Searchable abstracts of presentations at key conferences in endocrinology
Previous issue | Volume 25 | SFEBES2011 | Next issue

Society for Endocrinology BES 2011

ea0025p222 | Pituitary | SFEBES2011

Has you appearance changed over the last few years? Oh I’m really ugly now!

Eligar Vinay Somashekar , Dacruz Thomas , Thind Munveer , Rao Srinivas , Williams Meurig , Rice Samuel

Forty two year Mrs SJ, community support worker with a background history of hypothyroidism was referred by her GP with excessive tiredness and weight gain. She had been attending her surgery for few months with somatic symptoms and her GP had noticed significant change in facial characteristics and large hands. She complained of increase in her feet size from a size 6 to a 9. No disturbance of vision was reported.She was noted to have hyperglycaemia and...

ea0025p223 | Pituitary | SFEBES2011

Mortality in cushing’s disease: stoke-on-trent data and meta-analysis

Clayton Richard , Raskauskiene Diana , Reulen Raoul , Jones Peter

There are very limited data on long-term mortality in pituitary ACTH dependent Cushing’s disease (CD).We report on our data from Stoke-on-Trent, UK, spanning 50 years and provide a meta-analysis of six other reports which addressed mortality of CD. Case records of 60 CD patients from 1958-31 Dec 2009 from Stoke-on-Trent were reviewed. The standardised mortality ratio (SMR) overall and separately for patients in remission and having persistent diseas...

ea0025p224 | Pituitary | SFEBES2011

Negotiating with a pea-sized hormone factory: the mediatory role of pituitary formyl peptide receptor (FPR) ligands in times of stress

Naughton Vance , Spencer-Dene Bradley , John Chris , Buckingham Julia

Pituitary folliculo-stellate cells express annexin-A1 (ANXA1), a mediator protein necessary for glucocorticoid(GC)-induced negative feedback of adreno-corticotrophic hormone (ACTH) release. ANXA1 acts via formyl peptide receptors (FPR in man, Fpr in rodents). Whilst pituitary tissue does not express Fpr1, functional data suggested Fpr2/Fpr3-selective ligands mediate feedback-like inhibition of ACTH.Hypothesis: Fpr2-selective ligands inhibit secretagogue-...

ea0025p225 | Pituitary | SFEBES2011

Pituitary dysfunction is uncommon in pituitary incidentalomas

Tarik Ammar , Peacey Steven

The frequent use of brain and head MRI/CT has lead to an increase in the number of incidental pituitary lesions reported, so called pituitary ‘incidentalomas’. Such lesions require endocrine evaluation of pituitary function and radiological follow up. We performed a retrospective study to examine the source of these referrals, size of the incidentalomas, frequency of pituitary dysfunction and changes during follow-up. We performed a search of the departmental endocri...

ea0025p226 | Pituitary | SFEBES2011

A case of lymphocytic hypophysitis with spontaneous remission

Iliopoulou Amalia , Tun Julie Kyaw , Ward Emma

A 19 year old girl presented at 39 weeks gestation with headache and blurring of vision. MRI showed an enhancing pituitary mass measuring 1.2 cm maximum height, extending suprasellarly and distorting the optic chiasm. Visual field testing showed bilateral constriction. 0900 h cortisol was 502 nmol/l, thought to be relatively low for the stage of pregnancy and FT4 was 9.3 pmol/l suggesting TSH deficiency. Prolactin was appropriately raised for the gestational age at 4951 mU/l.<...

ea0025p227 | Pituitary | SFEBES2011

An unusual cause of a sellar mass presenting as a pituitary adenoma

Mohammed Abdul , Amin Peshraw , Chee Carolyn

A 57-year-old man presented with a 6-month history of worsening headaches and bitemporal hemianopia on visual field examination. MRI of the brain revealed a 3 cm pituitary lesion impinging the optic chiasm and indenting the pons. Appearances of the lesion on imaging and the patient’s normal anterior pituitary hormonal profile were highly suggestive of a non-functioning pituitary adenoma and this was the presumed diagnosis. The patient underwent trans-sphenoidal resection ...

ea0025p228 | Pituitary | SFEBES2011

An audit of 220 insulin tolerance tests

Ajala Olubukola , Flanagan Daniel

Objective: We reviewed the depth and length of hypoglycaemia in a cohort of patients undergoing Insulin Tolerance Tests (ITTs). We evaluated the safety of the test, its reproducibility and explored factors that might predict the optimal dose of insulin.Methodology: ITTs were performed at a teaching hospital in the south of England between 2005 and 2010.Result: The major indication for ITT was non-functioning pituitary macro adenoma...

ea0025p229 | Pituitary | SFEBES2011

20 year experience in the surgical management of cushing’s disease in a UK tertiary referral centre

Hassan-Smith Zaki , Johnson Alan , Toogood Andrew , Arlt Wiebke , Sherlock Mark , Stewart Paul

Objective: The past 2 decades have seen advances in the surgical management of Cushing’s disease (CD). Our aim was to meet the need for current data on clinical features, long-term outcomes, and prognostic indicators.Patients and methods: We conducted a retrospective study of 71 patients treated by trans-sphenoidal surgery (TSS) for CD. All patients were operated on by the same surgeon in a single centre between 1988–2009. Diagnosis was confirm...

ea0025p230 | Pituitary | SFEBES2011

Suspected spontaneous resolution of pituitary cushing’s disease

Leong Wen Bun , Warner Darren

A 49-year-old lady was referred by her GP with lethargy, oligomenorrhoea and persistent hypertension despite three anti-hypertensives (lisinopril, amlodipine, and atenolol). She denied exogenous steroid usage and had no other medical history.On examination, she had features of Cushing’s syndrome including plethora, moon face, central obesity and androgenisation of her facial skin. She weighed 98 kg.Overnight (1 mg) low dose de...

ea0025p231 | Pituitary | SFEBES2011

Tri-phasic changes in sodium levels post pituitary surgery

Ellis Hollie , Webb David , Robertson Iain , Howlett Trevor , Levy Miles

Case: A 73-year-old lady presented with hyponatraemia six days post-transphenoidal surgery for a non functioning pituitary macro-adenoma. Peri-operatively she developed diabetes insipidus requiring short term desmopressin whilst on the neurosurgical ward. At post-operative presentation she complained of weakness, confusion and nausea; sodium 125 mmol/l, serum osmolality 268 mOsmol/kg, urine osmolality 474 mOsmol/kg. Over the next few days she became symptomatically worse and h...

ea0025p232 | Pituitary | SFEBES2011

Rare case of disseminated adenocarcinoma prostate metastasising to the pituitary, with a normal PSA

Trinh Huong , Javadpour Mohsen , Baborie Atik , Ewins David , Goenka Niru , Joseph Franklin

Mr DP was referred by palliative care to ophthalmology with anisocoria, diplopia and nystagmus. He was known to have a poorly differentiated carcinoma of the prostate with skeletal metastasis (Gleason score 4+5=9). He was on hormonal therapy and had received radiotherapy to the cervical spine. PSA was normal, at 5.31 μg/l.An MRI scan revealed a 12 mm mass in the left side of the pituitary gland, displacing the stalk to the right and lying close to t...

ea0025p233 | Pituitary | SFEBES2011

An unusual case of extremely high prolactin due to stalk disconnection hyperprolactinaemia

Haniff Haliza , Marks Paul V , Ismail Azzam , Moisey Robert S

A 75-year-old man was admitted acutely with a 1 week history of headaches, reduced visual acuity, diplopia and ptosis of his left eye. Examination confirmed a left III and VI nerve palsies with decreased visual acuity in the left eye. A CT and subsequent MRI revealed pituitary mass lesion measuring 2.4×2.1×1.5 cm with extension into the left cavernous sinus. The pituitary stalk appeared thickened and was deviated to the right. The optic apparatus was uninvolved.<...

ea0025p234 | Pituitary | SFEBES2011

The risk of cardiac valvulopathy in cabergoline-treated endocrine patients in a district general hospital

Balaguruswamy Saravanan , Lewis Natalie , McNulty Sid , Furlong Niall

Aim: Over the last decade, cardiac valvular fibrosis has been associated with the use of high dose (ergot-derived) dopamine agonist therapy in Parkinson’s disease. Although the risk in endocrine patients appears significantly lower, routine echocardiographic monitoring is now recommended. This study evaluated the incidence of significant cardiac valvulopathy in endocrine patients treated with cabergoline in a District General Hospital Population, and compliance with MHRA ...

ea0025p235 | Pituitary | SFEBES2011

Cancer stem cells with a stabilising mutation in beta-catenin are implicated in the aetiology of human adamantinomatous craniopharyngioma

Andoniadou Cynthia Lilian , Gaston-Massuet Carles , Tissier Paul Le , Dattani Mehul , Martinez-Barbera Juan Pedro

Somatic stem cells of multiple tissues such as brain, blood, gut epithelium and epidermis, have specific roles in tissue homeostasis and plasticity of cell types. There is evidence that, when mutated, such cells, termed cancer stem cells (CSCs), also underlie tumorigenesis, but their presence in many tumours is elusive. In the pituitary gland, somatic stem cells (PSCs) have been previously identified and characterised in vitro and in vivo, but so far there is no ...

ea0025p236 | Pituitary | SFEBES2011

Long term morbidities in a large series of patients with Cushing’s disease

Ntali Georgia , Siamatras Thomas , Komninos John , Tsagarakis Stelios , Wass John , Karavitaki Niki

Cushing’s disease (CD) is a rare condition, associated with significant morbidities.The long-term morbidities in a series of patients with CD who presented in two tertiary referral centres between 01/1967-06/2009 were assessed. All information was collected as documented in the records of the patients.224 patients were identified (174 females) with median age at diagnosis 39 years (range 10–76 (females 38 (12–72) &#1...

ea0025p237 | Pituitary | SFEBES2011

Molecular and functional characterisation of an endocannabinoid system in LβT2 gonadotrophs

Smith Lorna , Davies Elizabeth , Gastaldello Annalisa , Thompson Iain , Perello Edward , Korbonits Marta , Campanella Michelangelo , Fowkes Robert

Cannabinoids are known to exert effects throughout the endocrine system, including in the anterior pituitary. Whilst cannabinoid receptors (CB1 in particular) are expressed in numerous tissues, expression and function of an endocannabinoid system within specific anterior cell types has not been investigated. We have used well-characterised gonadotroph (LβT2 and αT3-1) and somatolactotroph (GH3) cell lines to establish the expression and functional role for cannabinoi...

ea0025p238 | Pituitary | SFEBES2011

Assessment of the feasibility of early hospital discharge following trans-sphenoidal pituitary surgery

Biswas Sujata , Barber Thomas , Cudlip Simon , Wass John

Objectives: Reducing length of inpatient stay following trans-sphenoidal pituitary adenectomy (TSA) could create significant financial saving for the NHS. We assessed early complication rates post-TSA to determine feasibility of early hospital discharge (3 days) post-TSA.Methods: We identified retrospectively 60 patients who underwent TSA at the John Radcliffe Hospital. These consisted of patients with a pre-operative confirmed diagnosis of non-functioni...

ea0025p239 | Pituitary | SFEBES2011

A debilitating case of cushing’s disease?

Amin Anjali , Hatfield Emma , Meeran Karim

A 48-year-old lady presented to neurology with a 2 year history of progressive leg weakness, rendering her wheelchair-bound. Neurological examination revealed a proximal myopathy. She had a 2 year history of diabetes, and an endocrine opinion was sought to see if the clinical features could be related to diabetes. It was then noted that she appeared Cushingoid, with a blood pressure of 158/92, central obesity, striae and facial acne. She had been amenorrhoeic for 2 years. Endo...

ea0025p240 | Pituitary | SFEBES2011

Cranial nerve palsy related to previous radiotherapy in a treated case of acromegaly

Martin Allison , Bano Gul

A 56-year-old woman presented with an acute onset of left sided ptosis, diplopia and failure of upward gaze almost 20 years after conventional pituitary irradiation for a growth hormone secreting tumour. Her visual fields were full. Visual acuities were 6/9 in the right eye and 6/6 in the left eye. She had a complete left third nerve palsy. She was growth hormone deficient and had primary hypothyroidism, hypercholesterolemia and hypertension. These were well controlled on trea...

ea0025p241 | Pituitary | SFEBES2011

Worsening of thyroid functions following surgical removal of a combined GH/TSHoma

Kaimal Nisha , Elsadig Ahmed , Bradley Donal , Gnanalingham Kanna , Kearney Tara

A 51 year old lady presented with a 3 week history of persistent headache, sweating, increase in shoe and ring size and prognathism. Imaging confirmed an 18×19 mm pituitary macroadenoma indenting the optic chiasma. Visual fields were normal.Bloods: IGF1-181 nmol/l (11.3–30.9 nmol/l), prolactin 76 mU/l (102–496 mU/l), LH 22 U/l (2–13 U/l), FSH 46.6 U/l (4–13 U/l), TSH 0.63 mU/l (0.27–4.2 mU/l), FT4- 25.9 pmol/l (12–22 pm...

ea0025p242 | Pituitary | SFEBES2011

Pitfalls in transphenoidal surgery: a 10 years experience

Mukherjee Kanchan , Khosla Virender , Mathuriya Suresh , Bhansali Anil , Dutta Pinaki , Khandelwal Nilanjan , Singh Paramjeet , Vasishta Rakesh , Radotra Bhisham , Pathak Ashis , Gupta Sunil , Tewari Manoj , Chhabra Rajesh

Three hundred and thirty six cases of pituitary adenomas were operated by the transpenoidal route in the last 10 years by a single surgeon. Majority of these were giant non functioning adenomas. Prolactinomas were excluded unless a part of dual adenoma.In nearly 80% of tumours, total or near total removal was achieved. Long term outcome with follow up of more than 5 years revealed recurrence requiring resurgery in only 4 out of 102 patients. Endocrine re...

ea0025p243 | Pituitary | SFEBES2011

Pituitary apoplexy is a rare endocrine emergency, historically confused with other acute medical conditions, which delayed the diagnosis, however with advances in brain imaging, diagnosing this condition is much easier

Jayashekara Acharya , Flanagan Daniel

We describe seven patients with pituitary apoplexy diagnosed between July 2009 and Oct 2010.Presentation and Management: Five patients presented with sudden onset headache, nausea and vomiting. One developed headache while on carbegoline and other presented with fluctuating level of consciousness.All but two patients were inpatients at the hospital when diagnosed and all had MRI scan of pituitary to confirm the diagnosis and any ma...

ea0025p244 | Pituitary | SFEBES2011

BAC recombineering to understand the role of the alternative promoter in the regulation of prolactin expression

Awais Raheela , McNamara Anne , Harper Claire , Adamson Anthony , Spiller Dave , Semprini Sabrina , Mullins John , Davis Julian , White Michael R H

Alternative promoters control many genes including prolactin (PRL), which in man is expressed at extra-pituitary sites controlled by an alternative promoter located 5.8 Kbp upstream of the pituitary transcription start site. Previous studies using short promoter fragments may be misleading, as the human hPRL genomic locus has many conserved far-upstream regions. To study the function of the alternative promoter, we engineered a bacterial artificial chromosome (BAC) expressing ...

ea0025p245 | Pituitary | SFEBES2011

Evaluation of the interaction of phosphodiesterases 2A and 4A5 with the aryl hydrocarbon receptor interacting protein in pituitary cells

Lennox Carole , Trivellin Giampaolo , Korbonits Marta

Background: Aryl hydrocarbon receptor interacting protein (AIP) mutations have been identified in ~15% of patients with familial isolated pituitary adenomas (FIPA). In addition, dysregulation of the cyclic adenosine monophosphate (cAMP) signalling pathway has been identified in both syndromic and sporadic somatotropinomas. While crosstalk between these two systems is known to occur, the exact mechanism of interaction remains elusive. The identification of direct binding...

ea0025p246 | Pituitary | SFEBES2011

SIADH of cancer: rapid diagnostic evaluation using copeptin as a marker of AVP

Dixit Kashinath , Morgenthaler Nils , Brabant Georg

With the advent of vaptans as a therapeutic option, rapid and precise diagnosis of SIADH is essential. SIADH due to paraneoplastic stimulation of AVP is an expected but not the only cause of hyponatraemia in cancer patients. Therefore a precise evaluation of the cause of hyponatraemia is necessary before any therapeutic approach. Using Copeptin, a stable marker of AVP, which is stoichiometrically released with AVP, we evaluated 49 patients with hyponatremia due to various form...

ea0025p247 | Pituitary | SFEBES2011

Hypopituitarism: is it due to bacterial meningitis?

Kannappan Daniel , Kenz Sami , Farook Selena , Brabant Georg

A 75-year-old man presented to Emergency department with fever and 3 episodes of tonic clonic seizures. He had recent ear infection. He was intubated and ventilated and taken to ICU.He had CT head which was normal. Lumbar puncture results were consistent with Pneumococcal meningitis. He was treated with appropriate antibiotics.During recovery he had persistent hyponatremia. He was reviewed by Endocrine team and his TFT, cortisol an...

ea0025p248 | Pituitary | SFEBES2011

Thyroid function in patients with pituitary disease: difficulties of individualisation

El-Laboudi Ahmed , Lynch Julie , Baxter Paul , Barth Julian , Murray Robert

Introduction: Identification and treatment of central hypothyroidism in hypopituitarism is crucial particularly in patients with significant lethargy under consideration for GH replacement. Early Identification of TSH deficiency can be challenging particularly when both the TSH and fT4 lie within the normal range.Methods: 26 362 TFTs derived from ambulatory community dwelling individuals represented the control group. TFTs from 227 patients with a putati...

ea0025p249 | Pituitary | SFEBES2011

Prospective assessment of pituitary function in patients with macroprolactinoma treated with cabergoline

Karavitaki Niki , Dobrescu Ruxandra , Wass John

Background: Patients with macroprolactinoma often present with pituitary hormone deficits associated with hyperprolactinaemia or mass effect. Restoration of normoprolactinaemia and tumour shrinkage by dopamine agonist is expected to reverse, at least partially, the pituitary dysfunction. Studies assessing prospectively the pituitary function in subjects with macroprolactinoma treated with cabergoline are lacking.Aim: To check the time course of recovery ...

ea0025p250 | Pituitary | SFEBES2011

Delivery of anti-POMC siRNA using a novel polymer

Prescott Helen , Munir Alia , Canton Irene , Battaglia Giuseppe , Newell-Price John

Background: Previously, we have demonstrated highly potent knockdown of POMC mRNA and significant reduction in secreted ACTH using siRNA, both in vitro and in vivo. Highly efficient delivery of siRNA to a target tissue is of critical importance for any therapeutic approach. Here we assess the suitability of a pH-sensitive polymer, PMPC-PDPA polymersomes encapsulating siRNA, as a novel delivery system as these have potential for tissue-directed delivery by ...

ea0025p251 | Pituitary | SFEBES2011

Structure and function of lactotrophs in the anterior pituitary of TPC1 null mice

Ajanaku Ayo , Parrington John , Morris John , Christian Helen

Calcium mobilization from intracellular stores represents an important cell signalling process that is regulated, in mammalian cells, by inositol-1,4,5-triphosphate (IP3), cyclic ADP ribose (cADPR) and nicotinic acid adenine dinucleotide phosphate (NAADP). Intracellular calcium is important for mobilization of secretory granules to the plasma membrane in preparation for exocytosis. NAADP mobilizes calcium from lysosome-related acidic compartments and it has recently...

ea0025p252 | Pituitary | SFEBES2011

An uncommon cause of panhypopituitarism

Srinivas-Shankar Upendram , Bujawansa Sumudu , Leonard Niamh , Clark Peter , Syndikus Isabel , Forsyth Leigh , Hickey Sian

Introduction: Langerhans’ Cell Histiocytosis (LCH) is a rare disease, more common in children than in adults, resulting from aberrant proliferation of Langerhans’ cells, belonging to the monocyte–macrophage system.Case history: We present the case report of a 40-year-old man with a 16-year history of polyuria, polydipsia and tiredness. For 10 years he had perianal, groin, abdomen and scalp scarring, hyperpigementation along with follicles ...

ea0025p253 | Pituitary | SFEBES2011

Associations of overall GH and IGF1 exposure with ischaemic heart disease and cardiomyopathy in patients with treated acromegaly

Clarke Holly , Jayasena Channa , Comninos Alexander , Donaldson Mandy , Meeran Karim , Dhillo Waljit

Background: Patients with acromegaly require lifetime monitoring due to the excess mortality and morbidity associated with untreated disease, and the propensity for disease relapse following treatment. There is controversy whether GH or insulin-like growth factor 1 (IGF1), better predicts the onset of cardiovascular complications such as cardiomyopathy and ischaemic heart disease (IHD) in acromegalic patients.Aim: To examine associations of overall GH an...

ea0025p254 | Pituitary | SFEBES2011

Overall GH exposure is raised in acromegalic patients with type 2 diabetes and impaired glucose tolerance, when compared with euglycaemic acromegalic patients

Clarke Holly , Jayasena Channa , Comninos Alexander , Donaldson Mandy , Meeran Karim , Dhillo Waljit

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

ea0025p255 | Pituitary | SFEBES2011

Morphological analysis of lactotrophs in pregnant and lactating mice

Lockey Joe , Morris John , Christian Helen

Recent studies have demonstrated that rather than being a collection of heterogeneously dispersed cells, the pituitary gland is wired by multiple and specific endocrine cell networks to synchronise hormone release. Prolactin (PRL) is primarily important for lactation. In response to changing physiological demands during pregnancy and lactation the pituitary has the ability to expand and contract its cell number. We have investigated changes in lactotroph morphology and cell-to...

ea0025p256 | Pituitary | SFEBES2011

Hypertrophic pachymeningitis and pituitary pathology: lymphocyctic hypophysitis or cabergoline related fibrosis?

Raghavan Rajeev , Mallam Elizabeth , Scolding Neil , Bradley Karin

Case history: A 51-year-old lady with a background of classical migraine and amenorrhoea conceived successfully via IVF, without prior endocrine assessment. Symptoms during the third trimester of pregnancy led to the diagnosis of a pituitary mass lesion (see Table). Possible differential diagnoses, on subsequent endocrine review, included macroprolactinoma, microprolactinoma with expansion during pregnancy, or lymphocytic hypophysitis.After 6 years of do...

ea0025p257 | Pituitary | SFEBES2011

Thyroid function in patients with pituitary disease: difficulties of individualisation

El-Laboudi Ahmed , Lynch Julie , Baxter Paul , Barth Julian , Murray Robert

Introduction: Identification and treatment of central hypothyroidism in hypopituitarism is crucial particularly in patients with significant lethargy under consideration for GH replacement. Early Identification of TSH deficiency can be challenging particularly when both the TSH and fT4 lie within the normal range.Methods: 26 362 TFTs derived from ambulatory community dwelling individuals represented the control group. TFTs from 227 patients wi...

ea0025p258 | Pituitary | SFEBES2011

An unusual presentation of thyrotroph adenoma

Raghavan Rajeev , Plaha Puneet , Nelson Richard , Lightman Stafford , Levy Andrew

Background and case: A 38-year-old man presented acutely with left-sided retro-orbital pain, a heavy/numb sensation in his left arm and blurred vision and diplopia on left lateral gaze. Baseline biochemistry, liver function and haematology were normal. His TSH was 3.9 (0.3–4 mU/l) and CRP 92 mg/l (<10). Plain CT head was unremarkable as was the MRI as reported, and atypical migraine was suspected. Vertical diplopia on left lateral gaze and left upper arm paraesthesia ...

ea0025p259 | Pituitary | SFEBES2011

Wide range of eye abnormalities in patients with hypopituitarism; implications for diagnosis and treatment

Alatzoglou Kyriaki S , Kelberman Daniel , Spadoni Emanuella , Gaston-Massuet Carles , Woods Kathrine , Maghnie Mohamad , Bitner-Glindzicz Maria , Dattani Mehul T

Background and aim: The development of the pituitary gland is closely linked to this of the eyes and forebrain, as they all originate from the same embryonic origin, the anterior neural ridge. The constellation of symptoms leading to septo-optic dysplasia (SOD) is well established; other ophthalmic signs may be under-reported. The aim of the study was to define if patients with hypopituitarism present with eye abnormalities, which are distinct from SOD, and if this association...

ea0025p260 | Pituitary | SFEBES2011

Abstract withdrawn....

ea0025p261 | Pituitary | SFEBES2011

Lymphocytic hypophysitis–extrapancreatic manifestation of autoimmune pancreatitis

Suresh Damodharan , Conway Gerard

Background: Auto-immune pancreatitis (AIP) is a rare chronic inflammatory disease, characterised by raised serum levels of IgG4, which may mimic pancreaticobiliary malignancy, and is noted to have an IgG4-positive plasma cell infiltrate on pancreatic histology. Extrahepatic manifestations in liver, kidneys, and retroperitoneum, are increasingly recognised.We present a case of extrapancreatic manifestation of AIP in the pituitary gland causing lymphocytic...

ea0025p262 | Pituitary | SFEBES2011

Elusive ectopic ACTH source

Kenz Sami , McGlynn S , Kannappan Daniel , Kearney Tara

Introduction: The ectopic ACTH syndrome accounts for 12% of patients with Cushing’s syndrome. Its diagnosis and treatment remains a challenge. This especially true in patients with ectopic ACTH production.Case: We report the case of a 41-year-old man who presented with progressive muscle weakness in his arms and legs. He was found to be borderline hypertensive BP 145/92, cushingoid plethoric rounded face and mild proximal muscular weakness. His init...