Endocrine Abstracts

Case: An 89 year old gentleman was admitted to hospital following a collapse at home. His capillary blood glucose was found to be 1.4 mmol/l by the paramedics. The patient had experienced multiple collapses at home in the preceding 2 weeks. Each time, he had been found to be hypoglycaemic but treated and discharged from A&E. He complained of reduced appetite, weight loss and change in bowel habit. The patient’s past medical history included a large fibroma of the left...

Case history: A 54 year-old gentleman was transferred as an inpatient from another centre for investigation and management of refractory hypoglycaemia following a revision gastric bypass. He was requiring a continuous infusion of 20% dextrose on transfer to maintain normoglycaemia. He had a complex bariatric surgical history dating back 7 years. His initial procedure had been a sleeve gastrectomy that was subsequently converted to a gastric bypass which had then been reversed ...

Case history: An 11 year old girl was diagnosed with von Hippel-Lindau disease (VHL) on cascade genetic screening due to a positive family history and was enrolled in a VHL surveillance programme. She developed bilateral phaeochromocytomas and underwent staged bilateral adrenalectomies at the age of 12 and 14. At the age of 16, she was discovered to have a 2.5 cm tail of pancreas pancreatic neuroendocrine tumour (pNET) on routine surveillance imaging. This enlarged during foll...

A 50 year old lady was referred with a two year history of recurrent spontaneous hypoglycaemic episodes. She had put on a stone in weight over this time period. She was otherwise fit and well and took no regular medications. She had a past medical history of treated melanoma. None of her family members had diabetes mellitus. Neither she nor her husband worked in a healthcare setting but her daughter was a district nurse. Prior to referral, she had a normal short synacthen test...

A 68-year-old lady presented with a right-sided breast lump detected on routine mammography. Past medical history included type 2 diabetes, asthma, and hypothyroidism following radioactive iodine for toxic multinodular goitre. Staging CT showed 2 presumed metastases in the left lung, and one in the right lung. She was referred for biopsy and/or resection of these lesions. Histology of the left lower lobe lesion showed a typical carcinoid tumour with an adjacent neuroendocrine ...

A 29 year old lady presented to an outside hospital with 1 year’s history of episodes of confusion in the mornings. The patient’s partner had noticed that 2–3 times a week she awoke with episodes of confusion, minimal communication, stereotyped lip smacking and winking lasting up to 20 min. She had one nocturnal tonic-clonic seizure abroad, requiring A+E attendance. She was then seen by a neurologist, had a normal sleep deprived EEG and was diagnosed with focal ...

Introduction: Symptomatic hypoglycaemia unrelated to the treatment of diabetes is rare. As symptoms of hypoglycaemia are non-specific, investigation should only be instigated if Whipple’s triad can be fulfilled- signs and symptoms of hypoglycaemia, a recorded low plasma glucose and resolution of symptoms after treatment.Case history: A 37 year-old woman presented to the emergency department with fatigue and lightheadedness. She has modified her diet...

A 35-year-old patient was referred to a tertiary referral unit for further investigation of severe watery diarrhea. Infectious agents had already been excluded. Biochemistry revealed a strikingly raised serum calcium concentration of 4.09 mmol/l (NR 2.1–2.65 mmol/l), chromogranin A was grossly elevated at 293 U/l (NR 2–18 U/l) and vasoactive intestinal peptide (VIP) was also raised at 130 pg/ml (NR 10–60 pg/ml). Computed tomography (CT) of the abdomen demonstrat...

Postprandial Hyperinsulinaemic Hypoglycaemia reportedly occurs in 0.1 to 0.3% of patients after Roux-en-Y Bypass procedures. In our Bariatric Surgery Service we seem to be seeing this complication more frequently. Most patients can be managed in a step-wise approach, but we have a few patients who appear refractory to conventional treatment. This case illustrates one such patient. Mrs P was referred to the Weight Management service in 2011, aged 45. She weighed 108 kg, with a ...

Hypoglycaemia is often referred to Endocrinology for investigation and management. Occasionally, these referrals are in the context of malignancy and we seek to exclude ectopic insulin secretion, as well as other causes. This case highlights a less recognised cause for hypoglycaemia in haematological malignancy. The patient, a 78 year-old man with advanced Mantle Cell Lymphoma presented with hypoglycaemia and was admitted under Haematology, who had been treating with chemother...

Pancreatic neuroendocrine tumors are rare neoplasms of this organ. The majority of them are tumors without hormonal activity. Approximately 35% of the pancreatic neuroendocrine tumors (pNETs) are functional, the most common of which is an insulinoma. We present a 57 year old lady with dyspepsia, nausea and Fe deficiency anaemia for more then a year. On examination had a epigastric mass, endoscopy was consistent with a well differentiated endocrine grade 2 tumor. Octeotide scan...