Endocrine Abstracts

A 42 year old lady was referred to the endocrine clinic with a five month history suggestive of hypothyroidism and a high TSH and low T4 levels. Clinical examination revealed increased skin pigmentation, low systemic blood pressure, bilateral axillary lymphadenopathy and hepatosplenomegaly. Short synacthen test confirmed cortisol insuffiency and she was started on thyroxine and hydrocortisone, and went on to have further investigations for the lymphadenopathy and hepatosplenomegaly. Liver biopsy showed non specific inflammatory changes, and trephine bone marrow biopsy showed findings suggestive of an underlying myeloproliferative process and no features of lymphoma or leukaemia and a normal bone marrow cytogenetics. Despite initial improvement in symptoms, the patient deteriorated and developed symptoms suggestive of mild peripheral motor and sensory neuropathy and sclerodermatous skin changes. Free IgA-lambda light chains were detected in the urine specimen and an osteosclerotic focus was noted in the left pelvis. These features were diagnostic of POEMS syndrome. She had an autologous haematopoietic cell transplantation and chemotherapy. She is currently fit and well and looking forward to going back to her job as a nurse.