Endocrine Abstracts

The in-hospital pharmacological management of patients with diabetes has recently been identified by the National Diabetes Inpatient Audit as a key safety issue. Over 30% of inpatient drug charts surveyed in the 2013 audit had at least 1 diabetes medication error in the preceding week. Patients with a diabetes medication error on their drug chart were also twice as likely to have one or more hypoglycaemic episodes during their hospital stay.A paper by Br...

Background: Following the RECOVERY study, dexamethasone is prescribed for patients requiring inpatient treatment of Covid. Cases of new and atypical diabetes have been reported during this pandemic. The risk of steroid induced hyperglycaemia is well recognised but other metabolic sequelae less so. We present a patient who developed severe hypernatraemia following commencement of dexamethasone.Case Report: A 44-year-old man (unvaccinated) was diagnosed wi...

Flash glucose monitoring has increased dramatically in patients with diabetes since the introduction of the FreeStyle libre 2 (FSL) incorporating hypoglycaemia predictive features and an alarm system. A 31-year-old lady, gravida 2, para 1 presented at 26 weeks’ gestation following a car accident where she fractured clavicle and navicular. She reported blurred vision and subsequent collapse whilst driving (with her daughter as a passenger) prior to the accident. Paramedics...

We describe the use of plasmapheresis for pre-operative stabilisation in a case of refractory Grave’s thyrotoxicosis. Our case is a 21 year woman with 12 month history of severe Grave’s disease. Her serum freeT4 was >100 pmol/L (ref.range 11–24) and TSH <0.014 mU/L at diagnosis, had no goitre and negative thyroid peroxidase antibodies. Thyroid uptake scan confirmed Grave’s disease. She was treated with carbimazole 60 mg daily and propranolol. She re...

Background: The incidence of gestational diabetes appears to be rising, likely related to the increasing prevalence of overweight/obesity in the general population, and the trend of increasing maternal age. However, it must be remembered that some women newly diagnosed with diabetes in pregnancy have latent type 1 diabetes; GAD (glutamic acid decarboxylase) antibody measurement may be useful in cases with atypical features. We present two such cases.Case...

The differential diagnosis of diabetes insipidus includes psychogenic polydipsia and a water deprivation test is sometimes difficult to perform due to patient’s confusion, compliance or extreme thirst. We present a simple, cost effective alternative to the water deprivation test.67-year-old male was admitted with a 3 week history of polyuria, polydipsia and extreme thirst. On systemic enquiry he complained of left sided pleuritic chest pain for few ...

Patients with significant hypercalcaemia unrelated to primary hyperparathyroidism have suppressed or undetectable levels of Parathyroid Hormone (PTH). We present a case where the hypercalcaemia was not due to primary hyperparathyroidism yet the PTH was elevated.82 year old male was admitted with 2 weeks history of lethargy, vomiting, increased frequency of micturiton, light headedness and confusional state. Past medical history included Type 2 diabetes, ...

Hyponatraemia is recognised as a serious metabolic emergency with varied aetiology. We report an unusual case of hyponatraemia.A 36 year old woman was admitted following a seizure. Her relationship with her boyfriend had recently ended. She was disorientated with a GCS of 11/15. She was apyrexial and examination was unremarkable. Old notes recorded an interest in complimentary health and 'systemic' candidiasis.A drug overdose was suspected until plasma biochemistry ret...

We present a complex case of basal skull prolactinoma presenting with CSF rhinorrhoea and without elevated prolactin. Our case is a 41 year woman who presented 2 years ago with streptococcal meningitis and CSF rhinorrhoea. Initial imaging suggested right sphenoid tumour eroding the skull base involving structures in anterior and middle cranial fossa. After the tumour was biopsied by ENT team, she developed signs of recurrent meningitis, therefore referred to neurosurgery. She ...

Introduction: Adrenal incidentalomas are a common reason for endocrinology referral. We present a case of an incidentally discovered adrenal mass biochemically mimicking phaeochromocytoma with rapid resolution on subsequent imaging.Case report: A 53-year-old female was found to have a 5 cm mass adjacent to the right kidney on ultrasound performed to investigate abnormal liver function tests. CT confirmed a right adrenal mass. The patient was normotensive...