Endocrine Abstracts

We present the case of a 27-year-old man who was first diagnosed with type 1 diabetes mellitus when he presented with diabetic ketoacidosis (DKA) and during later admissions was found to have grossly abnormal liver function tests. Following diagnosis, his diabetic control has been a challenge to manage despite the patient’s claim he had been taking his insulin ‘religiously’. He has had repeated admissions with DKA and has failed to attend clinic follow-ups on se...

Introduction: Primary hyperparathyroidism (PPTH) is a common referral to endocrine clinics with a clinical spectrum ranging from an asymptomatic state to a symptomatic disorder with or without end organ damage. We audited our management against the NIH guidelines which are endorsed by the Endocrine Society.Methods: There is no outpatient coding system to correctly identify all patients with primary hyperparathyroidism. We included patient on radiology da...

Introduction: We report a patient with hypercalcaemia secondary to parathyroid hormone related peptide (PTHrp) from metastatic oesophageal cancer and co-existing primary hyperparathyroidism.Case report: A 52-year-old lady was admitted to the hospital with a 2-week history of right scapula pain, reduced appetite and weight loss.Blood test revealed an adjusted calcium of 3.99 nmol/l (NR 2.1–2.55 nmol/l), PTH of 147 ng/l (NR 15&#...

We present two thyroid antibody positive euthyroid women with history of recurrent miscarriage who had successful pregnancy outcome when treated with levothyroxine.A 31-year-old Caucasian lady was referred to our endocrine services with a history of three previous miscarriages. She had strongly positive thyroid peroxidise antibodies (TPO) with normal thyroid function tests.We commenced her on 25 μg of levothyroxine. Within two...

Introduction: Hypoglycaemia in a non-diabetic patient is not a common condition and is often a diagnostic challenge.Case report: A 78-year-old gentleman was admitted to hospital by paramedics when his neighbours found him unresponsive. He had a background history of primary hypothyroidism. Capillary blood glucose reading done on site was 1.0 mmol/l. He received intravenous glucose which resulted in prompt recovery. All other vital signs were normal.<...

Introduction: Hypercalcaemia is a frequent complication of breast cancer with bony metastasis. There is also an increase incidence of primary hyperparathyroidism among patients with breast cancer. We report a patient with breast cancer presenting with hypercalcaemia secondary to both parathyroid hormone- related peptide (PTHrP) from liver metastasis and possibly co-existing primary hyperparathyroidism.Case report: A 53 year old woman, with a history of r...

We report a 41 yr old man who was found dead in his bed with a continuous glucose monitoring device in situ. He had type 1 diabetes diagnosed at age 14 years. He had poor glycaemic control during his teenage years and suffered from severe hypoglycaemic episodes and reduced hypoglycaemic awareness resulting in three road traffic accidents. His diabetes was complicated by proliferative retinopathy, nephropathy and peripheral neuropathy. He began continuous subcutaneous insulin p...

A 38 year lady was referred with a five month history of secondary amenorrhea, galactorrhoea, failure to conceive and elevated prolactin levels of 2023 miu/L (reference 102–496 miu/L). She could not undertake an MRI scan of the pituitary gland as she was claustrophobic and hence a CT scan was performed which did not show and gross pituitary lesion. Microprolactinoma was diagnosed and she commenced bromocriptine. She had normal white blood cells and neutrophil count prior ...

Pituitary apoplexy is a rare but life threatening condition if not diagnosed and treated promptly. Common causes include hypertension, head trauma, major surgery, dynamic pituitary tests, anticoagulant use and pregnancy. In pregnancy, hyperplasia and hypertrophy of the lactotroph cells increase pituitary volume by 45% returning to original size at 6 months post-partum. Pituitary apoplexy is uncommon in pregnancy and an underlying adenoma is usually the cause. Very few...

Grave’s disease is an auto-immune condition associated with hyperthyroidism caused by TSH-receptor antibodies (TRAB) expressed by follicular cells of the thyroid gland. Grave’s ophthalmopathy has been reported in 25% of the patients and is rarely associated with dermopathy and thyroid acropachy. Management is by anti-thyroid drugs, radioactive iodine ablation or surgery, either alone or in combination. We present a rare case of resistant Graves who has detectable ant...