Endocrine Abstracts

A 39-year-old man presented with thyrotoxicosis and was diagnosed with Graves’ disease. Despite high doses of anti-thyroid medication for 18 months, he remained biochemically and clinically hyperthyroid. Therefore, a thyroidectomy was planned. Four days before surgery, he developed double vision and was referred for urgent Neurosurgical review at our centre. On further questioning, he reported a 12-month history of lethargy and low libido. On examination, he had right 6th...

Introduction: Diaphoresis, or excessive sweating, is well recognised as a presenting complaint for endocrine disorders such as hyperthyroidism, acromegaly, and phaeochromocytoma. However, diaphoresis is an unusual presenting complaint for Cushing’s syndrome.Case: We present the case of a 35-year-old lady who first presented to health services for symptoms of excessive sweating, and feeling hot most of the time. Whilst initial investigations such as ...

Introduction: Graves’ disease is an autoimmune disorder which may lead to thyroid overactivity and eye disease. Oestrogen and progesterone are thought to be immunomodulatory and have been postulated to play an important role in the difference in prevalence of autoimmune disorders between men and women. Autoimmune disorders, including autoimmune thyroid disease, are often quiescent during pregnancy with an increased prevalence postpartum. The increase in immune mediated th...

High protein diets suppress appetite and facilitate weight loss, but are difficult to adhere to. Understanding the mechanisms by which protein suppresses appetite may establish targets for more acceptable interventions to treat or prevent obesity. Of particular interest is the concept of functional foods or novel products, which aim to potentiate satiety.Receptor systems that respond to amino acids have been identified. However, the specific mechanisms r...

Cabergoline has long been used to treat prolactinomas for symptomatic, radiological and biochemical resolution of pituitary tumours. As clinicians we are well-versed at screening for physical side effects, but are we holistic enough? We present two cases illustrating the damaging social consequences of cabergoline treatment for prolactinomas.Case 1A 49-year-old married father of two presented with a seizure in April 2018. MRI showe...

Lithium increases retention of Iodine-131 in the thyroid gland and inhibits thyroid hormone release following radioactive iodine (RAI) administration. However, outcomes of studies of the effects of lithium on the efficacy of RAI are conflicting. The aim of this study was to assess whether adjuvant lithium increases the efficacy of RAI treatment in hyperthyroidism. A retrospective cohort study was performed of 204 hyperthyroid patients (163 Graves’ disease, 26 toxic multin...

The hypothalamus regulates multiple homeostatic systems, and is essential for the regulation of appetite and energy balance. Neuropeptide Y, a 36 amino acid peptide and member of the PP-fold family, is a key hypothalamic neuropeptide involved in the regulation of energy balance, potently stimulating food intake following central administration. NPY is expressed in the arcuate nucleus (ARC) and NPYergic neurones project to multiple hypothalamic nuclei and extra-hypothalamic sit...

Aim: Population studies have shown that basal calcitonin concentrations are below 10 ng/l in the normal population. Ten nanograms per liter is used as a diagnostic cut-off by most laboratories and patients with levels higher than this are offered a pentagastrin stimulation test to exclude medullary thyroid carcinoma. However, these guidelines were adopted from studies that used the Cisbio Immunoradiometric assay for measuring calcitonin. Most laboratories have now moved to che...

Background: The water deprivation test serves as a key diagnostic test to differentiate between Arginine Vasopressin Deficiency (AVP-D), Arginine Vasopressin Resistance (AVP-R), and Psychogenic Polydipsia (PP) in patients presenting with symptoms of polydipsia and polyuria, when common causes such as diabetes mellitus have been excluded. This study evaluated the established diagnostic values for serum osmolality, serum sodium, and urine osmolality.Method...

Introduction: In up to 50 percent of Cushing’s disease patients, corticotroph adenomas are not clearly identified on MRI and long-term medical treatment to lower cortisol may be needed. Osilodrostat, which inhibits 11 beta hydroxylase, is effective in normalising urinary free cortisol (UFC). We are the UK’s first centre to use osilodrostat for Cushing’s disease in MRI negative patients.Method: Five patients (one male) with Cushing’s d...