Endocrine Abstracts

We report a 61-year-old female with a history of bronchiectasis, primary Sjogren’s syndrome and osteoporosis. She had taken oral glucocorticoids initiated by the rheumatologists for 10 years, which were stopped 2 years ago. She was referred to the Endocrine Clinic with a short history of polyuria and polydipsia. Biochemistry confirmed new hypercalcaemia and an acute kidney injury: corrected calcium 3.14 mmol/l, phosphate 1.13 mmol/l and 25-hydroxyvitamin D 66.4 nmol/l. At...

The short Synacthen test (SST) is used to evaluate adrenal glucocorticoid secretion in response to synthetic ACTH (also known as tetracosactide or Synacthen). Traditionally, after a baseline cortisol and ACTH, two plasma cortisol samples have been taken after i.v. or i.m. administration of Synacthen 250 μg, one at 30 min and one at 60 min. However practice varies and some physicians only take one cortisol measurement at 30 min.Hypothesis: A protocol...

MM, a 51-year-old female was reviewed in the Endocrinology clinic for the assessment of hypercalcaemia, hyperprolactinaemia, and an adrenal mass. Bipolar depression had been diagnosed 24 years previously with continuous use of Lithium Carbonate since. An acute deterioration in mental state 3 years previously prompted Risperidone treatment which was ongoing. Hypercalcaemia (calcium=2.78 mmol/l, PTH=13.8 pmol/l, vitamin D=33 nmol/l) was recorded. Polyuria and nocturia was noted....

Section 1: Case: A 42-year-old woman developed central chest pain four hours after undergoing right mastectomy for intraductal breast carcinoma. Serial blood pressures were recorded as significantly elevated, up to 240/130mmHg. There was no history of new-onset headaches, palpitations, anxiety, hirsutism, change in weight or easy bruising. She had no other significant past medical history or family history. Section 2: Investigations : An electrocardiogra...

Case History: A 30 year old woman presented with the history of swollen painful eyes for 4 weeks while visiting Italy. She had a background of Hashimoto’s Thyroiditis since 2010 and was treated with levothyroxine 100 mcg once daily. She was given a course of oral steroids for 2 weeks and her thyroxine dose was reduced to 25 mcg once daily in Italy. Since then, her orbital swelling began to improve. She was a non-smoker. On examination, she was noted to have bilateral mild...

Prolactinomas are the most common hormone-secreting pituitary tumors. They typically present with hypogonadism, decreased libido, infertility, and gynaecomastia in men. We present an interesting case of a 44-year-old gentleman who was referred to our endocrine clinic for ‘abnormal thyroid function tests’ with a low T4 despite a normal TSH (TSH 2.01, T4 7.5, T3 3.9). He reported a few years’ history of increasing weight gain and lethargy, generalized aches and pa...

Alemtuzumab, a humanized anti-CD52 monoclonal antibody is effective in treating multiple sclerosis. However, it has been associated with thyroid disorder in up to 30–40% patients. While Graves’ disease is the most common disorder (70%), thyroiditis has been reported up to 4.9% cases.Case 1: 34 year old woman with the background of multiple sclerosis and autoimmune hypothyroidism (on levothyroxine 50 mcg OD) was given Alemtuzumab infusion in Jul...

Germline mutations in the succinate dehydrogenase subunit-B gene (SDHB) are well recognised for predisposing to head and neck paraganglioma, sympathetic paraganglioma, phaeochromocytoma and renal cell carcinoma. The co-existence with pituitary adenomas remains uncommon.We report a 31-year-old female who presented at age 29 years old with 9 months of secondary amenorrhoea. Prolactin was 3000 mIU/l and a 1.7-cm macroprolactinoma revealed on MR pituitary. T...

Case history: Ectopic adrenocorticotropic hormone (ACTH) production accounts for 10–20% of all endogeneous Cushing’s syndrome. The ideal treatment is curative surgery of the underlying tumour. In difficult cases bilateral adrenalectomy is an option. We report a 58-year-old woman with an aggressive ectopic Cushing’s syndrome that required bilateral adrenalectomy undertaken in 1989 at age 32-years.Investigations: At 16 years post adrenalecto...

17alpha hydroxylase deficiency accounts for less than 1% of all patients diagnosed with congenital adrenal hyperplasia. Almost 100 mutations in the CYP17A1 gene causing 17-hydroxylase/17,20-lyase deficiency (17OHD) have been described (OMIM 609300). CYP17A1 is expressed in both the adrenals and gonads. Hallmarks of 17OHD include hypertension, hypokalaemia, primary amenorrhoea and absence of secondary sexual characteristics. Most patients with 17OHD remain infertile.</...