Endocrine Abstracts

A 38-year male with background history of Tetralogy of Fallot which had been surgically corrected, presented with symptomatic supraventricular tachycardia in July 2015. This required amiodarone therapy. Thyroid function was normal prior to starting amiodarone. Amiodarone therapy was discontinued in July 2017 when he converted to sinus rhythm. Seven months after stopping treatment, he presented to A&E with signs and symptoms of hyperthyroidism. His TSH was <0.03 mU/l (0...

Case history: An 18-year-old Caucasian female presented with primary amenorrhoea after her younger sister aged 16 years old started menstruating. She had a normal childhood and progressed through puberty normally, with no past medical history or family history. BMI was 22.6 with a normal examination including secondary sexual characteristics (Tanner Stage 5) and no signs of hyperandrogenism.Investigations and Results: Bloods showed an elevated LH:FSH rat...

Introduction: Macroprolactin is a physiologically inactive form of prolactin, usually composed of a prolactin monomer and an IgG or anti-prolactin antibody molecule. Whilst clinically non-reactive, it interferes with immunological assays used for prolactin detection. It is identified by polyethylene glycol (PEG) precipitation, and levels of macroprolactin are generally believed to remain stable over time.Case: We present the case of a 36-year-old gentlem...

Background: Correct identification of patients with HPA axis dysfunction following trans-sphenoidal pituitary surgery is important. Our centre measures post-operative day 5 0900 h serum cortisol (24 h after the last dose of glucocorticoid) to identify the need for glucocorticoid replacement. This is given if post-operative day 5 0900 h cortisol concentration is <300 nmol/l, until dynamic pituitary function assessment occurs.Methods: Data were reviewe...

A 28-year-old woman presents with a one-year history of marked weight gain of 18 kg, increasing hirsutism and night sweats. Clinically, hyperandrogenism and Cushing’s syndrome were suspected. A diagnosis of Polycystic ovarian syndrome was made based on Rotterdam criteria and Metformin was initiated. Initial testing for Cushing’s syndrome demonstrated a high 24 h urinary free cortisol (306 nmol/l) with incomplete cortisol suppression on an overnight dexamethaso...

A 59-year-old gentleman with schizoaffective disorder, treated with long-term lithium therapy and depot fluphenazine, underwent elective cystectomy and ileal conduit formation for transitional cell bladder carcinoma.Post operatively, he developed acute renal impairment, evidenced by a fall in eGFR from 68 to 26 ml/min per 1.73 m2. This resulted in accumulation of lithium to a toxic level of 1.82 mmol/l (0.4–1.0); despite stopping lithium,...

Background: Temporary hypocalcaemia occurs in up to 40% of patients following a total thyroidectomy. Serum calcium and parathyroid hormone (PTH) measurements are currently used to predict post-thyroidectomy hypocalcaemia. However, immediate access to PTH measurement is expensive and not widely available. Serum phosphate responds rapidly to changes in circulating PTH levels and its measurement is readily available in all hospitals. We evaluated the use of serum phosphate to pre...

Context: Hydrocortisone day curves (HCDC) are used to monitor hydrocortisone replacement by obtaining serum samples to measure cortisol levels throughout the day. Salivary measurement of free cortisol offers a non-invasive alternative to serum measurements.Objective: To validate salivary cortisol measurement as an alternative method to assess the adequacy of hydrocortisone replacement in patients with hypoadrenalism.Setting, patien...

We present the case of a 33-year-old woman diagnosed with congenital adrenal hyperplasia (CAH) due to classical 21-hydroxylase deficiency following a salt-losing crisis as a newborn. She had previously been controlled on dexamethasone 0.25 mg bd and fludrocortisone 100 mcg od, as evidenced by high-normal 17-hydroxyprogesterone (17-OHP) and low-normal testosterone levels (8.5 and 0.4 nmol/l respectively).However, she had experienced significant symptoms o...

This gentleman was diagnosed with hyperparathyroidism at the age of 34 and was found to have multiple manifestations of MEN1.Hyperparathyroidism: He was diagnosed with hyperparathyroidism and underwent a parathyroidectomy with removal of 2 glands. Four years later calcium levels were raised once again and two further hyperplastic glands were removed, with cure of his hypercalcaemia.Gastrinoma and other pancreatic islet cell tumours...