Endocrine Abstracts

We present the case of a 51-year-old gentleman who had a giant parathyroid adenoma. He has a past medical history of deep vein thrombosis and hypertension. He is taking amlodipine 10 mg od. He is a non-smoker and drinks alcohol in moderation. He was admitted with right leg swelling found to be a new thrombosis. Incidental finding of extreme hypercalcaemia found on bloods with raised PTH (CorrCa 4.23 mmol/l, PTH 83.1 pmol/l.) Patient was completely asymptomatic. CT imaging of c...

A 37 year old woman was referred to the endocrinology clinic from the gynaecologists. She was awaiting an 8 cm left ovarian cyst removal and found to be hyperthyroid (fT3 7.8 pmol/l, fT4 of 19.0 pmol/l, TSH <0.01 mU/l). She described 4 months of palpitations, change in bowel habit and menstrual irregularity. She had no tremor or tachycardia. She had no palpable goitre or eye signs. She had a past medical history of asthma on inhalers. There was no family history of thyroid...

Phaeochromocytomas (PC) are tumours of the adrenal medulla and paragangliomas (PGL) refer to their extra-adrenal counterpart arising from sympathetic or parasympathetic tissue. Mutations in the citric acid cycle enzyme succinate dehydrogenase (SDH) predispose to PC/PGL. Clinical practice guidelines suggest that plasma metanephrine and normetanephrine levels measured in the supine position should be used in the first instance for biochemical diagnosis, and those with positive r...

Canagliflozin is an oral hypoglycemic agent from the novel class of Sodium Glucose co-Transporter 2 (SGLT2) inhibitors, used in the treatment of patients with Type 2 Diabetes Mellitus (T2DM). Although effective in treatment of hyperglycemia, these medications have been linked to development of diabetic ketoacidosis (DKA) in patients with T2DM. We describe the case of a patient with T2DM, who presented with severe metabolic acidosis while taking Canagliflozin.<p class="abst...

In the National Health Service (UK), there are ever increasing demands to streamline care and develop patient pathways and guidelines as justification for any test or procedure. This is to ensure optimisation in patient care and experience.The role of a specialist nurse focuses on ensuring appropriateness and swiftness of investigations, including providing a high level of clinical care which has its foundations on communication and education for the pat...

Background: The investigation of short stature includes evaluation of a number of clinical, radiological, and biochemical factors. This often includes dynamic function testing to rule out abnormalities of the hypothalamic–pituitary axis to rule out GH deficiency (GHD). NICE guidance advises that two GH stimulation tests demonstrating subnormal GH peak <6.7 μg/ml (20 mU/l) is required to confirm the diagnosis of GHD.Objectives: To interrogat...

Introduction: Patients with adrenal insufficiency (AI) lack endogenous cortisol and require oral hydrocortisone. In primary AI (PAI) endogenous aldosterone synthesis is also lost and patients require oral fludrocortisone. Important long-term issues include wearing MedicAlert jewellery (MAJ) and adequacy of steroid replacement including fludrocortisone, assessed by plasma–renin activity (PRA).We identified patients with AI attending our unit and aime...

Introduction: Islet transplantation (ITx) is a therapeutic option for patients with Type 1 diabetes. However there is attrition of graft function and the majority of patients require exogenous insulin injections and/or further transplants, within five years. Mouse models help elucidate mechanisms of islet graft failure and the NOD/Lt-scid IL2rγnull (NSG) mouse is useful to study human islet engraftment but few published studies exist. As diffe...

The recently published Endocrine Society Clinical Practice guideline on phaeochomocytoma and paraganglioma (PPGL) recommends measuring plasma metanephrines (PMets) with patients in the supine position after an overnight fast and using appropriately defined reference intervals.1 Studies have shown higher diagnostic sensitivities using the latter pretesting criteria.2 However, this testing protocol is resource intensive and arguably impractical in routine c...

A 83-year-old lady presented to hospital with a one week history of malaise, dyspnoea and chest pain. Her admission bloods revealed a markedly elevated calcium of 4.16 mmol/l. Further investigations revealed a PTH of >5000 ng/l. Clinically the patient had poor dentition which had developed over the past 3 years and a history of episodic abdominal pain and constipation. For investigation of primary hyperparathyroidism, she had an ultrasound neck, which revealed an enlarged ...