Endocrine Abstracts

Case history: A 45-year-old male was referred to Endocrinology from the Infectious Diseases clinic for investigation of possible adrenal insufficiency. The patient had multiple co-morbidities including asthma, hepatitis B and HIV. The patient’s GP had introduced a fluticasone inhaler to control the symptoms of his asthma, however when the patient was seen in Infectious Diseases clinic as an interaction with his protease inhibitor (atazanavir) was suspected. A random corti...

A 32-year-old man was urgently referred to the endocrinology and neurosurgical teams by the neuro-ophthalmologist. He gave a 3 week history of sudden onset of left-sided visual impairment, with further visual deterioration a week previously. Urgent review in the eye clinic had revealed that the visual acuity in his left eye was reduced to finger counting only, with a pale left optic disc and a relative afferent pupillary defect on examination. Visual field testing demonstrated...

A 37-year-old woman was referred to the endocrine team for the assessment of her adrenal axis, as she had been taking high dose prednisolone (20-40 mg) for several years for the management of her brittle asthma. Drug history included inhaled Symbicort 200/6 (SMART regime), tiotropium and montelukast. Her respiratory symptoms improved with the introduction of theophylline, thus enabling her prednisolone to be switched to oral hydrocortisone, with appropriate ’sick- day&#14...

Numerous epidemiologic studies have associated hyponatremia with both osteoporosis and bone fractures. Disordered bone metabolism with hyponatremia occurs primarily by direct sodium-sensing mechanisms on osteoclasts that are independent from osmolality. Additional effects may be mediated by arginine vasopressin (AVP) receptors on osteoclasts and osteoblasts. Further, even mild hyponatremia can contribute to neurological dysfunction via gait instability and increased falls, bot...

Aim: To determine patient outcomes following radioactive iodine (I131) therapy in a UK district general hospital for the treatment of benign thyroid disease.Methods: A record of all patients at University Hospital Hairmyres (Scotland, UK) undergoing radioactive iodine therapy for benign thyroid disease was kept. Patients were identified using a unique community health index (CHI) number. A retrospective case note review was then carried out fo...

We present a 50-year-old man who was referred to endocrine clinic with painful gynaecomastia of 3 months duration. He was waiting hip replacement. He had history of a lump in his left breast 9 years ago. He had USS and FNA. He was treated with some tablets for a month and discharged from breast clinic. He had no other past medical history. He worked as a physical trainer to metropolitan police. He did not smoke or drink and was on no medication. He had never used recreational ...

Thyroidectomy is a definitive form of treatment for patients with hyperthyroid Graves’ disease particularly those who are noncompliant with or have serious side effects to the antithyroid drugs, have very large goitres, refuse 131I therapy or, have moderate to severe ophthalmopathy. The risk of perioperative thyroid storm is usually higher following an acute event such as surgery, trauma, or infection. Thus, patients with thyrotoxicosis presenting for surgery should ideal...

Controversy exists as to the best way to determine which thyroid nodules we should have fine needle aspiration (FNA). The lack of consensus in the British and American Thyroid Association guidelines has not helped to clarify this. The use of ultrasound scan (USS) determined U grading versus a composite of nodule size and pre-determined number of suspicious features continues to be debated. We therefore set out to compare the accuracy of U grading with other identified USS feat...

Introduction: Hyponatraemia is a common cause of morbidity and mortality affecting 15–28% of inpatients. Tolvaptan is a competitive vasopressin 2 antagonist licensed to treat hyponatraemia secondary to the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). There has been concern that tolvaptan treatment may lead to rapid overcorrection of sodium in a minority of patients, thus potentially leading to osmotic demyelination syndrome.Met...

Pituitary tumorigenesis has been analysed from multiple perspectives, yet mRNA expression profiling studies are limited. In this study, microarray analysis was used to identify pathways and networks related to pituitary tumour physiology using key de-regulated genes and bioinformatics analysis. Eight pituitary adenomas (five non-functional tumours, two GH-secreting tumours and a TSH/prolactin-secreting tumour) and a pool of random normal control RNA were profiled for RNA expre...