Endocrine Abstracts

TSH receptor antibodies (TRAb) are autoantibodies directed against the TSH receptor, predominantly located on the thyroid epithelial cell surface. Two types of TSH receptor antibody have been found to exist in patients with autoimmune thyroid disease: thyroid stimulating antibodies (TSAb) and TSH-stimulation blocking antibodies (TSBAb). It has generally been felt that patients with positive TSAbs develop Graves’ hyperthyroidism and those with TSBAb antibodies develop hypo...

Contracts with primary care encourage screening for diabetes and as a result a fasting blood glucose is frequently performed on asymptomatic patients. During the last year three such patients were found to have significant hypoglycaemia with elevated c-peptide levels and were referred for further investigation.The first, a 50 year old woman, developed significant hypoglycaemia 22 hours into a fast with elevated c-peptide and insulin levels. A CT scan of ...

A 73 years old gentleman with a diagnosis of mesothelioma presented with symptoms typical of hypoglycaemia. Other than the expected abnormal chest signs there were no significant examination findings.Capillary glucose was unrecordable; lab testing confirmed serum glucose of 0.9 mmol/l. He had no history of diabetes mellitus or any medication that may induce hypoglycaemia. There was a slight rise in CRP and white cell count was elevated. There was no clin...

A 51-year-old woman with no significant past medical history presented with left flank pain, accelerated hypertension, progressive deterioration in renal function and left sided pleuritic chest pain. CTPA revealed pulmonary oedema and left adrenal haemorrhage. Urinary catecholamines were marginally elevated (24 h Urinary Metadrenalines 7.58 μmol/24 h) raising the possibility of an underlying phaeochromocytoma. Short synacthen test showed a sub-optimal response (0 min cort...

Section 1: Case history: This 41 year old lady was seen in the Endocrine clinic with an 8 year history of worsening hypertension, obesity and Type 2 diabetes. She had no conditions known to cause physiological hypercortisolism, no exogenous steroid use and had clear physical features of Cushing’s syndrome.Section 2: Investigations: Investigations confirmed Cushing’s syndrome with two elevated urinary free cortisol assessments (UFC) (934 and 906...

Hyponatremia is the commonest electrolyte abnormality presenting to Medical Admissions and when acute, severe and symptomatic, is associated with high mortality. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common underlying disorder in hospitalised patients with euvolaemic hyponatraemia and is a complication of many clinical conditions and drug therapies.We discuss the cases of two patients...

Hyponatremia is the commonest electrolyte abnormality presenting to Medical Admissions and when acute, severe and symptomatic, is associated with high mortality. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common underlying disorder in hospitalised patients with euvolaemic hyponatraemia and is a complication of many clinical conditions and drug therapies.We discuss the cases of two patients...

Several preparations of thyroxine are available nowadays but is a great challenge for every clinician when the oral and intramuscular administration is failing and has to consider long term intravenous administration. This is a 42 years old lady who had a total thyroidectomy for Graves thyrotoxicosis. She commenced on multiple oral preparations of thyroxine and liothyroxine with no biochemical response. This is not a case of pseudomalabsorption as oral absorption studies of hi...

Background: Magnesium, the second most abundant intracellular cation, plays a key role in cellular and metabolic reactions including protein synthesis, neurotransmission and electrolyte balance. There are no specific signs or symptoms of hypomagnesaemia and it can coexist with other electrolyte abnormalities. According to various surveys the prevalence of low Magnesium varies between 2–10% in hospitalized patients. However, there are no clear guidelines about when to scre...

Ectopic Cushing’s syndrome (CS) is commonly caused by malignancy, often behaves aggressively and may not clinically manifest with features of hypercortisolism due to its rapid course and associated cachexia. This may mislead clinicians into discounting the diagnosis in patients with more indolent features of CS. We present a 41 year old woman with an 8 year history of Cushingoid features with associated hypertension, obesity and Type 2 Diabetes. Investigations confirmed C...