Endocrine Abstracts

Introduction: Adrenocortical carcinoma is a rare malignancy with an incidence of 1–2 per milion population. We present our experience of three patients with adrenal incidentalomas which were subsequently confirmed to be metastatic adrenocortical carcinoma.Discussion: Our first case presented at 56 years of age with abdominal pain in the background of recent type 2 diabetes and history of alcohol related pancreatitis. CT sh...

Introduction: Adrenocortical carcinoma is a rare malignancy with an incidence of 1–2 per milion population. We present our experience of three patients with adrenal incidentalomas which were subsequently confirmed to be metastatic adrenocortical carcinoma.Discussion: Our first case presented at 56 years of age with abdominal pain in the background of recent type 2 diabetes and history of alcohol related pancreatitis. CT sh...

The adrenal glands are common metastatic sites of lung and other cancers. Secondary adrenal hemorrhage due to these metastases is extremely rare and to our knowledge, only 3 cases have been described in literature. We present a patient who developed hypoadrenalism due to bilateral adrenal hemorrhage secondary to adrenal metastases from lung carcinoma. A 66 year old man with a 3 year history of non-small cell lung cancer previously treated with neo-adjuvant chemo-radiotherapy p...

Objective: We reviewed the depth and length of hypoglycaemia in a cohort of patients undergoing Insulin Tolerance Tests (ITTs). We evaluated the safety of the test, its reproducibility and explored factors that might predict the optimal dose of insulin.Methodology: ITTs were performed at a teaching hospital in the south of England between 2005 and 2010.Result: The major indication for ITT was non-functioning pituitary macro adenoma...

We describe seven patients with pituitary apoplexy diagnosed between July 2009 and Oct 2010.Presentation and Management: Five patients presented with sudden onset headache, nausea and vomiting. One developed headache while on carbegoline and other presented with fluctuating level of consciousness.All but two patients were inpatients at the hospital when diagnosed and all had MRI scan of pituitary to confirm the diagnosis and any ma...

Introduction: High testosterone level lowers the seizure threshold in patients previously well controlled on medication.Clinical scenario: A 59-year-old male, with a history of complex partial seizure, having 12 years of seizure free period on phenytoin and lamotrigine, presented with short history of vomiting, positional headache, and visual impairment. A diagnosis of pitutary macro adenoma was made following a MRI scan of his head. He underwent a trans...

Fasting hypoglycaemia may occasionally be caused by non islet cell tumours (NICTH). Mostly they are large retroperitoneal, intra-abdominal or intrathoracic tumours that are slow growing though malignant. We report a case of recurrent hypoglycaemia associated with metastatic ovarian carcinoma.About 66-year-old lady was admitted with increasing abdominal distension and shortness of breath over 6 weeks duration. There was no significant past medical history...

A 56 year old lady presented with a short history of neuromuscular weakness. She was dehydrated but conscious, alert and oriented and without focal neurology. Her initial blood results revealed a corrected calcium 5.02 mmol/L, phosphate 1.49 mmol/L, alkaline phosphatase 152 iu/L, urea 31.8 mmol/L and creatinine 266 micromol/L.Intravenous rehydration with normal saline and 90 mg of pamidronate was given. She received 4 litres of normal saline daily and her renal functions norma...

Case: We present an interesting case of pituitary hypophysitis following ipilimumab therapy. A 66 year old lady previously diagnosed with left ocular melanoma in 2006 was under oncology follow up, when routine surveillance scan showed recurrence in segment six of the liver. She underwent laparoscopy and was found to have multiple liver metastases following which she was commenced on ipilimumab. Four weeks after completing her second cycle of ipilimumab, she developed severe he...

Introduction: Insulin stress test (IST) has long been the gold standard for testing the hypothalamus-pituitary–adrenal (HPA) axis. There are concerns about the safety of IST as hypoglycaemia can give rise to various symptoms including seizure and coma although this is rarely seen in clinical practice. Hyperinsulinaemic hypoglycaemic clamp is a common research procedure used to induce hypoglycaemia in a step-wise fashion to study the effect of hypoglycaemia.<p class="a...