Endocrine Abstracts

Introduction: Adrenal and Thyroid disease symptoms remain enigmatic because of their pronounced non-specificity. Physicians need to have a high index of suspicion for these clinical conditions in order to save patients from unnecessary turmoil.

Case Presentation: OA, a 35 year old Nurse presented at the Endocrine clinic on self referral in July 2011 after having presented at both the Out-patients and Gynaecology units at various times in the previous 8 months with history of Generalized weakness, numbness of the toes and fingers, excessive menstrual flow, dizziness and bone pains. After months of un-abating symptoms and worsening generalized weakness and after being told by one Doctor that her symptoms made no sense to him, she decided to come to the Endocrinology clinic on self-referral. Presenting symptoms were a year’s history of progressive hair loss, 9 months history of generalized weakness and somnolence and 6 months history of excessive menstrual flow and recurrent history of anterior neck pain. She was found to be pale, ill looking with lassitude, with dark patches on the anterior third of the tongue. Pulse rate was 104 b/m while BP was 90/60 mmHg.

Results: – Thyroid function test of 1/7/11: Free T4: 8.3 [7.2–16.4 pmol/L] Free T3: 4.6 [3.8–6.0 pmol/L] S-TSH: 10.63 [0.37–3.50 mIu/L] Thyroid peroxidase antibody: >1030.0 [0–9 Iu/ml] Anti-Thyroglobulin antibody: 58.7 [0–60 Iu/ml]

– Short Synacthen test: Plasma cortisol at 0 Hour (8 AM): 183.32 [240– 618 nmol/L] Plasma cortisol after 1 hour: 538.02 [240– 618 nmol/L] ACTH: 1.1 [1.6–13.9 pmol/L].

Discussion/Conclusions: An assessment of Hashimoto’s Thyroiditis with Secondary Hypoadrenalism was made. She was commenced on Hydrocortisone and Thyroid function tests monitored. Atenolol was added when she developed tachycardia with elevated T4. Adrenal and Thyroidal dysfunction should be considered by Physicians when confronted with ill patients who display non-specific symptoms.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.