Endocrine Abstracts

Case history: A 47 year old male presented to his GP with non-specific symptoms of fatigue and weight gain. Thyroid function tests revealed elevated TSH (28.4 mU/l) with normal Free T4 (14.3 pmol/l). Anti-TPO antibodies were undetectable. A presumptive diagnosis of subclinical hypothyroidism was made and he was commenced on Levothyroxine which was titrated over 9 months to 150 mcg/d given a persistently elevated TSH. The patient was unable to tolerate this dose due to the deve...

Background: Papilledema and raised intracranial pressure has been reported frequently in patients with hypoparathyroidism but very rarely optic neuritis (1).Clinical case: We report a case of 63-year-old male who presented to ophthalmology with right-sided visual loss and a relative afferent pupillary defect. He was diagnosed with optic neuritis and underwent MRI brain which showed bilateral white matter changes with the possibility of demyelination. He ...

An 84 year old female with a known history of chronic kidney disease (stage IV) and benign lung tumour presented to the Emergency Department with collapse. She had suffered recurrent collapse over the previous 2 years. Of note she reported significant weight gain during this period. She was diagnosed with symptomatic hypoglycaemia (venous blood glucose 2.8 mmol/l). She was admitted to the ward and found to have recurrent hypoglycaemia both when fasting and post-prandial.<p...

Pneumocystis jirovecii pneumonia (PJP) is well recognised in HIV infected and transplant recipient populations and prophylaxis is standard practice. PJP may also occur in rarer cases of immunodeficiency. We report 2 cases of Cushing’s syndrome complicated by PJP. Patient 1 was a 30 year old Indian male who presented with 2 weeks of bloody diarrhoea, abdominal pain and lethargy. He was cushingoid and investigations showed severe hypercortisolism (urinary cortisol >266,...

Extra-cellular nicotinamide phosphoribosyltransferase (eNAMPT; also referred to as visfatin/PBEF) concentrations are elevated in serum of patients with type 2 diabetes (T2D). However, the relationship between abnormally elevated serum eNAMPT and the pathophysiology of T2D is unclear. eNAMPT circulates in functionally and structurally distinct monomer and dimer forms. eNAMPT-dimer exerts NAD-biosynthetic activity. The role of eNAMPT-monomer is unclear but may exert NAD-independ...

Case: We present the case of a previously fit and well 53-year-old lady who presented with persistent hypokalaemia (1.9 mmol). She was cushingoid and testing confirmed Cushing’s syndrome with random cortisol of >1750 nmol/l, ACTH 838 ng/l and non-suppressed cortisol (1099 nmol/l) after low dose dexamethasone suppression test. MRI pituitary was normal. Abdominal CT scan showed bilateral adrenal hyperplasia and large (>10 cm) mass with necrotic centre replacing the ...

A 39-year-old female presented with an 18-month history of borderline hypertension, headaches, palpitations and some anxiety symptoms. Both parents also had hypertension. Blood pressure was 160/102 on no medications. She had a large single cafe au lait spot but no neurofibromata. Urinary dopamine levels were repeatedly elevated (5398–8653 nmol/24 h (n<3900)) with normal noradrenaline and adrenaline levels. Serum calcium was also elevated at 2.83 mmol/l (n...

We present a case of Phaeochromocytoma co-secreting ACTH as a rare cause of Cushing’s syndrome. Our patient is a 49 year lady admitted acutely with sudden onset headache and severe hypertension. CT brain and CSF analysis were normal. Her urinary catecholamines were found to be elevated. Noradrenaline 709 and 972 nmol/ mmol of creatinine (ref range 0–48), Adrenaline 215 and 256 (ref range 0–10). CT abdomen revealed 4.2 cm left adrenal mass, MIBG scan confirmed ph...

TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain.A 42-year-old lady presented with a three-month history of three stone weight loss, palpitations, heat intolerance and tremor. Her sister was being treated for Graves’ disease. Visual fields were intact.Thyroid function tests showed free T4 concentration 29.5 pmol/l (9.0–19.0) and TSH concentration 3.672 mU/l (0....

Hypopituitarism is associated with increased cardiovascular mortality. It has been suggested that hypogonadism, hypothyroidism, growth hormone deficiency (GHD), or indeed unphysiological hormone replacement regimens, might contribute to this excess cardiovascular risk. The adverse effect of hypercortisolaemia on insulin resistance, carbohydrate metabolism and hypertension is well recognised. It is also known that glucocorticoids adversely affect the coagulation-fibrinolytic sy...