Endocrine Abstracts

We describe four female patients with T2DM, presenting with nocturnal dizziness (ND), low capillary blood glucose & low BP, that was partially relieved with oral glucose & salt water. C1: MB 66 years, on background of hypertension (HT, valsartan + hydrochlorthiazide (HCT) + amlodipine (AM) ), hypothyroidism (T4D) (levothyroxine 700 mg/week) & IHD (pEF) presented, 3 years into her diagnosis, A1c 52 mmol/mol, with unsteady gait, frequent falls (normal-neurology), swollen feet & generalised non-exertional fatigue. Four years into follow-up, A1c-41 & weight reduced by 3.8 kg. An evaluation was undertaken because of ND while on canagliflozin C/vildagliptin V/Met. C2: SB 64 yrs, (Met/gliclazide/Insulin treated), background of HT (nifedipine + metoprolol) & anxiety (antidepressants-AD) presented, 32 years into her diagnosis, A1c-52, with leg pains, unsteady gait (severe neuropathy) & unprovoked weight gain. After 5 year follow-up, stiffness & fatigue worsened. She lost 5 kg & A1c was 41 & evaluated for recurrent ND (RND) C3: SA 45 yrs old, C + V + Met treated, on background of HT (telmisartan + HCT), anxiety (AD) and T4D (T4 875 mg/wk) presented to us 4 years into her diagnosis, A1c-55, with complaints of generalised non-exertional fatigue and bodyache. After 1 yr of follow-up she gained 1.8 kg, A1c was 57 & evaluated for ND C4: MN 54 yr old, Met + sitagliptin + gliclazide treated, on background of anxiety (AD) & T4D (175 mg/day) presented, 6 years into her diagnosis, A1c-50, with complaints of extreme fatigue & pain in both legs (normal neurology). After 4 months she had RND despite stopping gliclazide Baseline tests suggested isolated GH deficiency (IGHD) in C1, 2, 3, C4 had panhypopituitarism, confirmed by glucagon stimulation test. MRI (pituitary) for C1, 2 & 3 was normal. C4 had non-functioning pituitary macroadenoma (removed transphenoidally). Three patients were initiated rGHT, titrated to mid-centile IGF-1 & followed for 1 year. C4 received hydrocortisone. BMI (C1:30.86–31.25; C3:39.72–40.09; C4:22.89–25.39), A1c mmol/mol (C1:43–48; C3:55–64; C4:48–82), urine microalbumin mg /mmol (C1:0.29–1.12; C3:1.36–2.45; C4:0.62–1.67) & HDL mmol/l (C1:0.93–0.98; C3:1.00–1.03, C4:1.12–1.293) increased. Hs-CRP nmol/L (C1:24.47–16.19; C3:90.57–75.14; C4:6.75–5.71), NT-ProBNP pmol/l (C1:10.40–3.33; C3:7.09–1.77; C4:8.39–2.36) & triacyglycerol mmol/l (C1:1.76–1.19; C3:1.58–1.21; C4:0.89–0.89) reduced. Hypopituitarism (IGHD) should be considered in T2DM patients presenting with nocturnal hypoglycaemia.