Endocrine Abstracts

Background: Elevated low-density lipoprotein cholesterol (LDL-C), which arises due to genetic and environmental factors, has a causal role in the pathogenesis of cardiovascular disease (CVD). Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are approved for patients with familial hypercholesterolaemia (FH) and patients at high risk of CVD due to non-familial hypercholesterolaemia (non-FH). In clinical trials, PCSK9 inhibitors are well-tolerated and lead to redu...

Introduction: Hypercalcaemia is a common electrolyte disturbance in patients presenting acutely and can be cause or effect of a multitude of disorders. We present four cases, in which the hypercalcaemia masked or unmasked underlying pathology that may have otherwise gone undiagnosed.Case series: A 36-year old man presented with acute pancreatitis after completing a marathon. Bloods: adjusted calcium (cCa) 3.16 mmol/L, phosphate 0.5...

Introduction: Hypercalcaemia is a common electrolyte disturbance in patients presenting acutely and can be cause or effect of a multitude of disorders. We present four cases, in which the hypercalcaemia masked or unmasked underlying pathology that may have otherwise gone undiagnosed.Case series: A 36-year old man presented with acute pancreatitis after completing a marathon. Bloods: adjusted calcium (cCa) 3.16 mmol/L, phosphate 0.5...

Objective: To describe the clinical presentation of forefoot and midfoot diabetic foot ulcers (DFUs) complicated by osteomyelitis and their outcomes with conservative management in a multi-disciplinary care environment and determine predictors of ulcer healing.Methods: This is a retrospective study of all consecutive cases of DFUs complicated by osteomyelitis presenting to our multi-disciplinary diabetes foot clinic between 1st January and 30th June 2016...

Case history: An 80-year-old female presented with progressive leg and facial swelling, postural dizziness, generalised lethargy and reduced mobility. She suffered with chronic kidney disease (stage 3), rheumatoid arthritis and hypertension and had undergone partial thyroidectomy. Examination revealed marked bilateral leg oedema to the sacrum, facial oedema, an ejection systolic murmur, normal JVP and a clear chest.Investigations and results: Investigati...

Introduction: Recent evidence supports the use of high dose steroids for 28 days in acute alcoholic hepatitis. We present a patient with Childs Pugh C liver cirrhosis, who developed adrenal axis suppression following such treatment. We discuss the complex aetiology and biochemistry of hypocortisolism in liver disease.Case: 48 year-old female admitted with alcoholic hepatitis, treated with a non-tapering 28-day course of 40 mg prednisolone. The patient wa...

Thyroid nodules are common in the general population. In 2006, we audited and discovered that primary care direct access to thyroid ultrasound (TUS) has limited value in detecting sinister thyroid pathology. To improve quality of thyroid nodule management, in May 2007, we introduced four changes (1) appointed a thyroid MDT coordinator, (2) produced a thyroid nodule proforma to guide primary care referrals, (3) established the rapid access one-stop thyroid ultrasound FNA clinic...

The prevalence of thyroid nodules is extraordinarily common. An increase in the use of head and neck imaging, including ultrasound, computed tomography (CT) and carotid Dopplers, has increased the number of non-palpable thyroid nodules identified. For most patients, their thyroid disease is non-neoplastic and asymptomatic. The challenge in the management of thyroid nodules is identifying patients with clinically significant disease, most notably thyroid neoplasia, without exce...

Grave’s orbitopathy typically presents with symptoms of proptosis and diplopia. It is an autoimmune condition of retro-orbital tissues. We present a case in which the management of orbitopathy has been complex and required escalation to immunosuppression and consideration of biological agents. A 34-year-old female presented with 2 weeks of diplopia. She had normal visual acuity with no past medical or family history. She never smoked. Thyroid eye disease was diagnosed, sh...

A 59-year-old lady presented with significant weight gain, and a history of hypertension for investigation of possible Cushing’s syndrome. Her BMI was 29, with mainly central obesity. Initial tests revealed elevated untimed cortisol on two separate occasions, at 905 nmol/l and 893 respectively with detectable midnight cortisol, at 548 and 481. Of 24-hour urinary free cortisol (UFC) was also elevated on two separate occasions, at 931 nmol/24 h and 827 respectively. ACTH wa...