Endocrine Abstracts

The last few decades had seen major breakthroughs in the management of Heart Failure (HF) especially in relation to the modulation of the pathogenetic mechanistic pathway. One of these is the AVP pathway antagonism via the V2R which is promising. However, the influence of the HF complex pathophysiologic pathways in the context of AVP disorder is not well defined. We present an 83-year-old man with long-standing AVP related disorder presenting with acute decompensated HF. He ha...

Case: 60yr old male presented to his GP with symptoms of polydipsia, polyuria, reduced appetite and weight loss of about 1 stone over 6-7 weeks. Routine bloods showed abnormal blood film with left shift in neutrophils, moderate thrombocytopenia (61), basophilia and occasional blasts (1%). Morphology was suggestive of Chronic Myeloid Leukaemia (CML) or alternate myeloproliferative disorder (MPD). He was referred to haematology for further management and had specialist bloods an...

Langerhans Cell Histiocytosis (LCH) is a neoplastic histiocytic disorder that is rare in adults. LCH can present as a single or multi-site disease (mostly bone/skin). The most frequent endocrine abnormality associated with LCH is Arginine Vasopressin Deficiency (AVP-D), followed by growth hormone and gonadotropin deficiency. We present the case of a 34-year-old female with complex, sequential multi-system involvement. She had a background history of untreated Graves’ dise...

De novo vasopressin insufficiency (VI) is extremely rare in patients with pituitary adenoma who have not had biopsy or surgery and raises the question of differential diagnoses including malignancy and infective or inflammatory disease affecting the pituitary. Here we present a case of a patient initially presenting with cystic pituitary adenoma subsequently developing VI. A 24 year old woman presented to her GP with headache and secondary amenorrhoea. MRI brain revealed a cys...

Background: Lymphocytic hypophysitis is a rare pathology of the pituitary gland which presents with features of hypopituitarism due to inflammation of the pituitary gland and/or a sellar mass lesion. It is an autoimmune condition and is the most frequent histopathological subtype of primary hypophysitis. Given that it is relatively rare, diagnosis and treatment can be challenging.Case Description: A 60-years-old female with history of type 2 diabetes ref...

A 54 year old male was referred for evaluation of Diabetes Insipidus in 2021 with a 12 month history of polyuria, polydipsia and nocturia 3-4 times per night. He always carried water with him and drank 750 ml overnight. He had a history of Ulcerative Colitis, enteropathic osteoarthritis and asthma. He was on Secukinumab monthly. Partial Central Arginine Vasopressin (AVP) deficiency was confirmed by a water deprivation test (serum osmolality >293 mOsm/kg, urine osmolality 3...

A 53-year-old Lithuanian man presented with worsening right sided vision (hand movements) and recurrent headaches on a background of previous haemorrhagic strokes. A CT head/angiogram revealed a hyperdense suprasellar mass. His local endocrinology team reviewed and started emergency treatment for presumed pituitary apoplexy (hydrocortisone 50 mg IM/IV 6 hourly) and he was blue-lighted to a tertiary centre for neurosurgical input.Investigations: Blood tes...

An 84-year-old lady presented with a month’s history of polyuria and polydipsia. She reported waking up seven times during the night to pass urine and constantly feeling thirsty. Her measured 24-hour urine output was 4.9 L. She was otherwise doing well with a past medical history of hypertension, hyperlipidaemia, gastro-oesophageal reflux disease and prolonged hospital admission 20 years ago for Guillain Barré syndrome. Her drug history included Lisinopril, Atorvasta...

Arginine vasopressin deficiency (AVP-D) is a rare condition that can happen following brain surgery or trauma, as well as conditions affecting the hypothalamus and pituitary gland. Here we describe a case of 76-year old man who had AVP-D secondary to large suprasellar mass of unknown aetiology. He presented with generalised malaise, weight loss, polyuria and polydipsia. Past medical histories include type two diabetes mellitus with Hba1c 52 mmol/mol, Graves’ thyrotoxicosi...

Case history: 29-year female presented with sudden onset unquenchable thirst, drinking 7 litres fluids/day, waking 4–5 times at night to drink with polyuria and nocturia. She felt lethargic, nauseated with headaches and weight loss. Past Medical History: Hypertension, following Membranous nephropathy in childhood (previously treated with Tacrolimus and steroids). Examination was unremarkable, with full visual fields.Biochemical Investigations: Confi...

67 year old lady presented to emergency department with general decline, osmotic symptoms and weight loss of 10 kg in the past 6 weeks, worsening over the past 10 days. She had been reviewed in weight loss clinic 6 months prior, however no aetiology was identified (normal glucose level at the time). No other systemic complaints. Past medical history was unremarkable except for a fracture of right ankle. She was hyperglycaemic with a mixed picture of Diabetic Ketoacidosis and H...

A 24 year old student was referred from her GP in 2022 with a one month history of polyuria and polydipsia, drinking up to 15 litres of water a day. Renal function, serum glucose and Hba1c were unremarkable but urinalysis showed a specific gravity 1.010. On further questioning her symptoms had progressively worsened over the past 6 months and reported weight gain of 6 kg in 6 months and intermittent headaches but regular menstrual cycles. She had no past medical history of not...

This case describes a 23-year-old male with known epilepsy, who was admitted to hospital with generalised tonic-clonic (GTC) seizures and acute severe hyponatraemia. He had been feeling generally unwell for two days, but had not doubled his steroids. He has panhypopituitarism due to Langerhans’ histiocytosis, including arginine vasopressin deficiency (AVP-D). His medication included antiepileptics, hydrocortisone, (nasal) desmopressin (DDAVP), levothyroxine and topical te...

I present a case of a 32 year old Vietnamese woman who presented on 3rd September 2023 with abdominal pain and vomiting. Her blood tests showed; Hb 151g/l, WCC 18.3, Na 130 mmol/l, K 1.8 mmol/l, Ur 4.7 mmol/l, Creatinine 91 umol/l, Corrected Calcium 2.93 mmol/l, Phosphate 0.54 mmol/l, Lipase 191 unilts/l. Venous Blood Gases showed pH 7.25, Bicarbonate 15.6, Lactate 1.9, pCO2 4.5, Glucose 7.0 mmol/l. She had a background of treated TB aged 25, recent diagnosis of H. Pylori gast...

An 82 year old lady was admitted under the general medical take with a fall and reduced consciousness. She had a history of two previous trans-sphenoidal surgeries for Cushing’s disease 30 years prior, with subsequent cranial diabetes insipidus and panhypopituitarism. Trans-sphenoidal surgery failed to control her cortisol excess, and resulted in a bilateral adrenalectomy. Medication history included full hormone replacement therapy including oral desmopressin 100 mg thre...

80-year-old female admitted with a fractured neck of femur was found to have hypernatraemia refractory to treatment. On initial assessment, she was polydipsic and hypovolaemic. She had a background of chronic kidney disease. During admission, her serum sodium rose to 167 mmol/l, eGFR was stable at 69 mL/min and her calcium and potassium were within normal limits. Her HbA1c was 40 mmol/mol excluding diabetes mellitus. On further assessment, she reported polyuria (up to 7L/day) ...

A 46 years old male with a background history of hypertension and asthma for which he was taking irbesartan and clenil inhaler respectively, was referred to the Endocrine service with a 3 weeks’ history of polyuria, polydipsia, nocturia and occasional headaches. On initial screening, diabetes mellitus and hypercalcemia were excluded. Initial biochemistry showed a sodium level was 144 mmol/l (135-144) with a serum osmolality of 300 mOsm/kg (275-295). A diagnosis of Diabete...