Endocrine Abstracts

In 2003, a 60-year-old man presented to our unit non-specifically unwell. Thyroid function tests (TFTs) demonstrated an elevated fT4 of 50 pmol/l (reference range 10–22 pmol/l)), T3 8.8 pmol/l (reference range 3.1–6.8 pmol/l) and TSH of 10.3 mU/l (reference range 0.5–4.5 mU/l)). Following appropriate investigations, a TSHoma was confirmed. MRI of the Pituitary confirmed the finding of a macroadenoma and the patient underwent pituitary decom...

A 64-year-old man was referred with an incidental finding of multiple bilateral thyroid cysts following CT scanning for abdominal pain. He had originally presented with an acute episode of left upper quadrant pain. CT scan of the abdomen demonstrated multiple lesions in the liver compatible with simple cysts. There were also multiple bilateral renal cysts, of which the largest was 10 cm. A small amount of retroperitoneal fluid was seen, probably as a result of a ruptured cyst....

A 68 yr old male with a history of type 2 diabetes presented with myalgia and girdle weakness affecting him on a frequent but episodic basis. Investigations confirmed Cyclical Cushing's Disease. Pituitary MRI was normal. Further investigations include bilateral inferior petrosal sinus sampling (BIPSS) which can help determine the origin of ACTH-dependent Cushing’s syndrome. After CRH-stimulation, a peak central to peripheral ACTH ratio of >3 suggests a pituitary ACTH ...

We report a case of severe postradiation encephalitis presenting 6 months following pituitary radiotherapy for pituitary adenoma. Our patient (78 years old female) was diagnosed with non-functioning pituitary ademona compromising the optic chiasm in 1999 at the age of 66 years. She underwent transphenoideal decompression in 2000. Over the next 8 years there was slow re-growth of the pituitary adenoma and by 2008 it was causing optic chiasm compression. At this stage, the patie...

A 28-year-old man presented to his GP in Turkey complaining of fatigue. As part of his work up, serum PTH was assessed and was found to be markedly elevated at 29.9 pmol/l (normal range 1.6–6.8), with normal calcium, phosphate, alkaline phosphatase, renal function, 1,25- and 25-hydroxy vitamin D3 levels. A DEXA scan was normal and a Sestamibi scan did not reveal any parathyroid adenoma. Prior to any further investigations or treatment, he moved to the UK.<p class="abs...

A 60-year-old HIV positive man was referred from the genitourinary physicians for investigation of hypercalcaemia (calcium 3.20 mmol/l). He described non-specific symptoms of tiredness and polyuria. Past medical history included well-controlled HIV with an undetectable viral load, secondary syphilis and a history of renal stones. Medications included Didanosine, Emtricitabine, Darunavir and Ritonavir.Initial investigations demonstrated a suppressed parat...

A 29-year-old lady with known Addison’s disease and hypothyroidism was admitted with a history of increasing lethargy and dizziness for 2 weeks. At the time of admission she was on (and compliant with) Hydrocortisone 20 mg twice daily, Fludrocortisone 100 mcg once daily and Thyroxine 150 mcg once daily. On the day of admission her BP was 128/92 mmHg with no postural drop. Her electrolytes were normal, however an early morning cortisol measured 28 mmol/l. She was treated w...

Urinary catecholamine assessment is one of the screening tests for phaeochromocytoma but false positives results can occur. The pretest probability for phaeochromocytoma is 0.5% (1 in 200 patients tested) in the presence of hypertension and suggestive symptoms. We present two cases of elevated urinary catecholamines in hypertensive subjects treated with serotonin and noradrenaline re-uptake inhibitors (SNRI).Case1: A 27 year old male presented with palpi...

Phaeochromocytomas show a positive correlation between tumour size, metanephrines level and symptoms. Small tumours (<1 cm) are usually asymptomatic and are picked up through hereditary screening or surveillance of previous tumours. We present a 72-year-old gentleman who was referred to the Endocrinology service with symptoms of palpitations, sweating, dizziness and hypertension for several years. He was investigated for palpitations but no cardiac arrhythmias were present...

Langerhans Cell Histiocytosis is an inflammatory myeloid neoplasia caused by mutations of several genes in the MAPKinase (MAPK) pathway which can present in single or multiple sites. Our patient presented to her GP with several months of amenorrhoea, thirst, tiredness and 3 stone weight loss. She was previously fit and well, working, and married with children. Blood tests revealed panhypopituitarism with low 9am cortisol 117 nmol/l (133-537). Oestrogen and gonadotrophins were ...