Endocrine Abstracts

Total thyroidectomy is one of the definitive treatments for Graves’ disease. This case describes the rare recurrence of thyroid eye disease (TED) and thyrotoxicosis due to thyroid remnant tissue. We present a 58 year old lady with Graves’ disease first seen in 2005 with positive TSH receptor antibodies (TSHRab) level of 2.5 U/l. She had a large multinodular goiter at presentation and this continued to grow with retrosternal extension and subsequent tracheal deviation...

A 54 yr old man presented with a six-month history of palpitations, sweating and weight loss. He had a past history of hypertension, type II diabetes, asthma and was HIV-1 seropositive since 14 yrs and was taking potent anti-retroviral therapy: Nevirapine 200 mg bd; Kaletra 3 capsules bd; and didanosine ec 400 mg od.Investigations confirmed Graves thyrotoxicosis (fT4 72.1 pmol/l; TSH <0.01 mU/l; and TSH receptor antibody positive). He was initially t...

A 36 year old lady presented with a 6 month history of amenorrhoea & increasing fatigue. There was no background of headaches or visual disturbance. She denied thyroid related symptoms. Examination revealed her to be both pale and fatigued however there were no other significant findings. Investigations revealed: random cortisol 56 nmol/l; prolactin 1698mU/l (0-480); LH 0.3U/l; FSH 2.9U/l; fT4 <5pmol/l (10-24); TSH 21.92mU/l (0.4-4.0); IGF1 12.5nmol/l (10-24) An insulin...

A 55-year-old gentleman was referred to surgeons for screening colonoscopy in view of family history of bowel cancer. His mother, maternal aunt and two cousins had history of bowel cancer. When seen by the surgeons, he gave 4-month history of intermittent abdominal bloating and rectal bleeding. His past medical history included a recent diagnosis of hypertension, a chronic history of facial neuralgia and history of excision of numerous facial skin tags. He was on amlodipine 5 ...

A 55 year old woman presented in May 2002 with symptoms of chronic fatigue, depression, intermittent and headaches. She had a history multinodular goitre and was found to have a fT4 of 15 pmol/L (N: 11–23) and TSH of 0.32 mU/L (N: 0.5–4). Medication was citalopram and thyroxine 50 ug once daily commenced by her GP. On examination her BMI was 24 kg/m2. She had scant body hair, was normotensive, and had normal visual fields on confrontation. Baseline investi...

A 54-year-old Afro–Carribean woman developed worsening obesity, hypertension, and proximal muscle weakness. Clinical examination revealed cushingoid facies, truncal obesity (BMI 34.8), abdominal striae and a BP of 150/90, Ferriman–Gallway score 12.Investigations:- FBG 10.7 mmol/l, 24 urine cortisols 147 mmol/l, 207 mmol/l (NR 25–280 nmol/24 h), normal short synacthen test (cortisol 471 rising to 1002 nmol/l). Subsequent testing revealed a ...

There is a known correlation between dyslipidaemia and hypogonadism in diabetes. In non-diabetic men, calculated free testosterone correlates better than total testosterone with the elements of the metabolic syndrome. The aim of this study is to investigate if this was also true in diabetic men.Methods: This is a retrospective observational study. We analyzed biochemical parameters from 140 sequential male diabetic patients who attended the diabetic erec...

We report the case of a seventy year-old type 2 diabetic man presenting with a fifteen year history of erectile dysfunction. He had micro- and macrovascular complications of diabetes and liver cirrhosis secondary to Hepatitis C infection. Investigations showed a high total testosterone of 32.3 nmol/l, raised SHBG at 127 nmol/l with elevated LH 20.4 IU/l and FSH 14.9 IU/l. Initial calculated free testosterone was 281 pmol/l with a bioavailable testosterone of 1.67 nmol/l, both ...

Subclinical Cushing’s syndrome (CS) has not been adequately characterised and the natural history is unknown. We report two cases of subclinical CS that presented as perforated duodenal ulcers (DU) and in both cases the disease rapidly progressed to overt CS.Case 1A 60-year-old women presented with perforated DU requiring laparotomy and repair. Abdominal CT scanning demonstrated a right adrenal mass 4.2 cm. There were no clini...

A 76 year-old man presented with back pain anorexia and cachexia. CT scan confirmed a pancreatic mass with liver metastasis. Liver biopsy confirmed a neuroendocrine tumour. Because of left ventricular failure he was unsuitable for tumour reduction therapy. He was hypercalcaemic (2.54–3.1 mmol/l), PTH and PTHrP were elevated [2.5 pmol/l (1.9–6.9), 7.1 pmol/l (<1) respectively]. A diagnosis of PTHrP secreting neuroendocrine tumour with coexisting primary hyperparat...