Endocrine Abstracts

Introduction: Copeptin is the C-terminal fragment of proAVP and secreted in equimolar amounts with AVP. While AVP is unstable in vitro and has proved difficult to measure in clinical practice, copeptin is relatively stable and can be measured using an automated immunoassay. Therefore copeptin measurement offers potential as a more practical alternative to the direct measurement of AVP in the investigation of polyuria/polydipsia.Methods: AVP, cop...

This retrospective cohort study examined Hospital Episode Statistics (HES) and Hospital Pharmacy Audit (HPA) data from 41 hospital trusts to understand how hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is currently treated in England, and to understand the associated resource use. Hyponatraemia is the electrolyte disturbance that is most commonly encountered in clinical practice (affecting 10–30% of hospitalised patients), wit...

Introduction: A 22q11.2 deletion syndrome (velocardiofacial syndrome) is an autosomal dominant disorder affects various organs including the parathyroid gland. Because of its incomplete penetrance, multi-system affectation, and variable clinical presentation, the diagnosis is often delayed or never made. Delayed diagnosis may have significant impact on morbidity and mortality. We present a patient with a long history of clinical features of a syndrome which was diagnosed after...

Background: NEQAS data demonstrate a divergence in bias of cortisol immunoassays over the last 10 years. Despite this, a serum cortisol of 50 nmol/l has been universally applied as the cut-off for the overnight dexamethasone suppression test (ONDST), the commonest screening test for Cushing’s syndrome.Aims: To assess the effect of assay bias on interpretation of the ONDST and determine the necessity for a method-specific cut-off.<p class="abstex...

Germline mutations account for hereditary phaeochromocytoma (PCC) and paraganglioma (PGL) syndromes. SDHB immunostaining can be used to functionally characterise SDH status on PCC and PGL tumours. Genetic testing of multiple candidate genes is increasingly performed in patients presenting with PCC/PGL tumours. We investigated the effectiveness of SDHB immunostaining as an initial screening tool in identifying SDH mutations.This was a retrospecti...

Background: Accurate measurement of serum cortisol is essential in the investigation of the HPA axis. It has been documented that routine immunoassays are liable to both under- and over-recovery leading to inaccurate results and subsequent inappropriate investigations. This study seeks to provide an up-to-date assessment of the accuracy of the major immunoassay platforms and compares results to a liquid chromatography–tandem mass spectrometry (LC–MS/MS) candidate ref...

Introduction: Vasopression-2 receptor antagonists (VPAs) have been licensed for the treatment of hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). As usage extends to other causes of hyponatraemia, over-rapid correction and hypernatraemia remains as important side-effect. We present a patient with severe SIADH highlighting the need for guidance and vigilance when using these potent drugs.Case: A 82-year-old lady...

Background: The intrauterine foetal environment is crucial for its survival and long term health. Intrauterine growth retardation of the foetus is a pregnancy specific disorder which involves the restriction in the physical and or mental growth of the foetus during the course of the pregnancy. Lactate dehydrogenase is an intracellular enzyme that converts lactic acid to pyruvic acid. It has been proposed as an important marker for liver diseases, myocardial, renal, and pulmona...

A 85-year-old man presented with a 2-week history of malaise, confusion and agitation and 4 weeks of polydipsia and polyuria, with water intake of 6 l/day. His past medical history included hypertension, congestive cardiac failure, and chronic kidney disease. On examination he was hypervolaemic. Initial investigations were as follows: serum sodium 115 mmol/l, potassium 4.6 mmol/l, urea 8.1 mmol/l (2.5–7.8), creatinine 138 μmol/l (66–112), serum osmolality 245 mO...

Introduction: Hyponatraemia is defined as serum sodium concentration <135 mmol/l. It is the most common electrolyte disorder encountered in clinical practise. It is associated with an increase in mortality and length of stay, independent of diagnosis and clinical variables. Despite this it is often inadequately investigated and poorly managed. As a number of endocrine conditions can cause hyponatraemia, endocrinologists often have the necessary clinical skills and expertis...

The epidemiology of hyperprolactinaemia is not well characterised in the literature. Using unique patient identifier we were able to link data from biochemistry, prescribing, hospital admissions, radiology, general registry office and maternity data. Observational data was collected for Tayside Scotland between 1993 and 2013. Any patient with a serum prolactin measurement >1000 mU/l or at least three prescriptions for a dopamine agonist were included. Patients who were pre...

Background: Hypomagnesaemia is one of the most commonly encountered electrolyte disorders in clinical practice. The reported prevalence of hypomagnesaemia varies from 2.5 to 15% in the general population to as high as 65% among patients admitted to intensive care units. There is a general lack of awareness among physicians regarding the prevalence, clinical significance, and management of hypomagnesaemia.Aim and method: To review current practice of the ...

Introduction: Measurement of plasma metanephrines (PMETS) is widely regarded as one of the best screening tests for phaeochromocytoma/paraganglioma (P/PGL). Current Endocrine Society guidelines recommend that samples for PMETS are ideally collected in the supine position after 30 min rest and interpreted using supine reference ranges, in order to optimise the diagnostic performance of the test. Current practice in our centre is to collect samples for PMETS from seated patients...

Introduction: Osmotic demyelination syndrome (ODS) or commonly known as central pontine myelinolysis is commonly associated with rapid correction of hyponatraemia resulting in neurological deficits that manifests within days. The population commonly affected include alcohol dependence patients, the malnourished and liver failure patients. We describe a case of ODS developing in an alcoholic patient with symptoms developing 4 weeks after correcting hyponatraemia.<p class="a...

Background: Hypokalaemia (potassium below 3.5 mmol/l) is a common electrolyte abnormality associated with cardiac instability and myopathies. Untreated hypokalaemia can lead to inpatient morbidity and mortality.1Aim: To review the management of hypokalaemia, in terms of potassium replacement therapy, potassium-level monitoring and cardiac monitoring, in Maidstone hospital.Methods: A cross-sectional study of inpatients wi...

Background: There is much debate about the best imaging modality for parathyroid adenoma. Parathyroid ultrasound is operator dependent and in skilled hands leads to localisation of tumour. Small adenomas can be difficult to detect and radiologists are helped by clinical and biochemical data to predict ease of adenoma detection. We investigated whether any factors could predict adenoma size.Methodology: This was a retrospective CWS analysis of patients wh...

Background: Adrenal incidentaloma (AI) increasingly pose a diagnostic challenge. This retrospective observational study evaluated biochemical investigations performed in patients referred to Endocrine Surgery with AI and assessed adherence to Guidelines. Biochemical, histological and radiological characteristics of AI were also reviewed.Methods: Data were collected from Hospital and Laboratory records for referrals between January 2012–April 2014.</...

Introduction: Hyponatraemia is defined as serum sodium concentration <135 mmol/l. It is the most common electrolyte disorder encountered in clinical practise (1). Proton pump inhibitors (PPI’s) are commonly prescribed in the UK, and the indication and duration of treatment is often not reviewed.Methods: A retrospective audit was performed of patients admitted to The Great Western Hospital (GWH) with a serum sodium of 127 mmol/l or less on admiss...

It is estimated that one episode of severe hypokalaemia will occur each week, in a hospital serving a population of 150 000. Proper management of hypokalaemia is important as severe forms may cause fatal cardiac dysrhythmias. However, recognition of hypokalaemia may be difficult as it is mild in the majority and also asymptomatic. We present a patient who was had asymptomatic hypokalaemia, with an identical twin with a similar problem.A 45-year-old previ...

Introduction: Severe hyponatraemia is a medical emergency and can be life-threatening. It requires prompt assessment, investigation and treatment which can be a challenge as it presents to multiple departments. We therefore looked to undertake a review of severe hyponatraemia cases in our 1000-bedded acute trust with the aim of determining most appropriate care.Aims and methods: Retrospective notes review of all patients with Na ≤110 mmol/l between...

Background: The short Synacthen test (SST) is frequently used to diagnose adrenal insufficiency; however the role of baseline cortisol. With the recent European shortage of synacthen, there was a pressing need to identify the best possible way to use the resource and rationalize the test. Our aim is to identify whether baseline cortisol can be safely used to rule out adrenal insufficiency in clinical practice.Methods: All SSTs performed at the OPD, Royal...

Introduction: B cell lymphoma of brain is a rare form of lymphoma of brain and it presetting as SIADH is very rare. In this case it was very difficult to find the cause for SIADH with all routine tests. Ultimate diagnosis was by histopathology.Case report: 68 year old gentlemen admitted with vomiting found to be hyponatraemic with serum sodium of 122 mmol/litre. He was known to have chronic lymphocytic lymphoma treated with chemotherapy with good remissi...

Introduction: Primary hyperparathyroidism (PHPT) is a clinical condition often recognized as a result of biochemical screening. While surgery is indicated in symptomatic hypercalcaemic states, the need and timing of surgery in asymptomatic patients is not always clearcut. We conducted a retrospective audit on the diagnosis and management of primary hyperparathyroidism between the years 2010 and 2014.Method: Patients were identified through our histopatho...

Hypercalcemia is uncommon in lymphoma, it is generally a feature of histologically high grade disease with other aggressive clinical features, such as the presence of B symptoms and an elevated lactate dehydrogenase (LDH). The mechanism of hypercalcaemia is unknown but there is strong evidence for humoral factors that may or may not be related to parathyroid hormone (PTH).Case: A 92-year-old lady who was found to have incidental hypercalcaemia (calcium 2...