Endocrine Abstracts

Introduction: Recently, the factory calibrated FreeStyle Libre (FSL) flash glucose monitoring system has been introduced for use in patients with diabetes mellitus. We assessed the accuracy of FSL compared to the finger prick capillary blood glucose (CBG) over a 2 week period in patients with congenital hyperinsulinism (CHI) and assessed the parents’ experience of using FSL.Methods: About 346 episodes of CBG along with corresponding swipe FSL readin...

The commonest cause of hypercalcaemia is primary hyperparathyroidism (PHPTH). The diagnostic work up includes paired blood samples for serum corrected calcium, parathyroid hormone (PTH) and vitamin D levels. But in young patients, rare genetic conditions could be contributing towards hypercalcaemia and hence could produce a diagnostic challenge. We report hypercalcaemia work up in two young females where genetic tests were required.Case 1<p class="ab...

Hypercalcaemia due to primary hyperparathyroidism (PHPTH) is fully curable by parathyroidectomy. Occasionally recurrent hypercalcemia presents as a results of either residual adenoma, recurrent disease or an ectopic parathyroid gland. The most challenging cases are those with ectopic glands which are not identified on usual surgical neck exploration. We present a similar case that went through multiple surgeries for recurrent hypercalcemia. A 79-year-old lady initially was dia...

The incidence of recurrent primary hyperparathyroidism (PHPTH) (> 6 months from initial exploration) has been reported to be between 1–10%. Repeated neck explorations could be challenging for surgeons and ensuring normalised biochemistry is vital for peri-operative safety. Recurrent parathyroid adenomas can present with aggressive hypercalcaemia which can be challenging to control prior to surgery. We report a similar case below. A 72 year old lady had her first prese...

A 41 year old lady presented to emergency department with tremors and palpitations. Her examination and routine bloods were normal but ECG showed sinus tachycardia (heart rate = 141 bpm). She was treated with propranolol and discharged. She was readmitted in emergency department with ongoing palpitations, lethargy and tremors. On examination, she had a diffuse goitre but no signs of Graves’ eye disease. The blood tests showed overt thyrotoxicosis (TSH<0.01 mU/l, FT4 =...

Background: Pegylated interferon-alpha (IFN-α) is licensed as an antiviral, immunomodulatory and anti-proliferative therapy, but may induce autoimmune conditions including Type 1 diabetes Mellitus/latent Autoimmune Diabetes of Adults (LADA). Case Report: A 50-year-old male presented with a 3-week history of polyuria, polydipsia and weight loss. Following review by his General Practitioner he was found to have an elevated serum glucose (55.4 mmol/l)....

Background: Our previous study revealed a high prevalence of abnormal mineralization markers namely low 25 hydroxyvitamin D (47.9%); high serum alkaline phosphatase (3.7%) and low calcium-phosphate product (9.8%) suggestive of biochemical signs of osteomalacia (OM, defined as any two of these risk factors). OM was more prevalent in girls (11.2%) compared to boys (5.0%). In this follow-up study, we aimed to evaluate if biochemical OM was associated with low intakes of calcium a...

Background: Children with hyperinsulinaemic hypoglycaemia (HH) are at a high risk of brain injury, while children with ketotic hypoglycaemia (KH) are believed to be neurologically normal, due to the absence and presence respectively of ketone bodies that act as an alternate fuel during hypoglycaemia. Our objective was to ascertain if children with HH sustain greater white matter (WM) injury in comparison to children with KH.Methods: Neurologically normal...

Case report: A 9-year-old girl of mixed ethnic origin presented with symptomatic hypercalcaemia with a 3-month history of weight loss and lethargy. Autoimmune hypothyroidism had been diagnosed 10 months previously. Serum vitamin D concentration (11 nmol/l) was low and cholecalciferol 20 000 units daily for 7 days followed by 800 units daily was commenced. One month later, her symptoms worsened and she had developed anaemia and renal impairment. Hypercalcaemia was noted (Corr C...

The overproduction of ACTH, in conditions such as Congenital Adrenal Hyperplasia (CAH) leads to significant morbidity. Current treatment with glucocorticoids does not adequately suppress plasma ACTH, resulting in excess adrenal androgen production. At present, there is no effective medical treatment that would directly block ACTH action. Such a therapy, especially one that can be orally administered, would be of great clinical value allowing a ‘block and replace’ tre...