Endocrine Abstracts

Vitamin D is not only essential for maternal health but insufficient levels during pregnancy and breast feeding can lead to infantile rickets or osteomalacia in their offspring. NICE recommends that vitamin D supplements should only be offered to pregnant women with dark skin, those who usually cover their skin, vegans and women between the ages of 19–24. Although it is widely known that these women are at high risk of vitamin D deficiency, the incidence of vitamin D insu...

Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies. During pregnancy, maternal thyroid hormone requirements increase. It is known that the pregnant woman is the sole source of the fetal supply of thyroid hormones from conception to approximately 13 weeks of gestation when fetal thyroid function has developed. Organogenesis particularly of the nervous system is dependent on adequate thyroxine levels in fetal circulation. An elevated thyrot...

A 75-year old gentleman presented with symptoms of increasing lethargy, loss of appetite associated with weight loss and constant micturition. A CT scan showed extensive peritoneal mass in the lower abdomen and pelvis with disseminated intraperitoneal malignancy. A CT guided biopsy confirmed a poorly differentiated tumour. Immunohistochemistry showed that all the cytokeratin markers were negative, but vimentin was positive and CD117 (c-kit) was strongly positive, indicating th...

The possibility of optimal testosterone replacement is hotly debated. Conventional testosterone ester injections give widely fluctuating testosterone levels and may be painful. Testosterone patches currently available in the UK frequently cause intolerable skin irritation and are conspicuously large. The only safe oral preparation testosterone undecanoate rarely provides sustained sufficient circulating testosterone concentrations. Testosterone pellets have been used since sho...

Introduction: Strategies for optimising adherence in patients with growth hormone disorders often focus on enabling them to achieve autonomy in the management of their treatment, including self-injection of growth hormone (GH). However, there is a scarcity of published data on the effectiveness of this approach. We conducted a survey to elicit responses from UK endocrinologists and endocrine nurses, to investigate ‘real-world’ clinical practices around the initiation...

Case history: We present the case of a 73 year old lady who was admitted following a neck of femur fracture after a fall. She had surgery performed with no major complications. During her inpatient stay, she unexpectedly became very unwell, complaining of abdominal pain, low grade pyrexia, tachycardia, tachypnoea, hypotension, nausea and vomiting (1). Initial management was as sepsis of unknown source.Investigations: Bloods on admission (23/08/23): Hb 13...

The calcium-sensing receptor (CaR) is the key controller of parathyroid hormone (PTH) secretion and extracellular calcium homeostasis. Hyperphosphataemia increases PTH secretion and is associated with secondary hyperparathyroidism (SHPT). We reported recently that inorganic phosphate (Pi), and sulphate, can attenuate CaR activity directly (in CaR-transfected HEK-293 cells) and Pi can increase PTH secretion rapidly from human and murine parathyroid cells. To investigate this fu...

A 55 year-old Nepalese lady, previously fit and well, presented to her GP 2 months ago with palpitations and weight loss. She was diagnosed with Graves thyrotoxicosis based on her clinical history and biochemistry, and was started on carbimazole 40 mg daily. She suffered from COVID19 infection a month later and started self-isolating. She continued to feel unwell for three weeks but did not seek urgent medical attention due to the perceived general recommended isolation guidel...

39-year-old female, with a past medical history of Graves Hyperthyroidism, underwent total thyroidectomy 18 years ago, with resultant hypoparathyroidism, hypocalcaemia and hypothyroidism. Her calcium levels are usually in the range of 1.6-1.8 mmol/l, but there are times when it can go to dangerously low levels (range of 1.4-1.15 mmol/l) causing symptoms, sometimes with ECG changes, requiring hospital admissions and IV calcium replacements. There is no parathyroid activity dete...

Sixty six year old gentleman was referred to clinic with hypercalcaemia. He suffered with low mood, “funny turns”, nocturia and loose stools with urgency to open bowels. He appeared tanned but no increase pigmentation in skin folds. There was no palpable lymphadenopathy or neck lump. The calcium levels were around three with low normal PTH of 3.7 (2.8 on repeat). He had not developed any complications like osteoporosis, fracture or renal stones secondary to hypercalc...