Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a relatively frequent problem presenting with hypercalaemia detected on a routine blood test. All PHPT patients should have a urine calcium concentration, DEXA scan and vitamin D level checked at the time of diagnosis. Vitamin D supplementation aims to achieve a vitamin D level over 50 nmol/l which may be associated with positive outcomes such as a lower serum parathormone (PTH), calcium and alkaline phosphatase concentration...

Case history: A 45-year-old male was referred to Endocrinology from the Infectious Diseases clinic for investigation of possible adrenal insufficiency. The patient had multiple co-morbidities including asthma, hepatitis B and HIV. The patient’s GP had introduced a fluticasone inhaler to control the symptoms of his asthma, however when the patient was seen in Infectious Diseases clinic as an interaction with his protease inhibitor (atazanavir) was suspected. A random corti...

Introduction: Hypercalcaemia is a common electrolyte disturbance in patients presenting acutely and can be cause or effect of a multitude of disorders. We present four cases, in which the hypercalcaemia masked or unmasked underlying pathology that may have otherwise gone undiagnosed.Case series: A 36-year old man presented with acute pancreatitis after completing a marathon. Bloods: adjusted calcium (cCa) 3.16 mmol/L, phosphate 0.5...

Introduction: Hypercalcaemia is a common electrolyte disturbance in patients presenting acutely and can be cause or effect of a multitude of disorders. We present four cases, in which the hypercalcaemia masked or unmasked underlying pathology that may have otherwise gone undiagnosed.Case series: A 36-year old man presented with acute pancreatitis after completing a marathon. Bloods: adjusted calcium (cCa) 3.16 mmol/L, phosphate 0.5...

A 34-year old lady with a history of Crohn’s colitis and depression presented to the Emergency Department (ED) reporting an allergic reaction to azathioprine. She complained of mild headache, anxiety and nausea but denied wheeze, shortness of breath, tongue swelling or rash. Her medications were prednisolone, predfoam enemas, escitalopram, combined oral contraceptive pill (OCP) and azathioprine, commenced one month ago. She denied alcohol or recreational drug consumption....

We present two patients who have increased uptake in the thyroid on PET imaging.Mrs AN is a 76-year-old woman with hypertension, atrial fibrillation, deep vein thrombosis and primary autoimmune hypothyroidism with positive TPO antibodies on thyroxine. When abroad she had a carotid USS which discovered a thyroid nodule. Referred to us she was euthyroid with an USS finding of a 5 mm calcified nodule with no vascularity in the right thyroid. She had a FNA i...

19-year-old gentleman was initially investigated by his local hospital when he presented with 2-year history of diarrhoea, intermittent abdominal pain, sweating, and depression with suicidal ideation. His only past medical history was eczema. His maternal grandmother had PTHP aged 50 years. A paternal grandmother had colon and pancreatic cancer and cousin had Graves’ disease.Gastroenterology investigations were normal. However he was found to have h...

A 36-year-old lady (gravida 2 para 0) presented with subfertility, dysmenorrhoea and mild hyperprolactinaemia (prolactin of 881 mU/l no macroprolactin). She was also found to be hypercalcaemic whilst on calcium supplements. Despite a negative home pregnancy test, her β-HCG was elevated at 1471 IU/l confirming she was pregnant.She remained hypercalcaemic despite stopping calcium supplements and starting colecalciferol. At 9 weeks into her pregnancy, ...

A 64-year-old gentleman was referred with persistent hypercalcaemia following two previous parathyroidectomies from an external hospital. He was found to be hypercalcaemic incidentally by his GP in 2011. Prior to surgery in January 2011, his corrected calcium (cCa) was 2.83 mmol/l, PTH 1.9 pmol/l, vitamin D 38 nmol/l, 24 h urine calcium creatinine clearance ratio (24 h UCCR) was 0.0135. Histology from his 1st neck exploration revealed one hyperplastic parathyroid gland. A furt...

A 33-year-old woman was referred to our service for investigation of secondary amenorrhea. She is from India and moved to the UK 8 years ago. She has two children aged 7 and 4 years. She has a history of TB adenitis treated in 2007 with quadruple anti TB medication for 6 months. She was told she had no pulmonary involvement and was clear after treatment. She is currently on no medication. During 2012 she noticed her menstrual cycles were lengthening with amenorrhoea since Janu...