Endocrine Abstracts

Normocalcaemic hyperparathyroidism (NPHPT) is characterised by persistently normal calcium levels and elevated PTH values on at least two consecutive measurements, after excluding other causes of secondary hyperparathyroidism. This group of patients is challenging to identify and characterise. The prevalence of the disease in the literature varies significantly due to the various definitions used and the fact that not all causes of secondary hyperparathyroidism have been exclu...

We present a case of a 52-year-old man with a past medical history of primary hypothyroidism on treatment, presenting with elevated TSH levels, suggesting inadequate thyroxine (T4) replacement. The patient was managed with 200 μg of T4 for 14 years with no compliance issues. TSH levels failed to normalise despite increasing the dose of T4. In addition to elevated TSH levels the patient noted progressive leg swelling and associated shortnes...

Non-neoplastic pituitary stalk thickening is rare in patients without infiltrative disorders and diabetes insipidus. We present a non-diabetic patient with end stage renal failure with hyperprolactinaemia and pituitary stalk thickening.A 53-year-old Nigerian gentleman presented with reduced libido, erectile dysfunction and painful gynaecomastia. He denied galactorrhea, headaches or visual disturbances. He previously received spironolactone for resistant ...

Somatostatin analogues (SSA) have an established role in the medical management of patients with neuroendocrine tumours (NETs). They are effective in the symptomatic treatment of some metastatic NETs and may also provide tumour stabilisation or reduction. We report two patients with disease progression who benefited from SSA. Mrs HW, 64-year old woman, was diagnosed with a grade 1 small-bowel NET with lymph node and liver metastasis in 2012: Ki-67 index < 1%. Despite a seg...

Introduction: Avascular necrosis of the femoral head (AVN) is most commonly a consequence of glucocorticoid excess and is believed to be due to osteocyte apoptosis. It can also be due to vascular occlusion or trauma. We describe a patient with congenital adrenal hyperplasia secondary to 17-hydroxylase deficiency who presented with osteoporotic vertebral fractures and atraumatic avascular necrosis of the femoral head. She was also found to have mild cardiomyopathy.<p class=...

Background: At the Metabolic Bone Centre in Sheffield, UK, patients with asymptomatic primary hyperparathyroidism (PHPT) are followed up annually through a register, with annual blood tests, questionnaires inquiring about symptoms or renal stones within the past year, and biennial DXA scans, which doctors then evaluate. Patients are recalled to the clinic if their reported symptoms and/or biochemical results suggest abnormalities associated with PHPT requiring...

Aim: The BTA guidelines published recently suggested an uniform U1–U5 classification of thyroid nodules on ultrasound (US) and organising management and follow-up based on these grades. The aim of our retrospective analysis was to assess the reliability and usefulness of US in assessment of thyroid nodules, in comparison with post-operative histological diagnosis.Methods: All patients who underwent thyroid surgery for thyroid nodules were assessed, ...

Aim: Assessment of the clinical impact of a positron emission tomography/computed tomography (PET/CT) with FDG in the management of differentiated thyroid cancer (DTC) in patients with increased or positive thyroglobulin autoantibodies (AbTg).Methodology: Retrospective study involving 15 patients seen in the follow-up with confirmed DTC primarily treated with total thyroidectomy and Iodine 131. Patients presenting with increased AbTg and a negative or no...

We report the case of an 82-year-old lady who was admitted with hypercalaemic crisis (adjusted Calcium 4.82 mmol/L) and acute kidney injury (creatinine 169 micromol/L). PTH was 295 pmol/L, raising the suspicion of an underlying parathyroid carcinoma. She had no palpable neck mass. Her ALP was 131 IU/L and Vitamin D 73 nmol/L; myeloma screen was negative and chest radiograph showed no pathology. A DEXA scan revealed osteoporosis. The hypercalcaemic crisis...

A 22-year-old female first presented in 2008 with a six-month history of galactorrhoea and irregular menses. She had hyperprolactinaemia (2401 mIU/L), a negative macroprolactin screen and her pituitary MRI scan demonstrated a 4 mm microadenoma. Her cannulated prolactin levels were >1500 mIU/L. TFTs, IGF-1, cortisol and remaining pituitary profile were within normal range.Cabergoline was commenced and gradually i...