Endocrine Abstracts

Introduction: Thyroid hormone resistance due to a TRα mutation is rare and only recently described. We report a case of primary hyperparathyroidism in an adult patient with a known TRα mutation.Case presentation: A 60 year old female was referred with hypercalcaemia and hyperparathyroidism that persisted despite correction of vitamin D deficiency. Parathyroid hormone levels continued to be elevated or inappropriately normal with hyper- or normo...

A 19 years old student from Bahrain,she has Diabetes mellitus Type II on metformin tablet twice daily for two and half years, she has hypertension uncontrolled on Coveram 5/5 perindopril/amlodipine increased twice daily but still uncontrolled. She has presented with subclinical hypothyroidism TSH is high above 5 and normal T4. Clinically she has mild abdominal obesity, acne, and mood changes.Investigations: FBS 7.3 urea 2.9 Cortisol 769.3 at 0...

Introduction: Severe hypercalcaemia is a medical emergency which can result in severe cardiovascular and neurological dysfunction. Pathophysiological mechanisms of hypercalcaemia include increased osteoclastic activity, osteolytic bone metastasis, extra-renal activation/production of 1,25 hydroxyvitamin D and decreased urinary calcium excretion. Understanding these mechanisms is important to guide the diagnostic process and the long-term management of hypercalcaemia.<p cla...

Mr RP is a 69 year old gentleman who presented to A&E following a fall. He described several weeks of lethargy, ataxia, confusion and polydipsia. He had a past medical history of hypertension and COPD, but was otherwise fit and well. On admission bloods revealed an adjusted calcium of 5.25, with a PTH of 2.4. He also had a significant AKI with an eGFR of 22. After initial management with IV fluids, a cautious dose of pamidronate was given. Basic investigations did not iden...

Case history: This 32 year old lady developed anterior and posterior pituitary failure following chemotherapy, radiotherapy and bone marrow transplant for acute lymphoblastic leukaeamia in childhood and subsequent CNS recurrence. During her teens, she required GH replacement with which she was poorly compliant. She had a mastectomy and currently takes hormonal treatment for oestrogen receptor positive T2N1M1 breast cancer, which is possibly a consequence of her total body irra...

A 22-year-old Caucasian female was referred to thyroid specialist clinic due to difficulties fully suppressing her thyroid stimulating hormone (TSH) despite high dose combination therapy of triiodothyronine (T3) and thyroxine (T4) treatment. She had a well-differentiated thyroid -carcinoma of left thyroid lobe treated with left lobectomy. Several other small primary thyroid carcinoma lesions were detected on further examination of the histology which lead to completion thyroid...

Case history: 62 Year old male known to have inflammatory bowel disease, ischemic cardiomyopathy, ICD implant for sustained ventricular tachycardia was referred to endocrine clinic by the GP for thyrotoxicosis which was found on lab workup for worsening diarrhoea and tiredness.Drug historyAmiodarone 200 mg od since 2012, Bisoprolol, Eplerenone, Atorvastain and Pentasa.Investigations: FT4 48.6 pmol/l (6.5&#150...

Case history: A 72 year old gentleman from Zimbabwe presented to clinic with MRI pituitary findings of 1.5×1.4×1 cm pituitary macroadenoma. This had been discovered incidentally during outpatient investigation for severe headaches refractory to standard analgesia at another hospital. The mass was in contact with but not compressing the optic chiasm. He did not describe any visual loss. He had an unintentional weight loss of 10 kg in the last 2 months. He described de...

Summary: A case of intermittent hypercalcemia with a suppressed parathyroid hormone (PTH) for nearly 3 years. It was found that high calcium specifically occurred in summer and each one lasted for about a month. Once calcium normalised the renal function also improved. Exact aetiology has not been found even after extensive investigations.Case presentation: A 67-year-old gentleman first presented to the endocrine clinic in early 2014 with Hypercalcemia. ...

A 39-year-old man presented with thyrotoxicosis and was diagnosed with Graves’ disease. Despite high doses of anti-thyroid medication for 18 months, he remained biochemically and clinically hyperthyroid. Therefore, a thyroidectomy was planned. Four days before surgery, he developed double vision and was referred for urgent Neurosurgical review at our centre. On further questioning, he reported a 12-month history of lethargy and low libido. On examination, he had right 6th...

A 37-year-old female referred by gynaecologist with elevated serum testosterone found on evaluation for amenorrhoea. She has had oligomenorrhoea for 5 years with induced bleed on Logynon and no change on stopping. Episodes of feeling hot and sweaty and going red in face. On examination: weight 68 kg, BMI 25 kg/m2, euthyroid, euadrenal, no hirsutism. BP: 116/86 (lying) & 110/90 (standing for 2 min). Available blood results: Estradiol- 43–91; LH- <0.1&#15...

A 20-year-old lady presented to her GP with menstrual irregularity and worsening right-sided headaches with associated vomiting. Blood tests showed a mildly raised testosterone level and a markedly raised prolactin level, approximately 80% of which was macroprolactin (normal monomeric prolactin level). She was subsequently referred by her GP for an MRI Pituitary, which was reported as showing a 6-mm hypoenhancing lesion. Medical history includes migraines and hayfever; she was...

Africo Caribbean gentleman was referred to our endocrine department for management of secondary hypertension. He initially presented to his doctor with headache and he was found to be hypertensive with systolic BP of 200 mmHg and hypokalaemia. A renal MRI showed a right adrenal mass, 2.9×2.4 cm, and echocardiogram showed moderate left ventricular hypertrophy and diastolic dysfunction. He had normal 24 h excretion of metanephrines and free cortisol. An aldosterone renin ra...