Endocrine Abstracts

Background: Prevalence of FHH in hypercalcaemic patients with a raised PTH has been quoted as 1 in 20. Parathyroidectomy has no benefit and therefore it is important to exclude FHH prior to considering surgery.Objectives: The aim of our study was to idenitify hypercalcaemic patients with a 24 hour urine calcium creatinine ratio (Ca/Cr) between 0.01–0.02 with a view to propose a cut-off ratio of 0.015 which will provide optimal...

Background: Prevalence of FHH in hypercalcaemic patients with a raised PTH has been quoted as 1 in 20. Parathyroidectomy has no benefit and therefore it is important to exclude FHH prior to considering surgery.Objectives: The aim of our study was to idenitify hypercalcaemic patients with a 24 hour urine calcium creatinine ratio (Ca/Cr) between 0.01–0.02 with a view to propose a cut-off ratio of 0.015 which will provide optimal...

Somatostatin analogues (SSA) have an established role in the medical management of patients with neuroendocrine tumours (NETs). They are effective in the symptomatic treatment of some metastatic NETs and may also provide tumour stabilisation or reduction. We report two patients with disease progression who benefited from SSA. Mrs HW, 64-year old woman, was diagnosed with a grade 1 small-bowel NET with lymph node and liver metastasis in 2012: Ki-67 index < 1%. Despite a seg...

54 year old lady presented to the endocrine clinic. She was diagnosed with breast cancer and right ovarian tumour at the same time in August 2015. She had right lumpectomy of breast and Salpingo-Oophorectomy in November 2015. She was not feeling very well for the last few weeks. She complained of extreme lethargy and tiredness. She had blood test done on 15th November 2016 that showed prolactin level at 2849 nmmol/l with negative macroprolactin. Hence, she was referred to the ...

A 56 years old lady was referred to our endocrine service for further management of levothyroxine replacement. She was diagnosed with Graves’ disease 26 years ago and underwent thyroidectomy as definite treatment. Post-operatively, she was commenced on 100mcg of levothyroxine and continued to have regular follow up with her GP. It was noted that her levothyroxine dose had to be reduced to 50 mcg daily over a period of 10 years due to persistently suppressed TSH levels wit...

A sixty-four year old man presented for investigation of mild hypercalcaemia (2.68 mmol/L) incidentally discovered during preoperative workup for elective removal of a testicular cyst. He had no family history of renal stones. His younger brother had undergone a parathyroidectomy at the age of 60. His father died in a road traffic accident aged 54. His mother was 84 and had no history of endocrine disease. Urine calcium:creatinine excretion ratio was 0.0207, excluding familial...

Due to availability of easy routine blood testing, normocalcaemic primary hyperparathyroidism is increasingly seen. However, due to its mild nature, it often poses diagnostic difficulties. We present a case of 65 year old gentleman who was diagnosed with osteoporosis in 2015. He had a history of traumatic fractures of tibia, fibula and calcaneum in 2013. He was later diagnosed with unexplained osteoporosis in 2015 (T-score of hip −2.5 and T-score of spine −1.2) and...

Endocrinopathies are common complications following cancer therapy and may occur decades later. We present a case of 37 year old lady with a background of chronic myeloid leukaemia (CML) which was treated with sibling allogenic stem cell transplant and total body irradiation in 2002. She was noted to have elevated calcium levels with raised PTH 10 years later. In view of young age, she underwent genetic screening for MEN1 through buccal swab as her lymphocytes were not suitabl...

Hypogonadism persisting in males with macroprolactinoma requires exogenous testosterone replacement therapy but this may cause secondary elevations of prolactin. We present a case of a 44 year old gentleman who was diagnosed with macroprolactinoma after being investigated for ‘abnormal thyroid function tests’ with a low T4 and a normal TSH. He reported a few years’ history of increasing weight gain, lethargy, generalised aches and pains, occasional headaches and...

We present two uncommon cases of cyclical ectopic ACTH-dependent Cushing’s syndrome due to diffuse idiopathic pulmonary neuroendocrine tumour (DIPNECH).Case 1: 62 yr lady presented with rapid onset of muscle weakness, diabetes and hypokalaemia. Random cortisol:1710 nmol/l, ACTH level:610 ng/l. LDDST: failure to suppress cortisol levels. Imaging: normal pituitary gland and bilateral adrenal hyperplasia, consistent with ACTH dependent Cushing’s s...