Endocrine Abstracts

We report five cases of hyperthyroidism with complex management issues, which were successfully treated with iopanoic acid prior to thyroidectomy.Three patients (cases 1–3) had Graves’ disease; two developed agranulocytosis on carbimazole and one had uncontrolled severe thyrotoxicosis and poor compliance with treatment. Radioiodine was either declined or contraindicated due to radio-protection issues. All patients were rendered euthyroid with i...

We present a fascinating and instructive case of unexplained suppression of thyroglobulin (Tg) levels following resection of a presumed carcinoid tumour, subsequent re-examination of which revealed it to be a solitary metastasis from a follicular thyroid carcinoma.The patient, RB is a 79-year-old woman who presented 11 years ago with a 2-week history of neck swelling. Examination revealed a 5 cm diameter nodule in the left lobe of the thyroid, confirmed ...

A 67-year-old lady presented with hypoglycaemic coma, treated with dextrose infusion. Previously she had a 3-month history of weight gain with increasingly frequent episodes of shaking and blurred vision, particularly at night, relieved by food.A 72-hour fast was undertaken. Within 2 h, she became confused. Serum glucose was 1.1 mmol/l with serum insulin 527 pmol/l (0–60 pmol/l), proinsulin 320 pmol/l (0–7 pmol/l) and C-peptide 2991 pmol/l (174...

Background: Insulin resistance (IR) commonly manifests in acromegaly leading to impaired glucose tolerance (IGT) and diabetes mellitus (DM). Studies have shown that ‘control’ of growth hormone (GH) and insulin-like growth factor 1 (IGF1) hypersecretion typically ameliorates glucose homeostasis. However, suppression of beta-cell function by somatostatin analogues may potentially attenuate glycaemic benefits of reduced IR. Effects on insulin’s other pleiotropic ef...

A 50-year-old man with poorly controlled type 2 diabetes mellitus on oral hypoglycaemics was under review as a diabetic outpatient. In April 2007, he developed idiopathic thrombocytopaenic purpura which, on a background of probable diabetic nephropathy, precipitated end-stage renal failure. He was treated with oral steroids and was established on haemodialysis. To achieve better glycaemic control, he was converted to twice daily insulin. His treatment dose of prednisolone was ...

TRAB antibody is specific for diagnosis of Grave’s disease. We have conducted an audit to on our practice on parameters which TRAB could influence.Method: TRAB (NR 0–1 IU/l) positive patients were identified from biochemistry laboratory form April 2003 to February 2004. Sixty case notes were randomly selected for reviewed. Data were analysed subsequently.Result: 46 cases (77%) were female. Mean age was 42, range 6 to 78 y...

Aim: Focussed parathyroidectomy is an established technique in subjects where imaging has identified a single parathyroid lesion. The aim of this study was to examine the long-term cure rate following this procedure.Method: Of 188 patients undergoing surgery for primary hyperparathyroidism between 2001 and 2006, 150 had a single parathyroid lesion on imaging using sestamibi +/− neck ultrasound. These patients were treated by focused parathyroidecto...

Primary hyperparathyroidism in pregnancy is reported as being rare rare. It can be associated with significant complications. Maternal complications include symptomatic hypercalcaemia, renal calculi, hyperemesis, muscle weakness, and pre-eclampsia. Fetal complications include IUGR, low birth weight, preterm delivery, intrauterine death, neonatal tetany and fits.Patient 1 presented with asthma and was found to have primary hyperparathyroidism, corrected c...

A 44 yr old IT systems analyst, presented in 2003 with a six month history of weight gain, diabetes and hypertension. On examination he was floridly Cushingoid. Investigations showed raised 9AM cortisol (1887 nmol/l) with failure to suppress following low and high dose dexamethasone, together with elevated 24 h urinary free cortisol (3300 nmol) and circulating ACTH (130 ng/l) levels. CT scan demonstrated a complex 11.5×9 cm lesion in the left lobe of liver and biopsy indi...

We report a rare case of acute myeloid leukaemia (AML) with high risk cytogenetics and associated hypothalamic diabetes insipidus (HDI).A 48-year-old female presented to her GP with a 3-month history of tiredness and lethargy. Full blood count revealed haemoglobin 7.0 g/dl (MCV 103fl), white cell count 12.1×109/l (neutrophils 1.33×109/l), platelets 91×109/l; circulating blast cells were evident on the perip...