Endocrine Abstracts

A 68-year-old gentleman presented with proximal myopathy in association with severe hypokalaemia (K+ 2.3mmol/l) and metabolic alkalosis. He had recently been diagnosed with type 2 diabetes. His random cortisol was 1045nmol/l. His 24-h urinary free cortisol was 3536nmol/24 h, and midnight cortisol was 85nmol/l. On a low dose dexamethasone suppression test, his cortisol failed to suppress (cortisol 1195–983nmol/l, ACTH 275ng/l), consistent with ACTH-dependent Cushing’s...

Introduction: Iatrogenic Cushing’s syndrome (ICS) can be caused by virtually all forms of steroid treatment with or without suppression of hypothalamic–pituitary–adrenal (HPA) axis. Here we report betamethasone nasal drops used as treatment post septorhinoplasty as a cause of iatrogenic Cushing’s syndrome.Case: A 36 years old female with background history of depression presented to endocrinology clinic for evaluation of progressive w...

Introduction: Pituitary tuberculosis (TB) is a rare form of intracranial TB and remains a diagnostic challenge in the absence of systemic TB. A limited number of cases has been reported in the literature.Case: A 47-year-old south Asian man presented to the accident and emergency department with complete isolated left third nerve palsy which had developed gradually over the course of a week. Brain magnetic resonance imagining (MRI) revealed a 15 mm inflam...

Phaeochromocytomas are rare neuroendocrine tumours. Prediction of aggressive tumour behaviour remains a major challenge. We report a 68-year-old female who was found to have a locally arising colonic adenocarcinoma on biopsies. Staging also identified a 10.7 cm right adrenal lesion and work-up revealed markedly raised urinary metanephrines and positive MIBG imaging. The MDT decision was to first remove the colonic cancer with appropriate alpha blockade. It was felt that a comb...

A 50 year-old lady was referred to the endocrine service for evaluation of significantly elevated 3-methoxytyramine (3-MT) levels. Past medical history included well controlled HIV and hypertension controlled by a single agent only (amlodipine). On one occasion, she was noted to have an elevated systolic blood pressure of 189 mmHg in clinic and therefore 24 h urinary metanephrines were requested. She did not have any other symptoms to suggest excess catecholamines. Systems rev...

A 57-year-old gentleman presented with a very sudden change in hair colour to bright white and eyebrow loss. On further questioning, he had been shaving much less and had not been getting any erections. On examination he had gynaecomastia. Initial blood tests showed hypogonadotrophic hypogonadism (LH 0.6 IU/l, FSH 0.1 IU/l, testosterone 1.6 nmol/l) with an otherwise normal anterior pituitary hormonal profile. Oestradiol was found to be significantly elevated at 582 pmol/l. He ...

Aim: Recent studies reported a wide range in baseline and peak cortisol responses to surgery. We report the results of cosyntropin stimulation testing following unilateral adrenalectomy for non-steroid secreting lesions.Methods: Data of 36 patients who underwent cosyntropin stimulation testing on the second day post unilateral adrenalectomy were collected retrospectively. None of the patients had clinical signs of hypercortisolism. No patient received pr...

Cardiac phaeochromocytomas account for only 1% of all extra-adrenal phaeochromocytomas. We present a rare case, which through a multidisciplinary approach achieved an excellent outcome. A 49-year-old male presented with chest pain. Echocardiography revealed a pericardial mass behind the left atrium and subsequent cardiac angiography confirmed a highly vascular lesion, suspicious for a phaeochromocytoma. Urine and plasma metanephrines were elevated; urine normetadrenaline 10888...

A 58 year old female, with a 15 year history of hypertension and recent poor control, was admitted to the emergency department after an out of hospital cardiac arrest due to ventricular fibrillation requiring DC cardioversion. Initial investigations showed a metabolic alkalosis with profound hypokalaemia at 1.7 mmol/l. In view of lateral ST depression on the ECG post-resuscitation, she underwent an urgent coronary angiogram which demonstrated unobstructed coronary arteries. Wh...

Phaeochromocytoma and paragangliomas (PH/PG) are rare neuroendocrine tumours. Prediction of aggressive tumour behaviour remains a major challenge. The Phaeochromocytoma of the Adrenal gland Scaled Score (PASS) is used to separate benign from malignant lesions with a score > 4 showing potential for biologically aggressive behaviour. Pre-operatively, MIBG together with CT/MRI remain the diagnostic radiological gold standard.We report a 68-year-old fema...