Endocrine Abstracts

Background: Myasthenia gravis and thyroid disease can sometimes create diagnostic confusion because the two may have similar clinical features and may also co-exist in the same individual.Case: A 68 years male, was seen in the Neurology clinic with drooping of his left eyelid, first noticed 8 months prior, worse in the evenings. There were no other complaints. He had history of type2 diabetes, and Graves’ disease. On examination, he appeared to have...

Background: MEN2A-causing RET variants are considered highly penetrant, and early prophylactic thyroidectomy is recommended to prevent the development of Medullary thyroid cancer (MTC). However, existing risk estimates may be exaggerated due to their reliance on clinically selected patients, leading to unnecessary surgeries. To address this, we conducted a comprehensive study of 450,000 clinically unselected individuals to evaluate the risk of MTC wit...

Background: Cranial diabetes insipidus (DI) is characterised by the inability to produce ADH (antidiuretic hormone) also known as AVP (arginine vasopressin) resulting in uncontrolled diuresis. Desmopressin is a synthetic form of AVP used to treat this. Treatment errors can lead to dehydration and hypernatremia which can be life-threatening. In view of recent literature suggesting current concerns with Desmopressin administration worldwide, Diabetes Insipidus i...

Based on the traditional belief that the lower vagina does not form owing to excess androgens in utero, extensive dissections are undertaken to bring the vagina down to the skin level in 46XX CAH individuals. However, long held knowledge about the embryological origins of the lower vagina and the key role of androgens has been questioned by genetic and molecular studies [Cai Y. 2009. https://doi.org/10.1387/ijdb.082846yc ]. Our aim was to assess the level of the vaginal introi...

Bilateral adrenal haemorrhage is an uncommon but life-threatening condition which may result from trauma, sepsis, coagulopathy, underlying tumour or autoimmune conditions. We present a 62-year-old female with a history of well controlled hypertension and asthma who was admitted with sudden onset epigastric pain and suspected cholecystitis. She received her first dose of Astrazeneca (AZ) Covid-19 vaccine seven days prior to onset of symptoms. Her systolic blood pressure was mor...

We describe a 68 year lady who was found to have bilateral adrenal masses (7 cm on the right side and 1.3 cm on the left) during investigations for gastrointestinal symptoms, in early 2016. Biochemistry revealed high urinary normetanephrines of 41.7pmol/24h (ref 0–3) and metanephrines of 40pmol/24h (ref 0–1.8). A PET and MIBG scan revealed uptake in both adrenals and therefore a diagnosis of bilateral phaeochromocytoma was made. The patient had complained of occasion...

A case is reported of a man with stage IV grade 2 pancreatic VIPoma. At diagnosis he had several features which may have expedited the diagnosis including refractory diarrhoea containing undigested foodstuffs, alcohol-related flushing, electrolyte abnormalities and intestinal oedema on imaging. Symptom control was challenging. There was no benefit from creon, loperamide or codeine and escalation to both short and long acting somatostatin analogues was futile. Consistent with a...

Androgen-producing tumours of the adrenal are extremely rare. The androgen effects and malignancy potential can be detrimental in children. Adrenal adenomas are usually small, whereas carcinomas are larger and aggressive. We present the challenges in managing a female toddler with a large androgen secreting adrenal adenoma. A 22 months old 46 XX girl presented with features of hyperandrogenism but not of glucocorticoid or mineralocorticoid excess: tall stature, facial and pubi...

The combination of hypophosphataemia and hypercalcaemia has numerous aetiologies, which can be challenging in the clinical setting. Careful early biochemical identification will facilitate appropriate further imaging and management. We report a case of a gentleman who presented in his ninth decade with deteriorating cognition, proximal muscle weakness and reduced mobility on a background of hypertension, type 2 diabetes with associated ...

Background: The British Thyroid Association’s thyroid cancer guidelines (2014) advocate the U1-5 nodule grading system as a primary diagnostic and classification tool.Aims: We assessed whether practice reflected guidelines, and examined patient outcomes.Methods: Patients with a thyroid ultrasound, undertaken by radiographers or general radiologists, in January-June 2015 were identified. Investigation and outcomes...