Endocrine Abstracts

Case presentation: A 43 year old female patient presented to the Emergency Department (ED) after a seizure episode in which the patient was confused, with repetitive movements of her upper limbs touching the left side of her face. This episode lasted 5 minutes, and the patient was confused for 45 minutes following this. Her mother telephoned an ambulance, and on arrival of the paramedics, her capillary glucose was found to be 1.5 mmol/l. The severe hypoglycaemic episode was tr...

A 76 year-old male was admitted to hospital after an episode of dysarthria and right upper limb weakness. On initial assessment by the pre-hospital team, a capillary blood glucose of 2.9 mmol/l was found and symptoms and signs resolved upon correction with intravenous (IV) 10% dextrose. The patient reported a six month history of episodic episodes of tremors, diaphoresis and fatigue, without loss of consciousness. Occurring mostly late in the morning when he skips breakfast an...

Non-Islet Cell Tumour Hypoglycaemia (NICTH) is a rare paraneoplastic phenomenon caused by aberrant production of pro-IGF-II from tumours, usually mesenchymal or epithelial in origin. Previous case studies report significant reduction in hypoglycaemia with tumour resection, while medical therapy with glucocorticoids and sometimes growth hormone has reduced the frequency of events in some cases. A 63 year old non-diabetic lady presented with a collapse and episodes of fatigue, d...

A 64-year old female presented to the emergency department with a three week history of worsening shortness of breath, palpitations and fatigue. In the preceding 5 years, she was reviewed by various specialists for diarrhoea, nausea, palpitations, shortness of breath, weight loss and fatigue. The colorectal team organised a CT chest abdomen pelvis (CTCAP) in 2020, which reported multiple mesenteric, para-aortic and mediastinal lymphadenopathy. No masses were identified. Her ch...

Insulinomas are functional pancreatic tumours which is mostly benign. Malignant disease is rare with variable course. Much remains unknown with regards to clinical trajectory as well as response to treatment to the commonly used agents between a benign or malignant disease. 70-year-old-man, very fit enthusiastic cyclist a month before initial presentation at another hospital with collapse, blood glucose of 2.4 and mild eosinophilia at which point Addison disease was explored. ...

Introduction: Insulinomas are the most common functioning endocrine neoplasms of the pancreas. 53% of patients are diagnosed within five years of experiencing their first symptoms. Surgical resection is the primary treatment modality. However, patients awaiting surgery or who are not surgical candidates have achieved symptomatic relief from medical therapy. Cases of insulinoma masking diabetes has been described but are rare and diabetes often presents following surgery. Here,...

Non-islet cell tumour hypoglycaemia (NICTH) is a relatively rare form of hypoglycaemia affecting patients with solid tumours originating from mesenchymal and epithelial cells. The hypoglycaemia is due to the excessive secretion by these tumours of high molecular weight insulin-like growth factor (IGF)-2 or pro IGF-2 which stimulate the insulin receptor and suppresses GH secretion by negative feedback mechanism, resulting in hypoglycaemia. The causative tumours may present with...

A previously fit and well 29-year-old male presented with an 8-month history of progressive facial and peripheral swelling, accompanied by generalised weakness, weight gain, nocturia and a 2 year history of left-sided abdominal pain. He was originally from Ghana and moved to the UK in 2022 with limited family support. On examination he was hypertensive (157/108 mmHg) with facial fullness, dry skin, proximal muscle weakness, conjunctival injection and haematomata at recent vene...

Background: An insulinoma is a rare pancreatic neuroendocrine tumour. The incidence is about four cases per million individuals per year. The most common presentation of insulinoma is fasting hypoglycaemia with associated neuroglycopenic symptoms. They are commonly sporadic, usually small in size and majority are benign in nature. A few cases have been associated with genetic mutations.Clinical Case: A 26-year-old man presented to the endocrine clinic wi...

We present a case of a 45-year-old female referred from cardiology with a history of blackouts and palpitations. Initial investigations by GP revealed T-wave changes on ECG, prompting further evaluations, including 24-hour Holter ECG and echocardiogram. Despite extensive cardiac investigations, the patient’s symptoms persisted, leading to referral to the endocrine clinic. The patient reported frequent episodes of hypoglycaemias-associated symptoms such as excessive eating...

Idiopathic ketotic hypoglycaemia is cited as the most frequent cause of hypoglycaemia in childhood but is a rare phenomenon in adults. We present the case of a 72 year man without diabetes presenting to the emergency department with spontaneous symptomatic hypoglycaemia with a glucose of 2.2 mmol/l. On admission he had a normal pituitary profile, negative insulin antibodies, a normal short synacthen test, a negative urine and serum sulphonylurea screen and a normal IGF-II and ...

Ms T. B. is a 72-year-old retired teacher referred with asymptomatic hypoglycemia found on screening for diabetes with fasting plasma glucose 1.8 mmol/l, HbA1 c 23 mmol/mol (4.3%). On repeated questioning, denies any symptoms of neuroglycopenia or autonomic activation even after prolonged fasting. Her only symptom is a 1.5 kg weight gain over the past 6 months.Social: Ms. T.B. is a nonsmoker and nondrinker. She is divorced, with 2 children. On the basis ...

Case report: A 47-year-old lady presented to the Emergency Department (ED) with an episode of dizziness, sweating and palpitations. On ambulance arrival CBG was low at 2.2 mmol/l, and symptoms resolved after treatment of hypoglycaemia. She had first noticed these symptoms eight years ago when fasting for Ramadan. However over the past two years she had experienced episodes multiple times per day, relieved by sugary food or drinks. She occasionally woke at night with symptoms b...

A 64 year-old Caucasian woman was admitted with a five-week history of lethargy, sore throat and dyspnoea, and diarrhoea with intermittent rectal bleeding, with a collapse on the morning of admission. She presented to the Emergency Department via ambulance and was found to be profoundly unwell with cold sepsis. She had a background of rheumatoid arthritis treated with weekly methotrexate, with no history of diabetes or long-term steroid-use. Blood tests revealed pancytopaenia,...

47 M Presented with increasingly frequent unresponsiveness and hypoglycaemia. Systemic review revealed a recent pattern of similar events, associated profuse sweating and uncharacteristic aggression. The patient had poor memory of the events but reported his symptoms improved by eating and he had gained weight. He also reported eating overnight. Past medical history included a Vasectomy and Haemorrhoids A 72 hour fast was terminated after symptomatic hypoglycaemia at 16 hours ...

51 year male ex-professional hockey player, now works as a coach 2 years ago had knee injury and was less active. He gained 3 stone weight over 2 years and feels that he needs to eat more. Started ketogenic diet (PronoCal) for trying to lose weight. The day after starting this diet spent one hour in gym and whilst playing tennis developed double vision. Then he ate lunch at 12 pm mostly protein and vegetables. Che had conference call at work between 4-5 pm and his writing was ...

Background: Reactive hypoglycaemia following Roux-en-Y gastric bypass (RYGB) surgery poses unique challenges in diagnosis and management. This abstract explores the utility of Metformin and GLP-1 analogues in two distinct cases.Case 1- LH: LH, a post-RYGB patient, presented with recurrent hypoglycaemic episodes, intriguingly manifesting primarily at night; after a long day at work in a fasted state followed by a carbohydrate heavy meal. LH experienced hy...

A 70-year old gentleman was referred to the endocrine clinic by the Cardiology team following an admission with blackouts- three in three years, two causing road traffic accidents. During one of the accidents, his capillary blood glucose reading dropped below 3 mmol/l. The patient reported dizzy spells, accompanied by hot flushes, sweats, tremor, change in colour- “looking grey”, feeling hungry and nausea, alleviated by sugary snacks. These episodes were linked to mi...

A 61-year old woman, referred to the endocrine clinic, post Roux-en-Y gastric bypass, exhibited symptoms of dizziness, weakness, light-headedness and sweating. These symptoms were associated with light meal following prolonged fast. A clinical diagnosis of reactive hypoglycaemia was made. She was advised to make lifestyle modification and adopted a low glycaemic index diet. Baseline bloods including cortisol, IGF-1 and urinary metanephrine were within reference range. Mixed me...