Endocrine Abstracts

A 35-year-old lady presented 20 years ago with difficulty in walking. She was born in Newcastle and was brought up by her mother with no contact with father. Early childhood was further traumatised when mother moved in with a man affected from multiple sclerosis with whom she never adjusted. Consequently, she was placed with two foster parents but could not adjust there either. Two years earlier, she was admitted in hospital with drug overdose. By age 25, she had hypothyroidism, intermittent hypertension, depression, obesity, and benign intracranial hypertension with bilateral papilloedema. Lumbar puncture revealed a pressure of 400 mm of water and she was treated with dexamethasone, and bendrofluazide in addition to thyroxine and prothiaden for her concurrent problems. Biochemical tests showed corrected calcium of 1.84 mmol per litre and inorganic phosphorous of 1.67 mmol per litre. Repeated lumbar punctures maintained normal cerebro spinal fluid pressure, although there were some difficulties as she missed a few appointments, while giving evidence in a murder trial. EEG at this stage revealed abnormal theta activity suggestive of epilepsy, and carbamazepine (and later on lamotrigine) was started to control her myoclonia and blackouts. Subsequent tests detected low parathyroid hormone (5 nanogram per litre). Maintaining normal levels of calcium was difficult. In spite of high dose of calcium and 3 microgram of one-alpha calciferol, the ionised calcium never reached 1.0 mmol per litre. At 30, she had abortion of trisomy 16 foetus. Next year she gave birth to a normal baby although the pregnancy was complicated with gestational diabetes and iron deficiency. Maintaining eucalcaemia continues to remain a challenge in this mother of two even now, resulting in some episodes of seizure requiring IV calcium. Concomitant epilepsy and benign intracranial hypertension complicate the management further.