Endocrine Abstracts

Background: A cardinal feature of acromegaly is insulin resistance. Patients with acromegaly are therefore predisposed to developing impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). It is therefore imperative to develop better biomarkers predicting the onset of IGT and T2DM in treated acromegalic patients. There is controversy whether GH or insulin-like growth factor 1 (IGF1) better predict the onset of IGT or T2DM in treated acromegalic patients. However ...

A 30-year-old lady was transferred to our hospital at 37 weeks of pregnancy. Hypertension was noted at 24 weeks of gestation and managed with methyldopa and labetalol. Despite treatment, BP was labile with a systolic of 90–220 and diastolic of 50–129 mmHg. She reported occasional palpitations but not chest pain or shortness of breath. The patient had a history of migrainous headaches but not hypertension prior to pregnancy. Her brother had previously had an operation...

Primary hyperparathyroidism (HPT) in pregnancy is an uncommon phenomenon, mostly occurring in the 2nd or 3rd trimester. HPT in pregnancy may cause complications affecting both the mother (renal stones, pancreatitis) and fetus (neonatal tetany, seizures, intra-uterine growth retardation and preterm labour). We report two recent cases that highlight the potential risks.Results: The patients, 37 and 35 years old at presentation respectively, both presented ...

Hypophysitis describes inflammatory pituitary lesions which can be classified into lymphocytic (autoimmune), granulomatous or xanthomatous. Rathke’s cleft cysts (RCC) are usually assymptomatic, benign tumours derived from remnants of Rathke’s pouch. We present a case of lymphocytic hypophysitis secondary to a ruptured RCC and the first reported case of post-surgical recurrence.A 34-year-old female presented with secondary amenorrhoea and fatigu...

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...

A 36-year-old man was referred to the neurologists for leg weakness and pain, fatigue and lethargy for 2 years. Sarcoidosis was diagnosed 6 years previously, on the basis of uveitis, lower motor neurone facial palsy, hilar lymphadenopathy and transbronchial biopsy. Prednisolone had been discontinued 3 years prior to his current presentation.His blood pressure was 99/71. Examination was otherwise unremarkable. His ACE was 109 U/l (10–70). His TSH was...

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...

Background: Patients with adrenal insufficiency (AI) require glucocorticoid replacement therapy. Current Endocrine Society guidelines recommend thrice-daily hydrocortisone (15-25mg) or once-daily prednisolone (3-5mg). Concerns around prednisolone use have been based on evidence using higher doses. We have been using low-dose (2-4mg) once-daily prednisolone since 2014 for glucocorticoid replacement in adult patients with AI. This study aimed to compare the effe...

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...

Introduction: Adrenal Venous Sampling (AVS) is considered the gold standard to identify surgically treatable primary aldosteronism (PA) subtypes. Current guidelines suggest using plasma cortisol concentrations to confirm successful adrenal vein (AV) cannulation and lateralisation, but cortisol co-secretion by adrenal adenomas can lead to diagnostic misinterpretation. Plasma metanephrines (MN) have a half-life of 3 to 6 min and are not affected by cortisol co-secretion, and the...