Endocrine Abstracts

A 53-year old male presented to his optician with blurring of vision on the right and was diagnosed to have branch retinal vein occlusion. Over the next 6 weeks he manifested further visual impairment, initially due to right central retinal venous occlusion (CRVO) and after another 3 months left CRVO. He received intravitreal Ranibizumab injections and timolol-dorzolamide eye drops in both eyes. Soon after this, he had a hospital admission for infected submandibular gland and ...

Familial Benign Hypocalciuric Hypercalcaemia (FBHH) is a benign autosomal dominant condition characterised by elevated serum calcium and parathyroid hormone (PTH) and low urine calcium. It is a genetically heterogeneous disorder but the majority of cases (type 1 FBHH) can be shown to be due inactivating mutations in the Calcium Sensing Receptor (CASR). This is a guanine nucleotide-binding-protein (G-protein) coupled receptor that signals through the G-protein subunit α11 ...

Successful management of diabetes requires an empowered patient/family that is well-educated about their condition and feels confident to self-manage with the support of their medical team. The linchpin to assessment and effective change is the quality of available information. Most patients/families have no way of pulling all their diabetes information together efficiently, and consequently often feel helpless and do not take charge of making their therapy adjustments. Diasen...

Hydrocortisone therapy should be individualised in patients with adrenal insufficiency to avoid over and under replacement. We assessed hydrocortisone absorbtion at different times of day which may impact on treatment regimens. We assessed the oral absorption of hydrocortisone in 48 patients (21M) aged between 6.1 and 20.3 years with congenital adrenal hyperplasia due to P450c21 deficiency. Hydrocortisone dosing ranged between 11.5 and 22.6 mg/m2 per day in three or...

Objectives: The Diabetes Team at Birmingham Children’s Hospital modified the advanced bolus algorithm suggested by Bell (2015), to develop the KISS (Keep it Simple and Safe). KISS involves adding 25% extra insulin to meals identified as very high fat and protein, and spreading the insulin by a split bolus, 50% now and 50% over 2.5 hours. KISS also has an adjustment tool allowing extra insulin to be added and the split modified from monitoring. KISS is intended to be a sim...

A 58-year-old non-diabetic Caucasian man was admitted with a capillary glucose of 1.9 mmol/l following an episode of confusion and disorientation. During his admission he had frequent episodes of nocturnal and early morning hypoglycaemia with capillary glucose <3.0 mmol/l. After 21 h of supervised fasting he was symptomatic with plasma glucose 2.3 mmol/l, insulin >1000 mU/l and C-peptide 19.6 μg/l. Sulphonylurea screen was negative. Given the magnitude of serum in...

We present the case of a young man who had been known to the endocrine department with difficult to control hyperthyroidism and atrial fibrillation. After a period of treatment with carbimazole, during which he missed several appointments, he was referred for radioactive iodine therapy, which was administered in January 2013. He failed to attend for follow-up appointments and continued to take carbimazole.He was subsequently referred to the acute medicin...

Background: Thyroid function is affected by critical illness – termed as non-thyroidal illness – and usually presents with low serum TSH and FT3 levels but normal FT3 concentrations. Critically ill patients may also have impaired immune function that could contribute to increased susceptibility to acquired infections and mortality. Thyroid hormones influence neutrophil levels and function but the effect of non-thyroidal illness on neutrophil fun...

Introduction: We present a case of a patient with type two diabetes mellitus (T2DM) who started empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor and the P90X diet and presented with euglycemic DKA seven days later.Case Presentation: A male in his 5th decade of life with a history of T2DM presented for a routine office appointment and had a measured hemoglobin A1C of 9.3. His home diabetes regimen consisted of metformin and sitagliptan. D...

Background: Clinical scoring systems were used traditionally in the diagnosis of hypothyroidism before biochemical diagnosis became the norm. There are two well validated clinical scoring systems (Billewicz and Zulewski) for diagnosing hypothyroidism. Both these scores were validated in younger patients with hypothyroidism and may not be useful in older patients. We conducted this study to determine the clinical utility of these two scoring systems among patients over the age ...