Endocrine Abstracts

Inappropriately low circulating PTH levels following thyroid surgery, is the most common cause of iatrogenic hypocalcaemia. Standard treatment of hypoparathyroidism has comprised vitamin D analogue and calcium supplementation. However some patients remain hypocalcaemic despite use of maximal titrated and tolerated therapy. Teriparatide is recombinant formulation of endogenous PTH, containing 34 amino acid sequence which is identical to the N-terminal portion of this hormone. W...

A 33 year-old-lady presented to the emergency department with acute abdominal pain and per vaginal bleeding. Her last menstrual period was six weeks prior to admission. She had a positive urine pregnancy test and a trans-vaginal ultrasound confirming an ectopic tubal pregnancy. She underwent an emergency laparoscopic right salpingectomy under general anaesthesia with blood loss intra-operatively of 300 ml. One day post-op, her haemoglobin dropped from 129 g/l to 86 g/l. She re...

A 77 year old female was referred to endocrinology with an incidental finding of hypophosphataemia (0.26 mmol/l) on routine bloods. She described a slight unsteadiness on her feet, but denied bone pain or overt muscle weakness. Past medical history included Type 2 Diabetes Mellitus, a left humeral fragility fracture and the subsequent diagnosis of osteoporosis 2 years previously. At presentation the corrected calcium was slightly elevated (2.64 mmol/l), which normalised when r...

Primary hyperparathyroidism is a fairly common endocrine problem affecting women twice as common as men. The first case of primary hyperparathyroidism in pregnancy was reported in 1931. We present a case of a 29 years old lady who was referred to the endocrine clinic from inpatient admission for her high corrected calcium (Corr Ca) levels (3.27 mmol/mol) and high Parathyroid Hormone (PTH) levels (58.9 pmol/l), while she was 12 weeks pregnant. Her past medical history was signi...

Introduction: Familial hypocalciuric hypercalcemia (FHH) is a benign condition characterized by asymptomatic hypercalcemia secondary to hypocalciuria. Affected patients have variable parathyroid hormone levels. It is caused by a loss-of-function mutation in the calcium-sensing receptor (CASR) gene. The occurrence of both FHH and primary hyperparathyroidism (PHPT) in the same patient has rarely been described. We report an interesting case.Case: ...

Introduction: Sclerochoroidal calcification is an uncommon condition that classically manifests as multiple discrete yellow placoid lesions, often discovered as an incidental finding. It is ordinarily believed to be idiopathic, but is also associated with primary hyperparathyroidism. It is important that these patients are identified because of the systemic implications and treatable nature of these disorders.Case: 82 years old patient with history of Pr...

Milk Alkali syndrome (MAS), a rare cause of hypercalcaemia, is reversible and caused by the ingestion of large amounts of calcium (Ca) and absorbable alkali. We report a case of MAS in a 37 year old female, admitted with Ca of 3.44 (2.15–2.62 nmol/l). Presenting complaints include 6 months history of worsening fatigue, thirst, polyuria, abdominal pain and a complex background of bipolar disorder, fibromyalgia, spina bifida, lumbar spine fusion and extremely limited mobili...

We set out to describe a case of persistent PTH elevation post parathyroid carcinoma resection and assess its significance via literature review. A 71 year old lady presented with abdominal pain and weight loss. Blood tests revealed calcium of 3.42 mmol/l and PTH of 47.8 pmol/l. Ultrasound neck and SESTAMIBI scan suggested right lower parathyroid adenoma. She underwent right inferior parathyroidectomy however histology revealed parathyroid carcinoma with incomplete excision ne...

A 54-year-old man was admitted to hospital with a new diagnosis of Miliary Pulmonary Tuberculosis (TB). Early in admission he developed septic shock with multiorgan failure requiring organ support and anti-TB medications. Recovery was complicated by persistently low Glasgow coma score (GCS), noradrenaline dependency and limb threatening microvascular injury. At day-25 he was apyrexial but remained hypotensive and drowsy with no evidence of sepsis or hypoadrenalism. Over the ne...

A 48 year-old lady was referred to Endocrinology clinic in November 2016 with symptoms of tiredness and lethargy for two months. Routine bloods were unremarkable, apart from an incidental finding of raised Vitamin D:258 nmol/l(NR: 50–150). She had depression and was otherwise fit & well. She was on Citalopram and combined oral contraceptive pill (Microgynon). She denied any excessive sun exposure. She didn’t drink any milk, only drank orange juice. She took multi...

Introduction: Hypercalcaemia is a commonly encountered biochemical abnormality. The most common causes of hypercalcaemia are primary hyperparathyroidism and malignancy. Familial Hypocalciuric Hypercalcaemia (FHH) is a rare cause of hypercalcaemia.Case: We present a 53-year-old female, who was referred to the endocrinology clinic for further investigation of a persistent hypercalcaemia associated with low-to-normal parathyroid hormone level (1.5pmol/l). S...

We present the case of a 35-year-old woman who was well until pregnancy 4y previously in Israel. Her antenatal course was uncomplicated. She breastfed postpartum and a few months into this she experienced acute back pain on reaching for a nappy. MRI demonstrated six vertebral fractures. DEXA scan confirmed osteoporosis (lumbar T-score −4.3, hip T-score −3.3). She received a single dose of denosumab. She moved to the UK 2y later and was referred to our Endocrine Bon...

An 88-year-old Caucasian man with hypertension, single functioning kidney, vitamin D insufficiency and transurethral resection of the prostate was admitted with worsening confusion. On admission, he had acute on chronic renal impairment (Urea- 17.2 mmol/l (range: 2.5–7.5 mmol/l), Creatinine- 163 μmol/l (range: 60–120 μmol/l), eGFR- 35 (Baseline- 60 ml/min/1.73m2) and a normal serum/corrected calcium (2.51 mmol/l (range- 2.2–2.6mmol/l). He wa...

We report a 45-year-old man who developed acquired primary hypoparathyroidism based on a low serum adjusted calcium level and low parathyroid hormone level. His past medical history included recurrent chronic anaemia requiring multiple transfusions since 2011. He was an ex- intravenous drug user, and suffered from chronic bilateral venous leg ulcers, and liver cirrhosis following Hepatitis C infection. Despite using doses of up to 8 mcg Calcitriol daily, his calcium levels fel...

A 46 year old female presented to orthopaedics with a painful swelling at the base of the middle finger, which was gradually increasing in size. Ultrasound and x-ray showed a highly vascular irregular mass with bony involvement of the third metacarpal. Initial suspicions were of an enchondroma. Following an MRI scan, the orthopaedic team proceeded to biopsy the lesion. The histology suggested a giant cell tumour. Curretage of the lesion, with bone grafting was performed and fu...

Hypercalcemia is a rare pathology in pregnancy and postpartum, but an important one to recognize in the effort to reduce fetal and neonatal morbidity and mortality. We describe a case of hypercalcemia at end of pregnancy. A30 year-old woman was referred to Endocrine clinic at 36 weeks Gestations for symptomatic mild hypercalcemia (tired and lack of energy). She had previous history of acute lymphocytic leukemia treated with bone Marrow Transplant in remission for the last 6 ye...

Introduction: Decreased bone mass is associated with inflammatory bowel disease (IBD), due to multiple factors, including endocrine disturbances, deficits in calcium and vitamin D, malnutrition, drugs (corticosteroids), chronic inflammation. If in older man and postmenopausal women, the treatment is well established, for young patients is not a general consensus.Case report: We report the case of a 20-year-old, male, nonsmoker, diagnosed with Crohn disea...