Searchable abstracts of presentations at key conferences in endocrinology
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24th Joint Meeting of the British Endocrine Societies

ea0009p180 | Clinical | BES2005

Pituitary Apoplexy. Retrospective review of 28 patients: is surgical intervention always necessary?

Gruber A , Kumar S , Robertson I , Howlett T , Mansell P

We report 28 patients (21M 7F; 17-86y) with pituitary apoplexy presenting between 1988 and 2004. Presenting features included: headache in 25 patients, 'collapse' in 3, vomiting in 13, complete blindness in 4, decreased visual acuity in 13, visual field loss in 12 and ophthalmoplegia in 16. Only 4 had no initial visual deficit. Predisposing factors included a known pituitary tumour in 4 patients, anticoagulant therapy in 3 patients and ITP in 1 patient. CT was initial imaging ...

ea0009p181 | Clinical | BES2005

Pituitary macroadenoma: is IGF-I measurement enough to exclude growth hormone excess? 3 case reports

Basu A , Heald A , Kane J , Reid H , Buckler H

IntroductionPituitary macroadenoma requires extensive endocrine investigations to diagnose any evidence of hormone excess or deficiency. As a part of routine investigation, IGF-1 is frequently used to exclude growth hormone excess. Here we report 3 cases of pituitary macroadenoma, who had a normal pre-operative IGF-1 but post-operatively developed biochemical evidence of growth hormone excess.CasesWe report 3...

ea0009p182 | Clinical | BES2005

Familial expansile osteolysis (FEO): a rare cause of tooth loss

Thomas R , Welbury R , Wallace R , Parr J , Hughes A , Pearce S , Cheetham T

Familial expansile osteolysis is a rare autosomal dominant disorder of bone, first described in a kindred from Northern Ireland in 1988. There are histological similarities to Paget's disease but the disorder typically presents in the young.Case report: Our patient presented at 15 years of age with sensorineural hearing loss, skeletal pain, gingival hypertrophy and mobile teeth. Neither parent was similarly affected. Radiographs demonstrated tooth root r...

ea0009p183 | Clinical | BES2005

A novel calcium-sensing receptor gene mutation in a family with an extensive history of familial hypocalciuric hypercalcaemia

Ryan J , Thorne J , Hoashi S , Green A , Powell D

Familial Hypocalciuric Hypercalcaemia (FHH), originally described in 1966, was first linked to mutations in the Calcium-Sensing Receptor (CaSR) gene in 1993. FHH results from inactivating mutations affecting a single allele inherited in an autosomal dominant pattern. The calcium-sensing receptor is a cell surface-expressed G protein-coupled receptor with 1078 amino acids. Gene mutations are usually single-point in nature and result in an elevated set point for calcium sensing ...

ea0009p184 | Clinical | BES2005

Refeeding Blaine: studies following a 44 day fast

Korbonits M , Blaine D , Elia M , Powell-Tuck J

The opportunity to study the effects of prolonged fasting is rare. In this study we recorded anthropometric, biochemical and endocrine changes during the refeeding period following a 44 day fast, and compared them with results from 16 age-, sex- and body mass index (BMI)-matched controls.The index subject took only water to drink during the fast. He lost 24.5kg changing his BMI from 29 to 21.6. He underwent careful slow refeeding for the first 4 days usi...

ea0009p185 | Clinical | BES2005

Appropriate management of CAH requires detailed mutational analysis to be interpreted within the context of family history and biochemistry

Davis N , Robertson S , Burren C , Crowne E

We present two families illustrating complex management issues introduced by mutational analysis in CAH.Family 1. A female index case presented at birth with ambiguous genitalia and was diagnosed with severe salt losing CAH. She is a compound heterozygote with two severe mutations: 659G (intron 2 splice site mutation) from her mother and CYP21 deletion from her father. Mother and mother's identical twin sister have compound heterozygosity for the mild mu...

ea0009p186 | Clinical | BES2005

Isolated thyroid stimulating hormone (TSH) deficiency: A rare condition? Three case reports

Basu A , Heald A , Kane J , Rudenski A , Buckler H

IntroductionIsolated TSH (thyroid stimulating hormone) deficiency has been reported in the literature as a rare condition. Only 60 cases have been reported so far since 1960. It has been defined as central hypothyroidism without evidence of any other pituitary hormonal deficiencies or evidence of any structural pituitary abnormality. We report 3 cases of suspected isolated TSH deficiency, 2 of which presented in a year to one endocrine centre.<p clas...

ea0009p187 | Clinical | BES2005

Pituitary mass due to lymphocytic hypophysitis presenting in late pregnancy with spontaneous post-partum resolution

Watt A , Bidgood K , Watson J

Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland. The aetiology is unknown though probably of autoimmune origin.We report the case of a 40 year-old woman who presented 39/40 weeks pregnant with an inferior bitemporal homonymous quadrantinopia. She had primary hypothyroidsim and had had previous unsuccessful in-vitro fertilisation, though this conception was spontaneous. Magnetic resonance imaging (MRI) demonstrated a large p...

ea0009p188 | Clinical | BES2005

Graves' disease and Struma Ovarii

Moisey R , Nagi D , Andrew J , Anathhanam A , Raja U , Ali D , Burr W , Jenkins R

A 34-year-old woman was referred by her GP in 2000 with thyrotoxicosis (TSH undetectable, free T4 36.4 pica moles per litre, reference range 10-25). She had no ophthalmic symptoms or signs and no goitre. There was no family history of thyroid disease. Her thyroid peroxidase antibodies were undetectable but thyrotropin-binding inhibitory immunoglobulin was 30 (Reference range 0-15) confirming Graves' disease. Carbimazole was initiated but changed to propylthiouracil after a pre...

ea0009p189 | Clinical | BES2005

Myelinolysis following the treatment of Addisonian crisis

Lockett H , Smith J , Dyer R , Crook N

Myelinolysis is a recognised complication following over-rapid correction of hyponatraemia. However, the risk of myelinolysis following the treatment of Addisonian crisis is rarely reported. We report 2 cases of primary adrenal insufficiency (PAI) both associated with severe hyponatraemia. In the first case, myelinolysis developed following treatment with corticosteroids and isotonic saline in line with current recommendations. In the second case, deliberately cautious correct...

ea0009p190 | Clinical | BES2005

A case of insulin sensitivity

Tahrani A , Macleod A , West T

A 32-year-old woman was referred, at 12 weeks in her second pregnancy, to the antenatal diabetic clinic for control of Type 1 diabetes. HbA1c was 6.5% (4.5-6.2%DCCT).At 32 weeks gestation she was admitted with premature labour. Treatment with betamethasone resulted in hyperglycaemia. Four days later she was admitted with a suspected subarachnoid haemorrhage. Brain CT was normal. She declined lumbar puncture. Over the next 2 days she developed recurrent h...

ea0009p191 | Clinical | BES2005

Ulcerative colitis presenting after bilateral adrenalectomy

Zachariah S , Wright J , Russell-Jones D

Patients with Cushing's disease have high levels of circulating corticosteroids. Treatment may result in unmasking of steroid dependant conditions. We report a case of ulcerative colitis presenting after bilateral adrenalectomy.Case reportA 19 year old girl underwent bilateral adrenalectomy in November 1998 for pituitary dependant Cushing's disease. She was discharged on hydrocortisone and fludrocortisone and post operatively her c...

ea0009p192 | Clinical | BES2005

Antibodyless, painless, steroid responsive thyrotoxicosis

Arosi A , Ruge P , Ratcliffe L , Rajbhandari S

An eighty four year old lady was admitted to medical ward with an acute on chronic confusion. She was diagnosed to have thyrotoxicosis 5 weeks prior to this [TSH less than 0.02 (ref range 0.35 -5.00 miu per litre) & fT4 of 41.7 (ref range 11.0 - 23.0 pmol per litre)] and was treated by her general practitioner with carbimazole 30 mg daily. Despite this her thyroid function did not improve. The dose of carbimazole was further increased to 60mg daily with minimal response. T...

ea0009p193 | Clinical | BES2005

Coexistent acromegaly and thyroid-associated ophthalmopathy: chance or association?

Arutchelvam V , Dickinson A , Neoh C , Perros P

Acromegaly and thyroid-associated ophthalmopathy(TAO) are uncommon diseases with different pathogenetic mechanisms.We report two patients with acromegaly and TAO and speculate on a possible association.A 54 year old man with subclinical hypothyroidism and strongly positive thyroid microsomal antibodies presented with features of TAO.MRI of his orbits confirmed the diagnosis.Clinical examination also revealed features suggestive of acromegaly,which was co...

ea0009p194 | Clinical | BES2005

Challenges of treating hyperthyroidism

Roy|#Chowdhury S , Varughese G , Redford D , West T , Barton D

We report the case of a 34 year old woman with recurrent hyperthyroid Grave's disease. She was initially found to be thyrotoxic in July 1996. Treatment was commenced with carbimazole, of which she received 12 months in a titration regimen. She relapsed in October 1999, six months following the delivery of her first child, and was restarted on carbimazole, remaining euthyroid on a dose of 10mg. She conceived again in May 2002 (whilst on carbimazole) and treatment was continued ...

ea0009p195 | Clinical | BES2005

Phaeochromocytoma in pregnancy: medical or surgical management?

Rees D , Agarwal N , Gibby O , Scott-Coombes D , Davies J , Scanlon M

A 22 year old lady, in her third pregnancy, presented at 35 weeks gestation with modest hypertension (BP 130/90). She was known to carry a high risk mutation for Von Hippel Lindau syndrome with no prior disease manifestations. Urinary catecholamine levels were normal at 18 weeks gestation and she remained asymptomatic throughout her pregnancy. Repeat measurement at 35 weeks demonstrated elevated noradrenaline and normetadrenaline values (1761 nmol/24h and 9.69 micromol/24h res...

ea0009p196 | Clinical | BES2005

A case of an angry old man

Grainge C , English P

A 92-year-old man presented with a one-month history of episodic aggression, confusion, urinary incontinence and auditory hallucinations. Episodes lasted 30 - 150 minutes, occurred daily and were abruptly self-terminating. Between episodes he was cognitively intact and lived independently. Initial investigations revealed a plasma glucose of 11.0 millimoles per litre, other biochemical tests were normal.He was known to have a pleural mass at the left lung...

ea0009p197 | Clinical | BES2005

Cushing's syndrome in pregnancy: a case report

Rice S , Lane H , Chudleigh R , Gibby O , Scott-Coombes D , Davies J , Scanlon M , Rees D

The association between Cushing's syndrome and pregnancy is uncommon due to associated sub-fertility. Recognising this is important, as there implications for both mother and foetus.A twenty year old presented at twenty three weeks gestation. Insulin requiring diabetes had developed as had oedema. Pigmented abdominal striae were prominent. Her serum sodium concentration was noted to be low (3 mmol/l). 24 hour urinary free cortisol was elevated (>1380 ...

ea0009p198 | Clinical | BES2005

Bromocriptine-sensitive acidophil-stem-cell adenoma co-secreting growth hormone and prolactin - A case report

D'Costa R , Kalk W

Case HistoryWe report a 28-year-old man who presented initially to our ENT department with 3-year history of intermittent epistaxis subsequently found to have an extensive acidophil-stem-cell adenoma, rare pituitary tumours usually unresponsive to dopamine agonists requiring radiotherapy and somatostatin analogues in resistant cases.He was clinically acromegalic, demonstrating an elevated Growth Hormone (GH) 17.9 milliunits per lit...

ea0009p199 | Clinical | BES2005

Pituitary failure as a presentation of previously undiagnosed metastatic lung cancer

Galliford T , Winocour P

The causes of panhypopituitarism are well known and pituitary metastases is a recognised but rare cause. It can often be difficult to diagnose because the non-specific features of malignancy mask those of pituitary involvement.We present the case of a 73 year old gentleman who complained of fatigue and weight loss. He had recently been treated for a radiographically proven bronchopneumonia. Endocrine checks suggested secondary hypothyroidism however (TSH...

ea0009p200 | Clinical | BES2005

Hyperthyroidism as the cause for ‘brittle' Addison's disease

Evans K , Flanagan D

A 40-year-old woman was admitted for investigation of severe fatigue, abdominal pain, anorexia and myalgia over the preceding year. Past medical history included vitiligo, coeliac disease and depression. Initial investigations revealed hyperkalaemia, normocytic anaemia and hypercalcaemia with an inappropriately normal parathyroid hormone level. Low TSH with normal free T4 and T3 (0.02 milliunits per litre, 17.1 picomoles per litre and 6.3 picomoles per litre respectively) were...

ea0009p201 | Clinical | BES2005

Controversial issues in the management of hypercalcaemia in a young patient

Varughese G , Roy|#Chowdhury S , Barton D

We report the case of a 41-year-old woman who was under investigation for deranged liver function tests following an insurance medical when she also serendipitously was found to have hypercalcaemia - 2.70 millimols per litre (Reference range 2.45-2.65 millimols per litre). She was completely asymptomatic and on no medication. She had an elevated Parathyroid hormone level of 11.6 picomols per litre (Reference range 0.9-8.0 picomols per litre), consistent with primary hyperparat...

ea0009p202 | Clinical | BES2005

Interpretation of the short synacthen test in the presence of low cortisol binding globulin

Moisey R , Wright D , Aye M , Murphy E , Peacey S

We present two cases where, without measurement of cortisol binding globulin (CBG), interpretation of their 250mcg short synacthen test (SST) would have falsely suggested inadequate pituitary-adrenal reserve.A 62yr old woman was referred with an incidental finding of a pituitary adenoma. Pituitary function tests confirmed gonadotrophin and growth hormone deficiency. Initial and subsequent SSTs were normal (30min cortisol reater than 600nmol/L). Follow up...

ea0009p203 | Clinical | BES2005

An incidental phaeochromocytoma

Tahrani A , Macleod A

48 year-old woman was referred to the endocrine clinic by the respiratory team for management of an incidental 2cm right adrenal mass found on chest/upper abdomen computed tomography (CT) as part of investigations for recurrent chest infections. On review, she described attacks of ' doom and gloom', flushing and palpitations with a rate of 140 beats per minute. The attacks were sporadic and occurred for some years. Blood pressure in the endocrine clinic was 210/110. Urea and e...

ea0009p204 | Clinical | BES2005

Langerhans cell histiocytosis and auto-immune thyroiditis presenting as a thyroid mass with progressive hypothalamic-pituitary dysfunction

Deepak D , Woodcock B , MacFarlane I

A 53 year old woman developed a firm thyroid mass which was removed. The histology of the thyroid mass showed auto-immune thyroiditis and Langerhans cell Histiocytosis ( LCH). She also complained of thirst and polyuria. A water deprivation test confirmed cranial diabetes inspidus (CDI) ,the symptoms of which resolved on DDAVP . A glucagon stimulation test showed a blunted growth hormone (GH) response of 13.3 milliU per litre with an IGF-1 level of 16 nanomol per litre. The cor...

ea0009p205 | Clinical | BES2005

Antineutrophil cytoplasmic antibody positive inflammatory athropathy during long term propylthiouracil treatment in a patient with Graves hyperthyroidism

Gruber A , Thomson G , Fernando D , Idris I

Objective: Propylthioracil (PTU) when given long term has recently been implicated in the development of antineutrophil cytoplasmic antibody (ANCA) related systemic vasculitis. We describe a case of ANCA positive athropathy induced by long term PTU therapy. Methods: Assessment was based on patient's symptoms, signs, serum markers and treatment outcome as revealed by case notes and patient review. A Medline search for PTU related vasculitis was also performed. Results: A 27-yea...

ea0009p206 | Clinical | BES2005

Thionamide resistant thyrotoxicosis - three illustrative cases

Lee S , Kapoor D , Thomas W , Jones T

Antithyroid drug (ATD) resistant thyrotoxicosis raises difficult management issues. We describe three recent cases of apparent refractory thyrotoxicosis.Case 1: A 31 year old woman presented in July 2003 with thyrotoxicosis. Despite treatment with carbimazole (CBZ) 20 milligrams tds, serum free thyroxine (FT4) concentrations remained around 60 picomoles per litre (11-20). In October, CBZ dose was increased to 40 milligrams bd and dexamethasone 2 milligra...

ea0009p207 | Clinical | BES2005

Autoimmune thyroid disease following treatment of multiple sclerosis with Campath-1H

Wotherspoon F , Kajicek J , Flanagan D

Graves' disease appears to be the clinical result of an autoimmune attack on thyroid tissue however the immune defect and triggering events remain unclear. The inflammatory process in multiple sclerosis (MS) is mediated by CD4 T lymphocytes. Campath-1H, a monoclonal antibody against the CD52 antigen of CD4 T cells, improves disease activity in MS and is associated with development of Graves' disease in one-third of patients. Thus Campath-1H provides an interesting insight into...

ea0009p208 | Clinical | BES2005

A somatostatin responsive, ACTH-secreting bronchial carcinoid- a diagnostic and therapeutic challenge

McDermott J , Sreenan S

A 32 year-old man was referred with complaints of weight gain, sweating and a rash. Examination revealed a moon face, hypertension, centripetal obesity, a dorsal fat pad, and violaceous abdominal striae. A diagnosis of Cushing's syndrome was suspected.Urine free cortisol was elevated (3674 nmol/24hrs) with an unsuppressed ACTH level (39ng/l). Serum and urine cortisol failed to suppress with low and high dose dexamethasone. Corticotrophin Releasing Factor...

ea0009p209 | Clinical | BES2005

Late change in immunohistochemical staining in a non-functioning pituitary adenoma following treatment with GnRH analogue

Gannon D , Nelson R , Moss T , Ulahannan T

A 64 year old man presented in 1992 with a dense bitemporal hemianopia and no endocrine symptoms. CT showed a large pituitary adenoma with suprasellar extension. He underwent transphenoidal resection of the tumour. Histology showed a typical chromophobe adenoma with no immunohistochemical staining. His vision recovered.He was followed regularly with serial MRI scan. No change was seen in the size of the residual intrasellar tumour. Pituitary testing show...

ea0009p210 | Clinical | BES2005

Young woman with alopecia, short stature and recurrent fractures

Kashyap A , Anand K , Kashyap S , Anand A

A 21-year old woman was referred to endocrinology outpatient with sparse hair on scalp, eyebrows, eyelids, and body since birth, short stature, bone pains, proximal muscle weakness, and recurrent fractures of long bones. She was a product of second-degree consanguineous marriage and was eldest of two siblings. Her younger brother aged 16-years had similar complaints.Clinically she had alopecia universalis, short stature, hypotonia, proximal muscle weakne...

ea0009p211 | Clinical | BES2005

Evolving tumour behaviour in a patient with combined Conn's and Cushing's syndrome

Forbes M , Daly M

In 1993 a 33-year old female was diagnosed biochemically with both Conn's and Cushing's syndrome. A large right-sided adrenal mass was found on CT scan of the abdomen and a right-sided adrenalectomy was performed. Histology reported a benign, 7 centimetre adrenocortical tumour, secreting both cortisol and aldosterone. Annual assessments of urinary cortisol and plasma aldosterone/renin ratios remained normal until September 2002, when she noticed a weight gain of 6 kilograms an...

ea0009p212 | Clinical | BES2005

Management of a macroadenoma in pregnancy

Hatfield E , Meeran K

A 25 year old female presented with a two year history of secondary amenorrhoea and expressible galactorrhoea. There was no history of headache or visual disturbance, and the patient took no regular medication. Examination, including formal perimetry, was normal. Investigations revealed a moderately elevated prolactin 1,029 (NR 59-619 mU/ml), 9am cortisol 366 nmol/L, remainder of pituitary profile normal. An MRI pituitary revealed a macroadenoma with stalk deviation and bowing...

ea0009p213 | Clinical | BES2005

A case of transient hypopituitarism and hyponatraemia

Raste Y , Smeeton F , Russell-Jones D

We present the case of a 34 year old man, previously well, who presented with a 4 week history of worsening headaches and confusion.He was disorientated and confused, but the rest of the examination was largely unremarkable. Admission blood tests revealed him to be profoundly hyponatraemic (serum sodium 100 millimoles per litre, urine sodium 72 millimoles per litre, serum osmolality 202 milliosmoles per kilogram, urinary osmolality 851 millimoles per kil...

ea0009p214 | Clinical | BES2005

Use of etomidate for control of severe hypercortisolism

Moyes V , Wat W , Akker S , Drake W , Monson J

Etomidate, an imidazole derived anaesthetic agent, potently inhibits adrenocortical 11-beta-hydroxylase at non-hypnotic doses in Cushing's syndrome. We report its use in controlling hypercortisolism in a patient with aggressive Cushing's disease requiring pelvic surgery for endometrial carcinoma.IJ, a 42-year old female was diagnosed with Cushing's disease in 1998 in Malaysia. 8am cortisol was 800nmol/l, midnight cortisol 659nmol/l and ACTH 103ng/l. MRI ...

ea0009p215 | Clinical | BES2005

Pituitary tumours coexisting with meningioma and astrocytoma - description of 4 cases in unirradiated patients

Palin S , Gittoes N

Pituitary radiotherapy (RT) causes hypopituitarism that is associated with a doubling in standardised mortality ratio. Other potential complications of pituitary RT are less clearly defined. Retrospective observational studies have estimated the risks of secondary intracranial tumour formation to be as high as 1-2% following conventional pituitary RT but these figures have been calculated against background normal population data. The majority of cases of intracranial tumors f...

ea0009p216 | Clinical | BES2005

Genuine carcinoid syndrome but spurious adrenal carcinoma - deception by heterophile antibodies

Nag S , Webb B , Kelly W

Case History: A 60 year old female presented with anxiety and weight loss. Serum free T4 was 50 pmol/l (normal 12-23). Despite restoring T4 to normal, symptoms persisted and included flushing attacks. Urine 5-HIAA was elevated (182 micro moles/24 hrs; normal 0-40).Tests were done to locate the primary and secondary carcinoid tumour.Investigations: CT of thorax and abdomen, and ultrasound of abdomen were negative. Routine biochemistry and haematology were...

ea0009p217 | Clinical | BES2005

The association of thyroid cancer with Graves' disease: potential cost implications

Brain H , Bano G , Nussey S

A 32 year old women presented to her G.P.with a four month history of a lump in her neck, weight loss and anxiety. She had hyperthyroidism (TSH <0.1 mU/l, fT4 >100 pmol/l, TPO antibodies 318IU/ml). Thyroid U/S showed a 2x3cm nodule in the right lower pole. A thyroid isotope scan was reported as showing increased uptake throughout the gland with an area of decreased uptake in the right lower pole. She was started on carbimazole 30mg o.d. and she was referred to a head and ne...

ea0009p218 | Clinical | BES2005

Cushing's syndrome in evolution

Biswas M , Rees D , Davies J

Introduction-Cushing's syndrome is characterised by hypercortisolaemia, loss of the diurnal rhythm of cortisol secretion and loss of negative hypothalamic-pituitary-adrenal (HPA) feedback. Patients with adrenal incidentalomas may manifest some signs of cortisol excess before developing overt Cushing's syndrome. This can be considered as 'Cushing's syndrome in evolution'.Case History-A 47 year old lady with ty...

ea0009p219 | Clinical | BES2005

Pitfalls in the biochemical assessment of acromegaly

Mukherjee S , Rees D , Page M , Scanlon M , Davies J

Introduction: The biochemical diagnosis of acromegaly is based on elevated plasma growth hormone (GH) that fail to suppress after an oral glucose load. Elevated insulin like growth factor 1 (IGF1) supports the diagnosis. Traditionally GH level of less than 2 miliunits per litre rules out acromegaly. With advent of recent sensitive GH assays, lower levels of GH are increasingly being recognized. We describe a case of acromegaly which differed from the traditional presentation.<...

ea0009p220 | Clinical | BES2005

Unusual presentation of multiple endocrine neoplasia 2A

Saravanan P , Goss L , Dunn J , Paisey R , Rankin J , MacLeod K

Multiple Endocrine Neoplasia 2 (MEN2) is a rare, autosomal dominant neuroendocrine tumour. MEN2A is a syndrome of medullary thyroid carcinoma (MTC), pheochromocytoma and parathyroid tumours. MEN2B is characterised by MTC, pheochromocytoma, marfanoid habitus and intestinal & mucosal ganglioneuromas. MEN2 syndromes are due to mutations in the RET proto-oncogene, located near the centromere of the chromosome 10. While the commonest mutations described in MEN2A is in exon 11 (...

ea0009p221 | Clinical | BES2005

Adrenal crisis in an individual with panhypopituitarism and new-onset Graves' disease

Lewandowski K , Marcinkowska M , Makarewicz J , Lewinski A

Acute presentation: 46 year old patient was admitted as an emergency with vomiting, hypotension and serum cortisol of 26 nmol/L indicative of adrenal failure. Despite previous history of panhypopituitarism he was found to be hyperthyroid (free T4 6.32 ng/dL (0.93-1.7), free T3 22.21 pg/mL (1.8-4.6)).Past Medical History: He was fit & well till the age of 45. Eight months prior to this hospitalisation he presented with diabetes insipidus and was found...

ea0009p222 | Clinical | BES2005

Hypothalamo-pituitary axis in chronic fatigue syndrome & incidentaloma

Thomas C , Renner C , Lloyd J

Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. However, there is...

ea0009p223 | Clinical | BES2005

Effect of timing of prolactin sampling on the incidence of spurious hyperprolactinaemia

Lewandowski K , Skowronska-Jozwiak E , Szosland K , Lewinski A

It is recognized that a substantial proportion of patients found to have raised prolactin (PRL) level on a single testing is subsequently found to have normal PRL levels. Though this is often attributed to stress or medication factor, it should be noted, that PRL secretion displays diurnal variation with a nocturnal peak in the late-night/early morning hours. In our study we tested the hypothesis, that in some patients raised PRL levels in the morning may reflect individual di...

ea0009p224 | Clinical | BES2005

‘Tired all the Time' - a positive diagnosis

Evans K , Flanagan D , Wilkin T

Background: Stress-related illness is commonly referred to the endocrine clinic, and often becomes a diagnosis of exclusion after extensive investigation. We provide evidence that a positive clinical diagnosis can be made without risk of missing organic illness.Methods: 101 consecutive and unselected referrals for ‘fatigue ?endocrine’ between 1/4/95 and 30/3/99 were identified from an endocrine clinic database (81 female, 20 male; mean age 41...

ea0009p225 | Clinical | BES2005

Management of hyponatraemia, are we doing enough?

Soran H , Alio Z , Pattison T , Burrows G , Cook G , Kong N

Introduction: Hyponatraemia is a common biochemical abnormality in hospital patients, a robust management plan and correct diagnosis is important in the medical care of these patients. However these are frequently lacking.Methods: We audited the management and outcomes of hyponatraemia in a large district general hospital. In-patients for a period of 3 months starting from January 2004 with hyponatraemia (Sodium less than reference rang 132-146 mmol per ...

ea0009p226 | Clinical | BES2005

An audit on the type and amount of specialist education that newly appionted endocrine nurses receive; educational needs unmet?

Smethurst L , Roberts M

There is an increasing pressure for nurses to have a recognised qualification in their specialist area to be able to use the title 'specialist' nurse. As there is a historical lack of a recognised qualification in endocrinology for nurses, we audited exactly where nurses gained their specialist knowledge in the first year in post.There were no publications on this topic.86 questionnaires designed to allow the individual to rate the...

ea0009p227 | Clinical | BES2005

An audit of the management of primary hyperparathyroidism

McDermott J , Smith C , Sreenan S

We audited the management of primary hyperparathyroidism (PHP) at our institution between 2000 and June 2004, to determine our adherence to the Consensus Development Conference on the Management of Asymptomatic PHP (2002) guidelines.Sixteen patients were referred with PHP during the period in question, 12 female. Average age at diagnosis was 59 years (range 36-81), average PTH level 155 ng/mL, and average corrected serum calcium 2.76 mmol/L (normal 2.1-2...

ea0009p228 | Clinical | BES2005

An audit of insulin stress tests performed by an individual endocrine specialist nurse - a safe and reliable procedure

Wright D , Shah M , Peacey S

The insulin stress test (IST) continues to be considered a potent test for assessing ACTH and GH reserve. The test has been shown to be safe when performed in an experienced unit. Many endocrine nurse specialists independently perform IST's using appropriate protocols. We audited all consecutive IST's performed by an individual endocrine specialist nurse in our unit. IST was not performed if patients had a history of seizure, ischaemic heart disease or were > 60 yrs. All pa...

ea0009p229 | Clinical | BES2005

The TRH test at South Tyneside, ‘should it be confined to the dustbin?’

Jordan A , Basu A , Parr J , Wahid S

Aims.To quantify the reasons for undertaking TRH testing and whether it changed management.Methods.A standard protocol was utilised-normal TSH response is peak 5-20 mUper litre at 20 mins with 60-minute level falling by third off peak. Hospital notes of 53-pts undergoing their first TRH test between October 2000 and May 2004 were reviewed.Results.44 (83%) pts had ...

ea0009p230 | Clinical | BES2005

Differential regulation of Urocortin 3 mRNA expression in the central nervous system by stress and glucocorticoids

Jamieson P , Li C , Vaughan J , Vale W

The CRF-related ligand Urocortin 3 (Ucn 3) is expressed in discrete subcortical areas with highest mRNA levels in the medial amgydala (MEA), hypothalamic median preoptic nucleus (MePO) and the rostral part of the perifornical hypothalamic area (PFN). Close anatomical association between major Ucn 3 terminal fields and the type 2-CRF receptor in hypothalamus, lateral septum and medial amygdala suggest it is well placed to modulate physiological processes including behavioural, ...