Endocrine Abstracts

An 82 year old lady was admitted with acute stroke on 3/1/18, confirmed on MRI. She was found to be in AF and had thyroid function tests checked on 4/1/2018, with TSH 0.01 (0.27–4.20) mIU/l and FT4 52.8 (12.0–22.0) nmol/l. She was commenced on Carbimazole 20 mg OD. TPO and TSH-receptor antibodies were both negative. An ultrasound scan confirmed a normal thyroid without any features of Grave’s disease or thyroid nodules. Clopidogrel 75 mg OD and Atorvastatin 40 m...

Gonadism is a medical term for decreased functional activity of the gonads (ovaries or testes) producing hormones and gametes. Male hypogonadism is characterised by a deficiency in testosterone – a hormone critical for sexual, cognitive and body function as well as development. Low testosterone levels can be due to hypothalamic, pituitary or testicular abnormalities. Hypogonadism is classified as primary (primary testicular failure) and secondary (a problem in the hypotha...

We present a case of a 54-year-old man who was urgently referred to A&E by his general practitioner with very low calcium of 1.32 mmol/l (normal 2.20–2.60 mmol/l). His only past medical history of note was of recently diagnosed multiple sclerosis (MS), which presented as optic neuritis six months ago. His initial investigations included high phosphate level of 2.0 mmol/l (normal 0.8–1.5), normal vitamin D levels (76 mmol/l) and a very low 24-hour urine calcium of...

Hypercalcaemia during pregnancy is unusual and primary hyperparathyroidism is the commonest cause: we present a more unusual case.Case history: 29-year woman, 34 weeks pregnant, was admitted with hypertension and oedema. She had gestational diabetes managed with diet alone. Initial calcium level was normal; it gradually increased in the next few days though this was not noted. She was diagnosed with preeclampsia and treated with steroids for foetal lung ...

Case history: Mrs SC, a 56 year old female was referred to the endocrine registrar with hypocalcaemia (corrected calcium 1.93 mmol/l). She was day 3 post-hemihepatectomy for liver metastases from a primary pancreatic tail neuroendocrine tumour (NET). She had paraesthesia and numbness of her fingers and toes but no spasms. Chvostek’s sign was negative and there were no ECG changes. Past medical history includes severe hypercalcaemia in September 2016 which...

A 55-year-old man known primary hypoparathyroidism, presented with recurrent episodes of collapses. Past Medical history of CVA, Recurrent episodes of collapse, Secondary Polycythaemia. His S Calcium ranges from 1.5 to 1.7. Not always symptomatic. Occasionally, c/o pins and needles. But having recurrent episodes of collapses with loss of consciousness. Each Episode lasts for 10 to 15 seconds. This is going on for more than 15 years. In 2013 his Calcitriol supplement was increa...

79 year old male had been admitted due to multiple falls within a space of 24 hours. On admission, he had a full set of bloods which showed hypercalcaemia and no other significant abnormality. His past medical history included Prostate Cancer, Type 2 Diabetes and Urinary retention for which he had a long-term catheter in situ. His current medications were Linagliptin, Apixaban, Bicalutamide and simple analgesia. Initially, he was fluid resuscitated, which seemed to im...

Pseudohypoparathyroidism during pregnancy can lead to challenging calcium fluctuations and can lead to maternal and foetal morbidity. There are limited case reports and no established management guidelines. Maintaining calcium level in healthy range during pregnancy is required to minimise the risks of associated complications. We report a case of Pseudohypoparathyroidism type 1a in 30 year old lady, who was initially referred to us by her general physician with calcium, of 1....

Case history: A 34 year old Chinese male was referred by GP as routine blood test which was done as part of investigation for ongoing hair loss that revealed hypocalcaemia. Patient was asymptomatic with no tingling sensation, numbness or anaesthesia. There was no history of carpopedal spasm, muscle pain or cramps. He does not give any history of symptoms suggestive of malabsorption. His PMH include Mild asthma and Eczema for which he was not on any regular medication. Social h...

A 69 year old male was referred with a 60 year history of recurrent hypoglycaemia. Over the previous 12 months he had several episodes of severe hypoglycaemia, which necessitated emergency treatment from paramedics. He had been diagnosed with a hypoglycaemic disorder at the age of 9 years, but no underlying cause had been identified. He had no other previous history of note, though he was macrosomic at birth with a birth weight of approximately 5.9 kg. His mother was diagnosed...

An 87 year old man was referred to our endocrine service from the medicine for the elderly team for investigation of suspected hypoglycaemia. He had several co-morbidities but did not have diabetes mellitus. There was a 6 month history of ‘funny episodes’ characterised by lethargy, profuse sweating and confusion. The symptoms resolved a few minutes after eating. One such episode occurred while attending his GP who arranged for blood to be drawn. The plasma glucose wa...

A 29 years old lady she has Diabetes mellitus type II, and obesity so she did sleeve gasterectomy and she was happy that her sugar was well controlled then later in complete remission. She has later recurrent symptomes of hypoglycemia and intloerable,when Hba1c done was hab1c 6.8%. She was started on Glucobay tablet 50 mg before each meal. Next visit she come, she was happy that her sugar is well controlled with treatment but her medicines is finished. After requiring how many...

Background: Insulinoma is the most common cause of hypoglycaemia due to endogenous hyperinsulinemia. However, they can sometimes present with atypical features. Some of the patients can also develop serious adverse effects to medical treatment. We present a case with atypical features and further developed serious adverse effects with medical treatment for insulinoma.Case presentation: A 42-year-old Caucasian female presented with recurr...

A 72 year old lady presented to endocrine clinic in January 2016 with a history of frequent episodes of feeling increasingly lightheaded, tremulous, sweaty and hungry. All symptoms resolved after eating. Her family doctor had twice documented a capillary glucose lower than 4 mmol/l. Continuous blood glucose monitoring was performed but there were no episodes of hypoglycaemia picked up. She was admitted for a 72 h fast in September 2016. Her capillary blood glucose readings nev...

A 49 year old Russian lady was found to have an elevated testosterone level (9 nmol/l) when investigated for hair loss. This was first detected some years ago when she apparently was given a provisional diagnosis of polycystic ovarian syndrome. When assessed in her local endocrine unit she did not report any excessive body hair growth or symptoms of virilisation. She claimed to reach the menopause aged 45 years and reported a family history of early menopause. Initial blood te...

We present here a case of 70 year old female, seen in endocrine clinic for Hypothalamic-Pituitary-Adrenal (HPA) axis suppression after prolonged glucocorticoid use. History revealed that she had prolonged use of prednisolone for her asthma in the past. In 2011, Prednisolone was stopped but she had to be started on Hydrocortisone replacement due to HPA axis suppression. She was taking Hydrocortisone 20 mg BD. Trials to wean her off Hydrocortisone failed due to ongoing tiredness...