Endocrine Abstracts

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...

Introduction: Pituitary apoplexy (PA) remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of evidence in the management of this condition. We present our experience of 23 current cases.In classical acute PA, headache is the commonest presenting symptom. We found that a significant proportion (36%) of patients presented with subacute pituitary tumour apoplexy (SPA) – a term used to describe intra-adenomatous pituitary ha...

Pituitary apoplexy whether due to haemorrhage or infarction remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of published evidence in the management of this condition. We present our experience of 12 current cases (nine males, three females).Eleven cases were managed conservatively (91.6%), one patient required urgent pituitary surgery. None of the above cases required pituitary radiotherapy.Present...

A 73-year-old man was referred to the general medical clinic with a 3-year history of shortness of breath and wheeze. During assessment he commented that over the same period he had also had intermittent sweats, flushing and redness of the face especially after eating and taking red wine. Echocardiogram and urinary 24-h 5-hydroxyindoleacetic acid (5-HIAA) were arranged. Surprisingly two of three urinary 24-h urinary 5-HIAA were positive (43 and 47.5 μmol/24 h and 30 &#956...

The short synacthen test (SST) is the first-line test of adrenal insufficiency. Different centres have varying protocols for cortisol response. At Derriford Hospital cortisol is measured at 0, 30 and 60 min post-synacthen 250 μg (i.m./i.v.). A normal response is judged with a measured cortisol >550 nmol/l.A recent national audit questioned the bias created by the discrepancy between true cortisol (measured by mass spectrometry) and many laborato...

Introduction: Meningitis is a recognized complication of the treatment of pituitary adenoma. It is usually considered as a peri-operative problem but does need to be considered as a potential complication at other points in the treatment pathway. We present two patients with meningitis where the link to pituitary pathology was originally unrecognized.Case report:Patient 2: 41 years old lady, presented with a history of nasal drip u...

Background: A 52-y-old lady (Mrs M) presented with a 10-day history of progressive generalised weakness, dysarthria and un-coordination. 26 y ago, she had cervical carcinoma, requiring a hysterectomy, oophorectomy and radiotherapy. This led to a vesicovaginal fistula, requiring a cystectomy and ureterosigmoidostomy. She is known to have osteoporosis. Medications: calfovit D3 one/d (started 5 days prior to admission), risedronate, lansoprazole. She had HRT until 50 y. Examinati...

Hydrocortisone day curves, Salivary cortisols, timed urinary free cortisols and 24 hour urine cortisols have been used to estimate hydrocortisone replacement in hypoadrenal patients.We looked at 39 patients who had hydrocortisone day curve estimations in our hospital. 35 of those patients had simultaneous 24 hour urine free cortisol estimation. All hypothyroid patients were on adequate replacement dose of thyroxine.The commonest cl...

Section 1: Case history: A 62 year old man presented with a three month history of abdominal bloating and discomfort, loose stools and weight loss. This progressed to hypoglycaemic symptoms that occurred initially after exercise. Symptoms included confusion and light-headedness, fatigue, cold sweats and shakiness. The patient had to eat regularly to prevent hypoglycaemia which resulted in weight gain. Hypoglycaemic episodes increased in frequency to the point where the patient...

Empty sella is an incidental finding characterised by the herniation of subarachnoid space into the sella turcica with resultant flattening of pituitary gland to varying extent. It was considered benign. But recent reviews have shown its association with some neuroendocrinopathies.Aims and Objectives: To determine if patients with radiological diagnosis of PESS were;1. Referred to Endocrinology team?2. What p...