Endocrine Abstracts

A 25-year lady was referred by her GP with a six-month history of symptoms suggestive of thyrotoxicosis; weight loss, palpitations, heat intolerance and lethargy. She also complained of thirst, polyuria and nocturia. Examination findings included tachycardia, tremor and a moderately enlarged goitre.In clinic, blood tests performed confirmed thyrotoxicosis: TSH<0.05 mU/l (NR 0.3–4.2 mU/l), free T3 >46.1 pmol/l (NR 2.5–5.7 pmol...

Somatostatinomas are rare neuroendocrine tumors usually arising from the pancreas and duodenum. Symptoms include hyperglycemia, cholelithiasis, diarrhea and steatorrhoea. Treatment with somatostatin (SST) analogue may appear paradoxical, but can lower SST levels and improve symptoms.Case: A 60-year-old gentleman presented with diarrhoea, opening his bowels between 12 and 13 times a day causing him to stop working and become depressed. Repeated fasting gu...

A 51-year-old gentleman underwent a thyroidectomy 7 years ago for a benign multinodular goitre. Unfortunately, as a consequence of the surgery he became hypocalcaemic secondary to hypoparathyroidism. He was commenced on calcichew 1 tablet daily, calcium carbonate ‘500’ twice daily, vitamin D injections and 1- alphacalcidol 1 mcg daily. Initially, his PTH remained detectable and therefore it was hoped there would be some recovery, but over time this was proven not to ...

Background: Post-operative hypocalcaemia affects up to 30% of patients. It may be delayed to the second or third post-operative day and is therefore the key determinant of post-operative stay. Various strategies have been used to overcome this problem including the blanket administration of calcium and discharge followed by daily blood tests.Objectives: To evaluate the use of using a parathyroid hormone (PTH) assay 4 h following surgery as a predictor of...

A 50 year old lady undergoing elective surgery for pyloric stenosis secondary to chronic ulceration, was diagnosed with primary hyperparathyroidism (calcium 3 mmol/l), elevated parathyroid hormone (PTH). Following exploratory parathyroidectomy, left and right superior parathyroid adenomas were removed. 2 years later she re-presented with hypercalcaemia (Calcium 2.74 mmol/l, PTH 26.5 pmol/l (1.1–6.8 pmol/l)) and appeared Cushingoid. Investigations confirmed Cushing’s ...

IntroductionThe Epworth Sleepiness Scale (ESS) is a validated simple method of measuring subjective daytime sleepiness in a variety of situations whereby patients are asked to score the probability of dozing as no chance, slight, moderate or high chance. An ESS>10 is regarded as excessive daytime sleepiness which may be a result of sleep apnoea or sleep disorders. The British Thoracic Society advise that patients who have ESS>10 or sleepiness in ...

In ACTH-dependent Cushing’s syndrome, the high dose dexamethasone suppression test (HDDST) has been traditionally used to identify differentiate between pituitary-dependent Cushing’s disease and ectopic ACTH production. However, more recently, concerns regarding the diagnostic accuracy of the HDDST have led to many centres abandoning this test in preference to bilateral inferior petrosal sinus sampling (IPSS). We aimed to establish current consensus in the UK for the...

IntroductionRadioactive iodine (RAI) is a well-established treatment for relapsed Graves and toxic nodular hyperthyroidism. Lithium reduces the release of organic iodide and thyroid hormones from the thyroid gland, which results in a reduction of urinary radioiodine excretion. Previous studies have shown lithium may improve the effectiveness of radioiodine therapy; however research in this area is limited.Objective<p class="abs...

Background: Measurement of mean serum growth hormone (GH) during an oral glucose tolerance test (OGTT) is currently used for determination of disease activity in patients with acromegaly post-treatment. In contrast to normal subjects, GH secretion in acromegalic patients is largely non-pulsatile, even after treatment.Aim: To determine if random serum GH correlated with mean serum GH during OGTT in patients with acromegaly post-treatment. Furthermore, we ...

A 76 year old female presented in 2000 with thyrotoxicosis secondary to Grave’s disease. She was treated successfully with propylthiouracil (PTU) for 2 years then opted for and received a standard therapeutic dose of radioactive iodine (131I) in September 2003. Her thyroid function tests (TFTs) normalised in the first 6 months after treatment (FT4 <14 pmol/l) and she was started on replacement thyroxine 50 mcg od for 8 weeks. She presented in March 2004 wit...