Endocrine Abstracts

Patients with central diabetes insipidus (CDI) and concurrent hypothalamic adipsia can experience significant sodium fluctuations requiring prolonged, recurrent hospital admissions and frequent serum sodium testing. We report a case of a 13-year-old male with adipsic CDI where the use of a point of care sodium analyser at home to titrate fluid and desmopressin administration resulted in stabilisation of his serum sodium, prevention of unplanned hospital admissions and improvem...

A 37-year healthy man initially presented to primary care with weight loss and palpitations and diagnosed to have thyrotoxicosis based on thyroid function tests (TFT) – TSH (< 0.05; n = 0.27-4.20μIU/l), FT4 (59.8; n = 12-22 pmol/l), and FT3 (32; n = 3.1-6.8pmol/l) . CBZ was started and 4-weeks later was seen in the Endocrine clinic where Graves’ disease was confirmed based on a goitre and positive antiTSH receptor antibody. However...

Insulinoma is an insulin-secreting tumour of beta cells resulting in hypoglycemia. This rare tumour presents with hypoglycemic symptoms and can be easily confused with transient ischemic attack or epilepsy or delirium. The diagnosis of an insulinoma is usually made biochemically and confirmed by localizing the tumour with imaging. We present this case of a 56 years old woman who repeatedly presented to emergency for her symptoms of diplopia and word finding difficulty. She als...

Case history: A 45-year-old male was referred to Endocrinology from the Infectious Diseases clinic for investigation of possible adrenal insufficiency. The patient had multiple co-morbidities including asthma, hepatitis B and HIV. The patient’s GP had introduced a fluticasone inhaler to control the symptoms of his asthma, however when the patient was seen in Infectious Diseases clinic as an interaction with his protease inhibitor (atazanavir) was suspected. A random corti...

Case History: A 71-year old male, who had been on amiodarone therapy for many years, was receiving Levothyroxine therapy due to amiodarone-induced hypothyroidism. He was subsequently found to have thyrotoxicosis, which remained after levothyroxine discontinuation. He had type 2 diabetes and ischaemic cardiomyopathy and had an implanted cardiac defibrillator due to multiple VT arrests. Amiodarone therapy had contributed to stabilisation of his cardiac arrhythmias and had contin...

A 71-year-old man was diagnosed with poorly differentiated T4N0M0 gastric adenocarcinoma. He received neoadjuvant chemotherapy, followed by elective subtotal gastrectomy. Mean arterial pressure was maintained above 70 mmHg throughout the 5-hour operation. On post-operative day 3, the patient became confused, pyrexial, hypotensive with new-onset atrial fibrillation. CT head was unremarkable and CT chest/abdomen/pelvis (CAP) showed bilateral pleural effusions with normal adrenal...

Aims: The short synacthen test (SST) is considered as the gold standard test to assess the viability of the hypothalamic-pituitary-adrenal axis. This study explores the appropriateness of its clinical use in a district general hospital. Furthermore, it assesses the effectiveness of the alternate use of 9AM cortisol in excluding hypoadrenalism and the cost-effectiveness of sampling both 30 and 60 minutes serum cortisol in SST.Me...

We report a case of two incidental lesions, a benign adrenal schwannoma and cerebral meningioma. There are no cases in the literature to link de-novo adrenal schwannoma and meningioma in patients. This case highlights the importance of multidisciplinary working to ensure expedited management in such cases.A 76 year old gentleman presented to ED with a seizure and a community-acquired pneumonia. Past medical history included atr...

We present a case of a middle-aged lady with clinical features suspicious of Addisons, however an initial false negative short synacthen test (SST), resulted in delay of diagnosis.Case: A 62-year-old lady presented to ED with a month history of generalised malaise, weakness, dizziness and vomiting. She had a background of type2 diabetes mellitus, previous left parathyroidectomy for primary hyperparathyroidism and B-thalassaemia trait. Admission bloods in...

Aims: The short synacthen test (SST) is considered as the gold standard test to assess the viability of the hypothalamic-pituitary-adrenal axis. This study explores the appropriateness of its clinical use in a district general hospital. Furthermore, it assesses the effectiveness of the alternate use of 9AM cortisol in excluding hypoadrenalism and the cost-effectiveness of sampling both 30 and 60 minutes serum cortisol in SST.Me...