Endocrine Abstracts

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....

Patients with acromegaly have characteristic clinical features of soft tissue overgrowth. Both somatic and metabolic features of acromegaly are secondary to excess GH secretion and high circulating levels of insulin-like growth factor 1 (IGF1). However, an acromegaloid phenotype associated with severe insulin resistance is occasionally seen in the absence of biochemical hallmarks of acromegaly (insulin-mediated pseudoacromegaly). Here we present a case of ‘insulin-mediate...

A 48-year-old lady presented to neurology with a 2 year history of progressive leg weakness, rendering her wheelchair-bound. Neurological examination revealed a proximal myopathy. She had a 2 year history of diabetes, and an endocrine opinion was sought to see if the clinical features could be related to diabetes. It was then noted that she appeared Cushingoid, with a blood pressure of 158/92, central obesity, striae and facial acne. She had been amenorrhoeic for 2 years. Endo...

A 25-year lady was referred by her GP with a six-month history of symptoms suggestive of thyrotoxicosis; weight loss, palpitations, heat intolerance and lethargy. She also complained of thirst, polyuria and nocturia. Examination findings included tachycardia, tremor and a moderately enlarged goitre.In clinic, blood tests performed confirmed thyrotoxicosis: TSH<0.05 mU/l (NR 0.3–4.2 mU/l), free T3 >46.1 pmol/l (NR 2.5–5.7 pmol...

Somatostatinomas are rare neuroendocrine tumors usually arising from the pancreas and duodenum. Symptoms include hyperglycemia, cholelithiasis, diarrhea and steatorrhoea. Treatment with somatostatin (SST) analogue may appear paradoxical, but can lower SST levels and improve symptoms.Case: A 60-year-old gentleman presented with diarrhoea, opening his bowels between 12 and 13 times a day causing him to stop working and become depressed. Repeated fasting gu...

A 51-year-old gentleman underwent a thyroidectomy 7 years ago for a benign multinodular goitre. Unfortunately, as a consequence of the surgery he became hypocalcaemic secondary to hypoparathyroidism. He was commenced on calcichew 1 tablet daily, calcium carbonate ‘500’ twice daily, vitamin D injections and 1- alphacalcidol 1 mcg daily. Initially, his PTH remained detectable and therefore it was hoped there would be some recovery, but over time this was proven not to ...

Background: Post-operative hypocalcaemia affects up to 30% of patients. It may be delayed to the second or third post-operative day and is therefore the key determinant of post-operative stay. Various strategies have been used to overcome this problem including the blanket administration of calcium and discharge followed by daily blood tests.Objectives: To evaluate the use of using a parathyroid hormone (PTH) assay 4 h following surgery as a predictor of...

Background: Arginine Vasopressin Deficiency [AVP-D] can occur as consequence of any abnormality or injury at one or more of the sites involved in the Antidiuretic hormone [ADH] secretion. AVP-D is one of the presenting features of suprasellar lesions with panhypopituitrism. The natural course of the disease differs based on the underlying aetiology. It is likely to be transient post-operatively. Idiopathic DI is usually permanent however DI can be reversible w...

Although NICE guidelines recommend that radioiodine is the first-line treatment for Graves disease, carbimazole is often used initially to get control of the hyperthyroidism. This patient was exquisitely sensitive to carbimazole initially, and despite initial recurrence, he cannot be treated with radioiodine as he now has intermittent hypothyroidism.Case: A 42-year-old male was diagnosed with Grave’s disease and initially treated fo...

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...