Endocrine Abstracts

Background: Approximately 20% of bariatric surgery candidates are excluded for reasons of mental health. All bariatric patients undergo a pre-operative assessment of suitability, including a mental health assessment. There are no NICE guidelines as to what level of mental illness is considered an exclusion; it is generally regarded that ‘unstable mental health’ is a contraindication to surgery. The main reason is concern regarding adherence to essential lifestyle cha...

Patients with Addison’s or adrenal insufficiency require regular steroid replacement usually in the form of oral hydrocortisone. Standard advice is given on how to deal with intercurrent illness and special situations such as surgery. Organisations such as the Addison’s disease self-help group provide authoritative guidelines for patients. Several of our patients with adrenal insufficiency have asked how their steroid replacement treatment should be adjusted for expe...

The Royal College of Physicians (RCP) published a report called Referring Wisely in June 2017. The report asked specialty physicians for a short list of conditions they felt would benefit from specialist input in the context of acute inpatient management (recommended referrals). It also asked for a list of conditions which need not be referred (avoid referrals).Methods: We retrospectively audited inpatient referrals from our electronic inpatient referral...

The Royal College of Physicians (RCP) published a report called Referring Wisely in June 2017. The report asked specialty physicians for a short list of conditions they felt would benefit from specialist input in the context of acute inpatient management (recommended referrals). It also asked for a list of conditions which need not be referred (avoid referrals).Methods: We retrospectively audited inpatient referrals from our electronic inpatient referral...

Background: As per 2014 Endocrine Society guidelines, 131I-MIBG therapy is usually reserved for metastatic or unresectable disease in patients with pheochromocytoma / paraganglioma. In this series, we describe three patients effectively treated with primary 131I-MIBG therapy. The indications were primary neo-adjuvant therapy prior to surgery, or palliative.Case series: Case 1 – 18-year-old male with a 60 mm para-aortic paragang...

Introduction: Primary aldosteronism (PA) is the most common endocrine cause of hypertension affecting up-to 10% of hypertensives. Saline suppression, a confirmatory test for PA helps avoiding patients undergoing invasive lateralisation procedures due to a false positive aldosterone-to-renin ratio (ARR). The proposed cut-off to exclude PA is post-saline aldosterone suppression to <140 pmol/l. We reviewed our biochemical work-up in order to optimise laboratory assessment.</p...

Hyponatraemia is associated with adverse outcomes including increased mortality and risk of falls. It is not previously known whether hyponatraemia, on discharge from hospital, is associated with an increased risk of readmission.We conducted a retrospective cohort study identifying all patients admitted to a UK teaching hospital as emergency general medical admissions over a 2-month period. We identified all readmissions within 28 days of discharge and c...

A 34-year-old African woman presented with a 4-month history of profound lethargy, weight loss and a 3-day history of vomiting, fever, confusion, and drowsiness. She had given birth to her third child 6 months previously. Her pregnancy and delivery were uncomplicated and she had breastfed for 5 months prior to discontinuing due to exhaustion.Investigations showed severe hypercalcaemia (4.94 mmol/l) and undetectable PTH. Hypercalcaemia was unresponsive to...

Case history: 37F presented with 4 years history of amenorrhea. In addition, she had fatigue, low mood and joint pains. She also had history of polyuria and nocturia. Investigations: Her investigations revealed FSH 2.4 IU/l, LH 1.1 IU/l, Oestradiol < 92 pmol/l, T4 <5 pmol/l, TSH 1.5 mIU/l, IGF-1 13.3 nmol/l (8.5- 30.07), Cortisol 65 nmol/l, Prolactin 68 mIU/l. She was started on Hydrocortisone and levothyroxine. Pituitary MRI revealed a 15 mm les...

Background: Cranial diabetes insipidus (DI) is characterised by the inability to produce vasopressin leading to uncontrolled diuresis. Management includes administering synthetic vasopressin analogue desmopressin (DDAVP). Recently, there have been several national reports of DDAVP omission causing serious patient harm. This study aims to evaluate the feasibility of an automated alert system using Natural Language Processing (NLP) in electronic health records (EHR) to detect DI...