Endocrine Abstracts

Incidence of MEN1 syndrome is 1/30,000 in general population and incidence of primary hyperparathyroidism (PHPT) in reproductive age women is 8/100,000 population/year. However, coexistent of MEN1, PHPT and pregnancy is extremely rare and true incidence is unknown.Despite improvements in medical and obstetric care, PHPT in pregnancy remains high risk pregnancy with significant morbidity and mortality.Case 1: ...

A 68-year-old woman presented with a several month history of nausea, confusion and generalised weakness. In addition, she reported decreased appetite with significant weight loss. She did not report any convulsions, abdominal pain, palpitations, or diarrhoea. Significant past medical history included well-controlled T2DM, hypertension, vitamin D deficiency and GI reflux disease. Importantly, she had no history of renal disease. Relevant medications incl...

We present the case of a 32 year old woman presenting to her GP with right lower leg pain. This pain was worse at night, but responded to simple analgesia. She was initially diagnosed with arthritis but the leg pain worsened and became bilateral. She had no other significant past medical history with no history of fevers, trauma, fractures or dental problems. She had no relevant family, social or medication history.On examination, ...

We present two patients with an unusual cause of primary hyperparathyroidism.A 50 year old man was referred due to incidentally noted raised serum calcium consistent with primary hyperparathyroidism (adjusted calcium 3.52 mmol/L, phosphate 0.66 mmol/L, PTH (parathyroid hormone) 99.5 pmol/L, Vitamin D 46 nmol/L). An initial neck ultrasound demonstrated a 1.2x1.7 cm left sided presumed parathyroid nodule but also a cystic 3.3x3.2x1.7...

Hypoparathyroidism following parathyroidectomy is commonly treated with activated vitamin D, (alfacalcidol and calcitriol). Alfacalcidol (1-hydroxyvitamin D) is converted by hepatic 25-hydroxylase to generate calcitriol (1,25-dihydroxyvitamin D) to act on target cells.We present the case of 66 year old man who was admitted with chest pain in November 2016 and found to have corrected calcium of 1.5 mmol/litre and PO4 2.7 mmol/litre....

This gentleman originally presented at the age of 60 years old with slurred speech, confusion and cerebellar signs and was found to have raised calcium and PTH. His sisters, son and daughter were known to have hyperparathyroid-jaw tumour syndrome (HPT-JT) due to a novel germline Leu63Pro missense mutation in CDC73 exon 2. An MRI brain identified cerebellar lesions and he had positive voltage gated potassium channels; both of indeterminate aetiology follo...

A 74-year-old man was admitted to hospital with diarrhoea, vomiting, abdominal and lower back pain and reduced urine output. Past medical history included hypertension, angina and hypercholesterolemia. Initial diagnosis was campylobacter gastroenteritis and managed accordingly.Two weeks later patient developed fatiguability, exertional dyspnoea and joint pain with persistently high creatinine. CT thorax/abdomen/pelvis was performed...

We report the case of an 82-year-old lady who was admitted with hypercalaemic crisis (adjusted Calcium 4.82 mmol/L) and acute kidney injury (creatinine 169 micromol/L). PTH was 295 pmol/L, raising the suspicion of an underlying parathyroid carcinoma. She had no palpable neck mass. Her ALP was 131 IU/L and Vitamin D 73 nmol/L; myeloma screen was negative and chest radiograph showed no pathology. A DEXA scan revealed osteoporosis. The hypercalcaemic crisis...

Introduction: Hypercalcaemia is a common electrolyte disturbance in patients presenting acutely and can be cause or effect of a multitude of disorders. We present four cases, in which the hypercalcaemia masked or unmasked underlying pathology that may have otherwise gone undiagnosed.Case series: A 36-year old man presented with acute pancreatitis after completing a marathon. Bloods: adjusted calcium (cCa) 3.16 mmol/L, phosphate 0.5...

We present a case of a 56 year-old man diagnosed with systemic mastocytosis by the dermatologists on presentation with classical skin lesions, confirmatory bone marrow biopsy and a tryptase level 105 ug/L (NR 2-14). Further genetic testing confirmed KIT D816V mutation. DEXA bone densitometry at diagnosis revealed marked osteoporosis (Lumbar T score -3.7 (Z -3.5), Femoral Neck T score of -2.0 (Z -1.1). He had no history of low trauma fracture and no relev...

59 year old woman with relapsing remitting multiple sclerosis (MS), not under Neurology follow-up was privately consulting a nutritionist based in Ireland and following the Coimbra protocol1 since December 2016. This included colecalciferol (1000-170000 IU/ day), vitamin B-complex and trace elements. Dose adjustments were advised during weekly skype consultations based on blood tests (via General Practitioner) and symptoms.<p class="abstex...

: A 67-year-old lady, previously fit and well, presented with chest pain. She denied gastrointestinal or urological symptoms. There was no history of depression, psychosis, previous hip fracture or steroid use. She had regular menstrual cycles until hysterectomy at 50 years of age. She doesn’t smoke or drink alcohol. Her mother and father had oesophageal and lung cancer respectively with no family history of hypercalcemia. On examination, she was normotensive with BMI 23....

A 69 year old man presented to hospital with acute hypercalcaemia and renal failure. History included nephrectomy for a benign renal tumour and thyroidectomy for thyroid carcinoma. Presentation adjusted calcium was 2.70 mmol/L with an incompletely suppressed parathyroid hormone level of 0.6 pmol/L. The hypercalcaemia was resistant to both intravenous fluids and bisphosphonates, rising to 3.20 mmol/L. Given his previous cancer, hypercalcaemia of malignanc...

A 58 year-old Polish lady was admitted to hospital after having had two tonic-clonic seizures. She reported a previous history of seizures but had been seizure-free for 10 years. In addition, she reported a 20 year history of hand spasms and perioral paraesthesia. As part of the investigation for seizures while she was living in Poland 10 years ago, CT head had shown bilateral basal ganglia calcification and on this basis she had been diagnosed with Fahr...

Objective: We present this case to emphasize the need to consider the uncommon causes of hypercalcaemia and the importance of history taking.Case report: A 79 year old man with multiple sclerosis was admitted with hypercalcaemia of 3.41 mmol/L, a suppressed PTH and AKI. He was investigated for non-PTH mediated hypercalcemia, having a whole host of investigation. He had normal serum ACE, with no radiological evidence of granulomatou...

We report the case of a middle age woman with the first presentation in our clinic for recurrence of hypercalcemia following surgery for parathyroid adenoma.Her personal history was positive for chronic thyroiditis and with long lasting asymptomatic hypercalcemia not exceeding 11 mg /dL for total plasmatic calcium since 2006. In 2011 her hypercalcemia was worsened (maximum level 13.49 mg/dL) and she was diagnosed with primary hyper...

Case History: A 79 year old gentleman sustained a traumatic fracture of his left humerus in November 2016. Given his age and non-union of fracture, he was referred for a dual X-ray absorptiometry (DXA) scan in May 2017. This demonstrated markedly elevated bone mineral density (BMD) and subsequent investigation was performed.The patient has a past medical history of type 2 diabetes mellitus, hypertension, asthma and kidney stones. H...

A 25 year-old female Polytechnic student who presented at the emergency department with a 5-day history of high grade fever with chills and rigor, headache, generalized body weakness, postpandrial vomiting, epigastic pain and passage of melena and feeling of cramps in her hands and feet. Had no history of PUD but had used NSAIDS for pains and the cramps.Her RBS was 155 mg/dl. Genotype unknown. LMP 6/4/17Physi...