Endocrine Abstracts

A 72-year-old woman was initially referred by her GP to the colorectal service of our Hospital. She had a 4-month history of weight loss, fatigue and appetite loss.

The initial blood tests at the GP surgery revealed a normochromic normocytic anaemia.

She had a diagnosis of SVT and she was on sotalol. She had never smoked nor she had a history of excess alcohol.

In her initial blood tests: Hgb 9 g/dl, albumin 27 g/l, ALP: 187 IU/l (40–150), adjusted serum calcium 2.61 mmol/l (2.15–1.58), creatininine 51 μmol/l, normal serum electrophoresis.

She first saw a colorectal surgeon.

A gastroscopy showed gastritis and the colonoscopy was difficult therefore she had a CT virtual colonoscopy which did not show any tumour in the bowel. However it revealed a 15 mm lesion in the left kidney. She was then referred to the Urologists. A CT chest was organised and this was clear. She also had an isotope whole body scan and this did not show any evidence of bone matastases.

Her case was discussed at the Urology MDT and it was deemed that the lesion is unlikely to be the cause of her systemic symptoms.

She was seen in the Endocrinology clinic for an opinion about her high calcium.

Her repeat cCalcium was 2.59 mmol/l, PTH 3.7 pmol/l (1.2–6.2), 25(OH) Vitamin D low at 33 nmol/l, ACE 350 U/l (13–55), ESR: 115 mm in the first hour and a CRP 105 mg/l. Her autoantibody screen was negative.

Based on the results above we proceeded with a PET scan which identified a large vessel vasculitis.

The patient was started on high dose steroids at the Rheumatology clinic. She reported a great improvement in her symptoms and all the repeat laboratory values including cCalcium had normalised.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.