Endocrine Abstracts

A 31 year old female presented to the Endocrine day ward due to headache and dizziness in 2015. She had a background of childhood acute lymphoblastic leukaemia diagnosed at age 7 treated with chemotherapy. She had a cerebral recurrence at age 10 and underwent cerebral radiotherapy, further chemotherapy and subsequently total body irradiation and bone marrow transplant. Following this treatment she was diagnosed with panhypopituitarism and required hormone replacement therapy w...

In 2009 a 39 year old gentleman presented to the Endocrine clinic with symptoms, signs and biochemistry consistent with severe glucocorticoid excess (urinary free cortisol level was significantly raised at >1380mol/24 hours, normal up to 124; early morning cortisol levels varying between 760nmol/land 1225nmol/lwith failure of suppression on a low dose dexamethasone suppression test). An ACTH level taken at this time was 43ng/l. He underwent an MRI pituitary gland which sho...

Case history: A 19 year old lady presented with amenorrhoea, fatigue and headaches. She had normal pubertal growth spurt with an appropriate height for mid-parental height. Her menarche was at age 17, another bleed at 18 but amenorrhoeic since. There was right sided galactorrhoea only on expression. In her teens she had an eating disorder, periods of self-harm and low mood. No treatment except for St. John’s Wort occasionally. No visual disturbance was present.<p clas...

The calcium-sensing receptor (CaSR) is a G-protein coupled receptor expressed in the parathyroid gland and kidneys. Loss of function mutations of the CaSR result in familial hypocalciuric hypercalcaemia (FHH). Rarer, gain of function mutations of the CaSR result in hypercalciuric hypocalcaemia and are inherited in an autosomal dominant pattern. The phenotype varies from asymptomatic individuals, to profound hypocalcaemia. We present a severely affected individual whose case hi...

Case history: A 72 year old gentleman from Zimbabwe presented to clinic with MRI pituitary findings of 1.5×1.4×1 cm pituitary macroadenoma. This had been discovered incidentally during outpatient investigation for severe headaches refractory to standard analgesia at another hospital. The mass was in contact with but not compressing the optic chiasm. He did not describe any visual loss. He had an unintentional weight loss of 10 kg in the last 2 months. He described de...

Urine free cortisol (UFC) is analysed in 24 h urine collections in suspected Cushing’s syndrome, and provides an integrated measure of cortisol secretion over the whole day. The aim of this audit was to review how clinically useful UFC results were, and whether this analytical service was still justified. The current automated immunoassay with manual sample preparation was time-consuming, expensive (disproportionate quality control / external quality assessment (EQA) samp...

Introduction: Primary aldosteronism (PA) accounts for 5-10% of patients with hypertension. Approximately 40-50% of cases are bilateral, usually managed using mineralocorticoid receptor antagonists (MRAs). Recent literature suggests a higher risk of renovascular disease and cardiovascular events in PA patients treated medically, compared to those with essential hypertension. This excess risk is mitigated in individuals with unilateral disease managed surgically...

Case history: A 59 year old Afro-Carribbean male with a 25 year history of cardiac enlargement and hypertension, on multiple anti-hypertensives, presented with increasing breathlessness and several years of markedly reduced exercise tolerance. He was intolerant of spironolactone and eplerenone. His past medical history included hypertersion, obstructive sleep apnoea, Steven-Johnson syndrome secondary to allopurinol, thyrotoxicosis treated with radio-active iodine, monoclonal g...

A 60 year old gentleman with a history of renal stones presented 5 years ago with left sided flank pain. A CT of his renal tract showed an unexpected metastatic deposit in the left iliac crest. Cross-sectional whole body imaging, performed to locate the primary, also identified an expansile soft tissue mass in the T8 vertebral body and a predominantly cystic looking left sided thyroid nodule. He proceeded to have an iliac crest biopsy which was consistent with metastatic folli...

A 69-year-old retired pharmacist was referred to our endocrine clinic with an incidental finding of hypokalaemia noted during recent spinal fusion surgery. He has been hypertensive for 6 years. His blood pressure was well controlled on Diltiazem 240 mg and Doxazosin 4 mg, but required 8 tablets of SandoK daily to maintain normokalaemia. His past medical history includes type 2 diabetes, diabetic retinopathy, chronic kidney disease, hypercholesterolaemia and benign prostatic hy...