Endocrine Abstracts

Gynaecomastia is common, occurring in 30–50% of healthy men, and its aetiology is usually benign. Clinical features inclusive of recent onset, rapid progression, and loss of libido and muscle strength, indicate the need to exclude a malignant aetiology.A 48-year-old man presented with an 18-month history of such clinical features. Investigations revealed cortisol 1136 nmol/l, 17-hydroxyprogesterone 6.6 nmol/l, androstenedione 13.3 nmol/l, DHEAS 21.8...

The classic episodic triad of headache, sweating and palpitations facilitates the diagnosis of phaeochromocytoma. The absence of these symptoms can lead to misdiagnosis in patients with uncommon symptoms attributable to phaeochromocytoma. We present such a case.Case report: A 64 year old man was referred to endocrinology having been coincidentally found to have a right adrenal mass with features of a phaeochromocytoma. He was asymptomatic and engaged in ...

A 48-year-old female received radioiodine ablation therapy for thyrotoxicosis secondary to a solitary toxic nodule. The subsequent unexpected requirement for replacement thyroxine was explained by Hashimoto’s thyroiditis with an anti-thyroid peroxidase antibody level of 692.3 IU/ml. Thirty months later she presented with debilitating left facial pain and painful sensory symptoms of her left arm and leg. She was euthyroid taking thyroxine 75 μg daily with a fT4</...

A 34-year-old female presented with an 18 months history of secondary amenorrhoea, hirsutism, weight gain and low mood. Examination confirmed typical stigmata of Cushing’s syndrome with skin thinning, purpura, acne, facial plethora, central adiposity and hypertension. Investigations revealed fT4 14.7 pmol/l, fT4 4.1 pmol/l, TSH 0.71 μ/l, prolactin 377 μIU/ml, FSH 3.5 μ/l, LH 2.2 μ/l, oestradiol 140 pmol/l, testosterone 5.1 nmol/l,...

Generalised resistance to thyroid hormone (GRTH), a subset of the syndrome of resistance to thyroid hormone (RTH), is characterised by variable reduced target tissue responsiveness to circulating thyroid hormones. Plasma thyroid hormone levels are raised and TSH levels inappropriately non-suppressed. We describe a 54-year-old female with GRTH diagnosed from the finding of raised fT4 and fT3 levels coincidental with non-suppressed TSH levels. A thyrotropin (TRH) test resulted i...

Hydrocortisone treatment in septic shock promotes shock reversal and reduces mortality. We hypothesised the doses that used (200–300 mg/2 h) would result in plasma cortisol levels sufficient to saturate the 11 beta-hydroxysteroid dehydrogenase 2 enzyme (11 beta-HSD 2) with cortisol inactivation overload. Consequently cortisol would access the mineralocorticoid receptor producing mineralocorticoid effects. Hypertensive metabolic alkalotic effects would tend to counteract t...

A 48-year-old man presented with classical symptoms and physical signs of severe acromegaly. Investigations revealed: fT4 12.8 picomoles per litre, TSH 1.4 milliunits per litre, testosterone 3.9 nanomoles per litre, FSH 4.3 units per litre, LH 2.1 units per litre, cortisol (09.00 hrs) 710 nanomoles per litre, prolactin 1657 microinternational units per millilitre and IGF1 155 nanomoles per litre. Growth hormone levels were greater than 150 milliunits per litre throughout an or...

A 67 year old man with 1 month history of malaise was referred when his thyroid profile suggested secondary hypothyroidism with a fT4 of 4.9 picomoles per litre, fT3 3.4 picomoles per litre and TSH 0.03 milli units per litre. Physical signs were unremarkable. Investigations:- cortisol (random) 294 nanomols per litre, prolactin 960 micro units per millilitre, testosterone < 0.04 nanomols per litre, FSH 5.2 units per litre, LH 0.07 units per litre and IGF-1 17.7 nanomols per ...

Encephalocoeles are congenital defects in the skull through which meninges and brain tissues herniate. Basal encephalocoeles represent 1.5% of all encephalocoeles and are found in 1:35,000 live births. Transphenoidal basal encephaloceles are very rare, representing only 5% of all basal encephaloceles. The pituitary and surrounding structures are drawn into the encephalocele with visual and hormonal disturbances being recorded in the few cases described.A...

Lymphocytic hypophysitis is a rare autoimmune disease of the pituitary gland.A 39-year-old woman presented with a 6-month history of general malaise, anorexia, nausea and vomiting followed by a 3-month history of secondary amenorrhoea. Basal pituitary function testing revealed: fT4 5.1 picomoles per litre, TSH 1.6 milliunits per litre, cortisol 32 nanomoles per litre, prolactin 1167 microinternational units per millilitre, LH 2.8 units per litre and FSH ...