Endocrine Abstracts

Case history: A 22-year-old woman presented with a week’s history of abdominal pain and constipation. further history revealed episodes of tachycardia during childhood but no cause at that time was identified. On examination she had a sinus tachycardia, her abdomen was mildly tender and the rest of her clinical examination was completely unremarkable, including blood pressure, and there were no clinical findings consistent with Addisonian crisis.Inv...

Case history: We present the case of a 64 year old gentleman diagnosed with hypoparathyroidism following presentation with acute hypocalcemia post thoracic aneurysm surgery for aortic dissection. The etiology was felt to be a complication of thoracic surgery with possible disruption of blood supply to the parathyroid glands.Deeper investigation at a subsequent review revealed persistent hypocalcaemia predating surgery by over 10 years. This was on the ba...

A 40 years old man with a diagnosis of Adrenoleukodystrophy (ALD) was referred for evaluation of symptoms suggestive of hypogonadism. He had a past medical history of ALD associated adrenal insufficiency and osteoporosis. He took regular hydrocortisone and a trial medication, MD1003.Following review, post clinic blood tests revealed a testosterone 24.5 nmol/l (7.6–31.4), LH 8.8 IU/l (1.7–8.6) and FSH 1.5 IU/l (1.5–12.4). Thyroid function t...

Case history: A 66-year-old man presented with a 1 month history of a productive cough, in the context of a 20 pack-year smoking history. CT chest revealed minor bronchiectasis and an incidental 3 cm right adrenal lesion. He was referred to the endocrine clinic for further evaluation. On questioning, he reported no symptoms suggestive of adrenal hormone hypersecretion and, aside from a short history (<1 month) of sweating episodes at night, he described no other constituti...

Case history: A 26 year old lady presented in 1999 with a 3 year history of worsening headache, increased sweating, excessive tiredness and progressive enlargement of hands and feet. She was otherwise well and had no family history of pituitary tumors, hypercalcaemia or renal stones. On examination she had typical facial features of acromegaly and acral enlargement. Her blood pressure was normal and visual fields were full.Investigations: Oral Glucose To...

Case history: Ectopic adrenocorticotropic hormone (ACTH) production accounts for 10–20% of all endogeneous Cushing’s syndrome. The ideal treatment is curative surgery of the underlying tumour. In difficult cases bilateral adrenalectomy is an option. We report a 58-year-old woman with an aggressive ectopic Cushing’s syndrome that required bilateral adrenalectomy undertaken in 1989 at age 32-years.Investigations: At 16 years post adrenalecto...

A 34-year old lady presented in the postpartum period following her 3rd pregnancy with severe hypertension. Her first two pregnancies were 3 and 5 years previously where she delivered via elective Caesarean section without any complications. During this pregnancy which was a twin pregnancy, her antenatal care was mainly unremarkable but on specific questioning, she reported increased sweating for a period of 4 months. Her blood pressure was noted to be normal during her antena...

Case history: A 30-year old female presented with a 10-month history of enlarging neck mass, fatigue and weight gain. Assessment by her GP found her to have a large smooth goitre and biochemical hypothyroidism. The patient had a history of intestinal failure secondary to mitochondrial disorder. As a result of intestinal failure she was entirely dependent on parenteral nutrition and was intolerant of any oral intake, with venting of her stomach to reduce pain. She was referred ...

We present a 50-year-old man who was referred to endocrine clinic with painful gynaecomastia of 3 months duration. He was waiting hip replacement. He had history of a lump in his left breast 9 years ago. He had USS and FNA. He was treated with some tablets for a month and discharged from breast clinic. He had no other past medical history. He worked as a physical trainer to metropolitan police. He did not smoke or drink and was on no medication. He had never used recreational ...

Case history: This 32-year-old lady was found to have a 23 × 17 mm bladder mass incidentally identified on a first trimester scan and confirmed with renal tract ultrasound. Urine collections showed mildly raised normetadrenaline 4.32 umol/24 h (normal range 0–3.0), plasma normetanephrine 1339 pmol/l (120–1180), no metastases were identified on MRI and genetic screening was negative. The patient had two previous normal pregnancies and deliveries. BP in the curren...

A 58-year-old female presented to Urology clinic after an abdominal ultrasound revealed a right sided mass. She had a 9 year history of hypertension which had been difficult to control despite treatment with six agents. She also had a history of Type 2 Diabetes Mellitus and Hyperlipidaemia. CT Thorax/Abdomen/Pelvis reported a 20 cm right renal mass with areas of calcification and following MDT discussion the diagnosis of renal cell carcinoma was made. An open right radical nep...

Case history: A 73-year-old female with a background of hypertension presented to the acute physicians with a 4 month history of progressive headaches. The headaches did not have any ‘red flag’ features. A non-contrast CT scan revealed an intrasellar lesion. She was referred to endocrinology for further management. Her history did not suggest hypopituitarism, Cushing syndrome or acromegaly. There were no visual field defects and her eye movements were normal.<p c...

Case history: We describe a rare case of a 59-year-old woman, whose hypercortisolism was unmasked following transphenoidal surgery for Acromegaly. She presented to the Endocrine Clinic in 2006 with acromegalic features and MRI revealing a pituitary macroadenoma 20×18×18 mm. Repeat dynamic evaluation showed inadequate GH suppression (initially normal), raising the possibility of early rumbling Acromegaly. 0900 h serum cortisol was 287 nmol/l. She was started on Caberg...

Case history: A 20-year-old female first presented to our endocrine clinic in 2013 with a 6-month history of feeling faint, palpitations, weight loss and oligo-amenorrhoea. She was found to have autoimmune thyrotoxicosis with a fT3 of 15.2, fT4 43.3 and TSH <0.05. Her TPO antibodies were strongly positive. She was subsequently commenced on Carbimazole 20 mg once a day and was biochemically euthyroid within 6 months. Interestingly, however, she continued to lose weight and ...

Case history: A 28 year old male presented following his first generalised tonic clonic seizure in the context of a headache with mild photophobia, nausea and vomiting. He was haemodynamically stable, euvolaemic and had no focal neurological deficit, but was mildly disoriented. He had reported cannabis and MDMA use 8 days prior to his presentation. The patient was profoundly hyponatraemic with a serum sodium of 108.Investigations: Serum osmolality was 22...

Case history: A 22-year-old female first presented to our endocrine clinic in 2008 with a six-month history of galactorrhoea and irregular menses.Investigations: She had hyperprolactinaemia (2401 mIU/l), a negative macroprolactin screen and her pituitary MRI scan demonstrated a 4-mm microadenoma. Her cannulated prolactin levels were >1500 mIU/l. She had reverse FSH:LH ratio hence the possibility of PCOS was considered. Her pelvic ultrasound did not s...

Case history: An 80-year-old female presented with progressive leg and facial swelling, postural dizziness, generalised lethargy and reduced mobility. She suffered with chronic kidney disease (stage 3), rheumatoid arthritis and hypertension and had undergone partial thyroidectomy. Examination revealed marked bilateral leg oedema to the sacrum, facial oedema, an ejection systolic murmur, normal JVP and a clear chest.Investigations and results: Investigati...

We describe a case of a male who presented to a rheumatologist with hypercalceamia at the age of 22 in 1995. Investigations were incomplete and he was lost to follow up. He was referred to a general surgeon in 2002 as another blood test had showed hypercalcaemia of 2.8 mmol/l (2.2–2.6), parathyroid hormone 9.5 pmol/l (1.6–6.9). A spot urine calcium/creatinine excretion ratio was 0.014. It was felt he probably had primary hyperparathyroidism and he was managed conserv...

Case history: An eight-year-old white male presented to his General Practitioner with a six-month history of cough and malaise. Blood tests revealed isolated hypercalcaemia (4 mmol/l). He was referred to the Children’s Emergency Department for urgent management. On examination, uveitis and lymphadenopathy were noted. Repeat blood tests confirmed hypercalcaemia. Despite hyperhydration and Furosemide, the serum calcium remained persistently elevated.I...

Fifty-five years old patient with background of type 2 DM, referred by the GP with low serum Cortisol levels (<50), when was investigated for his ongoing symptoms of tiredness with low energy level. He also noticed reduced sexual drive and erectile dysfunction worsening over years along with reduced shaving frequency, to twice a week and sparse hair growth on his body. He denied any trouble with his peripheral vision or any significant headaches, but did feel dizzy on occa...

An 86-year old man was admitted to hospital with gradual decline in mobility and leg weakness. Co-morbidities included atrial fibrillation, hypertension and osteoarthritis. The adjusted serum calcium on admission was 3.42 mmol/l; bone profile showed phosphate 0.56 mmol/l, alkaline phosphatase 140 U/l, albumin 34 g/l, parathyroid hormone 21.4 pmol/l. He was vitamin-D replete (68 nmol/l) with normal renal function. The hypercalcaemia was not thought to be due to any medications....

Forty-three years old lady with background of hypertension was seen in the GP surgery with hirsutism noticed over years. She was referred to the gynaecologist for further work up who in turn discharged her back suggesting possibility of PCOS in view of her biochemical and clinical findings but with no radiological evidence of ovarian cysts.Her PMHx was significant for mild asthma though rarely requiring inhaled steroids.Previously ...

Case history: A 76-year-old female presented following an unwitnessed. On arrival she was confused, dehydrated, complaining of nausea, constipation and abdominal pain. Bloods tests revealed serum calcium of 3.6 mmol/l. She had a history of bipolar disorder and had been taken off lithium due to suspected lithium-induced hyperparathyroidism. Whilst an inpatient, she had a sudden drop in consciousness (Glasgow Coma Scale 3). She was hypotensive, dehydrated and had an average urin...

Multiple parathyroid tumors causing hyperparathyroidism are the most common manifestation of multiple endocrine neoplasia type 1 (MEN1), displaying almost 100 percent penetrance by age 40–50 years. In most cases, it is the initial manifestation of MEN1.We report a case of young lady presented to hospital with diarrhoea and vomiting and diagnosed to have multiple peptic ulcers with severe oesophagitis. Her other biochemistry was consistent with prima...

Case history: Two cases:(1) NM 55-year-old man with no erectile dysfunction, normal libido, but low energy levels for 6 months. PH Hemithyroidectomy for benign nodule, CML with Philadelphia chromosome positive, vitamin D deficiency. Peripheral vascular disease secondary to kinase inhibitors.DH Sildenafil, aspirin, ibuprofen, MagnaPhate, Vitamin D3 1000 units, Levothyroxine 50 mcg, Imatinib 400 mg s...

Thyroidectomy is a definitive form of treatment for patients with hyperthyroid Graves’ disease particularly those who are noncompliant with or have serious side effects to the antithyroid drugs, have very large goitres, refuse 131I therapy or, have moderate to severe ophthalmopathy. The risk of perioperative thyroid storm is usually higher following an acute event such as surgery, trauma, or infection. Thus, patients with thyrotoxicosis presenting for surgery should ideal...