Endocrine Abstracts

AimsTo define the prevalence of hyponatraemia (serum sodium <135 mmol/l) on our medical admissions unit and review the laboratory investigations, diagnosis and management of patients with critical or severe hyponatraemia (serum sodium <120 mmol/l).MethodsSerum sodium levels requested from the medical admissions unit over a six-month period were retrospectively collated. Case notes and biochemistry dat...

Clinical case: A 37 year-old Caucasian man was admitted with sudden onset lower limb weakness following a carbohydrate-heavy meal the night before. Pulse was 110/min, sinus rhythm, BP 167/92 mmHg. There was generalised muscle weakness, particularly in his legs, with hyporeflexia and hypotonia. There was no sensory deficit and plantar responses were downgoing. Serum K+ was 2.4 mmol/L, associated with typical ECG anomalies, and was corrected with 40 mmol intravenous KCl followed...

Background: Enzalutamide is a next-generation androgen receptor (AR) antagonist, used as a daily oral agent, in the treatment of castration-resistant prostate cancer. Its suppression of 11β-hydroxysteroid dehydrogenase-2 enzyme has been reported in the literature, leading to hypertension through a relative increase in cortisol concentration at the level of the mineralocorticoid receptors. Enzalutamide is also known to be a potent inducer of drug metabolising enzymes (cyto...

Background: Optimization of sex hormone replacement therapy (SHRT) is essential in long-term management of patients with hypogonadism. However, approaches to formulations of therapy, dose change (if any), monitoring of adequacy of therapy and safety are not standardised.Objectives: The survey aimed to establish the approach to management of SHRT for male and female hypogonadism.Methods: Online survey, live for 4 weeks (1/11/2021) d...

Introduction: Hypercalcaemia diagnosed in hospital setting is most commonly PTH-independent and malignancy related, whilst hypercalcaemia discovered in community setting is commonly secondary to Primary Hyperparathyroidism (PHPT). Other rare causes include granulomatous diseases such as sarcoidosis and familial hypocalciuric hypercalcaemia (FHH).Case Summary: A 73-year-old male with a background of hypertension and chronic kidney disease stage 3 was foun...

Background: Congenital adrenal hyperplasia (CAH) is the commonest genetic endocrine disorder, affecting 1 in 18 000 UK births. The 2010 CaHASE Study identified a myriad of health problems associated with CAH and its treatment, and a lack of consensus on treatment strategies in adults. Endocrine Society guidelines (2010, revised 2018) have since been published to support management. As one of the original CaHASE centres, we have audited our recent practice against these new sta...

Background and aims: Electrolyte imbalance is common among hospital inpatients, reflecting severity of underlying illness, but also independently contributing to excess morbidity and mortality. However, studies have largely been retrospective, with incomplete data capture. We prospectively evaluated the prevalence of major Na and Ca disorders among inpatients at the Newcastle-upon-Tyne Hospitals.Method: With approval of the Information Guardian, we used ...

Activation of the hypothalamo-pituitary-gonadal axis, from the third trimester of pregnancy to the first post-natal months in males, results in serum concentrations of gonadotrophins and testosterone approaching adult levels. This phase, known as male mini-puberty, represents a key window of opportunity to identify congenital GnRH deficiency in early childhood.We present a case to illustrate the diagnostic efficiency of screening for mini-puberty in a ma...

Turner’s syndrome (TS) results from a genetic abnormality in phenotypical female individuals where the second X chromosome is either absent or present in a mosaic form. The most obvious consequences are short stature and primary amenorrhoea, although there are often dysmorphic features as well as cardiovascular and genitourinary complications. 90% of TS patients experience primary amenorrhoea with subsequent infertility. Spontaneous recovery of ovarian function in patient...

Background: Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder (1:4′000-10′000) characterized by absent puberty and infertility. There is striking gender discordance (3–4 males for each female case) thus women with CHH are the “rarest of the rare”. Unlike many orphan conditions, treatments are available and hormonal therapies are effective for inducing puberty and fertility. However, the presumable availability of treatment does not ne...