Endocrine Abstracts

Case history: A 52 year old lady presented to her GP with a 2 year history of headaches, anxiety and loose stools. The GP found lid retraction and fine tremor but no goitre. Her heart rate was 100. Her GP sent blood for thyroid function tests and results showed a TSH of <0.03 mu/l and free T3 of >30.8 pmol/l. She was started on propranolol 40mg thrice daily and referred to endocrinology. In clinic she described palpitations whilst watching TV and sweatiness. She had su...

Case History: Case 1: A 37-year-old lady with relapsing-remitting multiple sclerosis was initiated on Alemtuzumab and symptoms of sweats and heat intolerance arose. Hyperthyroidism was confirmed with free T4 30.1 pmol/l (12–22) and suppressed TSH. Symptoms settled without antithyroid medication and within 2 months T4 had fallen to 10.2 pmol/l with TSH 6.95 mIU/L. After a further 6 weeks T4 was 9.8 with TSH 20.35 and levothyroxine was initiated. Anti-TPO was raised at 442 ...

Mrs XY, 29 years. (gravida: 3 and para 2) was admitted under the obstetricians with severe hyperemesis gravidarum (HG). An ultrasonogram revealed single live foetus of 8 weeks gestation. Her two previous pregnancies were normal with no history of HG. Mrs XY was on levothyroxine 150 μg OD for autoimmune primary hypothyroidism with TPO antibodies of 259 kU/l (0–5.6). She was also taking sertraline 200 mg OD for depression. The hyperemesis settled with i.v. fluids as we...

Background: Sarcoidosis is an inflammatory granulomatous multisystem disorder commonly presenting with noncaseating granulomas in lung and lymphoid tissue. Other organs like skin, eye and joints also involved.Case report: We present a 62-year-old diabetic woman presented to the emergency with progressive alteration in sensorium and left hemiparesis for two days. Patient had lower respiratory tract associated with recurrent hypoglycaemic attacks two weeks...

Introduction: X-linked adrenoleukodystrophy (X-ALD) is an important cause of primary adrenocortical insufficiency (PAI) in men. It’s characterized by impairment in peroxisomal degradation of very-long-chain-fatty-acids (VLCFA), leading to its accumulation on central nervous system, adrenal cortex and testes.Adrenomyeloneuropathy, the most common phenotype of X-ALD, coexists with PAI in up to 70% cases.Case report: A 28-year-ol...

We present a difficult case of pituitary thyroid hormone resistance (PTHR) in a 6 year old girl. She presented at the age of 22 months with chronic cough, diarrhoea, failure to gain weight and gross motor delay. She was also noted to be hyperactive and clumsy with poor co-ordination. Persistent tachycardia was present on examination. Thyroid function tests revealed increased thyroid hormone concentrations with a free T4 of 63.7 pmol/l (9–25) and a free T3 of 20 pmol/l (3....

Introduction: Riedel’s thyroiditis is a rare disorder of unknown aetiology and may be seen isolated or as a part of multifocal fibrosclerosis. Multifocal fibrosclerosis involves two or more fibrotic disorders including Riedel’s thyroiditis, retroperitoneal fibrosis, sclerosing mediastinitis, retro-orbital pseudotumour and sclerosing cholangitis. We report a case of recurrent Riedel’s thyroiditis as part of multifocal fibrosclerosis presenting with a woody neck s...

Factitious thyrotoxicosis secondary to Levo-thyroxine accounts for approximately 0.3% of all cases of hyperthyroidism. Although recognised as a cause of thyrotoxicosis, there are no peer-reviewed published cases of thyrotoxicosis secondary to ingestion of Tri-iodothyronine.A 23-year old lady presented to endocrine clinic with a 6-month history of palpitations, heat intolerance and tremor. She had a history of PCOS and reported difficulties with weight co...

An 18-year old male presented with galactorrhoaea and obesity. PRL measured 16,630 mU/l, FSH 6.0 U/l, LH 5.0 U/l, testosterone 8.6 nmol/l, SHBG 15.0 nmol/l, IGF-1 22.0 nmol/l and TSH 1.39 mU/l. Several 24-hour urinary free cortisol estimations excluded hypercortisolism. Short synacthen test confirmed an intact HPA axis. Visual fields were full. Pituitary-MRI revealed a large adenoma extending into the right cavernous sinus without suprasellar extension. PRL started declining u...

Hypercalcaemia due to primary hyperparathyroidism (PHPTH) is fully curable by parathyroidectomy. Occasionally recurrent hypercalcemia presents as a results of either residual adenoma, recurrent disease or an ectopic parathyroid gland. The most challenging cases are those with ectopic glands which are not identified on usual surgical neck exploration. We present a similar case that went through multiple surgeries for recurrent hypercalcemia. A 79-year-old lady initially was dia...