Endocrine Abstracts

A 36-year-old female was referred to Endocrinology by her GP in August 2019 with polycythaemia, obesity, hypertension, type 2 diabetes, asthma, right shoulder and bilateral ankle pain [on 6-monthly steroid injections], easy bruising, hirsutism, PCOS and raised testosterone. Haematology had excluded likely causes of polycythaemia [JAK 2 negative]. The GP noted previous review by Endocrinology in another hospital [December 2012] regarding possible PCOS but was lost to follow up after one appointment. Clinic enquiry established daily face shaving and frequent waxing. Menarche at 17 years old. Current periods were very irregular. Examination noted fine pigmented stretch marks, a supraclavicular fat pad, acanthosis, seborrheic dermatitis and recent leg swelling. Investigations as per table. Surgery was delayed due to the COVID pandemic Lockdown. Diabetes, hypertension and weight were actively managed. Metyrapone was used pre-operatively and the patient was advised to shield. Partial apoplexy of the ACTH secreting pituitary adenoma occurred just before elective transsphenoidal surgery. Post surgery nausea and vomiting were troublesome symptoms for an extended period. Post-operative ACTH deficiency was confirmed and the patient remains on hydrocortisone; Weight has reduced by over 60 kg; Hypertension and T2DM are in remission; On last review she was pregnant and was promptly referred to the combined endocrine/antenatal clinic.