Endocrine Abstracts

Introduction: Short Synacthen Tests (SSTs) are the gold standard for diagnosis of Adrenal Insufficiency. An early morning cortisol may be an acceptable alternative. We wished to establish current local practice in testing and what lessons could be learned. Clyde uses the Architect Cortisol Assay – adequate response taken as post-Synacthen cortisol of ≥430nmol/l.Methods: We aimed to gather data on ≥100 SSTs and this took 11 weeks (20/05/1...

A 63 year old man was admitted with headache, nausea, vomiting and BP of 247/155 mmHg. He had a 4 month history of headache. Past medical history of depression, back pain and 40 pack year smoking history. There was no history of chest pain, palpitation or neurological disturbance. ECG: sinus rhythm, Rate 110, LVH. Cholesterol 6.1 mmol/l. Creatinine 118umol/l. CT head unremarkable. He was commenced on amlodipine. Tramadol and pregabalin were stopped due to possible serotonin sy...

The non-specific symptoms of Addison’s disease may be attributed to other conditions with consequent delay in diagnosis. We describe such a case of novel presentation. A 61 year old female presented with a one-day history of vomiting, abdominal pain and 15kg weight loss over 6 months. PMH: hypertension of 15 years duration, chronic kidney disease (CKD3) for 7 years and hysterectomy for endometrial carcinoma 8 years earlier. Examination: dehydrated, sinus tachycardia 110 b...

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...

The four major hypertensive disorders in pregnancy are preeclampsia/eclampsia/HELLP syndrome, gestational hypertension, chronic hypertension and pre-eclampsia superimposed on chronic hypertension. The prevalence of hypertension in pregnancy has been reported to be around 6%. The commonest aetiology was found to be gestational hypertension which made up 40% of all cases. To our knowledge, secondary causes of hypertension in pregnancy has never been well described. We present a ...

Introduction: Cushing’s syndrome can impair the gonadotrophic axis in women of child bearing age if left untreated. Furthermore undergoing endoscopic transphenoidal surgery can render patients hypogonadal, thereby reducing the chances of spontaneous conception. In such cases, pregnancy is usually achieved by assisted contraceptive techniques. We present a case of spontaneous pregnancy following transphenoidal surgery and bilateral adrenalectomy.Case...

Background: Primary hyperaldosteronism (PHA) is characterised by inappropriately high aldosterone production, most commonly caused by unilateral/bilateral adrenal adenoma or bilateral adrenal hyperplasia. It usually manifest as hypertension and/or hypokalaemia. There is emerging evidence to support the prevalence of PHA in more than 10% in hypertensive patients but only a minority will have a confirmed diagnosis and receive specific treatment.Aim: To pro...

Primary adrenal lymphoma is a rare cause of adrenal insufficiency, accounting for only approximately 1% of non-Hodgkin lymphoma cases. Most common subtype of PAL is diffuse large B cell lymphoma. A 71-year-old gentleman with the past history of hypertension, type 2 DM and the incidental finding of adrenal hyperplasia, presented with the general ill health with lethargy, weight loss and reduced appetite. He has the past history of hypertension, type 2 DM and the incidental find...

Introduction: Primary hyperparathyroidism affects 0.3% of the general population1. 90% are due to single parathyroid adenoma1. Surgical treatment is the only definitive cure2. Improvements in imaging permit radiologists to better identify parathyroid adenomas1, enabling more targeted surgery1, thus shortening general anaesthesia, as well as lowering post-operative complication rates. Neck ultrasound (US) and parathyroid sc...

Vitamin D is a pleotropic hormone with important actions in a wide variety of cell types. Whilst its role in the endocrine control of calcium metabolism via the active circulating metabolite 1,25- dihydroxy cholecalciferol is widely appreciated, other actions in a range of cells and tissues depend on activation of circulating 25-hydroxy vitamin D by intracrine mechanisms and paracrine actions which may be locally controlled. Of particular interest are the roles of vitamin D pe...