Endocrine Abstracts

Endocrinopathy is common in patients with HIV and presents a distinct series of challenges. Polypharmacy is common (both of prescribed and non-prescribed drugs) with the potential for drug-drug interactions and endocrine adverse effects of longterm medication. Structural pathology is also commoner than in the general population with the potential for both tumours and atypical infections affecting endocrine organs. Altered binding proteins are common, particularly high SHBG, af...

The true prevalence of clinically significant endocrine disease in HIV is difficult to get a handle on as the literature is in many cases Declaration of interesting or insufficiently illuminating. There is clearly potential for endocrine dysfunction, via many mechanisms including directly due to HIV, due to atypical infections and the drugs used to treat them, side effects of both prescribed and non-prescribed medications and structural pathology. Probably the best described e...

We present here the case of a 33-year-old woman, previously fit and well who presented initially with thyrotoxic symptoms. TFTs showed TSH <0.05, fT3 40. Thyroid uptake scan showed homogenous uptake of 8%. She was prescribed carbimazole 40 mg od and propanolol 40 mg bd with improvement.One month later, she presented to A+E with abdominal pain associated with diarrhoea and vomiting. She was found to be unwell, tachycardic and febrile. She had a global...

A 48-year-old Afro-Caribbean female was referred from Accident & Emergency in December 2007 with low serum potassium. She had been diagnosed elsewhere with hypertension due to primary aldosteronism at the age of 28 but was then lost to Endocrine follow-up. She reported intolerance to spironolactone – blood pressure was controlled with Amiloride until 1999 and then Amlodipine. Questioning in clinic, January 2008, revealed that she had had extensive investigations when ...

Case history: A 51 year old lady was referred to Endocrinology with low plasma cortisol, hyperprolactinaemia and galactorrhoea. Extensive past medical history included primary hypothyroidism, B12 deficiency, diaphragmatic paralysis requiring NIV, recurrent aspergillomas, sino-atrial node disease with PPM, immunodeficiency, inflammatory arthropathy and autoimmune pancreatic insufficiency. She took numerous medications:- Itraconazole 100 mg daily, Levothyroxine 75 μg daily,...

Case history: Patient 1, a 78 year old male, was diagnosed five years ago with a metastatic NET with octreotide avid disease including ileocolic/right common iliac nodal metastases and a solitary segment VII liver lesion. He elected for watchful waiting and was asymptomatic. Interval imaging showed gradual local disease progression. He was diagnosed with motor neurone disease resulting in unilateral arm weakness. He re-presented four years after diagnosis with progressive weak...

Case history: 52 year old gentleman presented in 2013 with a 1 year history of abdominal pain. Imaging to screen for gallstones identified a large adrenal mass which was radiologically suspicious for adrenal carcinoma with probable inferior vena cava (IVC) involvement.Investigations: Overnight dexamethasone suppression test (ONDST) failed to suppress cortisol (324 nmol/l) with undetectable ACTH (<5 ng/l). Failure of suppression on low dose dexamethas...

Background: Falls in the elderly are a major public health burden as more than one in three people over 65 years falls per annum. Vitamin D deficiency is common in the elderly due to decreased sunlight exposure, dietary vitamin D intake and efficiency of cutaneous vitamin D production. Vitamin D deficiency causes myopathy, impaired psychomotor function and increased sway thus increasing the risk of falls, whilst supplementation decreases falls. We hypothesized that vitamin D d...

Vitamin D deficiency is a particular concern in pregnancy as it can affect both mother and infant, with problems lasting into childhood. A high prevalence of deficiency during pregnancy has been reported among known risk groups. Current guidelines on supplementing pregnant women are conflicting, with universal replacement recommended by the Department of Health but not supported by NICE guidelines. We aimed to determine the prevalence of vitamin D deficiency in a West London p...

De novo vasopressin insufficiency (VI) is extremely rare in patients with pituitary adenoma who have not had biopsy or surgery and raises the question of differential diagnoses including malignancy and infective or inflammatory disease affecting the pituitary. Here we present a case of a patient initially presenting with cystic pituitary adenoma subsequently developing VI. A 24 year old woman presented to her GP with headache and secondary amenorrhoea. MRI brain revealed a cys...