Endocrine Abstracts

Aim: To establish the local Guidelines for management of SIADH.Methods: The European and NIH Guidelines are considered.Discussion: Diagnosis: Patients admitted with hyponatraemia are first assessed clinically for their hydration status. Those who are euvolaemic should have their urine sodium checked (if <30 mmol/l, hypothyroidism is suspected and if >30 mmol/l either SIADH or Addison’s disease is suspected). Hypothyroi...

A 49 year old lady was investigated for palpitation and weight loss of 12 kg over 6 months. She was diagnosed thyrotoxic (TSH- not detectable; free thyroxine-66.4; normal: 12–22 pmol/L and triiodothyronine-8.6; normal: 1.3–3.1 nmol/L) and commenced on 40 mg of carbimazole. Ultrasound of thyroid showed multinodular goitre. Her systolic BP was low (100/70 mm Hg) and she felt tired. Her morning cortisol was 104 (normal; 220–700 nmol/L). A short synacthen test showe...

We describe below a 72-year-old woman who presented clinically with short metacarpals and metatarsals and the following blood biochemistry: corrected calcium of 2.16 mmol/l (normal: 2.05–2.60), phosphate 0.61 mmol/l (normal: 0.8–1.45) and alkaline phosphatase of 108 U/l (normal: 35–104). She was 153 cm tall and weighed 109 kg with a round face. She had a history of Monoclonal Gammopathy of unknown significance, vitamin B12 deficiency and was admitted 10 years ag...

Silent and post-partum thyroiditis are autoimmune conditions, which result in a triphasic thyroid hormone disturbance. They are distinguished by the later condition’s relation to pregnancy. Their association in the same patient resulting in recurrent episodes of silent thyroiditis suggests a common aetiology.We report a 32-year-old female with post-partum and recurrent silent thyroiditis continuing over a decade. She presented post-partum with thyro...

We describe a 37-year-old woman with a BMI of 32 kg/m2 who presented with poorly controlled type 2 diabetes (HbA1c of 10.3%). She was requiring 138 units of insulin (Aspart 20, 24 and 30 units pre meal and glargine 64 units at night daily). She previously had diarrhoea with metformin and an allergic reaction to glimepiride. Rosiglitazone was discontinued because of worsening liver function. Her insulin requirement increased in a year to 1650 units daily owing to ins...

We describe below a 16-year-old male referred with neonatal hypothyroidism. He was commenced on levothyroxine at the age of 3 weeks. The TSH was >100 IU/l (normal: 0.27–4.7) and Total T4 was <10 nmol/l (normal: 60–150) and there was no uptake on thyroid isotope scanning. He was diagnosed as having congenital absence of thyroid tissue and given levothyroxine and the dose adjusted to maintain normal thyroid function. His mother was diagnosed with hypothyroidism...

We describe two cases of Conn’s syndrome both of whom had hyperprolactinaemia of which one was associated with pituitary adenoma, possibly as part of MEN 1.The first patient was a man aged 52 who presented with hypertension present for 10 years and a marginally low serum potassium. He was on doxazosin, lisinopril, candesartan and celiprolol. His Aldosterone/Renin ratio (8500:1) was very high suggestive of primary hyperaldosteronism. The patient was ...

A 56 year old lady was investigated by her GP for arthralgia and found to be thyrotoxic (TSH < 0.01 mU/l, free T4 34.8 (10–20 pmol/l), TPO 50 (<35 IU/ml)). She gave a history of anterior uveitis some 20 years earlier. She was commenced on carbimazole and referred to the endocrinology clinic, where her thyroid function rapidly normalised and a biochemical diagnosis of subacute thyroiditis was made. Thyroid pertechnatate scan showed reduced uptake throughout the gl...

A 34-year-old welder presented acutely unwell with a 2-week history of facial puffiness, swollen legs, and weight-gain. His GP had found him to be hypertensive and hypokalaemic and had commenced oral potassium supplements. Clinical examination revealed peripheral oedema (face and legs), BP was 179/100 mmHg, with no Cushingoid features. ECG and CXR were unremarkable. Tests showed leucocytosis but normal CRP, persistent hypokalaemia (2.5 mmol/l), normal venous bicarbonate and gl...