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3rd Hammersmith Multidisciplinary Endocrine Symposium 2008

Poster Presentations

(1)

Table of contents

ea0018p1 | (1) | MES2008

Can random urinary 5-hydroxyindolacetic acid/creatinine results and 24 hour urinary 5-hydoxyindolacetic acid levels predict carcinoid patient survival?

May Simon , Peaston Robert , Perros Petros

The use of 24 h urinary 5-hydroxyindolacetic acid (5-HIAA) concentrations to detect carcinoid patients is a well established procedure while random urinary 5-hydroxyindolacetic acid/creatinine ratio (5-HIAA/cr) may also offer a simpler approach in the diagnosis of carcinoid tumours. However, there is uncertainty regarding the ability of these tests to offer a prognostic indicator for patients.We retrospectively reviewed the initial paired urinary 5-HIAA/...
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ea0018p2 | (1) | MES2008

A comparsion of random urinary 5-hydroxyindolacetic acid/creatinine results with 24 hour urinary 5-hydroxyindolacetic acid values in carcinoid patients

May Simon , Peaston Robert , Perros Petros

Although 24 h urinary 5-hydroxyindolacetic acid (5-HIAA) concentration is a well established test for the detection and monitoring of carcinoid tumours, compliance, adequacy of collection and the influence of dietary sources of serotonin are problems associated with this approach. Recently, a random urinary 5-hydroxyindolacetic acid creatinine ratio (R/5-HIAA/cr) test has become available which can be used in outpatient departments, however its correlation to 24 h 5-HIAA (24/5...
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ea0018p3 | (1) | MES2008

A genetic cause for primary amenorrhoea

Martineau Marcus , Haq Masud

Primary Amenorrhoea is usually the result of a genetic or anatomical abnormality. Androgen insensitivity syndrome (AIS) is an uncommon cause in which individuals with a 46XY male karyotype are resistant to testosterone due to a defect of the androgen receptor.A 16-year-old female of non-consanguineous parents presented with primary amenorrhoea. There was no family history of delayed puberty. She was of normal female appearance (height 5′9″, B...
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ea0018p4 | (1) | MES2008

Management of a phaeochromocytoma in pregnancy

McGowan Barbara , Williamson Catherine , Meeran Karim , Banerjee Anita , Min Lee , Fleming Bill , Bassett Duncan , Tan Tricia

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...
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ea0018p5 | (1) | MES2008

Temporary extracorporeal jugulo-femoral venous bypass under local anaesthesia to relieve SVC obstruction prior to total thyroidectomy

Sligo Mary , Farquhar-Thomson Duncan , Cove David , Lagattolla Nicholas

The induction of general anaesthesia and initiation of positive pressure ventilation in cases of superior vena caval (SVC) obstruction carries an unacceptably high risk of cerebral venous congestion, and with it, the risk of cerebral oedema and death. Two similar cases have been dealt with successfully in our unit: both had thyrotoxic retrosternal multinodular goitres and SVC obstruction, and both had tracheal compression mandating surgery.Following cont...
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ea0018p6 | (1) | MES2008

This abstract appears as OC4....
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ea0018p7 | (1) | MES2008

This abstract appears as OC6....
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ea0018p8 | (1) | MES2008

Clinical diagnosis of phaeochromocytoma leads to correct perioperative management despite negative biochemical and functional investigations

Fountain Annabel , Todd Jeannie , Meeran Karim , Palazzo Fausto , Robinson Stephen

We present a 44-year-old female referred to us with a two year history of episodic palpitations, chest tightness, headaches and pallor associated with hypertension. She had previously been extensively investigated by neurologists and cardiologists including MRI of the brain, renal ultrasonography, 24 h tape and echocardiography – all normal. Given the history, a CT of the adrenals was performed in 2007 which revealed a 1.5 cm nodule in the right adrenal with abnormal enha...
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ea0018p9 | (1) | MES2008

Challenges in the management of Cushing's syndrome in the severely ill patient

Fountain A E C , McGowan B M C , Chaudhuri O , Saha S , Field B C T , Dhillo W , Todd J F , Goldstone A P , Martin N M , Meeran K , Tan T

We present a 57-year-old female with Cushing’s syndrome characterised by new type 2 diabetes, hypertension, weight gain, bruising, proximal myopathy and depression. She also had poorly-healing cellulitic ulcers on both legs. Investigations: hypokalaemia and ACTH-dependent Cushing’s syndrome. Low dose dexamethasone suppression test: T=0 ACTH 85 ng/l, cortisol 907 nmol/l, T=48 h cortisol 807. High dose dexamethasone suppression test failed to suppr...
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ea0018p10 | (1) | MES2008

Positive correlation between radioisotope and CT/MRI imaging techniques in functioning adrenal adenomas may obviate the need for invasive adrenal vein sampling

Fountain Annabel , Vaks Vladimir , Wren Alison

A 48-year-old Afro-Caribbean female was referred from Accident & Emergency in December 2007 with low serum potassium. She had been diagnosed elsewhere with hypertension due to primary aldosteronism at the age of 28 but was then lost to Endocrine follow-up. She reported intolerance to spironolactone – blood pressure was controlled with Amiloride until 1999 and then Amlodipine. Questioning in clinic, January 2008, revealed that she had had extensive investigations when ...
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ea0018p11 | (1) | MES2008

Treatment resistant acromegaly

Grant Paul

The issue of treatment-resistant pituitary tumour growth remains relatively under-explored. We describe the case of a gentleman whose diagnosis and management involved several medical disciplines and his management proved challenging over the long term.A 47-year-old gentleman who was seen by a variety of specialists before and after diagnosis for the complications of his aggressive acromegaly.Initially seen in 1997 by an Occupation...
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ea0018p12 | (1) | MES2008

Cushing's syndrome secondary to adrenocortical carcinoma without metastases at diagnosis

Miras Alexander , Palazzo Fausto , Naqvi Safdar

A 60-year-old gentleman of previously good health presented with a 6 months history of resistant hypertension, newly diagnosed Diabetes Mellitus, worsening obesity and proximal muscle weakness. Clinical examination revealed a buffalo hump, truncal obesity, paper thin skin with bruising and proximal muscle wasting. His biochemistry showed elevated midnight cortisol levels, no suppression of cortisol post high dose dexamethasone and an undetectable ACTH. Accompanying abnormaliti...
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ea0018p13 | (1) | MES2008

Unusual hypoglycaemia: real or factitious?

Sharma Sanjeev , Swords Francesca , Dozio Nicoletta

Factitious hypoglycaemia is characterised by high insulin levels but accompanied with low Proinsulin and C-peptide levels and a negative sulfonylurea screenWe present a 54-year-old woman who was initially diagnosed with type 2 diabetes in 2002 and by 2004, she was converted to insulin treatment due to poor tolerance to Metformin. She also had a previous history of Manic depressive psychosis and treated with lithium.In the months pr...
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ea0018p14 | (1) | MES2008

This abstract appears as OC7....
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ea0018p15 | (1) | MES2008

An unusual case of a gland in the neck

Siah Tee Wei , Krishnan Binu , Bingham Emma , Tringham Jennifer

A 23-year-old man initially presented to his GP with palpable ‘gland in his neck’ for 9 years. He was otherwise well with no medical problems. He has a family history of hypothyroidism. Examination revealed right submandibular gland enlargement and lymph nodes in the anterior cervical region bilaterally. His TPO antibody was negative and the only abnormal result was a raised TSH of 12.7. He was commenced on 50 μg of thyroxine daily. Ultrasound of the neck showed...
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ea0018p16 | (1) | MES2008

Primary hyperparathyroidism and pregnancy

Kirkby-Bott James , Williamson Catherine , Palazzo Fausto , Banerjee Anita , Meeran Karim , Tan Tricia

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 ...
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ea0018p17 | (1) | MES2008

A case of frontal ethmoid sinus mucocele: a late complication of pituitary surgery?

Hui Elaine , Amin Anjali , Chiti-Batelli Sandro , Patel Pooja , Linton Nick , Valabhji Jonathan

A 69-year-old Iraqi lady presented with a 4-day history of diplopia, headache and right eye swelling. She had a pituitary adenoma diagnosed in Beirut when she was 20 years old and underwent trans-frontal surgeries and radiotherapy twice and further transsphenoidal surgery in 1980. She was on prednisolone 2 mg+1 mg and thyroxine 50 mcg daily.She initially presented to the ophthalmology clinic. Examination revealed a pupil-sparing 3rd nerve palsy of the ri...
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ea0018p18 | (1) | MES2008

This abstract appears as OC1....
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ea0018p19 | (1) | MES2008

Young hyperparathyroidism: to localize or not

Skennerton Sarah , Tharakan George , Martin Niamh , Meeran Karim , Morganstein Daniel

A 37-year-old lady was referred to the endocrine clinic with a raised serum calcium of 2.73 mmol/l in the presence of an inappropriately raised parathyroid hormone of 8.7 pmol/l. Calcium:creatinine clearance ratio was elevated at 0.018, excluding familial hypercalcaemic hypocalciuria. Past medical history revealed an episode of renal stones 17 years ago but a renal ultrasound excluded nephrocalcinosis.A diagnosis of primary hyperparathyroidism was made.<...
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ea0018p20 | (1) | MES2008

Lymphocytic hypophysitis secondary to a ruptured Rathke's cleft cyst (RCC): a diagnostic and management challenge

Mehta Puja , Roncaroli Frederico , Mehta Amrish , Bhojak Maneesh , Lawrence James , Hatfield Emma , Meeran Karim , Dhillo Waljit

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...
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ea0018p21 | (1) | MES2008

This abstract appears as OC2....
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ea0018p22 | (1) | MES2008

Primary adrenocortical insufficiency despite a ‘normal’ short synacthen test

Mehta S R , Field B C T , Chaudhri O B , Shaikh H , Morganstein D L , Martin N M , Hatfield E C I , Meeran K

A 60-year-old gentleman who had previously undergone a right nephrectomy for renal cell carcinoma was admitted electively for a left adrenalectomy due to metastatic disease. Prior to this he had been treated with immunotherapy (Sunitinib) and radiotherapy for pulmonary and bony metastases respectively. He was given perioperative cover with hydrocortisone. A short synacthen test (SST) performed the morning after discontinuing hydrocortisone showed a baseline cortisol of 406 nmo...
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ea0018p23 | (1) | MES2008

The need for a coordinated multidisciplinary approach in the management of morbid obesity

Mukherjee Leena , Hussain Sufyan , Flood John , Kaushal Rashmi

We describe the case of a 22-year-old South Asian male presenting to Endocrine Services with morbid obesity (BMI>50), sexual immaturity and agoraphobia. Born at full term following an uncomplicated pregnancy, he reached all developmental milestones appropriately. His problems began aged 15 after witnessing a murder, with reactive depression and hyperphagia. By the age of 18, he weighed over 140 kg, had poor self-image and suicidal ideation. He was managed initially by seve...
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ea0018p24 | (1) | MES2008

Surveillance of a slowly progressive non-benign adrenal incidentaloma

Charles Debbie-Ann , Liu Yuk-Fun , Jaques Audrey , Carroll Paul

Adrenal incidentalomas are tumours of the adrenal incidentally discovered during evaluation for non-adrenal disease. The National Institute of Health consensus definition usually excludes lesions found during evaluation for malignancy. We present a case of an initially non-secretory adrenal incidentaloma that progressively increased in size over 6 years and became hormonally active.A 78-year-old hypertensive male was found to have a right adrenal mass du...
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ea0018p25 | (1) | MES2008

Early report of ultrasound vocal cord assessment for patients undergoing cervicotomy

Kirkby-Bott James , Mortier Amanda , Royle Gavin , Dewbury K

Introduction: The majority of dedicated endocrine surgery centres in the UK and abroad routinely perform pre-operative vocal cord checks prior to cervicotomy. Ultrasound scanning is increasingly used as routine imaging in the work up of patients being assessed with thyroid and parathyroid disease. We report on the additional use of USS as a method of performing pre-operative vocal cord checks.Method: We report the early results on 32 patients undergoing ...
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ea0018p26 | (1) | MES2008

Manubrial split provides adequate exposure for mediastinal exploration for parathyroid adenoma

Lake Edward , Kirkby-Bott James , Imtiaz Fawzia , Jackson James , Palazzo Fausto

Introduction: The traditional approach to mediastinal ectopic parathyroid adenomas has been through a median sternotomy. With improved localization techniques it has become possible to use less invasive approaches to access the mediastinum. We present our recent experience of three cases of mediastinal parathyroid adenomas successfully treated using a manubriotomy approach which provides good access to the superior and anterior mediastinum.Method: All pa...
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ea0018p27 | (1) | MES2008

Unusual case of hyperpigmentation

El-Gayar Heba , Chaudhri Owais

Cutaneous pigmentation results from the synthesis of melanin by the melanocytes. Its distribution pattern in the surrounding keratinocytes determines the actual colour of the skin. ACTH and α-MSH are equipotent at the melanocortin-1 receptor (MC-1R) that is expressed on the cell surface of melanocytes. Activation of these receptors stimulates both proliferation of melanocytes and melanin synthesis.We present the case of a 66-year-old lady. Originall...
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ea0018p28 | (1) | MES2008

A case of frontal ethmoid sinus mucocele: a late complication of pituitary surgery

Hui Elaine , Amin Anjali , Chiti-Batelli Sandro , Dassan Pooja , Linton Nick , Valabhji Jonathan

A 69-year-old lady presented with a 4-day history of diplopia, headache and right eye swelling. She had a pituitary adenoma diagnosed in Beirut when she was 20 years old and underwent trans-frontal surgeries and radiotherapy twice and further transsphenoidal surgery in 1980. She initially presented to the ophthalmology clinic. Examination revealed a pupil-sparing 3rd nerve palsy of the right eye, with complete ptosis, proptosis and reduced visual acuity (6/9). She was referred...
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ea0018p29 | (1) | MES2008

This abstract appears as OC3....
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ea0018p30 | (1) | MES2008

Atypical location and treatment for a rare neuroendocrine tumour

El-Gayar Heba , Morganstein Daniel , Meeran Karim

Somatostatinomas are rare neuroendocrine tumors usually arising from the pancreas and duodenum. Symptoms include hyperglycemia, cholelithiasis, diarrhea and steatorrhoea. Treatment with somatostatin (SST) analogue may appear paradoxical, but can lower SST levels and improve symptoms.Case: A 60-year-old gentleman presented with diarrhoea, opening his bowels between 12 and 13 times a day causing him to stop working and become depressed. Repeated fasting gu...
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ea0018p31 | (1) | MES2008

Diagnostic cut-off for calcitonin: is 10 ng/l still valid?

Ramachandran Radha , Benfield Patricia , White Sara , Chapman Richard , Meeran Karim , Donaldson Mandy , Martin Niamh

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...
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ea0018p32 | (1) | MES2008

Primary hyperparathyroidism presenting in pregnancy

Abbara Ali , Lecamwasam Varunika , Baynes Kevin , Bell Richard , Kurzawinski Thomas , Neila Mahadevan , Rafique Akkib , Kubba Faris

A 25-year-old pregnant lady presented to the accident and emergency department at 16 weeks gestation with intractable vomiting, weight loss and lethargy. She reported a 2 months history of hyperemesis gravidarum managed in the community prior to admission.She had no past medical history and her only medication was of a Polish antenatal vitamin containing 400 IU of Vitamin D (D2). Her blood biochemistry revealed a markedly raised corrected calcium at 3.57...
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ea0018p33 | (1) | MES2008

Pituitary stalk haemorrhage

Lecamwasam Varunika , Whittle Monica , Edwards Mark

We report the case of a 59-year-old male who presented complaining of several weeks of tiredness, poor appetite and dizziness on standing. He had been treated with flucloxacillin by his GP for otitis externa one week earlier.In 1982, he was diagnosed with nasopharyngeal carcinoma in Hong Kong, which was treated by radical dissection and radiotherapy.On examination, his standing and lying blood pressure were 150/100 and 110/90 respe...
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ea0018p34 | (1) | MES2008

A potential complication of radiotherapy for acromegaly

Lecamwasam Varunika , Abbara Ali , Bell Richard , Baynes Kevin , Rafique Akkib

Case report: A 40-year-old lady was diagnosed with acromegaly in 1993 after presentation with clinical symptoms. Imaging showed a 1 cm pituitary lesion and she underwent transphenoidal hypophysectomy in 1993. Post-operatively she was rendered hypopituitary, but still had biochemical evidence of active acromegaly. She proceeded to external beam radiotherapy and was started on bromocriptine medical therapy.On routine review in 2006, her acromegaly was bioc...
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ea0018p35 | (1) | MES2008

An unusual case of primary infertility

Amin Anjali , Robinson Stephen , Webber Lisa

We present a case of a 29-year-old lady who presented with subfertility. She had had a 2 years history of oligomenorrhoea with highly irregular menses. She had symptoms of depression and described tunnel vision. Clinically, she was euendocrine with no features of hormonal excess or deficiency. She was not hirsute. Visual field testing demonstrated a severe left superior temporal quadrantopia.Laboratory investigations demonstrated an oestriadol level rang...
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ea0018p36 | (1) | MES2008

A case of insulin allergy: something to zinc about

Simpson Katherine , Clements Michael , Ogilvie Arla , Carter Sharon , Feben Chris , Batta Kapila , Rubin Alan

A 50-year-old man with poorly controlled type 2 diabetes mellitus on oral hypoglycaemics was under review as a diabetic outpatient. In April 2007, he developed idiopathic thrombocytopaenic purpura which, on a background of probable diabetic nephropathy, precipitated end-stage renal failure. He was treated with oral steroids and was established on haemodialysis. To achieve better glycaemic control, he was converted to twice daily insulin. His treatment dose of prednisolone was ...
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ea0018p37 | (1) | MES2008

An unusual case of hypercalcaemia

Bala Anjali , Sandler Belinda , Kaplan Felicity , Kaniyur Sunil

We describe the case of a 70-year-old lady presenting with marked, symptomatic hypercalcaemia.Past medical history was of insulin-treated Type 2 Diabetes, macrovascular disease and chronic renal impairment.On admission, corrected calcium was noted to be 3.53 mmol/l with a paired PTH within normal range (4.3 pmol/l, range 1.6–9.3). Further questioning revealed a history of weight loss but no other clinical features specifically...
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ea0018p38 | (1) | MES2008

Rapid management of hypercalcaemic crisis: a multidisciplinary approach

Adjene Alero , Donaldson James , Steer Keith

A 69-year-old man with longstanding ulcerative colitis presented for annual review by the gastroenterologists. He complained of lower back pain for six months and a recent history of anorexia, constipation, thirst and urinary frequency.His serum calcium was 5.12 mmol/l, phosphate 1.77 mmol/l, urea 19.1 mmol/l and creatinine 252 μmol/l.He was admitted, rehydrated with 5 l of intravenous normal saline over 24 h and given pamidro...
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ea0018p39 | (1) | MES2008

Renal artery stenosis and possible coexisting Conn's adenoma

Shaafi K O , Russell S

A 47-year-old lady presented with a long history of resistant hypertension. Her GP referred her for further investigation to a cardiologist who found a smaller right kidney on ultrasound scan and an elevated rennin level. Renal artery MRA revealed right renal artery stenosis. On September 2008, she underwent right renal artery stenting and was advised to stop taking the antihypertensive medications (doxazosin and amlodipine). A week later she was admitted with headache, vomiti...
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ea0018p40 | (1) | MES2008

This abstract appears as OC5....
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ea0018p41 | (1) | MES2008

A diabetic foot dilemma resolved through the use of the diabetic foot MDT

Styles K F , Burns C M , Shaikh H , Turner J

A 63-year-old type 2 diabetic gentleman with paranoid schizophrenia presented in October 2008 with systemic sepsis arising from multiple neuropathic foot ulcers. Foot MRI confirmed extensive osteomyelitic change. This admission followed two previous similar episodes which culminated in surgical debridement of the ulcers and amputation of the second and third toe of his left foot. Post-operatively, as his condition improved he was unable to comply with IV antibiotics, VAC dress...
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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