Endocrine Abstracts

A 50-year-old woman was admitted to hospital feeling unwell.Biochemistry: Calcium 3.46 (2.15–2.6),PO4 0.42 (0.8–1.5), AlkalinePhosphatase 259 (30–95). She had been diagnosed 3 years ago with Carcinoma breast and had undergone surgery,chemotherapy and radiotherapy. Regular follow-up had not shown any recurrence.No breast lump or bony tenderness was recorded.Further biochemistry: PTH 30 (0–6...

We report 2 patients with Graves’ thyrotoxicosis complicated by jaundice.Case 1 - A 36 year old referred to the gastroenterologists with a 3-month history of general malaise, myalgia, jaundice, 4 stone weight loss and diarrhoea. A hepatitis and autoimmune liver screen were negative, bilirubin elevated at 200 umol/l, coagulation screen and ultrasound scan were normal and a liver biopsy showed cholestasis. Thyroid function tests (TFT’s) demonstra...

We report the case of a 27 year old female who was referred to our diabetes team from the antenatal clinic, when she was found to have an abnormal glucose tolerance at 16 weeks of gestation (fasting and 2 hours blood glucose values of 5.1 mmol/L and 12.2 mmol/L respectively). At the same time she was suffering with severe hyperemesis gravidarum for many weeks and had suffered significant weight loss (thyroid function tests were unremarkable). She had no specific symptoms to su...

A 22 year old lady, in her third pregnancy, presented at 35 weeks gestation with modest hypertension (BP 130/90). She was known to carry a high risk mutation for Von Hippel Lindau syndrome with no prior disease manifestations. Urinary catecholamine levels were normal at 18 weeks gestation and she remained asymptomatic throughout her pregnancy. Repeat measurement at 35 weeks demonstrated elevated noradrenaline and normetadrenaline values (1761 nmol/24h and 9.69 micromol/24h res...

Antithyroid drug (ATD) resistant thyrotoxicosis raises difficult management issues. We describe three recent cases of apparent refractory thyrotoxicosis.Case 1: A 31 year old woman presented in July 2003 with thyrotoxicosis. Despite treatment with carbimazole (CBZ) 20 milligrams tds, serum free thyroxine (FT4) concentrations remained around 60 picomoles per litre (11-20). In October, CBZ dose was increased to 40 milligrams bd and dexamethasone 2 milligra...

A 71 year old woman presented to neurologist with taste disturbance, tingling and stabbing pains across the face. Examination, blood tests and MRI scan of the brain were normal. Later that year she lost considerable amount of hair, developed severe onycholysis, nausea and loose stools. Weight started to decline and skin became darker. Endocrine referral was made.On examination she had titubation, partial alopecia and severe onycholysis. BP 140/80 mm Hg, ...

A 55 year old lady was referred by her general practioner with a six months history of generalised lethargy and cold intolerance.This was associated with abdominal bloating and constipation.She had been more irritable recently and was getting depressed. She also described symptoms suggestive of carpal tunnel syndrome. The only past history of note was of lactose intolerance.There was no family history of thyroid disorder.On examination she was clinically...

A 24-year old male who, was normal at birth, became listless and volume depleted at 3 weeks of age. Investigations yielded an Addisonian picture (serum Na+ 115 mmol/l; K+ 8.2 mmol/l; urea 15.8 mmol/l). Serum 17-hydroxyprogesterone (17-OHP) levels were measured and found to be high (2,564 nmol/l). Urinary 17-oxosteroids and 17-OHP were also elevated. The neonate was thought to have 21-hydroxylase-deficient congenital adrenal hyperplasia (CAH) and therapy with fludrocortisone an...

Vitamin D is commonly used in the treatment of hypoparathyroidism after thyroid surgery. It is well recognised that excess vitamin D therapy leads to hypercalcaemia, and that this effect may be prolonged, lasting upto several weeks with some vitamin D preparations. We describe a case of severe, life threatening hypercalcaemia from vitamin D therapy, in which the duration of action of vitamin D was exceptionally long. A 51 year old lady presented with acute, severe haemorrhagic...

We report the case of a 57-year-old woman who presented with headache of sudden onset and with blurring of vision in the right eye. This had been preceded by a week's history of fever, rigors and coryzal symptoms which had been treated as malaria and had subsequently settled. Examination demonstrated proptosis and complete ophthalmoplegia of the right eye with 6/60 acuity. Baseline investigations included normal urea and electrolytes, clotting screen and full blood count, with...