43 kg/m2. This presented a significant risk for laparoscopic abdominal surgery, general anaesthesia and post operative recovery. He was therefore urgently referred to a Tier 3 Bariatric Service and commenced on subcutaneous injections of Semaglutide, initially 0.25 ...

Case history: A 37-year-old female presented to her GP with myalgia, lethargy and weight gain. Of note she was 24 months post-partum and had not experienced thyroid problems in either of her two pregnancies. On examination she was overweight with marked myxoedema and proximal myopathy.Investigations: Serum TSH was greatly elevated at 206 mIU/l and free T4 was undetectable at <3.20 pmol/l. T3 was 2.8 pmol/l. She was referred urgently to the medical te...

Case history: A 35-year-old female was found to be significantly hypertensive (181/91 mmHg) following a first trimester miscarriage (at 8 weeks gestation) during her first pregnancy.Investigations: Blood tests demonstrated moderate hypokalaemia (2.6 mmol/l) with a normal serum sodium (140 mmol/l) and eGFR (>90 ml/min). ECG showed hypokalaemic changes with prolongation of the PR interval and T wave flattening. To avoid potential misinterpretation, add...

We present here a case of diagnostic dilemma in a 34-year female presenting with Amenorrhoea. She was recently married and saw GP for infertility and history of hot flushes, melasma and migraine. Clinic history revealed primary amenorrhoea diagnosed in Brazil at age 15. Patient was told she was born without ovaries and was started on Premarin (oetrogen). She had normal female secondary sexual charcteristics, functional female genitalia and growth. On examination, she had a nor...

A 68-year-old gentleman presented with proximal myopathy in association with severe hypokalaemia (K+ 2.3mmol/l) and metabolic alkalosis. He had recently been diagnosed with type 2 diabetes. His random cortisol was 1045nmol/l. His 24-h urinary free cortisol was 3536nmol/24 h, and midnight cortisol was 85nmol/l. On a low dose dexamethasone suppression test, his cortisol failed to suppress (cortisol 1195–983nmol/l, ACTH 275ng/l), consistent with ACTH-dependent Cushing’s...

A 57-year-old gentleman presented with a very sudden change in hair colour to bright white and eyebrow loss. On further questioning, he had been shaving much less and had not been getting any erections. On examination he had gynaecomastia. Initial blood tests showed hypogonadotrophic hypogonadism (LH 0.6 IU/l, FSH 0.1 IU/l, testosterone 1.6 nmol/l) with an otherwise normal anterior pituitary hormonal profile. Oestradiol was found to be significantly elevated at 582 pmol/l. He ...

Background: Due to practical limitations, the diagnosis of hypogonadism is predominantly based on a single measure of reproductive hormones, often with confirmation on a second occasion. Factors associated with reproductive hormone variation include: pulsatile secretion, diurnal rhythm, and food intake, which can affect the accuracy of diagnosis of reproductive disorders. There is limited data quantitatively estimating the variability of reproductive hormone levels over the da...

Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual health complaint worldwide, affecting 1-in-10 women. It is characterised by a persistent lack of desire for sexual activity and sexual fantasies, causing distress or interpersonal difficulties. Treatment options are limited, however, melanocortin-4 receptor (MC4R) agonists have emerged as a promising therapy for HSDD, through unclear mechanisms. Investigating the pathways involved is crucial for our u...

Background: Kisspeptin is a critical activator of hypothalamic gonadotrophin-releasing hormone neurons, inducing release of downstream reproductive hormones. Intravenous or subcutaneous kisspeptin administration has been shown to have significant potential to treat reproductive disorders. However, intranasal administration could offer a novel non-invasive delivery route, which would be clinically preferable. We therefore sought to determine the effects of intranasal kisspeptin...

Background: Hypoactive Sexual Desire Disorder (HSDD) is associated with dysfunctional brain activation in regions governing sexual responses, resulting in a deficiency/absence of sexual desire with marked distress. It affects up to 8% of men with detrimental effects on quality of life, interpersonal relationships and fertility, but so far has no licensed treatment options. The reproductive neuropeptide kisspeptin offers a putative therapeutic target owing to its emerging role ...