Endocrine Abstracts

In October 2006 a 53-year-old, non-smoking woman presented with ectopic Cushings from a small cell, undifferentiated carcinoma (Grade 3 neuroendocrine) from a 10 mm tumour at the left lung hilum (Cortisol: 09:00 a.m. 720 nmol/l; 24.00 mm 742 nmol/l. ACTH 114 ng/l). Four years before she had sustained a myocardial infarction, with atrial fibrillation, and was found to have Graves’ disease, being treated initially with carbimazole then radioactive iodine, becoming hypothyro...

Context: Hyperthyroidism is a common endocrine condition that can be associated with significant morbidity. It is important to ascertain the underlying cause of hyperthyroidism as the natural history, potential complications and response to treatment can be very different.Objective: To investigate if measurement of TSH-receptor binding inhibitory immunoglobulin (TBII), a TSH-receptor antibody found in Graves disease, in the serum of newly diagnosed hyper...

Aims: Despite the plethora of testosterone therapies, Successful testosterone replacement remains a challenge. We assessed patient empowerment, treatment satisfaction and adherence to current testosterone replacement guidelines.Methods: Data were collected from case notes and a testosterone diary questionnaire in 16-patients with testosterone deficiency.Results: Median age was 46-years (range 21–69). All patients received an e...

The synacthen test is a commonly performed endocrine test; we have looked at whether we overuse this test. Of 150 synacthen tests performed in one year 52 were randomly selected for audit. 19 were undertaken for symptoms alone (Group 1); 16 for a low random cortisol (below 261 nmom/l – Group 2); 17 for electrolyte disturbances (either low sodium, high potassium or both – Group 3). 3 in Group 2 and 1 in Group 1 were abnormal but in no patient with a random cortisol ab...

Thyroid hormone and TSH levels change during pregnancy yet most laboratories use reference ranges derived from subjects who are not pregnant and male. Does this lead to an underestimation of thyroid disorders in pregnancy?We have derived our own reference range for Free T4 and TSH levels in pregnancy. The hormones were measured in 82 euthyroid mothers at booking and 68 at 28 weeks of pregnancy. Mean (95%CI: reference range of +2SD) FT4 levels were...

Introduction: Myxoedmea coma is an extreme expression of hypothyroidism with a high mortality rate. It is rarely associated with thyroid lymphoma.Case report: A 66-year-old lady presented acutely unwell with a two week history of cough and shortness of breath. She was hypothermic, hypoxic with clinical and radiological signs of pneumonia. Her TSH was 99.8 mU/L and T4 less than 5 pmol/L with strongly positive thyroid microsomal antibodies, raised WBC and ...

Noradrenaline (NE) is a peripheral vasoconstrictor reducing mortality by 11% and major adverse events by two-thirds compared to dopamine [1]. NE acts as an agonist at alpha1 and beta1 receptors, with little-to-no beta2 or alpha2 activity. This vasoconstriction effect can be potent and can result in completely occluded blood vessels more frequently in the peripheries due to lower blood pressure. Septic shock accounts for nearly 1 in 10 admissions to ICU, where it is the most co...

• A 54-year old Lithuanian man presented with symptomatic hyperglycaemia and weight loss.• A diagnosis of new onset diabetes type 2 was confirmed for which he received treatment. In addition, his serum potassium remained low despite of intervention.• CXR was done and showed a bulky right sided hilar mass.• The combination of refractory hypokalaemia, hyperglycaemia, and lung cancer suspicio...

Partial lipodystrophy syndromes are characterised by a selective paucity of subcutaneous adipose tissue on the trunk and limbs but excessive fat on the face, neck, supraclavicular areas and pelvis. Metabolic complications include insulin resistance and polycystic ovary syndrome (PCOS). There have been no previous reports of genital disfiguremment in these conditions.We present the case of a 27 years old female, who initially presented to the gynaecology ...

Malignant glucagonomas are slow-growing tumours which more commonly cause symptoms through glucagon hypersecretion than through effects of tumour bulk. The glucagonoma syndrome includes necrolytic migratory erythema (NME), diabetes mellitus, weight loss, anaemia, chelitis, venous thrombosis and neuropsychiatric symptoms. The syndrome probably results from unrestrained proteolysis1, and rapid consumption of B-vitamins through accelerated intermediate metabolism2...