Endocrine Abstracts

Case: A 74-year-old female presenting with central weight gain, proximal myopathy, thin skin and bruising. Clinical examination identified central obesity, round facies, dorso-cervical and supra-clavicular fat pads.Investigations: Bloods revealed hypokalaemia (3.2mmol/l), elevated cortisol levels (>1000nmol/l) persisted post low dose Dexamethasone suppression test, with a supressed ACTH (<5). Urine free cortisol 1842nmol/24hrs (0-165). CT Chest-A...

A 65-year-old man presenting with urinary symptoms was incidentally discovered to have an adrenal mass on imaging. Abdominal computed tomography (CT) revealed a 9.5 x 8 cm heterogenous solid right adrenal tumour with no evidence of metastatic disease. Family history included a brother who died from metastatic carcinoid and another brother who died from metastatic neuroendocrine tumour. The initial differential lay between adrenocortical carcinoma (ACC) or a pheochromocytoma. T...

A 52 year-old female, newly diagnosed with Type 2 Diabetes during pre-operative assessment for cholecystectomy, was referred to Diabetes clinic. An initial trial of metformin was discontinued in view of intolerable gastrointestinal side effects and the patient was started on low dose gliclazide. The patient’s main concern was her struggle to lose weight despite lifestyle measures, a seemingly common issue faced by patients with diabetes on sulphonylureas. On further exami...

We present the case of a 53-year-old lady who was recently diagnosed with Type 2 Diabetes, Hypertension and Dyslipidaemia. She was referred by the lipid clinic with a 3-month history of progressive facial swelling, hyperpigmentation and proximal myopathy. Clinical history and examination were highly suspicious of endogenous hypercortisolaemia. An initial overnight dexamethasone suppression test yielded an elevated morning cortisol (752 nmol/l, normal <50nmol/l). Two 24-hou...

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumour of the adrenal cortex with an incidence of 0.7-2.0 per million per year. The majority are steroid-producing with non-ACTH dependent hypercortisolism the most frequent biochemical abnormality. Around 10-15% of cases are picked up incidentally on abdominal imaging. Management of ACC during the covid-19 pandemic poses specific challenges. We present the case of a 69-year-old man who was found to have a massive ...

Background : Adrenocortical cancer (ACC) is a very rare but aggressive tumour with annual incidence of 2 cases per million populations. Hypercalcaemia is a commonly encountered paraneoplastic manifestation of certain cancers such as lung, breast, kidney, gynaecological and neuroendocrine tumours but very rare in ACC. So far, there are only two cases of ACC and PTHrP-related hypercalcaemia reported in the literature.Case report: 32-year-old man presented ...

In 2009 a 39 year old gentleman presented to the Endocrine clinic with symptoms, signs and biochemistry consistent with severe glucocorticoid excess (urinary free cortisol level was significantly raised at >1380mol/24 hours, normal up to 124; early morning cortisol levels varying between 760nmol/land 1225nmol/lwith failure of suppression on a low dose dexamethasone suppression test). An ACTH level taken at this time was 43ng/l. He underwent an MRI pituitary gland which sho...

Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessment. Biochemical evidence of endogenous steroid excess is demonstrated through overnight dexamethasone suppression test (ODST), low dose dexamethasone suppression test and/or 24-hour urinary free cortisol estimation (UFC). Once endogenous steroid excess is confirmed, random serum ACTH measurement is key in determining the suspected source of steroid excess: ACTH-inde...

A 57-year-old gentleman presented with a very sudden change in hair colour to bright white and eyebrow loss. On further questioning, he had been shaving much less and had not been getting any erections. On examination he had gynaecomastia. Initial blood tests showed hypogonadotrophic hypogonadism (LH 0.6 IU/l, FSH 0.1 IU/l, testosterone 1.6 nmol/l) with an otherwise normal anterior pituitary hormonal profile. Oestradiol was found to be significantly elevated at 582 pmol/l. He ...

Case summary: A 40 year-old lady, who has a background of asthma, presented to emergency department with back pain radiated down to her left leg with associated foot drop. She also complained of 2 months history of weight gain, hirsutism, and menstrual disturbance. Clinical examination confirmed that she had some cushingoid features. Further assessment and investigations revealed that she had acute disc prolapse on MRI as well as an incidental finding of right adrenal gland an...

Identifying the cause of hypercortisolism is vital in ensuring the correct treatment plan for a patient. I present the case of a patient in whom the desmopressin test, as an adjunct to the CRH test, proved helpful in determining the cause. A 27 year old man who initially presented with weight gain, abdominal striae and sweating was admitted with low mood, anxiety and suicidal ideation. Tests showed elevated 24 hour urinary cortisol (highest 1446 nmol/24 hours), random cortisol...

Introduction: Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a rare cause of Cushing’s syndrome and is more often diagnosed as bilateral adrenal incidentalomas with subclinical cortisol production. It is mainly a heterogeneous disease, but familial cases have been reported. Treatment of PBMAH with overt Cushing’s syndrome is usually bilateral adrenalectomy with unilateral adrenalectomy occasionally used to normalize urinary free cortisol (UFC) in patie...

Adrenal cortical carcinoma (ACC) is extremely rare, the incidence is 0.5 - 2 cases per million populations per year. Most ACCs occur as sporadic tumours. It is more common in females and can occur at any age with a peak in fifth and sixth decades of life. We present a 45-year-old otherwise well and fit lady presented with headache, lethargy, and two stone rapid weight gain over a period of 6 months. She also had associated nocturia, insomnia, night sweats, hirsutism, and acne....

A 51 year old presented with headaches, fatigue and generalised weakness. She had a background history of hypertension diagnosed one year prior to presentation. Initial laboratory evaluation demonstrated life-threatening hypokalaemia, potassium 0.9mmol/l(R.I. 3.5-5.3). This profound hypokalaemia required ICU admission for replacement of potassium and monitoring. Management of subsequent fluid overload necessitated a brief period of hemofiltration. During the course of evaluati...

Introduction: Cushing’s syndrome is a rare endocrine disorder characterized by excess cortisol secretion. It can be caused by various etiologies, including ACTH-dependent and ACTH-independent forms. We report a case of a 78-year-old male who presented with severe hypertension, refractory hypokalemia, and severe hypercortisolaemia, diagnosed with ACTH-dependent Cushing’s syndrome with bilateral adrenal hyperplasia.Case Presentation: A 78-year-ol...

Case presentation: A 34-year-old woman was diagnosed with hypertension from the age of 26 years. She had been investigated in Canada previously and discovered to have a small left adrenal nodule, satisfactory aldosterone and renin levels, but raised urinary free cortisol levels and non-suppressed cortisol levels on overnight 1 mg dexamethasone suppression test. Upon assessment in our service, the patient reported a history of easy bruising and insomnia. Her BMI was 28.1 kg/m&#...