Endocrine Abstracts

We are presenting a common case of diagnostic dilemma with hypercalcemia.This 66 year female patient was referred to Endocrine clinic with hypercalcemia. She was asymptomatic with blood tests showing C.Calcium of 2.73 mmol/l. This was followed by investigations to rule out primary or tertiary hyperparathyroidism.Blood tests revealed high PTH of 12.2 pmol/l with low 25OH Vitamin D of 37 nmol/l, suggesting a diagnosis of tertiary hyp...

Myxoedema coma or severe decompensated hypothyroidism is rare but has high mortality; appropriate early recognition and treatment is essential. We present a case of severe hypothyroidism with multi organ failure. A 58-year-old lady with several months’ history of loss of appetite, tiredness and hair loss presented with progressive lethargy, sleepiness and abdominal distension for 1 week. On admission she was very drowsy, had a doughy dry skin and facial puffiness. Large a...

A 40 year old gentleman presented to his GP with a 12 month history of tiredness and breathlessness on playing basketball with his son. Initial investigations revealed he had a normocytic anaemia with haemoglobin of 9.8 and white cells and platelets were normal. He was referred to the Gastroenterologists and had normal renal function, liver function, bone profile, ESR and serum electrophoresis. His B12, folate and ferritin were normal. CT Abdomen was normal and duodenal biopsy...

We present here a case of diagnostic dilemma in a 34-year female presenting with Amenorrhoea. She was recently married and saw GP for infertility and history of hot flushes, melasma and migraine. Clinic history revealed primary amenorrhoea diagnosed in Brazil at age 15. Patient was told she was born without ovaries and was started on Premarin (oetrogen). She had normal female secondary sexual charcteristics, functional female genitalia and growth. On examination, she had a nor...

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) partic...

Background: Hyponatraemia is a frequently encountered problem in primary care. Management should be based on the cause as inappropriate treatment e.g. fluid restriction in patients with hypoadrenalism is dangerous and potentially life-threatening.Aims: We present five cases who presented with hyponatraemia in the primary care setting, to highlight diagnostic approach and implications for management.Case 1 - Hyponatraemia secondary ...

Introduction: The thyroxine absorption test (TAT) is well established to investigate persistently raised TSH in patients on L-thyroxine. We review our experience with this test.Method: Blood was taken for baseline FT4, FT3, TSH measurements and malabsorption screen. A week’s supply of L-thyroxine (1.6 mcg/kg×7) was administered orally under direct supervision and FT4 and TSH measured 2 h later. Patients continued o...

Aim: To investigate the relationship between baseline and stimulated cortisol responses in relation to the habitual time of rising and time of test.Method: The self-reported habitual rising time and time of cortisol testing were recorded in 63 consecutive patients (47F, 17M, age 18–94) undergoing standard stimulation testing with tetracosactide (SynActhen) 250 μg i.v. In total, 75 tests were analysed. A normal response was defined as a 30 min p...

Venous thrombosis is a common disease, with an annual incidence of 1–4/1000 persons. Before menopause its incidence is low and strongly increases with age. Combined hormonal contraceptives (COC) increased the risk of VTE. COC use explains a substantial part of VTE among childbearing-aged women and VTE is the most important determinant of the benefit/risk profile of hormonal contraceptive. The increase in thrombotic risk is the highest the first year of COC use and third g...

Introduction: Symptoms of hypothyroidism are very variable and are frequently present in the healthy population. The diagnosis can easily be missed if considered only in patients with classical symptoms. Aim: To describe the range of presentations in patients diagnosed with hypothyroidism in primary care.Method: Patients were recruited via the British Thyroid Foundation and from a local GP surgery. Respondents were asked to complete a questionnaire for t...