Endocrine Abstracts

Background: Adrenal insufficiency (AI) requires life-long glucocorticoid substitution therapy (1), and bears significant risks of infection, cardiovascular (CV) & metabolic disease burden. Historically Hydrocortisone (HC) has been the mainstay of treatment. Prednisolone is a once-daily alternative due to a longer half-life (up to 3.2 hrs). Currently, there is no discernible evidence supporting the superiority of either medication (2).Objective: To ex...

Background: The water deprivation test serves as a key diagnostic test to differentiate between Arginine Vasopressin Deficiency (AVP-D), Arginine Vasopressin Resistance (AVP-R), and Psychogenic Polydipsia (PP) in patients presenting with symptoms of polydipsia and polyuria, when common causes such as diabetes mellitus have been excluded. This study evaluated the established diagnostic values for serum osmolality, serum sodium, and urine osmolality.Method...

Introduction: Prolactinomas are the commonest type of secretory pituitary tumours. In current practice, dopamine agonists (DA) remain the mainstay treatment. However, treating physicians are increasingly aware of DA-associated impulse control disorders (ICD) in their patients. We describe 4 individuals with prolactinomas, who either developed ICD on DA or deemed at ‘high risk’, successfully managed surgically with preservation of pituitary function. All decisions for...

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Case history : A 44-year-old female presented with 6-week history of gradual deterioration in her left vision associated with eye pain. She saw an ophthalmologist who noted that she had reduced visual acuity (6/24) and colour vision (Ishihara colour vision score 3/15) in her left eye with left relative afferent pupillary defect (RAPD). It was thought that she may have a left retrobulbar neuritis so she was advised to attend A&E for an urgent neurology assessment. On examin...

A 30-year-old female presented to her general practitioner with a three-month history of fatigue, visual disturbance, polydipsia and dizziness. She was treated for iron deficiency anaemia, but re-presented two-months later with new-onset headache and worsening visual disturbance. Previously, she had childhood leukaemia, treated in Brazil with no cranial irradiation. On examination there was left eye loss of light/dark perception and right temporal vision loss. She was referred...

Purpose: There are sporadic reports illustrating more severe TED and complications in those with diabetes mellitus (DM) and from local experience these patients have poorer outcomes as seen in other diseases, such as cardiovascular disease. However, the relationship between glycaemia and clinical activity/severity and disease course are not well described.Methods: A multi-centre retrospective patient-cohort study of 236 patients referred to three TED mul...

Purpose: There is increasing evidence that a multidisciplinary (MDT) approach optimises diagnosis and management in active Thyroid Eye Disease (TED) and is recommended by current TEAMeD-5 guidelines1. Here we aim to describe the clinical and endocrine characteristics of a large cohorts of patients with TED seen in 3 MDT clinics in London.Methods: A retrospective patient-cohort study of 236 patients with suspected TED referred to these services...

A 38-year male with background history of Tetralogy of Fallot which had been surgically corrected, presented with symptomatic supraventricular tachycardia in July 2015. This required amiodarone therapy. Thyroid function was normal prior to starting amiodarone. Amiodarone therapy was discontinued in July 2017 when he converted to sinus rhythm. Seven months after stopping treatment, he presented to A&E with signs and symptoms of hyperthyroidism. His TSH was <0.03 mU/l (0...