Endocrine Abstracts

Introduction: Opioid drugs are used frequently for the management of moderate-to-severe chronic pain. Whilst their use is known to impact on endocrine function, this impact is not always well described. We present an unusual case of opioid-induced primary hypoadrenalism, which fully resolved on withdrawal of opioid medications.Case: A 54-year old female presented with a 13-month history of severe thoracic arthritic pain, for wh...

Introduction: Opioid drugs are used frequently for the management of moderate-to-severe chronic pain. Whilst their use is known to impact on endocrine function, this impact is not always well described. We present an unusual case of opioid-induced primary hypoadrenalism, which fully resolved on withdrawal of opioid medications.Case: A 54-year old female presented with a 13-month history of severe thoracic arthritic pain, for wh...

Case History: A 71-year old male, who had been on amiodarone therapy for many years, was receiving Levothyroxine therapy due to amiodarone-induced hypothyroidism. He was subsequently found to have thyrotoxicosis, which remained after levothyroxine discontinuation. He had type 2 diabetes and ischaemic cardiomyopathy and had an implanted cardiac defibrillator due to multiple VT arrests. Amiodarone therapy had contributed to stabilisation of his cardiac arrhythmias and had contin...

A 71-year-old man was diagnosed with poorly differentiated T4N0M0 gastric adenocarcinoma. He received neoadjuvant chemotherapy, followed by elective subtotal gastrectomy. Mean arterial pressure was maintained above 70 mmHg throughout the 5-hour operation. On post-operative day 3, the patient became confused, pyrexial, hypotensive with new-onset atrial fibrillation. CT head was unremarkable and CT chest/abdomen/pelvis (CAP) showed bilateral pleural effusions with normal adrenal...

We present the case of a 28-year old woman who presented with menstrual irregularity and hirsutism since menarche at age 11. She had been diagnosed with polycystic ovarian syndrome and treated with the oral contraceptive pill for 12 years, despite BMI of 21 kg/m2. Blood pressure was 101/66 mmHg. Baseline electrolytes showed sodium 140 mmol/L, potassium 3.6 mmol/L. Short synachthen test confirmed the biochemical diagnosis of congenital adrenal hyperplasia (CAH) [cort...

We present a case of a 53 year-old lady with HIV, who was referred to the endocrine service with a random cortisol of <20 nmol/l. She complained of fatigue, appetite loss and 13 kg weight loss. She had a history of brain histoplasmosis, which had been successfully treated >5 years previously. At that time she required a short course of steroid therapy acutely. Short synachthen test revealed inadequate response (cortisol at 0 min: 378 nmol/l, 30 min: 481 nmol/l, 60 min:...

25% of Cushing’s syndrome cases are caused by cortisol producing tumours of the adrenal glands. Adrenalectomy is standard treatment followed by glucocorticoid replacement therapy until the hypothalamic-pituitary-adrenal axis recovers. We present a challenging case of adrenal insufficiency after unilateral adrenalectomy for Cushing’s syndrome. A 38 year-old woman was referred with hyperlipidaemia and uncontrolled hypertension diagnosed 4 years previously. Examination ...

A 38-year old lady from the Philippines presented with a 2-year history of a painless thyroid lump, without pressure symptoms. Over the previous year it had gradually enlarged in size. She gave a history of disturbed sleep, tremor, anxiety and weight loss over the 2-year period. Past medical history included right middle lobectomy for bronchiectasis 10 years previously. Thyroid function tests revealed TSH<0.05 mu/l, FT4 86 pmol/l, FT3 18.3 pmol/l and ...

Introduction: Epidemiological evidence suggests that vitamin D (25(OH)D3) deficiency is an acquired risk factor for tuberculosis (TB). Lack of sunshine during the winter reduces 25(OH)D3 levels markedly, but darker skin pigmentation reduces 25(OH)D3 synthesis in African and Asian populations wherever they live.Aims: To examine 25(OH)D3 deficiency and its associations in TB patients in a regional population.Methods: Serum 25(OH)D3 c...

Thyroid ultrasound (US) is a useful tool in a spectrum of thyroid conditions. In some hospitals, primary care has direct access to requesting thyroid US, rather than via a speciality. We were keen to assess the outcomes of thyroid US referred by primary care.We analysed all primary care referrals for thyroid US, retrospectively, during the first six months of 2006 and analysed them according to the following 3 reasons for referral – 1) suspicion of ...