Endocrine Abstracts

A 52 year old Syrian gentleman with a background history of hyperlipidaemia and psoriasis presented to the emergency department following a referral from his GP who identified severe hypocalcaemia on bloods in the community. The gentleman had been complaining of symptoms of weakness and lethargy, alongside tingling in his hands and feet for the preceding 4 years. He spoke very limited English, which may have been one of the reasons behind his non engagement with healthcare ser...

Case: We report a 63-year-old woman who was referred to our Endocrine Bone Unit with difficult to control hypoparathyroidism. Sixteen-years previously, she underwent a total thyroidectomy with radioiodine ablation for multifocal papillary thyroid carcinoma with lymph node involvement. However, surgery was complicated by permanent postsurgical hypoparathyroidism, requiring regular calcium supplementation and active vitamin D (Alfacalcidol 1.25 mg). Over the 10-years prior to re...

Background: Hypophosphatemic osteomalacia (HPO)is an uncommon metabolic disease. We describe a case of HPO, where radiological findings of the looser zone (pseudo fractures) were confused with an actual fracture and were scheduled for orthopaedic intervention. Extensive biochemical and radiological investigations followed by an endocrinology review enabled the diagnosis of HPO and prevented surgical intervention.Case history: A 60-year-old gentleman pres...

An 18-year-old male, presenting with unexplained weight loss, was found to have asymptomatic hypocalcaemia (adjusted 1.72 mmol/l, range 2.2-2.6 mmol/l) and hyperphosphataemia (2.05 mmol/l, range 0.8-1.5 mmol/l). He had a background of repaired perimembranous VSD, mild learning difficulties and developmental delay. Parathyroid hormone (PTH) was found to be undetectable and 25-OH Vitamin D insufficient (43 nmol/l). Urine calcium/creatinine ratio was elevated (0.81 mmol/mmol). Th...

A 60 year old female developed iatrogenic hypoparathyroidism and hypothyroidism following a total thyroidectomy, performed for a multinodular goitre, in 1981. Post-operatively, this was treated with levothyroxine 100 mg daily, alfacalcidol 2 mg daily and Adcal-D3 four tablets daily. Other past medical history included hypertension, bilateral cataract extraction and recurrent hypokalaemia with high urinary potassium losses. Hypertension was treated with candesartan 8 mg and ami...

Background: Hungry bone syndrome (HBS) is a prolonged and profound post-operative hypocalcaemic state following parathyroidectomy or thyroidectomy. The incidence is uncommon, cited between 4-13% with surgically treated primary hyperparathyroidism, and can last up to a year post-operatvely. Hypocalcaemia in HBS (usually <2.1 mmol/l) is rapid, and is attributed to the sudden decline in parathyroid hormone (PTH) levels which alters the milieu of PTH-mediated osteoclastic bone...

Case Presentation: A 27-year-old female who recently moved to the UK, was referred to Endocrinology with suspected thyrotoxicosis. She was diagnosed with thyrotoxicosis 11 years prior, and was temporarily treated with a ‘block and replace’ regimen. She had history of traumatic brain injury with no long-term sequelae, and cholecystectomy leading to chronic diarrhoea. She reported swallowing difficulty and a choking sensation. Investigations identified hyperthyroidism ...

Although not used as first-line, recombinant human parathyroid hormone (rhPTH) has a role in the treatment of chronic hypoparathyroidism especially when the conventional treatment is deemed unsatisfactory. A 48-yr-old female with a history of total thyroidectomy for a benign multinodular goiter and post-operative permanent hypoparathyroidism was referred to us in 2011 due to treatment resistant hypocalcemia requiring intravenous calcium infusions. Her calcium remained mostly i...

We present a case of 18 Year male with autoimmune polyendocrine syndrome who presented with seizures to A and E presumed secondary to his profound severe hypocalcemia. Adjusted calcium levels of 1.80 mmol/l.Background: Primary adrenal insufficiency, Hypoparathyroidism, Pancreatic insufficiency and malabsorption, Pernicious anaemia, Aspergers syndrome and Stem cell deficiency in the eye. On admission he received calcium gluconate stat doses which was foll...

Introduction: Hypoparathyroidism is a rare endocrine disease with a prevalence of less than 40/100,000 people worldwide1. It has a variable presentation but can present with life-threatening arrhythmias or seizures.Case PresentationA 31-year-old male presented to our Emergency Department following a witnessed tonic-clonic seizure with no previous history of epilepsy. He was not on any regular medications and denied recreational drug use. Examination was largely unre...

We present a case of a 43 year-old male with permanent post-operative hypoparathyroidism following total thyroidectomy for toxic nodular goitre. His medical history includes Mccune-Albright syndrome and mild right optic atrophy. He had prolonged hospital stay post-surgery due to persistent severe hypocalcaemia with mild hypomagnesemia. Post-surgery, hypocalcaemia was treated with intermittent calcium infusion, oral calcium and D3 supplements and vitamin D analogues of alfacalc...

A 25-year-old lady with a background of Multiple Endocrine Neoplasia (MEN) type 2 a was referred to the endocrine team during her first pregnancy. She was initially diagnosed with bilateral phaeochromocytomas in Romania in 2018 after presenting with paroxysmal headaches and hypertension, and underwent laparoscopic bilateral adrenalectomies. Subsequently, she was diagnosed with MEN2 a when found to have a RET gene mutation: RET exon 11 C1901 G2a, p.CYs634Tyr. She was the index ...

A 40 y /M with no previous CVS/family history, presented with fall. On history, he was feeling unwell, had Appetite loss × 3 months, progressive SOB, Orthopnoea, PND and palpitations. No chest pain/fever. On Examination, he had tachycardia (160) and irregular rhythm, raised JVP, SpO2 92%, B/l ankle edema, bibasal fine inspiratory crackles in chest, Hepatomegaly(3 cm) CVS :S3 gallop, mild TR, MR. ECG: sinus rhythm with freq ectopics, long QT, paroxysms of tachycardia, T wa...

A 62-year-old lady was being followed up by endocrine surgeons for multi-nodular goitre. She underwent an elective total thyroidectomy in April 2017 and histology confirmed a multinodular goitre with no evidence of malignancy. The patient first developed hypocalcaemia immediately post-operatively and was started on Alfacalcidol 0.25 micrograms daily in addition to Levothyroxine replacement. Unfortunately, the patient was lost to follow-up and re-presented at our endocrine clin...

Hypocalcaemia, characterized by abnormally low calcium levels, can stem from various aetiologies, broadly classified as parathyroid hormone (PTH) dependent or PTH independent. PTH-dependent causes encompass deficiencies in circulating PTH, either in isolation or as part of complex syndromes or genetic disorders, further categorized into disorders of parathyroid formation, PTH synthesis or secretion disorders, and parathyroid gland destruction disorders. The patient, presenting...