Endocrine Abstracts

Pancreatic neuroendocrine tumours (pNET) in patients with MEN1 pose a particular and challenging clinical problem. Whilst patients with a pNET and clear clinical and biochemical evidence of hormonal hypersecretion are usually candidates for some form of surgical or medical therapy, the decision-making is far harder for those who are found to have a non-functioning tumour on surveillance imaging. There is a lack of knowledge of the differing biological behaviour between pNETs i...

Pituitary radiotherapy plays an important role in the overall management of pituitary disease, but needs discussion at an expert regional pituitary MDT. Repeat surgical exploration is increasingly performed either as an alternative to radiotherapy or to further reduce tumour bulk ahead of radiotherapy. Careful discussion with the patient on the risks and benefits of radiotherapy, and all the other options, is essential. It is best to consider the control of tumour growth and a...

Background: Prolactinomas are usually highly sensitive to dopamine agonists. We report the use of temozolomide in a 47-year-old gentleman with MEN 1 and a highly dopamine agonist-resistant, and aggressive prolactinoma.Case summary: He presented in 2001 with a 3rd nerve palsy and recurrent headaches. MRI revealed a pituitary tumour extending into the left cavernous sinus. Prolactin levels were 29 000 mU/l. (NR<360). Primary hyperparathyroidism, a lesi...

BackgroundCushing’s disease (CD) is caused by high levels of blood cortisol resulting from excess secretion of adrenocorticotropic hormone (ACTH) from an anterior pituitary corticotroph adenoma. Clinical manifestations include diabetes, hypertension, osteoporosis, and depression. If untreated, CD has an increased mortality of five-fold owing to cardiovascular comorbidities, stroke or raised vulnerability to infection. Currently, transsphenoidal surg...

Introduction: Trans-sphenoidal Surgery (TSS) remains the primary treatment for acromegaly in most patients, but no previous data exist on outcomes for patients treated with gamma knife radiosurgery (STRS) as a primary treatment.Methods: 20 patients with acromegaly underwent primary STRS at the National Centre for Radiosurgery, Sheffield, UK between 1985 and 2015. Data collection: note review, database, laboratory results, patient questionnaire, and death...

Aim: We had noted that certain patients with metastatic mid-gut carcinoid had subcutaneous nodules in the gluteal region. This prompted us to assess this in more detail as the concern was whether these represented metastases.Method: A cross-sectional study was designed to assess CT scans of 56 patients with metastatic mid gut carcinoid attending the Neuroendocrine Tumour Clinic. These were analysed by two independent radiologists blinded as to the treatm...

Background: Symptom management is a cornerstone of clinical care, particularly for patients with cancer. However, often patient’s symptoms go undetected by health care providers between clinic visits. Mobile health applications are increasingly used in oncological care to support cancer patients.Aims: To develop a patient focussed mobile application to enable patients to track symptoms, record quality of life, communicate with their clinical teams a...

Introduction: In addition to the medication prescribed by their doctors, patients may recourse to natural medicine and take herbal medications without thinking about their potential side effects and interactions with other drugs.Case Report: A 39-year-old female, with personal history of iron deficiency anemia, regular menses but long-standing dysmenorrhea and polymenorrhea and reactive anxiety-depressive disorder, complained of frequent intermenstrual s...

Patients with neuroendocrine tumours require co-ordinated multidisciplinary and multimodal management, with appropriate referral pathways and access to timely expert care. This is exemplified by the European Neuroendocrine Tumour Society (ENETS) Centres of Excellence (CoE). There are forty CoE in Europe, ten of which are in the UK. The bar to achieve CoE status is set high, and the standards used for the audit assessments are appropriate to deliver best care even where centre ...

Recent years have seen major advances in our understanding of the causes of adrenal and pituitary Cushing’s syndrome. Careful molecular analyses have yielded new information about the underlying cellular mechanisms leading to the excess secretion of ACTH from the pituitary or cortisol from the adrenal. Unpicking these mechanisms has allowed proposals for new clinical trials of medical treatments for Cushing’s disease. Intriguingly, inherited germ line mutations appea...