Endocrine Abstracts

Carcinoid tumours are neuroendocrine tumours characterised by production of serotonin (5-hydroxytriptamine, 5-HT) and tachykinins. Carcinoid syndrome occurs approximately in 10% of carcinoid tumours and symptoms arise when these vasoactive substances enter the systemic circulation escaping hepatic degradation. This normally occurs with metastasis to the liver or bronchus.We present a case of a 66-year-old woman who presented with carcinoid syndrome in th...

A 62-year-old male was referred by his GP querying acromegaly. His past medical history included sleep apnoea, hypertension, dislipidaemia and gout. Serum IGF1 was elevated at 827 ug/l (normal range 100–300 ug/l). Prolonged oral glucose tolerance did not show suppression of GH with a nadir of 9.0 mu/l. A pituitary MRI demonstrated a 5x6mm microadenoma. There were no visual field defects. The patient was pre-treated with somatostatin analogues and proceeded to transphenoid...

A frail, long-term surgical inpatient, was under-nourished on TPN. He had a tendency towards hypocalcaemia and was under regular review by the surgical and nutrition team. It was noted on his routine monitoring that his Ca had fallen to 1.78 mmol/l (2.2-2.6 mmol/l). He was reviewed out-of-hours and prescribed 10mls of 10% Calcium Gluconate infused over 10 minutes, as per the hospital guidance for the treatment of hypocalcaemia. A further prescription of calcium gluconate 10% i...

A 64-year-old lady presented feeling unwell with nausea, vomiting, headaches and dizziness. She was taking sulpiride for schizophrenia and had an 8-year history of hyponatraemia. The hyponatraemia, was associated with mild hyperprolactinaemia, prompting investigation for hypopituitarism twice previously by endocrinologists in a different hospital. Secondary adrenal insufficiency had been excluded on the basis of: cortisol 576 nmol/l at 30 min after 250 mcg synacthen and cortis...

Malignant paraganglioma causing skull metastasis is rare. We describe a 49-year-old male who gives a history of a mass on the vertex of the scalp, noticed a year before presentation and which grew rapidly from 1 cm to 5 cm. His past medical history is significant for hypertension (treated with Amlodipine), and back pain and headache on a regular basis. On MRI the mass measured 5.7 cm craniocaudal, by 7 cm AP and 6.9 cm transverse. Additionally, multiple additional focal areas ...

We present a case of a 48 year old male who presented originally with a 8mm prolactinoma. He presented with a reduced libido for 6 months, and lethargy and retro-orbital headaches for the previous 18–24 months. He had no visual disturbance. Initial investigations revealed hyperprolactinaemia with a level of over 4000 iu/L and a normal IGF1 of 184 iu/L in the presence of a pituitary macroadenoma (8 x 11mm). He responded well to Cabergoline with a noticeable improvement in ...

An 88 year old female presented with gradually worsening stridor and dysphagia. Her past medical history was complex and included included ischaemic heart disease and atrial fibrillation treated with warfarin. She had been initially referred for enlargement of her lonstanding goitre 6 years ago (2012) with investigations demonstrating a suppressed TSH and a normal FNA cytology. Respiratory function tests did not show any significant extra thoracic compression, but her CT scan ...

A 69-year-old man was referred to Endocrine clinic after presenting to his GP with dizziness, syncope, and fatigue. 0900 h cortisol was low at 39 nmol/l. The remainder of the anterior pituitary profile was unremarkable. He had been diagnosed with HIV in 1997 and was treated with highly active anti-retroviral therapy (truvada 1 OD, ritonavir 100 mg OD, and darunavir 800 mg OD) in addition to acyclovir 400 mg OD with control of his CD4 count and viral load. In addition, treating...

A 55-year-old male was referred to the endocrine clinic in October 2006 with a 6 month history of reduced libido, lethargy and right sided retro-orbital headaches. He was otherwise well and not on any medications. Examination revealed gynaecomastia, but no other cutaneous stigmata of endocrinopathies and visual fields were full to confrontational testing.Prolactin was elevated to 4791 mU/l, and a subsequent MRI confirmed a macroadenoma measuring 8×1...

An association between the use of proton pump inhibitors (PPIs) and profound hypomagnesaemia has been highlighted in a number of case reports. As the prevalence of this occurrence or cause remain unknown, we undertook a review of patients with significant hypomagnesaemia in our hospital with a particular focus on use of PPIs and management.35 patients (21f; mean age (S.D.): 71.3 (14.6); median: 74 years) with significant hypomagnesaemia (d...