Searchable abstracts of presentations at key conferences in endocrinology
Previous issue | Volume 19 | SFEBES2009 | Next issue

Society for Endocrinology BES 2009

ea0019p224 | Pituitary | SFEBES2009

Cloning and expression of calcium/calmodulin-dependent protein kinase ii isoforms in the developing zebrafish (Danio rerio)

Chand A , McGonnell I , Fowkes R

The family of calcium/calmodulin-dependent protein kinases (CaMK) are major effectors of calcium binding proteins in virtually all systems. Recently, CaMKs have been implicated in regulating pituitary and hypothalamic gene transcription to control the expression of gonadotrophin hormones and adrenocorticotrophin in the pituitary, and as a pivotal protein in the satiety pathway. Despite these observations, the spatial and temporal expression of the CaMKs is poorly documented an...

ea0019p225 | Pituitary | SFEBES2009

Transient hypopituitarism following a viral illness

Kyaw Tun J , Jenkins R , D'Costa R , Nagi D

A 68-year-old previously well man was referred to the endocrinology department in April 2007 with generalised tiredness and dizziness following a recent viral upper respiratory illness. He had no symptoms to suggest pituitary dysfunction. He was normotensive and lacked clinical features of hypopituitarism or dysthyroidism. Visual fields were normal to confrontation. Testicular volumes were normal. Initial baseline pituitary function tests (reference ranges in brackets): FT<sub...

ea0019p226 | Pituitary | SFEBES2009

Metastatic renal cell carcinoma masquerading as a vascular pituitary tumour

Sankar Erukulapati Ravi , Kane P , Mada S , Padmanabhan R , Rao P , Nag S

Introduction: Metastases to the hypothalamus and pituitary gland account for 1–2% of sella masses. The primary malignancy may be occult at the time of diagnosis and metastatic lesions are often detected incidentally. We present a case of metastatic renal cell carcinoma presenting as a vascular pituitary tumour.Case history: A 68-year-old lady presented with headaches and diplopia secondary to right abducent nerve palsy. CT Angiography revealed an in...

ea0019p227 | Pituitary | SFEBES2009

Effect of the d3 growth hormone receptor genotype on GH responsiveness in adult hypopituitary patients

Moyes VJ , Walker D , Owusu-Antwi S , Maher KT , Metherell L , Akker SA , Monson JP , Clark AJ , Drake WM

Objective: Variability in growth hormone (GH) responsiveness is evident in adult hypopituitary patients receiving recombinant GH (rhGH). Doses vary up to 4-fold for unexplained reasons. Deletion of exon 3 in the GH receptor (d3-GHR) has been linked to an increased response to GH treatment in children, although data are conflicting. We investigated the role of the d3-GHR polymorphism in determining GH responsiveness in adult GH deficient patients.Methods:...

ea0019p228 | Pituitary | SFEBES2009

Severe acute psychosis precipitated by replacement dose hydrocortisone in newly diagnosed panhypopituitarism

Mada S , Palmer C C , Mhando Y , Rao P , Erukulapati R , Nag S

Introduction: Psychiatric disturbance is a recognised complication of glucocorticoid therapy. Patients on a daily dose of 40 mg of prednisolone or its equivalent are at risk of developing steroid psychosis. Psychotic reactions with replacement doses of glucocorticoid are uncommon. We describe a patient with newly diagnosed hypopituitarism who developed severe steroid induced psychosis with low dose hydrocortisone.Case report: A 72-year-old lady presented...

ea0019p229 | Pituitary | SFEBES2009

Outcome following transsphenoidal adenectomy as treatment for non-responsive prolactinomas

Warnakulasuriya SR , Karavitaki N , Cudlip S , Wass JAH

Background: Surgery is indicated for patients with prolactinomas if intolerant of or resistant to medical therapy with dopamine agonists. The transphenoidal route offers fast relief from symptoms in the hands of an experienced surgeon, with remission achieved in up to 87% of microprolactinomas and 56% in macroprolactinomas.1Aim: To evaluate the outcome of transsphenoidal adenectomy for non-responsive prolactinomas in a single centre in the UK....

ea0019p230 | Pituitary | SFEBES2009

Echocardiographic findings in patients on long-term dopamine agonist therapy

Luck S , Carroll P , Chambers J , Powrie J

Ergot derived dopamine agonist therapy (EDDAT) has recently been associated with fibrotic cardiac valvulopathy in patients with Parkinson’s disease. These patients received a cumulative dose of 2800–6700 mg of cabergoline for an average duration of two years. This has raised concerns about the use of these agents in patients with prolactinomas and has led to the recent EMEA/MHRA guidance that all patient being treated with EDDA should undergo surveillance echocardiog...

ea0019p231 | Pituitary | SFEBES2009

Acromegaly: the contribution of prolactin in the management

Lambert KD , Munday LJ , Kar PS

History: A 62-year-old female presented with a 15-year history of tiredness and headaches. Clinically she had signs of acromegaly. This was confirmed with IGF1 688 ug/l and with a 2 h value (post GTT)of growth hormone 13.9 miu/l. MRI scan revealed a 3.5×3.5×2.5 cm mass in the pituitary fossa extending laterally to involve the left cavernous sinus and suprasellar extension causing moderate splaying of the optic chiasm. The left trigeminal nerve and internal carotid ar...

ea0019p232 | Pituitary | SFEBES2009

An unusual case of a disappearing TSHoma

Sharma Sanjeev , Swords Francesca , Gorick Sondra , Chatterjee VK , Al-Ali Nadia , Halsall David

TSH secreting tumours (TSH-omas) are uncommon, accounting for less than 2% of pituitary tumours. Typically, patients with such tumours demonstrate hyperthyroidism with detectable or elevated TSH levels, and show little response to TRH stimulation. Treatment is controversial: typically surgery, radiotherapy or somatostatin analogues.We present a 22 year-old man who was found to be tachycardic on joining a gym in 2003. There were no other symptoms or signs...

ea0019p233 | Pituitary | SFEBES2009

An unusual case of pituitary disease

Balaguruswamy S , Chattington PD

We report a case of multisystem Langerhans cell histiocytosis (LCH) with pituitary involvement nearly 20 years after initial presentation. LCH is a rare disorder in which granulomatous deposits occur at multiple sites within the body often involving the hypothalamo-pituitary axis.A 48-year-old gentleman had Histiocytosis X initially involving groin in1987, responding poorly to treatment with topical nitrogen mustard and radiotherapy. Involvement of exter...

ea0019p234 | Pituitary | SFEBES2009

‘Reasonably good’ – results of a survey on pituitary patients’ satisfaction with information and support from healthcare professionals

Jackson S , Morris M , Murray J , Woods T

Introduction: Pituitary conditions are rare and diagnosis may be slow because symptoms are ambiguous. The treatment may be a combination of surgery, radiotherapy and medication so patients see many healthcare professionals. This survey sought to assess patient satisfaction with the information and support they receive from GPs, endocrinologists, neurosurgeons, radiotherapists, specialist nurses, and other agencies (e.g. the pituitary foundation).Method: ...

ea0019p235 | Pituitary | SFEBES2009

Dealing with infertility as a consequence of a pituitary condition

Morris M , Harrison P

Background: Evidence from a Needs Analysis (2006) and Patient Satisfaction Survey (2008) for people with pituitary conditions suggested infertility was a key yet unexpected problem for the majority of respondents. Being infertile without the co-morbidity of pituitary condition confers a huge emotional burden on the individual. The aim of this piece of research was to investigate individual’s perceptions of managing infertility following a diagnosis of a pituitary conditio...

ea0019p236 | Pituitary | SFEBES2009

Dual pathology for headache masquerading as dopamine agonist intolerance

Mizban N , King R , Rajeswaran C

A 38-year-old lady was referred to our endocrinology department with headache, elevated prolactin concentration and intolerance to cabergoline by the gynaecologist. She was found to have elevated prolactin whilst investigating for secondary amenorrhoea. She described her headaches to be worse on cough, sneezing and laughing. There was no evidence for raised intracranial pressure clinically and no visual field defect was identified. Prolactin was 3194 miu/l, however there was n...

ea0019p237 | Pituitary | SFEBES2009

Assessment of in vivo proliferation rates in pituitary tumours of multiple endocrine neoplasia type 1 knockout mice: implications for evaluating treatment

Jeyabalan J , Walls G , Reed A , Harding B , Thakker R

Pituitary tumours occur in more than 40% of multiple endocrine neoplasia type 1 (MEN1) patients, and these are more aggressive and difficult to treat than those in non-MEN1 patients. Assessments of in vivo proliferation rates will be of importance in evaluating emerging treatments. We have used the uptake of the DNA nucleotide precursor, 5-bromo-2-deoxyuridine (BrdU), to assess proliferation rates of pituitary tumours in our Men1 knockout mouse model, which devel...

ea0019p238 | Pituitary | SFEBES2009

CSF rhinorrhoea – a rare complication of medical management of giant prolactinomas

Kalavalapalli Shyam , Gnanalingham Kanna , Kearney Tara

We present a 35-year-old male who was incidentally found to have a large macroadenoma when he presented with left sided weakness three months ago. He had no headaches or visual disturbances. His prolactin at presentation was >100 000 mU/l (86–324 mU/l). Magnetic resonance imaging confirmed an invasive macroadenoma. His Humphrey’s visual field tests were normal.Rest of the endocrine profile revealed a normal T4 of 14.3 (12–22...

ea0019p239 | Pituitary | SFEBES2009

Familial prolactinoma occuring in association with SDHB mutation positive paraganglioma

Brahma Anupam , Heyburn Philip , Swords Francesca

A 33-year-old male presented with headache and visual loss in May 2003. MRI pituitary showed a large tumor arising from pituitary fossa extending to suprasellar cistern compressing the optic chiasm with features recent infarction. He subsequently underwent urgent trans-sphenoidal decompression and a necrotic prolactinoma was excised with full recovery of his vision. His prolactin level remained elevated and so he was treated with cabergoline. Further questioning revealed that ...

ea0019p240 | Pituitary | SFEBES2009

Endocrine consequences of childhood traumatic brain injury

Khadr S , Crofton P , Wardhaugh B , Roach J , Jones P , Drake A , Minns R , Kelnar C

Objectives: To determine the prevalence/aetiology/clinical significance of pituitary dysfunction following moderate/severe childhood traumatic brain injury (TBI).Subjects: Twenty-six survivors of childhood TBI (20 males). Age at study: 5.4–18.9 year (median 13 year). Median time since TBI: 4.5y (2.3–6.7 year). King’s outcome scale for childhood head injury (KOSCHI) rating: 11 good recovery, 15 moderate disability, two severe disability.</p...

ea0019p241 | Pituitary | SFEBES2009

The acromegalic cardiovascular and respiratory outcomes with primary analogue therapy (A.C.R.O.P.A.T.) trial

Webb A , Gayton E , Annamalai A , Pilsworth S , Wallace S , Khan S , O'Toole S , Ariyaratnam S , Maki-Petaja K , Scoffings D , Antoun N , Wilkinson I , Dutka D , Shneerson J , Simpson H , Gurnell M

Seventeen newly-diagnosed acromegalic patients (8 female, 9 male: mean age 55 year, range 26–73 year) were recruited to the A.C.R.O.P.A.T. trial. Patients were assessed prior to, and following, 6 months of treatment with Somatuline Autogel® (SA).Growth hormone (GH) & insulin-like growth factor 1 (IGF1): Following treatment, GH and IGF1 levels fell significantly in all but one subject: median GH change −17.23 mU/l (interquar...

ea0019p242 | Pituitary | SFEBES2009

An analysis of the dose of levothyroxine in patients with central hypothyroidism

Diacono Fabrizio , Bilbao Ismene , Karavitaki Niki , Wass John AH

Background: Levothyroxine is the standard treatment for central hypothyroidism (CH). Studies assessing the optimal dose are limited and include subjects with other untreated pituitary hormone deficits, affecting the interpretation of results. A reliable comparison with the dose used in primary hypothyroidism (PH) has not been reported.Aims: To evaluate daily and body-weight-adapted levothyroxine dose (BWA-dose) in a cohort of patients with CH on appropri...

ea0019p243 | Pituitary | SFEBES2009

Growth hormone deficiency in adults: the NICE criteria do not discriminate an adverse cardiovascular phenotype

Aragon Alonso Aurora , Sherlock Mark , McGregor Elizabeth , Murray Robert , Stewart Paul M , Toogood Andrew A

Severe growth hormone (GH) deficiency in adults is associated with adverse changes in quality of life (QoL), body composition and cardiovascular risk profile. NICE guidance restricts GH replacement in the UK to those with impaired QoL, defined by a score of >11 in the QoL-AGHDA questionnaire.Aims: To assess whether the NICE guidance differentiates other clinical or biochemical features in GH deficient adults.Patients and...

ea0019p244 | Pituitary | SFEBES2009

Abnormal cortisol metabolism in growth hormone deficient adults; the role of hydrocortisone replacement therapy and effect on body composition

Sherlock M , Aragon Alonso A , McGregor E , Hughes B , Murray R , Toogood AA , Stewart PM

GH deficiency (GHD) in adults shares several clinical features with syndromes of glucocorticoid excess. Many patients with GHD also receive glucocorticoid therapy. GH inhibits the generation of active glucocorticoid by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), but the confounding effect of ACTH deficiency/ cortisol replacement therapy has not been evaluated.Aims: To assess corticosteroid exposure and metabolism and body composition in...

ea0019p245 | Pituitary | SFEBES2009

Effect of ACTH deficiency and hydrocortisone replacement dose on mortality in patients with acromegaly

Sherlock M , Reulen RC , Aragon Alonso A , Ayuk J , Clayton RN , Sheppard MC , Hawkins MM , Bates A , Stewart PM

Acromegaly and hypopituitarism are associated with elevated standardised mortality ratios (SMR) of between 1.3–3 and 1.2–2.17, respectively. There is little data on the role of hypopituitarism and in particular ACTH deficiency on mortality in patients with acromegaly and less still known about the role of hydrocortisone (HC) replacement. There is data to suggest that previous HC regimens may have overestimated normal cortisol production rates and recent data that hig...

ea0019p246 | Pituitary | SFEBES2009

The high dose dexamethasone suppression test is dead

Siamatras Thomas , Karavitaki Niki , Wass JAH

Introduction: The diagnosis of Cushing’s syndrome (CS) requires a screening test of high sensitivity, followed by biochemical evaluation aiming to identify the aetiology of hypercortisolism. The high-dose dexamethasone suppression test (HDDST) with the corticotropin-releasing hormone (CRH) test is commonly used for the differential diagnosis of ACTH-depended Cushing’s syndrome. However, the diagnostic utility of the HDDST has been questioned.Ai...

ea0019p247 | Pituitary | SFEBES2009

The specificity of ACTH recognition by the MC2R

Chung Teng-Teng , Clark Adrian

Background: The ACTH receptor (melanocortin 2 receptor – MC2R) is unique in that it is highly selective for ACTH and excludes all other MSH peptides. This contrasts with all other members of the melanocortin receptor family, which show broader specificity. The specificity of recognition of ACTH by the MC2R appears to depend on the presence of four basic residues, lysine, lysine, arginine, arginine at positions 15–18. Of α-, β- and γ-MSH are either iden...

ea0019p248 | Pituitary | SFEBES2009

Anaemia leading to diagnosis of pan-hypopituitarism in an elderly gentleman

Rao Preethi , Mada Srikanth , Erukulapathi Ravi , Jones S

Introduction: Pituitary hormones play a vital role in the development of various organs since birth. Testosterone is essential not only for the development of primary and secondary sexual characteristics but also influences erythropoiesis. We describe a clinically challenging case of hypopituitarism presented as normochromic normocytic anaemia at the age of 74 years.Case: A 74 years gentleman with a background of previous Myocardial Infarction was referr...

ea0019p249 | Pituitary | SFEBES2009

Exposure to a cocktail of environmental chemicals in sewage sludge: effects on foetal and post pubertal pituitary gonadotrophs in sheep

Bellingham M , McNutt CRE , Fowler PA , Rhind SM , Cotinot C , Sharpe RM , Evans NP

It has been hypothesised that the hypothalamo–pituitary gland complex is a prime target through which environmental chemicals may alter reproductive physiology. The aim of this study was to investigate whether exposure to an environmentally relevant mix of chemicals during in utero and post-natal development can alter pituitary function. Pituitary glands were collected from 110 day-old foetuses (8 control and 8 treated) and 18 month old, post-pubertal sheep (8 cont...

ea0019p250 | Pituitary | SFEBES2009

Wnt signalling in oestrogen-induced lactotroph proliferation

Giles A , Madec F , Friedrichsen S , Featherstone K , Chambers T , Resch J , Brabant G , Davis J

Prolactinomas are the commonest type of functioning pituitary adenoma in man. High circulating oestrogen levels are associated with lactotroph proliferation and increased PRL secretion essential for lactation. In vitro, oestradiol induces proliferation of the rat pituitary somatolactotroph GH3 cell line, and chronic oestrogen treatment of Fischer-344 rats in vivo results in lactotroph hyperplasia and adenoma formation, though the mechanisms responsible remain elu...

ea0019p251 | Pituitary | SFEBES2009

Differential effects of dopamine agonists at D2S and 5HT2B receptors

Igbokwe R , Jolas T , Waters A , Webster J

Recent reports have raised concerns that dopamine agonist drugs, particularly cabergoline and pergolide, may be associated with cardiac valvulopathy. Dopamine agonists exert their prolactin-suppressive effect via lactotroph D2S receptors, while cardiac fibrosis appears to be mediated via 5HT2B receptors. We have assessed the receptor binding and functional effects of a range of dopamine agonists to determine their relative potencies at these two receptors...

ea0019p252 | Pituitary | SFEBES2009

A retrospective analysis of management and follow up of patients with macroprolactinoma-12 year incident data from the South Tees endocrine register

Bowcock E , Connolly V , Kane P , Nag S

Background: Macroprolactinomas account for 10% of prolactin secreting tumours. There are few studies looking at the long-term outcome of these tumours. This study analysed clinical, endocrine and radiological characteristics of macroprolactinomas and evaluated the long-term management of these patients in a tertiary care centre.Methods: Retrospective audit of 21 consecutive cases of macroprolactinomas diagnosed between 1995 and 2007 in Teesside.<p cl...

ea0019p253 | Pituitary | SFEBES2009

A case of headache and severe hyponatraemia – SIADH or pituitary apoplexy?

Merriman R , Eggins A , Nasruddin A , Cummings M , Kar P

History: A 62-year-old female presented to casualty with headache and hyponatraemia (Na 113 mmol/l) on the background of nausea and vomiting, preceded by sudden onset occipital headache 10 days previously. Other routine blood results were unremarkable apart from K 3.4 mmol/l.Biochemical investigations were consistent with SIADH. (Serum osmolality 233 mos/kg, urine 641 mos/kg, urinary Na 43 mmol/l). Early morning cortisol on admission was 828 nmol/l.<...

ea0019p254 | Pituitary | SFEBES2009

Acromegaly: an audit of treatment outcomes

Gorick S , Powell K , Swords FM , Temple RC

Introduction: Guidelines suggest definition for cure in acromegaly is to achieve a nadir growth hormone (GH) <2 mU/l during a growth hormone suppression test and a normal IGF-1 level (Gustina 2000). Following an earlier retrospective audit (Brown et al. 2002), showing limited achieved cure success, we re-audited our patients.Methods: All patients with acromegaly were invited to undergo growth hormone suppression test and IGF-1measurement over ...

ea0019p255 | Pituitary | SFEBES2009

Successful treatment of a combined GH/TSHoma using SOM230

Dixit K , Higham C , Brabant G

Case: A 44-year-old lady was diagnosed with Acromegaly (IGF-1 of 1315 ng/ml, prolactin 498 mu/l). She was also thyrotoxic clinically and biochemically with T4 29 pmol/l (normal 9-26), total T3 3.24 nmol/l (normal 0.9–2.2) but high TSH of 3.50 mu/l (normal 0.35–3.5). Further work-up with TRH testing and α-subunit measurement confirmed a TSHoma. Pituitary MRI scan showed a macroadenoma displacing optic chiasm and extending into cavernous sinu...

ea0019p256 | Pituitary | SFEBES2009

A case of FSH secreting pituitary adenoma

Muralidhara Koteshwara , Vaughan Nick

A 43-year-old, previously well Asian male was found to have a large intrasellar mass when investigated with an MRI brain for a history of reduced hearing. He had no other clinical history. His visual fields were normal. The tumour had extended to the suprasellar cistern but there was no optic nerve compression. Pre-operative biochemistry showed mild panhypopituitarism with a 0900 a.m. cortisol of 135 mmols/l, a free T4 of 8.5 pmols/l, a free T3 of 3.2 pmo...

ea0019p257 | Pituitary | SFEBES2009

Secondary thyrotoxicosis in a patient with acromegaly presenting with recurrent atrial fibrillation following transphenoidal surgery

Nasruddin A , Kalathil S , Meeking D , Cummings M

Background: A recent study by the author suggests up to 73% of growth hormone (GH) secreting pituitary adenomas produce multiple hormones on histological analysis and 16% immunostain positive for TSH. We report the case of an acromegalic patient with a plurihormonal adenoma where diagnosis of thyrotoxicosis was made several years post-hypophysectomyCase history: Mr JT was diagnosed with acromegaly at the age of 59 having been noted to have acromegalic ph...

ea0019p258 | Pituitary | SFEBES2009

Growth hormone replacement and its effect on muscle strength in GH-deficient adults: a meta-analysis

Widdowson WM , Gibney J

A recently published meta-analysis has demonstrated a significant beneficial effect on exercise performance of growth hormone (GH) replacement in GH-deficient (GHD) adults. The current meta-analysis was carried out to determine whether GH replacement confers a similar improvement in muscle strength in this patient group. A medline search and examination of reference lists of included studies and relevant review articles identified five studies with utilizable, robust data, inv...

ea0019p259 | Pituitary | SFEBES2009

Pituitary diseases and arachnoid cysts: more than a coincidence?

Murthy NPN , Murthy A , Ashawesh K , Kulambil Padinjakara RN , Pua S , Randeva H

CASE 1: A 50-year-old male was referred to the endocrine clinic with decreased libido and erectile dysfunction. Physical examination showed normal sense of smell, testicular size and secondary sexual characters. Investigations revealed low testosterone (10.6 mmol/l), SHBG 29.6 nmol/l, LH (6 IU/l) and FSH (7 IU/l) with high prolactin (4000 mU/l). The rest of the anterior pituitary hormones were normal. A MRI scan of the head showed a pituitary microadenoma with arachnoid cyst i...

ea0019p260 | Pituitary | SFEBES2009

Hypoglycaemia during the insulin stress test – how low do we go?

Lockett H , Twine G , Flanagan D

Introduction: The insulin stress test (IST) used to assess the hypothalamic–pituitary–adrenal (HPA) and growth hormone axes requires blood glucose to fall below 2.5 mmol/l. This level of hypoglycaemia is considered safe for selected patients but blood glucose levels below this are associated with increasing risk. We reviewed the depth and length of hypoglycaemia in a cohort of patients undergoing IST.Method: Between October 2004 and 2008, 138 I...

ea0019p261 | Pituitary | SFEBES2009

A case of pituitary stalk tumour posing management challenge

Shaafi Khalifa , Mulcahy Michael

A 45-year-old lady presented with two years history of galactorrhea and tiredness. The galactorrhea had been getting progressively worse. Initially it was on squeezing the breast but later on it came on spontaneously. She had to change her bra more than twice a day. She was also feeling unduly tired. She got occasional headaches but no visual disturbances. The period was regular and she was on no regular medications. She is married and has three children, the youngest is four ...

ea0019p262 | Pituitary | SFEBES2009

Improvements in insulin sensitivity outweigh a decline in pancreatic beta-cell function in newly diagnosed acromegalic subjects treated with primary medical (Somatuline Autogel®) therapy

Gayton E , Annamalai A , Webb A , O'Toole S , Ariyaratnam S , Semple R , Simpson H , Gurnell M

Background: Insulin resistance (IR) commonly manifests in acromegaly leading to impaired glucose tolerance (IGT) and diabetes mellitus (DM). Studies have shown that ‘control’ of growth hormone (GH) and insulin-like growth factor 1 (IGF1) hypersecretion typically ameliorates glucose homeostasis. However, suppression of beta-cell function by somatostatin analogues may potentially attenuate glycaemic benefits of reduced IR. Effects on insulin’s other pleiotropic ef...

ea0019p263 | Pituitary | SFEBES2009

Plasmacytoma: an unusual cause of a pituitary mass lesion

Murthy NPN , Ashawesh K , Kulambil Padinjakara NPN , Syed A , Randeva H

Introduction: Plasma cell neoplasms include a variety of clinicopathologic entities including; multiple myeloma, solitary plasmacytoma of bone and extramedullary plasmacytoma. Plasma cell neoplasms of the pituitary area are very rare, with only 19 cases in the literature. We report a rare case of multiple myeloma presenting with parasellar mass.Case: A 44-year-old lady was admitted with sudden onset of diplopia and blurring of vision. She also mentioned ...

ea0019p264 | Pituitary | SFEBES2009

Hypogonadism secondary to hyperprolactinaemia: successful treatment and its adverse consequences….

Bujawansa S , Narayanan RP , Rimmer M , Qureshi Z , Heald A

Background: It is well known that care must be taken in initiating testosterone replacement in individuals with historically low androgen levels. However less is reported about the influence of restoration of normal endogenous testosterone production on behaviour.Here, we report the how adverse sequelae of successful treatment of secondary hypogonadism were managed through a joint approach.Case report: A 34-year-old Business Accoun...

ea0019p265 | Pituitary | SFEBES2009

Multiple neoplasms in acromegaly

Altaf Q , Ashawesh K , Murthy N P N , Shad A , Randeva H

Introduction: It has been reported that patients with acromegaly have an increased risk of developing several types of cancers, including breast and thyroid. However, co-existence of thyroid and breast acncers in acromegaly is very rare. We describe a rare case of acromegaly associated with primary thyroid and breast cancers.Case: A 63-year-old lady who presented to our endocrine clinic with complaints of increase in the size of her hands, feet, lips and...

ea0019p266 | Pituitary | SFEBES2009

Fifteen years experience of repeated colonoscopic screening of patients with acromegaly shows a high incidence of new colonic neoplasia and allows for effective screening guidelines

Dworakowska D , Gueorguiev M , Kelly P , Grossman AB , Monson JP , Besser GM , Chew SL , Akker S , Drake WM , Fairclough PD , Jenkins PJ

Introduction: Patients with acromegaly have an increased risk of colorectal cancer and pre-malignant adenomatous polyps; however the frequency of colonoscopic screening remains unclear.Aims: To determine optimum frequency for repeated colonoscopy of acromegalic patients.Methods: Since 1992, 254 patients (mean age 56.6 years) at our centre have undergone at least one fibre-optic colonoscopic surveillance; 156, 60 and 15 patients hav...

ea0019p267 | Pituitary | SFEBES2009

Predicting surgical cure rate of acromegaly based on degree of lateral tumour extension on MRI – a retrospective blinded study

Nasruddin A , Borland B , Macdonald J , Gawne-Cain ML , Lees PD , Sandeman DD

Objective: Transphenoidal hypophysectomy is currently the primary treatment for patients with acromegaly. Advances in medical and radiotherapy treatment options have resulted in uncertainty whether surgery should remain the treatment of choice for all acromegalics. The surgical cure rate for acromegaly is variable and there is a need to accurately counsel patients regarding the likelihood of successful surgical cure. We examined how lateral tumour extension into the cavernous ...

ea0019p268 | Pituitary | SFEBES2009

Two successful pregnancies in partially treated acromegaly followed by spontaneous improvement of GH axis postpartum

Pusalkar P , Prentice M

We describe the case of a 39-year-old lady who was diagnosed with acromegaly in 1997 with basal GH 89.9 mu/l with paradoxical rise to 152 mu/l on OGTT, her IGF-1 was 76 nmol/l refrange (9.5–45). She underwent transphenoidal hypophysectomy in 1998 for pituitary microadenoma and postoperatively her growth hormone level was 5 mu/l. Six months following surgery she had an OGTT during which she suppressed her growth hormone levels to a nadir of 5 mu/l and her IGF-1 was 46.1 nm...

ea0019p269 | Pituitary | SFEBES2009

The management of microprolactinoma: are we following the guidelines for dopamine agonist withdrawal?

Huda M , Wee J , Kwok H , Lawrence U , Moore R , Scally L , Gibbs C , Tremble J

Background: Dopamine agonist (DA) withdrawal is common in the management of microprolactinoma. Guidelines in 19971 and 20062 suggest that DA should be withdrawn after normoprolactinaemia for 3 years.Aims: To assess DA withdrawal and adherence to guidelines.Methods: We retrospectively examined casenotes from 1997 to 2008. Patients were included with clinical and biochemical evidence of hyperprolactinaemia, and ...

ea0019p270 | Pituitary | SFEBES2009

Factors determining the remission of microprolactinomas after dopamine agonist withdrawal

Huda M , Athauda N , Teh M , Carroll P , Powrie J

Background: Withdrawal of dopamine agonist (DA) therapy in the management of microprolactinoma is common practice. It is unclear however which patients are likely to attain long term remission.Aims: The aim of this prospective study was to identify clinical factors that might predict long term remission.Subjects: Fourty subjects (39 female, aged 24–60 years) with microprolactinoma; all had been normoprolactinaemic on DA therap...

ea0019p271 | Pituitary | SFEBES2009

The challenges in managing prolactinomas in patients with psychiatric illness treated with antipsychotic medication

Mehta SR , McGowan BMC , Ghaffar A , Shaikh H , Martin NM , Hatfield ECI , Meeran K

Antipsychotic induced hyperprolactinaemia, mediated by blockade of dopamine D2 receptors, is much more common than prolactinoma in patients receiving antipsychotic medication. We present two cases of the latter.Case 1: A 47-year-old gentleman with depression treated with amitriptyline, fluoxetine and risperidone presented with headaches and a left sided visual field defect. Pituitary MRI showed a 2 cm macroadenoma abutting the optic chiasm. Prolactin was...

ea0019p272 | Pituitary | SFEBES2009

A single early morning serum cortisol in the early post operative period following transphenoidal surgery for pituitary tumours accurately predicts hypothalamo–pituitary–adrenal function

Jayasena CN , Gadhvi KA , Gohel B , Martin NM , Mendoza N , Meeran K , Dhillo WS

Background: Secondary adrenal insufficiency is a common complication of transsphenoidal hypophysectomy (TSS) for pituitary adenoma. It is therefore imperative to rapidly and accurately identify patients requiring glucocorticoid replacement, thus minimising risks of adrenal insufficiency or unnecessary glucocorticoid exposure. The gold-standard test of HPA axis reserve, the insulin tolerance test (ITT), cannot be performed safely until after post-operative recovery. Nine am cor...

ea0019p273 | Pituitary | SFEBES2009

Pituitary natriuretic peptide signalling via guanylyl cyclase-B (GC-B) receptors in GH3 somatolactotrophs is regulated by protein phosphatase activity but not receptor internalisation

Thompson I , Waltho A , Lambertucci J , Wheeler-Jones C , Fowkes R

Current therapeutics target cGMP in treating erectile dysfunction and other cardiovascular disorders. In the endocrine system, cGMP mediates the vast majority of biological effects of the natriuretic peptides (ANP, BNP and CNP) acting via their specific guanylyl cyclases receptors (GC-A and GC-B). There are severe endocrine consequences for mice and humans exhibiting mutations to GC-B receptors, including achondroplasia, growth hormone deficiency and female infertility. Despit...

ea0019p274 | Pituitary | SFEBES2009

Body composition response following long-term GH replacement in adults with craniopharyngioma associated hypopituitarism

Liu Y , Powrie JK , Breen L , Thomas SM , Carroll PV

Patients with craniopharyngioma are frequently obese with a high prevalence of vascular morbidity. Many patients with treated craniopharyngioma have severe GH deficiency (GHD), which independently results in abnormal body composition and increased cardiovascular risk. This study investigated how GH treatment influences body composition in adults with treated craniopharyngioma and GHD.Using the electronic database Diabeta3® we identified 50 patients ...

ea0019p275 | Pituitary | SFEBES2009

Surgical outcome of acromegaly: significance of pre-operative prolactin and GH levels on likelihood of surgical cure

Nasruddin A , Borland B , Lees PD , Sandeman DD

Objective: The rate of surgical cure of acromegaly with transphenoidal hypophysectomy varies greatly. Factors that have been previously noted to affect outcome include tumour size and level of growth hormone (GH). We evaluated clinical factors associated with surgical outcome in our patient series.Method: Retrospective study of clinical data and surgical outcome of patients who underwent transphenoidal hypophysectomy for acromegaly by a single surgeon at...

ea0019p276 | Pituitary | SFEBES2009

Hyperthyroxinaemia with non-suppressed TSH in a clinically euthyroid woman with an unusual sella mass

Al-Ali N , Halsall D , Antoun N , Pickard J , Wood D , Simpson H , Jennings A , Chatterjee K , Gurnell M

Introduction: Thyrotropinomas comprise <1% of all pituitary tumours, but detection is increasing with more widespread use of ultrasensitive TSH assays. Although distinct, the classical biochemical signature – hyperthyroxinaemia with non-suppressed TSH – is not specific to thyrotropinoma, as drug effects, non-thyroidal illness, and assay interference can all yield similar patterns of thyroid function tests. Even when these more common confounders have been exclude...

ea0019p277 | Pituitary | SFEBES2009

Serial imaging in macroprolactinomas: for how long?

Diacono Fabrizio , Byrne James , Siamatras Thomas , Karavitaki Niki , Wass John AH

Background: Cabergoline is effective in achieving normoprolactinaemia and tumour shrinkage in about 70% of patients with macroprolactinoma. Only a few studies have followed-up the adenoma shrinkage for periods >2 years;the need for continuing imaging thereafter is not certain.Aim: To evaluate tumour volume changes in patients with macroprolactinoma responsive to cabergoline during a long follow-up period.Patients and methods: M...

ea0019p278 | Pituitary | SFEBES2009

Iron deficiency anaemia due to hypopituitarism

King R , Mizban N , Rajeswaran C

Pituitary gland has an influence on erythropoiesis. Anaemia is thought to be due to loss of thyrotrophic and adrenotrophic hormones. Testosterone is also known to stimulate erythropoiesis. Here we present a patient with long standing iron deficiency anaemia, which corrected with management of hypopituitarism.A 72-year-old gentleman was under regular review at the diabetic clinic with type 2 diabetes mellitus. He had a background medical history of COPD, ...

ea0019p279 | Pituitary | SFEBES2009

Macroprolactinaemia: what is the long-term prognosis? Results from an original series of 55 patients after 10 years clinical follow-up

Wallace I , Satti N , Courtney H , Leslie H , Bell P , Hunter S , McCance D , Sheridan B , Atkinson A

Macroprolactinaemia is defined as hyperprolactinaemia with a predominance of macroprolactin. It is present in approx 15–36% of cases of hyperprolactinaemia. Controversy exists as to the clinical relevance of macroprolactinaemia with a number of short-term studies demonstrating fewer classical symptoms of hyperprolactinaemia. The long-term prognosis is unknown.We have previously reported the findings after 5 years follow-up of a cohort of 55 patients...