Endocrine Abstracts

Case presentation: A 40-year-old Caribbean woman presented with sudden onset palpitations. She described 3 months of progressive shortness of breath, non-productive cough and 7kg weight loss. She denied chest pain, fevers or night sweats, but reported increased stool frequency, gritty eyes, and occasional visual blurring. She appeared cachectic and had a fine tremor, left eye proptosis and a visible pulsatile goitre. She was afebrile, tachypnoeic, hypoxic, hypotensive with fas...

We report the case of a previously healthy, 40 years old obese male, who was admitted in emergency with complaints of chest pain, shortness of breath and loose stools. His physical examination was relatively unremarkable except for sinus tachycardia and restlessness. He had no history of ischemic heart disease. He was admitted under cardiologists and had various investigations (echocardiogram, stress test and coronary angiogram), all normal. Due to the presentation, thyroid fu...

A 29 year old woman with multiple sclerosis and no history of thyroid dysfunction was referred to endocrinology with T3 thyrotoxicosis (TSH <0.01 mU/l, fT4 20.7 pmol/l, T3 2.9 nmol/l). She had received monoclonal alemtuzumab therapy 9 months prior. This hyperthyroid phase was short lived and in the absence of anti-thyroid medication developed symptomatic hypothyroidism within 2 months of referral (TSH 52.9 mU/l, T4 <5 pmol/l, T3 0.8 nmol/l). Thyroid receptor antibodies...

Background: Secretion and metabolism of glucocorticoids and sex steroids is disrupted in critical illness, and may be further disrupted in COVID-19. The host receptor (ACE-2) is expressed in endocrine tissues including adrenal cortex and gonad, and its occupancy may dysregulate the renin-angiotensin system. We hypothesise that severe COVID-19 results in glucocorticoid and sex hormone deficiency, and aldosterone excess.Methods: Plasma was obtained from 27...

Aim: A QIP to improve early recognition and treatment of adrenal crisis (AC) in adults. Issuance of new NHS emergency steroid cards (SEC) in accordance with National Patient Safety Alert (NPSA) August 2020.Background: National Reporting and Learning System found that two deaths and six incidents (severe harm) were associated with shortfalls in managing adrenal insufficiency (AI) over 4 Years. A resulting NPSA advised the care organisations to identify th...

Background: Short Synacthen Tests (SSTs) are integral to the diagnosis of Adrenal Insufficiency (AI). A 30-minute stimulated cortisol value is assessed against local assay dependent thresholds to ascertain or exclude the diagnosis. A diagnosis of AI is a life changing event requiring the initiation of life long glucocorticoid replacement therapy for survival. Glucocorticoid replacement is associated with long term morbidity and mortality, including an increased risk of diabete...

Background: Primary aldosteronism (PA) is a common, curable and high-risk subset of hypertension, mandating detection. In all but the most severe cases, learned society guidelines recommend confirmatory testing. Whilst a variety of confirmatory tests exist, data describing their safety are limited. Concerns centre around the potential of some tests to precipitate hypokalaemia or a hypertensive emergency in a patient with PA on sub-optimal anti-hypertensive medication. In this ...

Introduction: Small-group teaching (SGT) has been widely adopted in medical education to promote problem-based learning and enhance the process of deep learning. Simulation via Instant Messaging - Birmingham Advance (SIMBA) is a simulation-based learning approach using WhatsApp and Zoom to increase participants’ confidence in managing various clinical scenarios.Aim: To investigate whether SIMBA provided similar knowledge and experiences as compared ...

Introduction: Hypo-&hyperkalaemia are common laboratory abnormalities, complicating up to 10% of all hospital admissions and contributing to mortality. Ideally, patients with mild deviations can be treated as outpatients, and only those patients with objectively severe or life-threatening levels are hospitalized. Once admitted, there are few data as to whether the degree of electrolyte disturbance consumes greater resource(s). We analysed the admission and discharge data, ...

Background: SIMBA is a simulation-based learning platform designed to increase clinicians’ confidence in managing various clinical scenarios. The restriction of face-to-face learning during the COVID-19 pandemic led to switching Simulation via Instant Messaging – Birmingham Advance (SIMBA) to entirely virtual sessions.Objective: To explore SIMBA’s effectiveness to sustain medical education in endocrinology during the pandemic.<p class=...