Endocrine Abstracts

Background: The treatment of choice for primary hyperparathyroidism (PHPT) is surgical parathyroidectomy. Cinacalcet is the first calcimimetic approved by European Medicines Agency (EMA) in 2008 for use in patients with PHPT who are not fit for surgery or refuse surgery. British National Formulary (BNF) recommends it for hypercalcaemia in PHPT where parathyroidectomy is inappropriate. The main aim of treatment with cinacalcet is to keep calcium levels at safe levels.<p cla...

Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised patients. It is an independent risk factor for mortality and is associated with increased length of hospital stay.Method: The objective of audit was to review practice of investigations and management of hyponatraemia in adults at Bedford hospital in line with evidence based guidelines including European Society of Endocrinology 2014 clinical practice guidance. An observ...

A 68-year-old lady was admitted with constipation, epigastric pain, vomiting, occasional coffee ground emesis and melena. She had no chest pain, osmotic symptoms or weight changes. Past medical history was significant for peptic ulcer disease and she was not taking any medications apart from over the counter cod liver oil. She did not have diabetes or cardiovascular risk factors. Her sister had type 1 diabetes. Examination was remarkable for dehydration, mild tachycardia and m...

We present an interesting case of a 50-year-old woman with previous history of alcohol dependence, depression & oesophagitis who was brought to the emergency department by ambulance with vomiting, back pain and feeling generally unwell. Her GCS was 14/15, HR128/min, RR 32/min, BP 111/60, temperature 35.2 & CBG 11.2mmol. She reported consuming one bottle of Vodka every day. Initial venous blood gas analysis showed severe metabolic acidosis (pH 6.79, HCO3 3, Lactate 15, ...

We present a 60-year-old man who was referred to endocrine clinic with fatigue and a random cortisol of 136nmol/l . He had clear renal cell carcinoma and had right radical nephrectomy 7 years ago. Surveillance scans revealed involvement of mediastinal lymph nodes, pancreas and small bowel and he has pancreatic and small bowel resection in four years ago. He had recurrence a year ago and received Ipilimumab and Nivolumab. Biochemistry revealed low fT4 and inappropriately normal...

We report a case of malignant hemangiopericytoma in sellar region in a 73-year-old lady who initially presented with symptomatic hyponatraemia. She was found to have hypocortisolism on short synacthen test. She was treated with hydrocortisone and was found to have secondary hypothyroidism. Her gonadotropin levels were commensurate with menopause, prolactin levels were normal and there was no suggestion of diabetes insipidus. Initial pituitary magnetic resonance imaging (MRI) w...

A 56 year old man was admitted from psychiatry ward after episode of symptomatic hypoglycaemia with capillary blood glucose of 2.5 mmol/L. His background included CKD on thrice weekly haemodialysis, IHD, stroke, hypertension and paranoid psychosis but not diabetes. He denied taking hypoglycaemics, his oral intake was normal and weight was stable. He had another symptomatic hypoglycamia after 22 hours with venous glucose of 1.5 mmol/L, Insulin 320 mU/L (3.0–17.0) and C-pep...

A 54 year old Caucasian male presented with progressive muscle weakness leading to complete paralysis in upper and lower limbs evident on examination. Initial venous gas analysis showed potassium of 2.1 mmol/l, and ECG showed U waves with prolonged QTc. A diagnosis of hypokalaemic periodic paralysis was made, and intravenous potassium administered. The paralysis gradually resolved over the next 3–4 h, as repeat serum potassium level rose to 4.0 mmol/l. He described 6 mont...

A 64 year old Caucasian man with long standing type 1 diabetes and complications of retinopathy, neuropathy and nephropathy was referred with suspected deep venous thrombosis (DVT) in the left lower limb. He had a week’s history of worsening pain and swelling in the medial left thigh and struggled to weight bear on that leg. He felt unwell a day before admission and was found to have hyperosmolar hyperglycaemic state with ketosis on admission. Ultrasound Doppler was nega...

Hypokalemia is a common and potentially fatal electrolyte disturbance, especially in hospitalised patients. Therefore, prompt assessment and management is vital to avoid serious complications. We report a case of 77 Year old gentleman with a background of Alzheimer’s presenting with abdominal distension, intermittent diarrhoea and shortness of breath. He had normal blood pressure with no signs of Cushing syndrome but was found to have hypokalaemia. Plain imaging revealed ...