Endocrine Abstracts

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...

Background: Existing biomarkers have limited ability to discriminate indolent non-functioning pituitary adenomas (NFPAs) from those with a propensity to recur following primary surgery. Radiomics, the extraction of quantitative data from medical imaging, is increasingly recognised as a tool to augment clinical decision making.Methods: 39 patients who underwent primary trans-sphenoidal surgery for an NFPA between January 2007 and April 2017, were enrolled...

Background: Clinically relevant pituitary adenomas (Pit PA) affect approximately 1:1200 of the general population, and may manifest with hormone hypersecretion, hypopituitarism and compression of the visual pathways. Primary aldosteronism (Adr PA) is now recognised to account for 5–14% of all cases of hypertension and is associated with excess morbidity when compared with primary hypertension. Here, we report a patient who was noted to have a history suggestive of Adr PA ...

Background: 11C-Metomidate (MTO)-PET/CT has recently found utility as an alternative to adrenal vein sampling for lateralisation in primary aldosteronism. MTO binds with high affinity to 11b-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) and can be considered an adrenocortical-specific tracer. We and others have therefore hypothesised that combining MTO-PET/CT with 18F-FDG(FDG)-PET/CT would permit indeterminate adrenal lesions ...

Case history: A 20-year-old man was referred to the metabolic bone clinic following a left sided neck of femur fracture (sustained after a simple fall whilst roller skating). He was otherwise well with no past medical history; systemic enquiry was unremarkable. A DEXA scan revealed osteoporosis (Z scores: total hip −2.97; lumbar spine −3.1), and bone turnover markers were significantly raised. Unexpectedly, the patient was found to have an elevated serum t...

Introduction: A 22q11.2 deletion syndrome (velocardiofacial syndrome) is an autosomal dominant disorder affects various organs including the parathyroid gland. Because of its incomplete penetrance, multi-system affectation, and variable clinical presentation, the diagnosis is often delayed or never made. Delayed diagnosis may have significant impact on morbidity and mortality. We present a patient with a long history of clinical features of a syndrome which was diagnosed after...

Introduction: Interferon and Ribavarin-based Hepatitis C therapy can induce or exacerbate autoimmune thyroid dysfunction with variable clinical presentation. Being female, having prior thyroid dysfunction and raised anti-thyroid peroxidase (anti-TPO) antibodies are risk factors. We have a protocol for managing thyroid dysfunction that occurs during hepatitis C antiviral therapy. We present four cases.Case 1: A 48 year old man diagnosed with hepatitis C i...

Background: Pituitary apoplexy is a relatively rare but important clinical syndrome which may be associated with acute headache, visual compromise and hypopituitarism. It can be the initial presentation of a previously unsuspected pituitary macroadenoma. Recognised risk factors include hypertension and the use of antiplatelet agents and/or anticoagulant therapy. It may be life-threatening, requiring emergency endocrine (e.g hydrocortisone) replacement therapy[1] and...