Endocrine Abstracts

Objective: The diagnosis of subclinical Cushing’s syndrome in patients with incidentalomas is not always straight forward and a number of different criteria have been used. The 1 mg overnight dexamethasone suppression test has been recommended as a screening test, followed up by other tests of the hypothalomo–pituitary–adrenal axis to confirm the diagnosis. In this study we investigate whether the low-dose dexamethasone suppression test offers additional informa...

History: A 27-year-old woman with a background of HIV presented to the GUM department with sudden onset of weight gain (approximately five stones over 3 months). She had been started on kaletra (Lopinavir with Ritonavir) for her HIV, about 11 months previously, while she was on fluticasone (seretide) for her asthma. Clinically, she had a cushingoid appearance with extensive purplish striae marks over her abdomen and arms. Her Seretide was stopped and changed to ventolin- due t...

Background: Prolactinomas are usually highly sensitive to dopamine agonists. We report the use of temozolomide in a 47-year-old gentleman with MEN 1 and a highly dopamine agonist-resistant, and aggressive prolactinoma.Case summary: He presented in 2001 with a 3rd nerve palsy and recurrent headaches. MRI revealed a pituitary tumour extending into the left cavernous sinus. Prolactin levels were 29 000 mU/l. (NR<360). Primary hyperparathyroidism, a lesi...

Introduction: POMC is activated in ACTH-dependent Cushing’s Syndrome. We have previously shown that RNA interference (RNAi) targeting POMC coding and promoter sequences induces silencing of POMC and a reduction in ACTH. We have modified our most potent exonic sequence with locked nucleic acid (LNA) chemistry. This is purported to increase serum stability. Here we test whether the LNA confers stability without compromising siRNA silencing potency.<...

Endocrine diagnostic tests have long taken place in centres both with and without dedicated endocrine units. Problems with reliability have however been encountered, including difficulty in interpretation, the need for repeat tests with an inevitable delay of diagnosis, poor cost effectiveness and added stress to the patient. With the advent of the Endocrine Nurse post at the Royal Berkshire Hospital, the endocrine diagnostic tests were reviewed. To optimise the quality of the...

Introduction: Pro-opiomelanocortin (POMC) is a precursor polypeptide which is cleaved to make adrenocorticotrophic hormone (ACTH) in the anterior pituitary. It is activated in Cushing’s disease. Current therapies for Cushing’s disease are inadequate. RNA interference (RNAi) allows highly specific and effective suppression of gene expression by use of short interfering RNAs (siRNAs).Method: In the current study we employed custom designed siRNAs...

BackgroundPPAR-gamma agonists have been proposed as therapy to lower plasma ACTH in Cushing's disease. However, cyclical secretion may explain some of the 'responses' seen. In contrast, patients with Nelson's syndrome have continual high ACTH levels, and can present with pituitary mass effects and pigmentation. Since no established medical therapy exists, we assessed whether prolonged high-dose rosiglitazone therapy reduces circulating ACTH levels in Nel...

BackgroundPPAR-gamma agonists have been proposed as therapy to lower plasma ACTH in Cushing's disease. However, cyclical secretion may explain some of the 'responses' seen. In contrast, patients with Nelson's syndrome have continual high ACTH levels, and can present with pituitary mass effects and pigmentation. Since no established medical therapy exists, we assessed whether prolonged high-dose rosiglitazone therapy reduces circulating ACTH levels in Nel...

Background: The introduction of somatostatin analogues for the treatment of acromegaly has relegated dopamine agonists, once a mainstay of treatment, down the therapeutic ladder. Dopamine agonists are, however, added to somatostatin analogues to control active disease in some patients, in an attempt to achieve biochemical control. There are no reports, however, assessing this practise.Aim: To assess the effectiveness of adding dopamine agonist therapy to...

A 44 year old woman presented in November 2000 with a two week history of headaches, vomiting and blurred vision. Past history consisted of type 2 diabetes and migraine. Initial investigation revealed hyponatraemia (sodium 114 mmol/l) and deranged liver biochemistry. ANA, anti dsDNA, cANCA, pANCA, anti Ro, La, RNP, Scl-70, Jo-1, smooth muscle and mitochondrial antibodies were negative. MRI revealed a 13x18x15mm pituitary mass elevating the optic chaism, without evidence of rec...