Endocrine Abstracts

A 60-year-old HIV positive man was referred from the genitourinary physicians for investigation of hypercalcaemia (calcium 3.20 mmol/l). He described non-specific symptoms of tiredness and polyuria. Past medical history included well-controlled HIV with an undetectable viral load, secondary syphilis and a history of renal stones. Medications included Didanosine, Emtricitabine, Darunavir and Ritonavir.Initial investigations demonstrated a suppressed parat...

A 29-year-old lady with known Addison’s disease and hypothyroidism was admitted with a history of increasing lethargy and dizziness for 2 weeks. At the time of admission she was on (and compliant with) Hydrocortisone 20 mg twice daily, Fludrocortisone 100 mcg once daily and Thyroxine 150 mcg once daily. On the day of admission her BP was 128/92 mmHg with no postural drop. Her electrolytes were normal, however an early morning cortisol measured 28 mmol/l. She was treated w...

Urinary catecholamine assessment is one of the screening tests for phaeochromocytoma but false positives results can occur. The pretest probability for phaeochromocytoma is 0.5% (1 in 200 patients tested) in the presence of hypertension and suggestive symptoms. We present two cases of elevated urinary catecholamines in hypertensive subjects treated with serotonin and noradrenaline re-uptake inhibitors (SNRI).Case1: A 27 year old male presented with palpi...

Hypophosphatasia (HPP) is a genetic condition affecting teeth and bones, identified by low levels of alkaline phosphatase (ALP) activity in the blood. This deficiency is caused by mutations in the ALPL gene, leading to an accumulation of substances that hinder bone mineralization. In adults, this can result in osteomalacia, frequent fractures, premature tooth loss, and arthralgia. We describe the case of a 38 year old Caucasian woman who was 24 weeks into her third pregnancy a...

Phaeochromocytomas show a positive correlation between tumour size, metanephrines level and symptoms. Small tumours (<1 cm) are usually asymptomatic and are picked up through hereditary screening or surveillance of previous tumours. We present a 72-year-old gentleman who was referred to the Endocrinology service with symptoms of palpitations, sweating, dizziness and hypertension for several years. He was investigated for palpitations but no cardiac arrhythmias were present...

Langerhans Cell Histiocytosis is an inflammatory myeloid neoplasia caused by mutations of several genes in the MAPKinase (MAPK) pathway which can present in single or multiple sites. Our patient presented to her GP with several months of amenorrhoea, thirst, tiredness and 3 stone weight loss. She was previously fit and well, working, and married with children. Blood tests revealed panhypopituitarism with low 9am cortisol 117 nmol/l (133-537). Oestrogen and gonadotrophins were ...

Anabolic androgenic steroids (AAS) are class C drugs with adverse effects on health. Prevalence is increasing, often with a lack of awareness of the dangers. We present the case of a 33 year-old male with dilated cardiomyopathy and polycythaemia apparently due to AAS abuse over three years. The patient presented with five weeks of increasing breathlessness and chest tightness. Examination revealed evidence of congestive cardiac failure. Chest radiograph showed evidence of pulm...

We present a case of a 73 year old female with recurrent non-functioning adenoma and co-existent mantle cell lymphoma within the pituitary fossa. Mantle cell lymphoma (MCL) is rare comprising around 6% of non-Hodgkin lymphoma diagnoses. It infrequently involves the central nervous system, with only one published case of involvement of the pituitary gland. Our patient initially presented in April 2003 with marked visual loss due to a large non-functioning cystic pituitary macro...

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...

Background: We previously reported that a high number of synacthen tests are carried inaccurately within our trust with a significant delay in sample collection after tetracosactide injection. We also reported a high number of patients having Synacthen tests unnecessarily. In light of this we introduced a Synacthen proforma and re-audited our results.Method: A retrospective study was carried out on 36 patients undergoing Synacthen tests bet...