Endocrine Abstracts

A 63-year-old gentleman was admitted with right iliac fossa pain, nausea and constipation. Incidentally his potassium was found to be 2.3 mmol/l and he had ureteric stent insertion for right VUJ calculus after the potassium was corrected. Endocrine consultant who reviewed him in the acute medical unit advised an aldosterone to renin ratio (ARR)which was raised with aldosterone 920 and suppressed renin <0.2 but he was still taking Ramipril 5 mg, Amlodipine 10 mg and Doxazos...

A 70-year old female presented with 2-week-history of lethargy, reduced appetite, altered taste of food, weight loss, night sweats and easy bruising. Her past medical history only included PMR for which she was on low dose of prednisolone. Initial examination was unremarkable. Initial lab results showed unremarkable CRP, thrombocytopenia of 28, deranged LFTs (ALP 754 U/l, ALT 145 U/l, GGT 239 IU/l, Total Bilirubin 30 umol/l) and significantly raised Ferritin of 14837 mg/l. CT ...

Case presentation: A 40 year old woman with a history of epilepsy was referred to the endocrine clinic with hypertension and significant weight gain (BMI 42.3 kg/m2). She had a sleeve gastrectomy performed in Turkey several years previously, resulting in an 18 kg weight loss. However, she regained this weight, most of which occurred in the six months prior to presentation. She had also noted the recent development of striae and was complaining of myopathy, so severe...

A 56 year old lady underwent laparoscopic adrenalectomy for an incidental right adrenal mass. Plasma metanephrines were elevated pre-op and histology revealed PCC with a PASS score of 0/20 with SDHB immunostaining +. She remained asymptomatic until 9 years later when she presented with palpitations and worsening hypertension. Plasma metanephrines were 3-4 times above reference range. She was also found to have goitre and USG/FNA revealed THY4 lesion for which she underwent tot...

A reninoma is a tumour of the afferent arteriolar juxtaglomerular cells that secretes the enzyme renin, leading to hyperactivation of the renin-angiotensin-aldosterone system. It is a cause of pathological secondary hyperaldosteronism that results in severe hypertension and hypokalaemia. Fewer than 200 cases have been described, seven of which were associated with pregnancy. We present the case of a 29-year-old woman referred with hypertension and hypokalaemia at 10 weeks&#146...

Background: Clinically relevant pituitary adenomas (Pit PA) affect approximately 1:1200 of the general population, and may manifest with hormone hypersecretion, hypopituitarism and compression of the visual pathways. Primary aldosteronism (Adr PA) is now recognised to account for 5–14% of all cases of hypertension and is associated with excess morbidity when compared with primary hypertension. Here, we report a patient who was noted to have a history suggestive of Adr PA ...

A 57 year old man with a history of hypertension and type 2 diabetes mellitus (HbA1c 80 mmol/mol) presented with right sided flank pain and weight loss. He reported a history of intermittent palpitations and headaches. CT with contrast demonstrated a right renal mass and right adrenal mass. MRI adrenal showed a 2.4 cm T2 hyperintense right adrenal lesion that demonstrated a stricture diffusion with no signal dropout on out of phase imaging and a 2 cm mass in the upper pole of ...

30 M referred to the Surgical Same Day Emergency Care (SDEC) clinic with 2-month history of abdominal pain to left loin and RUQ and worsening back pain for 1-week. Abdomen was soft with tenderness to the RIF, LIF and bilateral loin area. Bloods demonstrated a CRP of 210, sodium 145, potassium 3.2, creatinine 63, ALP 572, ALT 73, bilirubin 12 with normal WCC and neutrophils. A CT abdomen pelvis demonstrated a large left adrenal 10 cm × 11 cm × 13 cm solid mass with so...

A 25 year old Afro-Caribbean man was referred for adrenal vein sampling for suspected Conn’s syndrome and the finding of a right adrenal nodule. He initially presented to his local hospital with vomiting. He had hypokalaemia, which persisted even after the vomiting had resolved. He required oral potassium supplementation to maintain a normal serum potassium level. He gave a history of fatigue and occasional muscle cramps during the last 3 years. Intermittent spontaneous h...

A 47-year-old man attending Endocrine services for the management of Cushing’s disease in remission, presented with resistant hypertension which warranted further investigation. He initially presented in 2013 with Cushing’s disease and underwent successful transsphenoidal surgery. Postoperatively he was diagnosed with ACTH deficiency, partial growth hormone deficiency, and diabetes insipidus for which he was prescribed hydrocortisone 10 mg daily and desmotab 0.2 mg n...

Pheochromocytoma is a rare catecholamine producing neuroendocrine tumor arising from the adrenal medulla. Approximately 40% of cases are hereditary and the remaining are sporadic. There are several familial syndromic disorders associated with phaeochromocytoma including: von Hippel-Lindau (VHL) syndrome, multiple endocrine neoplasia type 2 (MEN2) and, neurofibromatosis type 1 (NF1). Bilateral phaeochromocytoma should prompt suspicion of a hereditary familial syndrome such as M...

A 75-year-old patient was referred to the endocrinology department following the incidental discovery of a right adrenal mass during a CT scan of abdomen and pelvis conducted due to Doppler negative unilateral leg swelling which was present for 1 month. On clinical examination, the heart rate was 82 bpm, weight 78 kg, height 155 cm, BMI 32, blood pressure 185/90 mmHg, no organomegaly or lymphadenopathy and no clinical features of hormonal excess including catecholamine or cort...

Introduction: Primary hyperaldosteronism classically presents with hypertension and hypokalaemia, though many may be normokalaemic. It is most commonly caused by bilateral adrenal hyperplasia, while 30-40% have a unilateral adenoma or nodule. Aldosterone renin ratio (ARR) is performed, with confirmatory testing if required plus adrenal CT to identify an adrenal lesion. Adrenal venous sampling (AVS) distinguishes between unilateral and bilateral disease. Unilateral adrenalectom...

A 67-year-old lady was referred to Haematology for evaluation of Polycythemia (Haemoglobin 162 – 172 g/l, PCV 50 – 53%) A simultaneous referral was sent to Endocrinology for hirsutism, noting that her Testosterone level was 24 nmol/l, SHBG 33 nmol/l. Her past medical history was significant for hypothyroidism, hypertension and migraines for which she was on Levothyroxine, amlodipine and candesartan. She was a non-smoker and teetotaller. Her haematology workup was neg...

A 42-year-old man from Colchester was referred to our endocrinology service in January 2023. He was having abdominal pain for a year, unresponsive to a trial of PPI. He was also found to have hypertension for one year which was controlled by Amlodipine. An ultrasound organised by his GP revealed gallstones and a substantial right supra-adrenal mass, leading to a referral to the local urology team. Subsequently, CT scan was performed which characterised as a likely phaeochromoc...

A 63 year old male presented with sudden onset severe chest pain which clinically seemed cardiac in nature. A diagnosis of Non-ST Elevation MI was made and was managed conservatively. Later, after 6 months he again presented with chest pain. On this occasion, CT aorta and CT Thorax, Abdomen and Pelvis was done to rule out aortic aneurysmal rupture, and to look for post-infarct changes in the myocardium, cardiac MRI was done. Cardiac MRI and CTTAP both showed an incidental find...

29 year old female presented being generally° unwell with vomiting and black outs in Feb 2021. She was 3 weeks postpartum. It was normal vaginal delivery but the baby was small for date but otherwise healthy. She had past medical history of hypothyroidism on levothyroxine. On examination, she looked pale, unwell and tanned. Observations showed BP80/60 PR88/min, RR18/min temp 36.6° c. ABG showed PH 7.34, HCO3 22.3, Na126, k 5.6 cl 93 urea22.9 creat122 glu4.5 lac0.6. o...

A 56-year-old man of Ghanian descent was referred to the endocrine clinic with a 16-year history of drug resistant hypertension. His past medical history was of hypertrophic cardiomyopathy, chronic kidney disease, and horseshoe kidney. He is one of seven hypertensive siblings, two of whom died of complications of hypertension. An incidental finding of bilateral adrenal nodules was noted on abdominal computed tomography. Plasma aldosterone concentration (PAC) was 1020 pmol/l, p...

Background: Most phaeochromocytomas are unilateral and are not associated with a neuroendocrine syndrome. Although these tumours are often histologically benign, they tend to have potentially lethal presentations.Case: A 51-year-old female presented in 2016 with headache, vomiting, palpitations, and a cardiac-sounding chest pain for 16 hours. Her ECG showed a junctional rhythm with generalised ST-segment depression. Acute coronary syndrome treatment was ...

Introduction: Von Hippel-Lindau syndrome is an autosomal dominant condition due to the germline mutation of the VHL gene. Approximately 80% of VHL cases are inherited and 20% occurred because of de novo event. Phaeochromocytomas occur in 10 – 20% of VHL families. Bilateral phaeochromocytomas are more common than extra-adrenal paraganglioma and the majority secrete normetanephrine. Case: A 25-year-old lady of Asian origin was admitted to the hospital...