- |||||||||| Rhabdomyolysis Associated With Severe Hypothyroidism (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1818;
Atorvastatin was on hold... Clinicians should raise the suspicion of rhabdomyolysis in a patient with severe hypothyroidism, especially in patients with recent high dose statin use as rhabdomyolysis can be a rare and fatal complication of severe hypothyroidism, in the presence of precipitating factors.
- |||||||||| Neupogen (filgrastim) / Kyowa Kirin, Amgen
Thionamide Induced Pancreatitis and Agranulocytosis, a Rare Case of Concurrence (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1810;
She was given a 10mg dose of dexamethasone and sent home with antibiotics...She was admitted and started on filgrastim 5mcg/kg daily for thionamide-induced agranulocytosis...This change was suspected to be from propranolol, steroids, iodine load from her CT, and prior methimazole use...doi: 10.1001/jama.2023.19052. PMID: 37847271.
- |||||||||| Complex Case of Myxedema Coma Complicated by Cardiac Arrest in a Geriatric Patient with Multiple Comorbidities (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1802;
The intricate interplay of endocrine, cardiovascular, respiratory, and infectious complications necessitated a multifaceted and dynamic therapeutic approach. This case underscores the importance of compliance, vigilant monitoring, prompt recognition of complicating factors, and the need for a coordinated multidisciplinary approach in managing similar cases.
- |||||||||| thyroxine / Generic mfg.
A Case of Severe Myxedema Coma with Levothyroxine Allergy. (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1797;
Patients usually present with deteriorating mental status, hypothermia, and multiple organ system abnormalities. The diagnosis relies more on the clinical presentation and physical examination than on laboratory results.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
MD (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1783;
2023 Oct 5; 7(Suppl 1), Published online 2023 Oct 5. doi: 10.1210/jendso/bvad114.1977
- |||||||||| dexamethasone / Generic mfg., spironolactone / Generic mfg.
A Rare Cause of Hyperandrogenism in Postmenopausal Women: Ovarian Stromal Hyperplasia (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1697;
She took spironolactone for hirsutism with minimal relief...After treatment hyperandrogenism skin changes improve. It is important that clinicians consider OSH as a cause of hyperandrogenism to ensure timely diagnosis and treatment.
- |||||||||| Supplement Misadventures: A Case of Acute Heart Failure, Cardiogenic Shock, and Hormonal Dysregulation Secondary to Surreptitious Use of Multiple Hormonal Supplements (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1682;
A medication bag found by his family included online purchases of non-prescribed testosterone cypionate and enanthate, liothyronine, anastrozole, and clomiphene...He was discharged on levothyroxine 50 mcg daily and hydrocortisone 10 mg twice daily for outpatient reassessment.Transesophageal echocardiogram confirmed diagnosis of papillary fibroelastoma...This case highlights a previously healthy 28-year-old man who presented in critical condition with cardiogenic shock and hypothalamic-pituitary axis dysfunction from supplements he purchased online. There should be targeted educational interventions regarding the harm of supplements aimed at the bodybuilding community to prevent similar cases.
- |||||||||| Dulera (mometasone/formoterol) / Merck (MSD), Novartis
Central Adrenal Insufficiency from Inhaled Mometasone Manifesting as Growth Deceleration (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1680;
However, we present the case of a child with 3 years of inhaled Dulera use and significant central adrenal insufficiency. This case report is the first of its kind to detail decreased adrenal function with Dulera in particular.
- |||||||||| hydrocortisone / Generic mfg.
Medical Therapy to Restore Male Fertility in Classic Congenital Adrenal Hyperplasia (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1668;
At the time of this evaluation, his medication regimen included hydrocortisone 20 mg in the morning and 5 mg in the afternoon, plus fludrocortisone 0.2 mg daily...Though adrenal hyperandrogenism contributes to infertility, in male patients not seeking fertility, adrenal androgens may adequately support virilization and sexual function, so suppression may not be needed to achieve patient goals. However, in those seeking fertility, temporary use of nocturnal glucocorticoids can effectively reverse hyperandrogenemia and restore spermatogenesis and fertility.
- |||||||||| Lysodren (mitotane) / Perrigo Company
Complete Nine Years Disease Free Survival in a Patient with Metastatic Adrenocortical Carcinoma Following Systemic Chemotherapy Including Streptozotocin and Mitotane (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1664;
P3
However, in those seeking fertility, temporary use of nocturnal glucocorticoids can effectively reverse hyperandrogenemia and restore spermatogenesis and fertility. Combined therapy with mitotane and etoposide, doxorubicin, cisplatin (EDP) provided better response rate than mitotane and streptozotocin (N Engl J Med...Mitotane and hydrocortisone were introduced in Nov 2014 and EDP in December 2014...This case illustrates that, although rare, complete long-term remission of advanced metastatic ACC can occur in patients receiving systemic combination chemotherapy including SM and should be considered in patients with advanced ACC when EDP does not achieve a stable response and can be continued until toxic limitations, in our case peripheral neuropathy.
- |||||||||| dexamethasone / Generic mfg.
A Case of Deoxycorticosterone-Producing Adrenal Adenoma (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1660;
Workup should include evaluation of DOC and other mineralocorticoid precursors. The mechanism preventing elevation of aldosterone despite CYP11B2 tumor expression requires further investigation.
- |||||||||| dexamethasone / Generic mfg.
Pediatric Adrenocortical Oncocytic Neoplasm With Central Precocious Puberty: A Case Report (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1650;
Body composition assessment by DXA could be a safer and less expensive alternative in the evaluation and follow-up of patients with MACS. < 48ng/dL), DHEA-S (13490 ng/mL,ref<194 ng/mL) and a positive overnight 1mg dexamethasone suppression test (Cortisol5,8
- |||||||||| dexamethasone / Generic mfg., carvedilol / Generic mfg., irbesartan / Generic mfg.
DeBakey Type 1 Aortic Dissection in a Patient with Adrenal Cushing syndrome (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1641;
Our literature search revealed only a handful of case reports with the majority being Type B Stanford aortic dissections. Mechanisms which lead to dissecting aortic aneurysm in patients with CS remain unclear although severity of hypertension is a key factor.
- |||||||||| Metopirone (metyrapone) / Perrigo Company
A Case of Dual Secreting Adrenal Lesion With Multiple Complications Resulting From Hormonal Abnormalities (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1638;
She was started on spironolactone and phenoxybenzamine...ACTH was 156 ng/L (7.2-63.3) and 1mg overnight Dexamethasone suppression test failed to suppress serum cortisol...A discussion at the regional specialised endocrine MDT made a diagnosis of right pheochromocytoma with ectopic ACTH secretion with hyperplasia of the left adrenal gland, with no other clear source of ACTH on axial imaging, and high dose metyrapone initiated resulting in rapid control of the hypercortisolaemia... This case highlights an unusual presentation of Cushing
- |||||||||| dexamethasone / Generic mfg., albendazole / Generic mfg.
Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1636;
To the best of our knowledge, this is the first case report of an opportunistic echinococcus infection presenting as a pituitary lesion in the setting of Cushing Syndrome. We would like to highlight the importance of recognizing opportunistic infections, including Echinococcus as a potential etiology in the setting of hypercortisolism, especially for patients from endemic regions.
- |||||||||| dexamethasone / Generic mfg., prazosin / Generic mfg., metoprolol succinate / Generic mfg.
A rare case of a composite pheochromocytoma and ganglioneuroma in a 47-year-old male. (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1631;
In preparation for the surgery, we started treatment with Prazosin, followed by addition of Metoprolol succinate. Further work-up included a dexamethasone suppression test that ruled out Cushing
- |||||||||| Isturisa (osilodrostat) / Novartis, Recordati
Successful Treatment Of Severe Ectopic ACTH-dependent Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1629;
During her hospitalization, her hypokalemia was managed with spironolactone and potassium supplement, hypocalcemia with calcium supplement, and hyperglycemia with basal and bolus insulins...Hydrocortisone was continued as part of the block-and-replace regimen. This case described a unique sudden onset and rapid progression of ectopic ACTH dependent Cushing
- |||||||||| The Dilemma of Bilateral Adrenal Tumors: A Case of Pheochromocytoma with Contralateral Primary Aldosteronism (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1627;
HTN was controlled with amlodipine (AMLO) and carvedilol (CVDL), and physical exam was normal...BMP, dexamethasone suppression test (DST), DHEA-S, renin, and aldosterone were normal...His HTN became uncontrolled despite taking AMLO, CVDL, lisinopril, and hydrochlorothiazide...He was initially started on amiloride, which led to the improvement in HTN and hypoK, with the plan to switch to spironolactone.PCCs have highly variable clinical manifestations...All published guidelines agree that patients with hormonally active or malignant unilateral ATs are candidates for surgical interventions, but the risks associated with bilateral adrenalectomy outweighed the potential benefits in his case. Fortunately, he responded well to the medical therapy for PA.
- |||||||||| dexamethasone / Generic mfg.
An interesting case of Hypogonadism likely caused by Cushing's Syndrome (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1621;
Further, dexamethasone suppression testing showed suboptimally suppressed cortisol (14.4 mcg/dL)...Hypercortisolism can affect all parts of the body, including hormones, muscles, joints and bones. When presenting in the initial stages and with mild symptoms, the diagnosis of hypercortisolism is often challenging and can go undetected for many years.
- |||||||||| Functional Adrenocortical Carcinoma Presenting as Uncontrolled Hypertension (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1619;
His hypertension (HTN) was noted to be uncontrolled despite use of multiple antihypertensives (daily Lasix 20 mg, Lisinopril 40 mg, Metoprolol Succinate 100 mg and Amlodipine 10 mg)...An AM dexamethasone suppression test was notable for a cortisol of 39 ug/dl (<1.8 ug/dl) and an undetectable ACTH level of <1.5 pg/ml (7.2 - 63.3 pg/mL), suggestive of primary hypercortisolism...Ketoconazole 200 mg and Spironolactone 150 mg twice daily led to improvement in HTN and hypokalemia...2019;12(4):997-1006. doi:10.1016/j.path.2019.08.010
- |||||||||| RZ358 / Rezolute
RZ358 Therapy. A Novel Approach to Hyperinsulinemia in Metastatic Neuroendocrine Tumor Patients (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1610;
RZ358 represents a novel and unique treatment option for refractory HH in patients with metastatic NETs and can improve clinical outcomes when standard interventions fail. This case underscores the potential of RZ358, a monoclonal antibody, to treat HH beyond its approved use for congenital cases, suggesting its applicability to cases of hyperinsulinemia secondary to NETs in adults.
- |||||||||| Metopirone (metyrapone) / Perrigo Company
Diabetic Ketoacidosis as the First Manifestation of Ectopic Cushing (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1589;
Clinicians should suspect on this etiology of DKA based on clinical signs and cumulative morbidity not typical of a young patient. This hint would lead to the expedite implementation of targeted therapies for initial stabilization of the CS patient, and the timely institution of a proper diagnostic approach and definitive treatment of this challenging patients.
- |||||||||| Prolia (denosumab) / Amgen, Decadron (dexamethasone) / Merck (MSD), Evenity (romosozumab-aqqg) / Astellas, Amgen, UCB
Hypercalcemia of Immobilization (HCOM) Responding to COVID treatment: A mere coincidence or more? (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1558;
HCOM is managed by physical therapy, IV hydration, and IV bisphosphonates. Since hypercalcemia of immobilization is a sclerostin-mediated bone resorption process, a short course of steroids or the use of anti-sclerostin monoclonal antibody Romosozumab can be a reasonable treatment consideration however more research is needed for that.
- |||||||||| dexamethasone / Generic mfg., ethambutol / Generic mfg., azithromycin / Generic mfg.
Navigating Hypercalcemia: MAC Treatment Hurdles and the Unforeseen Impact of Vitamin D Supplementation (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1557;
Five months prior, he had restarted anti-retroviral therapy (ART) after having been out of care for over a year and was diagnosed with disseminated MAC for which he was on azithromycin and ethambutol...He represented one year later with a calcium level of 13.8 mg/dL with suppressed parathyroid hormone levels, which was refractory to bisphosphonate therapy, therefore was empirically initiated on dexamethasone...Vigilant monitoring for complications, particularly life-threatening calcitriol-induced hypercalcemia and timely use of corticosteroids, is crucial. This case also highlights the need for careful oversight in high-dose vitamin D supplementation for individuals with granulomatous disease and vitamin D dysregulation.
- |||||||||| cinacalcet HCl / Generic mfg.
Management Strategies for Hypercalcemia in Breast Cancer with Bone Metastases: A Focus on Glucocorticoids and Cinacalcet (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1553;
This case demonstrates the unusual occurrence of elevated 1,25-dihydroxyvitamin D in the setting of solid tumor, thereby suggesting the utility of glucocorticoids as a treatment option for HCM resistant to usual therapy. It also shows the effectiveness of cinacalcet in managing non-PTH-mediated HCM, which possibly works via increased renal clearance of calcium and could be used as an additional effective therapeutic option in these patients.
- |||||||||| dexamethasone / Generic mfg.
A case of non-neoplastic hypercortisolism leading to the diagnosis of glucocorticoid resistance syndrome due to a novel NR3C1 variant (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1386;
However, serum cortisol levels after an overnight 1 mg-dexamethasone suppression test showed as high as 8.3 ?g/dL with no suppression of midnight serum cortisol levels (8.7 ?g/dL)...In the present case, the absence of physical symptoms suggestive of CS despite hypercortisolemia, and the lack of an obvious cause of non-neoplastic hypercortisolism led to the suspicion of GRS. Identification of NR3C1 variants may rule out CS and avoid unnecessary invasive testing and treatment in such cases.
- |||||||||| miricorilant (CORT118335) / Corcept Therap
Characterization of Clinical Candidate Miricorilant in Preclinical Models for NASH (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1382;
PCLS were cultured for a total of 168 hours in the presence of 100 nM hydrocortisone, and with or without an exogenous lipid challenge. Miricorilant rapidly and effectively lowers hepatic lipid content in the mouse liver and in human PCLS, possibly via modulation of VLDL remodeling.
- |||||||||| hydrocortisone / Generic mfg.
Xp21-CGDS Case report (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1367;
Early detection is crucial for timely intervention and management of this genetic disorder encompassing AHC,HH and DMD mutations.REFERENCES:1.Ferraz-de-Souza B,Lin L,Acherman JC et.al.(2004):Molecular analysis of the NROB1 gene in patients with AHC and Xp21 contiguous gene deletion. Hormone Research.62(6).250-257.2.Rojek A, Obara- MoszynskaM, MaleckaE et.al.(2013):NROB1(DAX1) mutations in patients affected by congenital adrenal hypoplasia with growth hormone deficiency as a new finding.J Appl Genetics.54:225-230https://esicon2023.registeryourseat.in/submit_abstract.phpPage 1 of 1
- |||||||||| hydrocortisone / Generic mfg., desmopressin / Generic mfg.
Triphasic response of pituitary stalk post anoxic injury in a mechanically ventilated patient (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1334;
Further follow up was unattainable as neurological status deteriorated preceding to brain death. Most cases reported showed hypoattenuation lesion of posterior pituitary on MRI; MRI would have been required to determine if there was injury to the pituitary in this case.
- |||||||||| hydrocortisone / Generic mfg.
Pituitary Apoplexy Associated With COVID 19 Infection in a 55 Year Old Filipino Male: A Case Report (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1322;
With increasing reports of pituitary apoplexy in the setting of SARS-COV-2 infection there is a possibility that COVID 19 may be a risk factor for pituitary apoplexy. Hence, the prevalence of COVID- 19 may increase risk of patients with underlying pituitary tumors to develop pituitary apoplexy.
- |||||||||| Pituicytoma mimicking Craniopharyngioma (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1314;
Additionally, central adrenal insufficiency was managed with hydrocortisone, and central hypothyroidism with levothyroxine...Surgical resection, the primary treatment modality, proves curative in most cases, albeit with associated morbidity including CSF leak, DI, and panhypopituitarism. The role of adjuvant radiotherapy remains uncertain, potentially considered in cases of incomplete resection or recurrence.This case emphasizes three key aspects: first, the potential misdiagnosis of a lobulated suprasellar mass as craniopharyngioma when it could be pituicytoma; second, the development of postoperative DI due to pituitary stalk involvement; and third, the importance of considering pituicytoma in the differential diagnosis of sellar and suprasellar masses.In conclusion, pituicytoma, though rare, demands a nuanced diagnostic approach and comprehensive postoperative management to address potential complications and optimize patient outcomes.
- |||||||||| dexamethasone / Generic mfg.
A Rare Case of a Corticotropic and Gonadotropic Pituitary Double Adenoma (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1312;
They are characterized by their origin from different cell lines, which distinguishes them from plurihormonal adenomas, which originate from one single cell line. Here we demonstrate a SF1-T-Pit lineage combination resulting in a neighboring ACTH and FSH-adenoma.
- |||||||||| Pituitary Apoplexy as Presentation of Atypical Teratoid/Rhabdoid Tumor (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1305;
In the literature review performed in adults, only nine cases have occurred in the sellar or suprasellar region. Survival is variable in the different cases reported in the literature, with a mean of 26 months.
- |||||||||| dexamethasone / Generic mfg., spironolactone / Generic mfg.
Cushing Disease Presenting As Severe Persistent Hypokalemia (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1296;
Survival is variable in the different cases reported in the literature, with a mean of 26 months. Her hypokalemia was resistant to therapy and K level remained in 3.2-3.5 mmol/L range on the third week of admission despite oral and intravenous potassium replacements and spironolactone high dose therapy at 100mg twice a day...Given absence of otherwise clear etiology of hypokalemia, and presence of multiple features of Cushing
- |||||||||| hydrocortisone / Generic mfg.
A Case of Cerebral Infarction Resulting From Pituitary Apoplexy (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1294;
Our case displays that, while extremely rare, clinicians should be aware that pituitary adenomas can result in cerebral infarction secondary to mechanical compression of the internal carotid artery, typically caused by an apoplexy event, hemorrhagic or ischemic. Emergent medical and endovascular treatment of the infarction should take precedence, and if clinical stability allows, a delayed surgical approach to resect the pituitary mass may be appropriate.
- |||||||||| dexamethasone / Generic mfg.
The interplay of FOXO1 and NR3C1 in the development and function of pituitary somatotropes (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1291;
Our studies reveal that treating pregnant mice with the synthetic glucocorticoid, dexamethasone leads to premature somatotrope maturation...Further supporting this finding, the deletion of Nr3c1 results in a decreased number of GH-positive cells at e16.5. Altogether these findings demonstrate that NR3C1 and FOXO1 are key factors regulating somatotrope maturation.
- |||||||||| Late Onset Sheehan Syndrome 23 Years After Post-Partum Hemorrhage: A Rare Case (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1282;
Delayed onset Sheehan's syndrome is a rare but important condition that can occur months or years after childbirth. Early diagnosis, proper medical management, and hormone replacement therapy are essential for improving the quality of life for affected women.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
Nivolumab and Ipilimumab Induced Hypophysitis and Adrenal Crisis (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1281;
He was found to have a multi-drug-resistant E. coli urinary tract infection, treated with meropenem...He was given stress-dose hydrocortisone followed by levothyroxine, with a drastic improvement in his clinical course and blood pressures...Evaluation should also include a dedicated pituitary MRI and any corticotroph deficiency should be systematically treated with hydrocortisone. The presence of hyophysitis secondary to a first immunotherapy should not be considered a contraindication for maintaining immunotherapy.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Pembrolizumab-Induced Autoimmune Hypophysitis with (ENDOExpo PosterArea - BCEC) - May 5, 2024 - Abstract #ENDO2024ENDO_1279;
IntroductionAutoimmune hypophysitis caused by immune checkpoint inhibitors [ICIs; anti-CTLA-4 (Ipilimumab alone 7.9%), anti-PD-1 (Pembrolizumab alone 1.7%; nivolumab alone 0%)] are being increasingly documented, with anterior hypopituitarism affecting corticotrophs more commonly than thyrotrophs and gonadotrophs (large time span of onset; different recovery patterns)...Renal Cell Carcinoma S/P radical nephrectomy.2023 JulPET-CT= Metastatic pleuropulmonary nodules.Four admissions to Specialist Oncology Hospital [Four 2 weekly cycles of Inj Pembrolizumab 200 mg (with Tab Axitinib 10 mg/day)]. After first cycle: progressive fatigue, body aches, drowsiness.S Sodium= Pre-pembrolizumab= 137 mEq/L (135-145); Post-pembrolizumab= 124, 134, 132, 124;T3= 1.63 to 0.60 to 1.24 to 1.35 ng/mL (0.97-1.69);T4= 6.83 to 4.93 to 10.44 to 11.44 mcg/dL (5.53-11);TSH= 10.46 to 6.28 to 5.39 to 9.48 mIU/mL (0.46-4.68);S Cortisol 8 am= 1.54 mcg/dL (5-25);S Potassium= 4.59 mEq/dL (3.5-5.1)].One episode of loss of consciousness; EEG= abnormal; MRI Brain= normal.During every hospital admission, oncology, medical, endocrinology and nephrology teams attributed the same to
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