Searchable abstracts of presentations at key conferences in endocrinology
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17th European Congress of Endocrinology

Eposter Presentations

Clinical Cases–Pituitary/Adrenal

ea0037ep1152 | Clinical Cases–Pituitary/Adrenal | ECE2015

A case of TSH secreting pituitary adenoma with Evans' syndrome

Seki Toshiro , Yasuda Atsushi , Kitajima Natsumi , Seki Masami , Oki Masayuki , Takagi Atsushi , Fukagawa Masafumi

Introduction: To the best of our knowledge, there is no case report of Evans’ syndrome associated with TSH secreting pituitary adenoma (TSHoma).Case report: A 30-year-old woman was admitted to near hospital due to purpura and ecchymoses on her limb and body and epistaxis. A hematologic disease was suspected and she was referred to our hospital. The diagnosis of Evans’ syndrome was made on the bases of idiopathic thrombocytopenic purpura (ITP) a...

ea0037ep1153 | Clinical Cases–Pituitary/Adrenal | ECE2015

Recurrent hyponatremia in woman with undiagnosed postpartum pituitary insufficiency

Kurowska Maria , Malicka Joanna , Zwolak Agnieszka , Tarach Jerzy S

Introduction: Hyponatremia occurs in 33–69% of women with postpartum pituitary necrosis. The aim of the study was to present a patient in whom recurrent hyponatremia was one of the dominant symptoms of postpartum anterior pituitary hormones deficiency.A case report: 55-year-old woman with a diagnosis of Sheehan syndrome established 19 years after the last labor complicated by massive bleeding due to uterine atonia. The first symptoms of pituitary in...

ea0037ep1154 | Clinical Cases–Pituitary/Adrenal | ECE2015

A case report of Langerhan cells histiocytosis – the need for a good transition care

Balsa Ana Margarida , Bastos Margarida , Moreno Carolina , Guelho Daniela , Cardoso Luis , Vicente Nuno , Martins Diana , Oliveira Diana , Alves Marcia , Guimaraes Joana , Carrilho Francisco

Introduction: Langerhan Cells Histiocytosis (LCH) is a rare heterogeneous idiopathic clinical entity involving clonal proliferation of Langerhan cells that may infiltrate most commonly bone, skin, lymph nodes or lungs. It affects mainly children between 5 and 15 years. The most common endocrine manifestation is diabetes insipida.Clinical case: The authors describe a case of a 19-year-old female patient, admitted in the Transition Follow-up of the Endocri...

ea0037ep1155 | Clinical Cases–Pituitary/Adrenal | ECE2015

Case report: adrenal phaeochromocytoma presenting with ileus, renal vein thrombosis and pulmonary embolism

Lai Ray , Lee Daphne , Liew Huiling , Quek Timothy Peng Lim , Seow Cherng Jye

Introduction: We report a patient who presented with presumed intestinal obstruction, and was subsequently diagnosed with an adrenal phaeochromocytoma associated with venous thromboembolism. We review the literature and discuss underlying mechanisms for these uncommon manifestations.Case presentation: A 56-year-old man with background untreated hypertension presented with abdominal distension, vomiting, breathlessness and haemoptysis. Heart rate (HR) was...

ea0037ep1156 | Clinical Cases–Pituitary/Adrenal | ECE2015

Phaeochromocytoma and hypoglycaemic fits: a case report

Folling Ivar , Olsen Anne Lise , Nermoen Ingrid , Thorsby Per Medboe

Introduction: Phaeochromocytomas often induce hyperglycaemia. Few cases are reported with hypoglycaemic fits. The mechanism is unknown. Our findings may indicate a mechanism.The patient: A 37 year old female had a phaeochromocytoma, with typical characteristics: attacks of headache, nausea and sweating. High blood pressures, up to 237/134. Electrocardiogram indicated ischemia, normal coronary arteries on dynamic CT, normal Echo-Doppler heart examination....

ea0037ep1157 | Clinical Cases–Pituitary/Adrenal | ECE2015

An uncommon complication of post trans-sphenoidal surgery for pituitary adenoma

Tan Hiang Leng , John Kurien

Introduction: The commonest complications post trans-sphenoidal surgery is diabetes insipidus and the development of anterior pituitary hormone deficiencies. Other complications include meningitis, CSF leak, visual deterioration, haemorrhages and transient hyponatremia. We present a case of pituitary abscess 6 months post pituitary surgery who presented with viral meningitis and panhypopituitarism.Case report: A 55-year-old lady presented with a 3 weeks ...

ea0037ep1158 | Clinical Cases–Pituitary/Adrenal | ECE2015

Polyglandular autoimmune syndrome type 2 (Schmidt's syndrome)

Qari Faiza

A 58-year-old Saudi female presented with fatigue, dizziness and generalised skin hyper-pigmentation. She was diagnosed as Hashimoto’s hypothyroidism. She was diagnosed recently to be diabetic and her blood sugar was controlled with insulin. She reached menopause at the age of 36 years. Lab resultsPatient<td ali...

ea0037ep1159 | Clinical Cases–Pituitary/Adrenal | ECE2015

Sellar plasmacytoma masquerading as pituitary macroadenoma – a case report

Rajic Antonela Sabati , Skerget Matevz , Gomezelj Sarah

A 49-year-old male presenting with acute onset strabismus on left lateral gaze was admitted to the Endocrinology Department. The CT scan showed a 35×40×25 mm tumor mass, presumed to be a pituitary macroadenoma, in the sellar region which extended into the sphenoidal sinus, clivus, posterior ethmoidal cells, petrous part of the temporal bone and towards the nasopharynx. A MR scan of the head also revealed that the mass displaced the anterior pituitary gland and the in...

ea0037ep1160 | Clinical Cases–Pituitary/Adrenal | ECE2015

Pituitary apoplexy case caused by Hanta virus ınfection

Ayturk Semra , Genc Ahmet Bilal , Yaylaci Selcuk , Karabay Oguz , Tamer Ali , Celik Mehmet

Pituitary apoplexy (PA) is a rare but life-threatening medical emergency. Common predisposing factors include closed head trauma, blood pressure alterations, history of pituitary irradiation, cardiac surgery, anticoagulation, treatment with dopamine agonists, pituitary stimulation testing, and pregnancy. Hantaviruses belonging to the Bunyaviridae family are a group of rodent- or insectivore-borne single-strand ribonucleic acid (RNA) viruses. In humans, hantaviruses can cause h...

ea0037ep1161 | Clinical Cases–Pituitary/Adrenal | ECE2015

Pasireotide - the last treatment option in Cushing's disease - case report

Galesanu Corina , Condrea Adrian , Niculescu Dan , Florescu Alexandru , Buzduga Catalin , Moisii Liliana , Ciubotaru Vasile

Introduction: The most common cause of Cushing’s disease is ACTH secreting tumours of the pituitary gland. It is associated with high morbidity and mortality. Pasireotide, a potential therapy, has a unique, broad somatostatin-receptor–binding profile, with high binding affinity for somatostatin-receptor subtype 5.Case report: We present the a 40-years-old man diagnosed in 2005 with Cushing’s Disease for which a left adrenalectomy was perfo...

ea0037ep1162 | Clinical Cases–Pituitary/Adrenal | ECE2015

Lump it or leave it & bilateral adrenal macronodular hyperplasia: Case report and clinical insights

Lau Namson S , Manzoor Nadia

Clinical case MG was a 57-year-old female when first referred to endocrinology for investigation of adrenal incidentaloma. Relevant medical history included poorly controlled hypertension on two agents, dyslipidaemia and history of minimal trauma fracture. Baseline labs (including 24 h urine collection) were unremarkable as was clinical examination (exception hypertension). Cortisol levels on two 1 mg Dexamethasone suppression tests failed to suppress. Dedicated CT adrenal stu...

ea0037ep1163 | Clinical Cases–Pituitary/Adrenal | ECE2015

Clinical nonsecreting pituitary macroadenoma managed by cabergoline: anybody, anytime?

Arhire Amalia Ioana , Pascu Elena Iuliana , Fica Simona , Barbu Carmen Gabiela

Introduction: Therapeutic management of clinical nonsecreting pituitary adenomas with ophthalmological manifestations is certainly limited to surgery unless IHC from previous intervention could bring up new data.Case report: A 16-year-old patient was admitted in February 2014 in our Endocrinology Department for short stature (−3.5 S.D.), in the context of an iatrogenic pituitary insufficiency. 7 months before, he had been diagnosed w...

ea0037ep1164 | Clinical Cases–Pituitary/Adrenal | ECE2015

Catecholamine-induced cardiomyopathy: pitfalls in diagnosis and management

Mamoojee Yaasir , Artham Satish , Elsaify Wael , Nag Sath

Introduction: Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic workup and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms of catecholamine excess and all patients were well established on beta-blockers on presentation. All three patients had an adren...

ea0037ep1165 | Clinical Cases–Pituitary/Adrenal | ECE2015

Histiocytosis, a rare cause of hypopituitarism. Langerhans cell histiocytosis and Erdheim–Chester disease, two case reports of pituitary deficiency

Hana Vaclav Kosak Mikulas , Hana Vaclav

Introduction: Langerhans cell histiocytosis (LCH) is a rare disease with incidence of 1–2 adults per milion/year. Pituitary function is affected in 30% of cases presenting almost always with diabetes insipidus. Other deficiencies such as GH, FSH+LH, TSH and ACTH follow. Erdheim–Chester disease is a rare Non-LCH described in several hundreds of cases in the world so far, with the pituitary function involvement in similar frequency as in LCH.Case...

ea0037ep1166 | Clinical Cases–Pituitary/Adrenal | ECE2015

A rare case of primary empty sella syndrome and growth hormone excess in a patient with neurofibromatosis type 1

Iuliana Pascu Elena , Mihaela Epure , Ioana Arhire Amalia , Sorina Martin , Simona Fica

Introduction: Neurofibromatosis type 1 (NF1) is the most common type of NF, and accounts for about 90% of all cases. Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the pituitary fossa. Since it has been demonstrated that the small anterior pituitary size reflects loss of neurofibromin expression in the hypothalamus, leading to reduced GHRH, pituitary GH and IGF1 production, we agree that IGF1 and GH increased in our patient can be challengin...

ea0037ep1167 | Clinical Cases–Pituitary/Adrenal | ECE2015

Gonadotrophin secreting pituitary adenoma with hypersecretion of testosterone and testicular enlargement

Ganguri Murali , Aggarwal Naveen , Jenkins Alistair , Joshi Abhijit , Saysell Colin , James R A

Gonadotroph pituitary adenomas are common but majority of them are classified as non-functional as they do not lead to features of hormonal excess. Functional gonadotroph adenomas are rare and there are only few small series or individual case reports about these.Case report: 45-year-old gentleman presented with headaches, progressive visual failure and complaint of excessive tiredness. He had normal libido and had an 8-year-old child. On examination, he...

ea0037ep1168 | Clinical Cases–Pituitary/Adrenal | ECE2015

Adrenal cevernous hemangioma

Ivovic Miomira , Zivaljevic Vladan , Marina LJiljana , Vujovic Svetlana , Tancic-Gajic Milina , Arizanovic Zorana , Rakovic Dragana , Micic Dragan

Adrenal hemangioma is a rare adrenal tumour usually presented as incidental finding in asymptomatic patients. Due to its radiographic features sometimes it’s difficult to differentiate them from other malignant lesions. We present a 55-years-old men admitted to our department with adrenal incidentaloma size 5×4 cm confirmed by MSCT scan. Active phaeochromocythoma was excluded by normal urinary catecholamines. Endocrine evaluations revealed normal midnight cortisol, w...

ea0037ep1169 | Clinical Cases–Pituitary/Adrenal | ECE2015

Oncocytic adrenal cortical adenoma presenting as Cushing's syndrome: an exceptional clinical entity

Vega Maria Molina , Garach Araceli Munoz , Selfa Silvia Maraver , Perez Ana Gomez , Pareja Isabel Cornejo , Perdigones Cristina Diaz , Doblas Isabel Mancha , Madueno Francisco Tinahones

Introduction: Oncocytomas are tumours composed by oncocytes, cells with granular and eosinophilic cytoplasm filled with mitochondria. It is a neoplasm that can arise in several organs (more commonly described in the kidney, salivary gland and thyroid). Oncocytoma arising in the adrenal gland is a rare finding. Most of them are benign and non-functioning and are detected incidentally. However, functional adrenal oncocytomas presenting as Cushing’s syndrome and phaeochromoc...

ea0037ep1170 | Clinical Cases–Pituitary/Adrenal | ECE2015

Adrenal insufficiency revealing pseudotumorale surrenale tuberculosis

Abderahmane Samir Ait , Bensalah Meriem , Aribi Yamina , Brakni Lila , Ouldkablia Samia , Kemali Zahra

Adrenal tuberculosis was first described by Thomas Addison in 1855, Isolated adrenal tuberculosis is rare and between represents 1–2% of the aetiologies of adrenal masses called expired incidentalomas. We report the case of a related Addison’s disease is a progressive adrenal tuberculosis which could benefit from exploration and a tomography monitoring on anti tuberculosis treatment. Patient aged 35 years presented himself to medical emergency with clinical surgical ...

ea0037ep1171 | Clinical Cases–Pituitary/Adrenal | ECE2015

Three cases of successful pregnancy outcomes after different methods of therapy in women of acromegaly apart from remission of the disease

Molitvoslovova Natalia , Grigoriev Andrey , Trunin Yuri , Oleynik Olga

Reports of pregnancy in acromegalic women are uncommon.Case 1: Patient K., 25-year-old., 01/04/2008 – transsphenoidal adenomectomy in connection with active acromegaly (GH/OGTT – 47.2–64.0–38.0–29.6–28.7 ng/ml; macroadenoma 19×14×12 mm with compression of optic chiasm). Postoperative remission of the disease, recovery of menstrual function without additional therapy. At the end of August 2008 the patient became pre...

ea0037ep1172 | Clinical Cases–Pituitary/Adrenal | ECE2015

An unusual cause of central diabetes insipidus

Kazakou Paraskevi , Vandergheynst Frederic , Couturier Bruno , Dumarey Nicolas , Van Gansbeke Daniel , Pozdzik Agnieszka , Rorive Sandrine , Burniat Agnes

Introduction: In 30–50% of cases central diabetes insipidus (CDI) is idiopathic. Other causes include tumours, pituitary surgery, cranial trauma or infiltrative diseases. Long-term medical follow-up is crucial given that idiopathic CDI can be the earliest sign of an evolving process (inflammatory or tumoural).Case report: We report the case of a 23-year-old woman who presented with isolated polydipsia and polyuria. The diagnosis of isolated CDI was ...

ea0037ep1173 | Clinical Cases–Pituitary/Adrenal | ECE2015

Longest survival with central diabetes insipidus; more than 30 years without and 25 years with desmopressin treatment

Ozdemir Didem , Polat Sefika Burcak , Polat Yunus Halil , Ersoy Reyhan , Cakir Bekir

Introduction: Diabetes insipidus (DI) is a disease characterized by excessive thirst, polydipsia and excess diluted urine caused by insufficiency of antidiuretic hormone or renal resistance to its effect. Although it is generally a benign condition, severe hypernatremia and hypertonicity may cause death if water loss is not compensated.Case report: A 72-years-old man admitted to our clinic for routine control. In medical history, he told that when he was...

ea0037ep1174 | Clinical Cases–Pituitary/Adrenal | ECE2015

Positive MIBG scan in a patient with adrenal failure secondary to lymphoma: a coexistent paraganglioma or false positive involvement?

Ozdemir Didem , Polat Sefika Burcak , Asan Betul , Kilicarslan Aydan , Aksoy Sabire Y , Turkolmez Seyda , Ersoy Reyhan , Cakir Bekir

Introduction: We report stage IV B cell lymphoma in a patient presenting with adrenal failure and an intraabdominal mass which imaging techniques were suggestive for paraganglioma.Case report: A 71-years-old woman admitted to our emergency clinic with severe fatigue and stupor. She was diagnosed to have primary adrenal failure since serum ACTH was 229 pg/ml and cortisol response to 250 μg co-syntropin was 6.17 μg/dl. In abdominal MRI, bilateral...

ea0037ep1175 | Clinical Cases–Pituitary/Adrenal | ECE2015

Synacthen induced phaeochromocytoma crisis, an unusual presentation

Aldibbiat Ali , Ganguri Murali , Bliss RD , James Andy

75 male was referred to endocrine service with incidental pituitary macroadenoma measuring 4.2×3.1×3.3 cm noted on MRI-C-Spine done for ankylosing spondylitis with Atlanto-axial joint instability. He had reduced secondary sexual characteristics and left quadrantanopia. Endocrine studies confirmed thyrotroph and gonadotroph failure but normal lactotroph and HPA axis. He underwent trans-sphenoidal tumour resection followed by external beam radiation due to tumour resid...

ea0037ep1176 | Clinical Cases–Pituitary/Adrenal | ECE2015

Ectopic ACTH-secreting pituitary adenomas located in the sphenoid sinus: an overview

Johnston Philip C , Kennedy Laurence , Weil Robert J , Hamrahian Amir

Background: Ectopic pituitary adenomas are defined by the presence of adenomatous pituitary tissue outside the sella and distinctly separate from the pituitary gland. Ectopic ACTH-secreting pituitary adenomas (EAPAs) are a rare cause of Cushing’s syndrome. Detecting these radiologically can prove difficult, in part, due to their typically small size and unpredictable anatomical location.Aim: We reviewed the current literature on all previously repor...

ea0037ep1177 | Clinical Cases–Pituitary/Adrenal | ECE2015

Cushing's disease and co-existing phaeochromocytoma

Johnston Philip C , Recinos Pablo , Kennedy Laurence , Hamrahian Amir

Clinical presentation: We report a 46 year old female who presented with a 1 year history of bruising, thin skin and weight gain. In addition; she reported flushing of her chest, heat intolerance, palpitations and abdominal pain. On clinical examination she appeared cushingoid, blood pressure was elevated at 160/98 mm/Hg.Investigations: Biochemical investigations indicated ACTH-dependent Cushing syndrome: 24 h UFC 300 μg (0–50), ACTH 119 pg/ml ...

ea0037ep1178 | Clinical Cases–Pituitary/Adrenal | ECE2015

Cushing's disease from an ectopic parasellar adenoma

Johnston Philip C , Kennedy Laurence , Hamrahian Amir H , Weil Robert J

Background: Most cases of Cushing’s disease originate from the pituitary, rarely the source of excess ACTH is from an ectopic pituitary adenoma.Case: A 34-year-old woman had a 12-month history of a labile mood, weight gain, easy bruising, irregular menses and hypertension, she appeared cushingoid. Biochemical investigations demonstrated hypercortisolism: 24 h urine-free cortisol 520.7 μg (4–50), ACTH 152 pg/ml (8–42); midnight salivar...

ea0037ep1179 | Clinical Cases–Pituitary/Adrenal | ECE2015

Two cases of observation of teenagers after prostatectomy volume transnasal pituitary education followed by recombinant growth hormone therapy Dzhintropinom (Eurofarm)

Shakirova Mukhlisa , Urmanova Yulduz , Babakhodgaeva Shakhlo

Purpose: To examine two cases of teenagers after transnasal removal of pituitary volume of education followed by recombinant growth hormone therapy Dzhintropinom (Eurofarm).Materials and methods: During the period of 2014 in the department of paediatric endocrinology and neuroendocrinology RSNPM Endocrinology Center MoH (Tashkent), we examined two male patients, including the patient F., 2.5 g of a craniopharyngioma, and the second patient For 15 years w...

ea0037ep1180 | Clinical Cases–Pituitary/Adrenal | ECE2015

The case of a combination of pituitary hypoplasia and achondroplasia have a child (boy 6 years old)

Khodgaeva Feruza , Urmanova Yulduz , Babakhodgaeva Shakhlo , Rikhsieva Nazira

Purpose: To describe the case of a combination of pituitary hypoplasia and achondroplasia have a child (boy).Material and methods: Under our outpatient observation is a boy Abdulahatov S., born in 2008, lives in Samarkand. From history: The child was born in the closely related parents’ marriage (sisters’ children). Height at birth 50 cm, weight 3000 g, cried and took the breast immediately. Psycho-motor development – late. Constantly unde...

ea0037ep1181 | Clinical Cases–Pituitary/Adrenal | ECE2015

Atypical teratoid rhabdoid tumor as a form of presentation of pituitary apoplexy

Ojeda-Schuldt Maria Belen , Larran-Escandon Laura , Mateo-Gavira Isabel , Vilchez-Lopez Francisco Javier , Gavilan-Villarejo Inmaculada , Aguilar-Diosdado Manuel

Introduction: Even though pituitary apoplexy usually occurs in the context of a pituitary adenoma, it can also occur over other tumours, which is less common in adulthood and has faster growth and aggressiveness. It can also produce clinical, analytical and even radiological indications that are indistinguishable from a pituitary adenoma with ischemic and/or haemorrhagic events.Case report: A 43-year-old female, with no medical history of interest except...

ea0037ep1182 | Clinical Cases–Pituitary/Adrenal | ECE2015

17 α hydroxylase enzyme deficiency with hyperaldosteronism

Kartal Ilkay , Tamer Gonca Incemehmet , Mutlu Hasan Huseyin

Background: Congenital adrenal hyperplasia (CAH) resulting from 17 α hyroxylase enzyme deficiency (17OHD) is a rare autosomal recessive disorder. More than 150 cases were reported in the literature. Patients with 17OHD were reported to have hypoaldosteronism.Case: A 16-year-old female referred to endocrinology outpatient clinic from family medicine department with the absence of a secondary sexual characteristics and primary amenorrhea. On physical ...

ea0037ep1183 | Clinical Cases–Pituitary/Adrenal | ECE2015

Laryngeal carcinoma in acromegalic patients: a rare case

Akkus Gamze , Evran Mehtap , Sert Murat , Tetiker Tamer

Introduction: Acromegaly is a very rare disease with persistent GH secretion due to excessive release of liver IGF1. The risk of malignancy, particularly colon cancer, is increased in acromegalic patients. But no evidence is found in the literature associated increasing of laryngeal carcinoma in acromegalic patients. We aimed to present this case that laryngeal carcinoma should be considered in acromegaly by the clinicians.Case report: A 51-year-old male...

ea0037ep1184 | Clinical Cases–Pituitary/Adrenal | ECE2015

Psychotropic medication – endocrine consequences

Taujan Georgiana Cristina , Paun Diana Loreta , Nistor Mihaela , Dumitru Alina Maria , Dragomir Adina Simona , Dumitrache Constantin

Given the increasing incidence in psychiatric pathology, adverse reactions of psychotropic medications, especially the metabolic and endocrine side effects, are encountered more frequently in clinical practice. We present the cases of two female patients with psychiatric pathology, in whom the specific treatment was accompanied by significant endocrine adverse reactions, making the tumoural differential diagnosis very difficult. The first case is of a patient aged 61 years, kn...

ea0037ep1185 | Clinical Cases–Pituitary/Adrenal | ECE2015

Acromegaly due to McCune-Albright syndrome

Borodich Tatiana , Dzeranova Larisa , Pigarova Ekaterina , Belaya Zhanna , Przhiyalkovskaya Elena , Kutin Maxim , Vorontsov Alexander , Vladimirova Victoria , Averkieva Elena , Rozhinskaya Liudmila

A 27-year-old male patient during past 10 years noted a gradual change in his appearance, but began to seek a medical attention only 1.5 years ago due to reduced vision. Hormonal tests from March 2013 revealed marked elevation of GH to 106 mIU/ln (ref. values <20), and IGF1 to 567 ng/ml (121–336), decrease in testosterone levels to 1.91 ng/ml (3–12), with cortisol, LH, FSH, PRL, TSH values within the reference range; MRI of the brain showed a 4×7 mm adenoma ...

ea0037ep1186 | Clinical Cases–Pituitary/Adrenal | ECE2015

Spontaneous pneumocephalus associated with a giant craniopharyngioma

Daraki Vasiliki , Papadaki Efrosini , Zampoulakis Nikos , Mamalaki Evangelia , Kalikakis George , Papavasiliou Stathis

Introduction: Pneumocephalus is defined as the presence of air within the cranial cavity. It is usually associated with neurosurgical procedures but can also be caused by craniofacial trauma, infections and tumours of the skull base and rarely can occur spontaneously. Neoplasms involving the pituitary fossa are unusual causes of spontaneous pneumocephalus.Case report: A 39-year-old man presented in the emergency department with significant visual loss, h...

ea0037ep1187 | Clinical Cases–Pituitary/Adrenal | ECE2015

Late diagnosis, early response - or the story of a smile

Novac Roxana , Rosu Nicoleta

We present the case of a 33-year-old male who addresses an endocrinology service for the first time in May 2014 for marked asthenia, drowsiness, muscular aches, and a delay in growing. The physiological exam showed difficulties in communicating and relation with the others based on his own negative image of himself, lack of self- trust, auto-isolation tendency, state of depression. We raised the suspicion of a panhypopitutarism confirmed by the lab exams that describe a somato...

ea0037ep1188 | Clinical Cases–Pituitary/Adrenal | ECE2015

Ipilimumab-induced hypophysitis in cancer patients

Lafuente Christian , Arcano Karina , Guerrero Fernando , Marengo A , Peiro I , Soria Ainara , Diez Juan Jose , Villabona Carlos , Iglesias Pedro

Context: Ipilimumab is a human monoclonal antibody against cytotoxic T lymphocyte antigen-4 (CTLA-4), which enhances stimulation of cytotoxic T lymphocytes, resulting in an immune response against the tumour. This drug-induced hyperactivity of the immune system can lead to serious adverse effects including endocrine disorders such as autoimmune hypophysitis, thyroiditis and adrenal insufficiency.Objective: To report our experience on ipilimumab-induced h...

ea0037ep1190 | Clinical Cases–Pituitary/Adrenal | ECE2015

A case report of two sibling with untreated congenital adrenal hyperplasia

Karbek Basak , Eraydin Ayten , Ozbag Ozcan , Ozkaya Mesut

Introduction: The term congenital adrenal hyperplasia (CAH) encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. Deficiency of 21-hydroxylase, resulting from mutations or deletions of CYP21A, is the most common form of CAH, accounting for more than 90% of cases.Case report: Two female siblings were referred to endocrine clinic with the complain ...

ea0037ep1191 | Clinical Cases–Pituitary/Adrenal | ECE2015

Phaeochromocytoma and Cushing syndrome: a rare association

Cherifa Abdelkefi , Emna Haouat , Hajer Kandara , Nadia Hbaili , Leila Ben Salem Hachmi , Claude Ben Slama

Introduction: Phaeochromocytoma and Cushing syndrome are two uncommon endocrine conditions. The association of these two conditions is very rare and not well elucidated. We report an association of a phaeochromocytoma with an ACTH-dependant Cushing syndrome.Case report: A 32-years-old female patient was admitted in the endocrine department for paroxysmal hypertension diagnosed in the immediate post partum period. She reported sweating and palpitation cri...

ea0037ep1192 | Clinical Cases–Pituitary/Adrenal | ECE2015

Coexistence of ovary tumour, congenital adrenal hyperplasia and triple translocation involving chromosome 9,11 and 12: Initial steps of defining new syndrome?

Akbulut Sami , Durmaz Senay Arikan , Tuncali Timur , Sogutcu Nilgun

Introduction and aim: Congenital adrenal hyperplasia (CAH) is rare autosomal recessive disease. CAH due to 21-hydroxylase deficiency accounts for 95% of cases. We aim to define in this report 59-year-old woman with simple virilizing type CAH who diagnosed granulosa cell tumour and I172N mutation in the CYP21A as well as triple translocation involving chromosome 9p, 11p and 12p at first time in the literature.Case report: A 59-year-old woman was applied t...

ea0037ep1193 | Clinical Cases–Pituitary/Adrenal | ECE2015

Case report: an acromegalic patient presented with dysphagia

Gokosmanoglu Feyzi , Bahadir Cigdem Tura , Kan Elif Kilic , Atmaca Aysegul

Introduction: Acromegaly is a chronic disease characterized by prognatism, frontal bossing, coarsened facial features, enlarged hands and feet due to overproduction of growth hormone (GH) generally by a pituitary adenoma. Here, we aimed to present an acromegalic patient presented with retropharyngeal hypertrophy first time in the literature.Case report: 65-year-old female patient had been referred to our department from otorhinolaryngology outpatient-cli...

ea0037ep1194 | Clinical Cases–Pituitary/Adrenal | ECE2015

A rare case of adrenal histoplasmosis presenting as adrenal insufficiency and hypogonadism following a visit to bat caves

Mlawa Gideon , Deore Mahesh , Nageshwaran Saiji

Background: Histoplasmosis is an opportunistic fungal infection that commonly affects immunocompromised individuals. Histoplasmosis may be asymptomatic or may present with progressive systemic manifestations (pulmonary or disseminated). We present a case of a 76 year old immunocompetent man presented to hospital with 8 weeks history of general malaise and lethargy, intermittent night sweats, a productive cough, weight loss of 2.5 stones in two months and low grade fever. He ha...

ea0037ep1195 | Clinical Cases–Pituitary/Adrenal | ECE2015

Differential diagnosis of low renin hypertension – pseudohypoaldosteronism type 2

Kalere Ieva , Tonne Ieva , Lejnieks Aivars , Konrade Ilze

Introduction: Pseudohypoaldosteronism type 2 (PHA2), also known as Gordon syndrome is a rare inherited form of low-renin hypertension associated with hyperkalaemia and hyperchloremic metabolic acidosis in patients with a normal glomerular filtration rate (GFR). PHA2 is the result of mutations in a family of serine-threonine kinases called with-no-lysine kinases (WNK) 1 and WNK4. These enzymes regulate electron channels in the aldosterone sensitive distal nephron, resulting in ...

ea0037ep1196 | Clinical Cases–Pituitary/Adrenal | ECE2015

The hidden liquorice: apparent mineralocorticoid excess caused by inadvertent exposure to liquorice root extract

Main Ailsa Maria , Feldt-Rasmussen Ulla

Introduction: Excessive consumption of liquorice can cause endocrine symptoms of apparent mineralocorticoid excess (AME). This is usually caused by excessive consumption of liquorice-containing sweets and native liquorice root but the different chemical compounds in liquorice may also be used in many other products where it is considered an additive and therefore not explicitly declared.Case: We here report a 21-year-old patient who exhibited severe symp...

ea0037ep1197 | Clinical Cases–Pituitary/Adrenal | ECE2015

From erectile dysfunction to brain subependymoma: a case report

Bacun Tatjana , Kibel Aleksandar , Degmecic Dunja , Zibar Karin , Pavic Roman

Introduction: Endocrinopathies are rare causes of erectile dysfunction and previously cases of hyperprolactinaemia and pituitary adenomas have been reported.Case report: We present the clinical case of a 27-year old male, married for 4 years with no children, presented with possible infertility and erectile dysfunction which was previously interpreted as caused by a poor social and psychological situation in the family. After additional endocrinological ...

ea0037ep1198 | Clinical Cases–Pituitary/Adrenal | ECE2015

Intestinal obstruction and bowel perforation as a presenting feature of a phaeochromocytoma

Olaizola Izaskun , Elias Estela , Chacon Ana Maria , Bilbao Ismene , Egana Nerea , Garcia Cristina , Aranburu Maite , Matteucci Tomas , Yoldi Alfredo , Goena Miguel

Introduction: Phaeocromocytomas are a rare catecholamine secreting tumours that can present in multiple ways. The classic triad of symptoms consists of episodic headache, sweating, and tachycardia. Most patients do not have the three classic symptoms. Sustained or paroxysmal hypertension is the most common sign. Among less common symptoms and signs constipation has been described and few cases of megacolon and phaeochromocytoma have been published.Case r...

ea0037ep1199 | Clinical Cases–Pituitary/Adrenal | ECE2015

Spontaneous resolution of bilateral avascular necrosis of the femoral head following cure of Cushing's syndrome secondary to primary pigmented micronodular adrenal disease

Pazderska Agnieszka , Crowther Stephen , Govender Pradeep , Conlon Kevin C , Gibney James , Sherlock Mark

Avascular necrosis is a rare presenting feature of endogenous hypercortisolism. The literature suggests that, if left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of described patients with avascular necrosis due to endogenous hypercortisolaemia were treated surgically.Case report: A 36-year-old female, investigated for right leg pain, reported rapid weight gain, easy bru...

ea0037ep1200 | Clinical Cases–Pituitary/Adrenal | ECE2015

New onset Graves' disease as a cause of an adrenal crisis in an unrecognised empty sella

Marmouch Hela , Slim Tasnim , Boubaker Fadia , Arfa Sondes , Sayadi Hanene , Jmal Manel , Khochtali Ines

Introduction: A 66-year-old woman was admitted as an emergency with vomiting, hypotension and serum cortisol of 0.92 microg/dl indicative of adrenal failure. She was found to be hyperthyroid (fT4=72 pmol/l).Case report: She had hypotension (blood pressure 80/40 mm/Hg) She was fit and well till the age of 65. Endocrine assessment revealed deficiency in ACTH-cortisol, growth hormone, and gonadotropin, as well as low-normal fT4. On the...

ea0037ep1201 | Clinical Cases–Pituitary/Adrenal | ECE2015

Klinefelter syndrome with portal vein aneurysm: case report

Sari Isilay Kalan , Cosar Ramazan , Yilmaz Sevda , Demirci Huseyin

Introduction: Klinefelter syndrome (KS) is the most common chromosomal disorder characterized by clinical features of hypogonadism and infertility. Portal vein aneurysms are very rare clinic findings. Reported cases are increasing due to use of modern imaging techniques in clinic practise.Case report: 19-year-old man was admitted to our hospital with complaints of abdominal pain, nausea, and vomiting associated with eating. He was recently diagnosed with...

ea0037ep1202 | Clinical Cases–Pituitary/Adrenal | ECE2015

Exaggerated cortisol response in heterozygous carriers with a mutation in the melanocortin-2 receptor (MC2R) gene

Kyithar Ma Pyeh , Green Andrew , Hughes Claire , Murphy Nuala , Byrne Maria

Introduction: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disease characterised by ACTH resistance and isolated glucocorticoid deficiency. Mutations of ACTH receptor, known as melanocortin-2 receptor (MC2R), and melanocortin-2 receptor accessory protein (MRAP) account for approximately 25 and 15 to 20% of cases respectively. To date there is no strong evidence that heterozygous carriers have abnormal cortisol secretion.Case: We...

ea0037ep1203 | Clinical Cases–Pituitary/Adrenal | ECE2015

Pituitary enlargement in pregnancy presenting with visual field defects and interesting imaging

Yap Hsiu Lye , Moriarty Maura , Mills Edouard , Pokrajac Ana , Galliford Thomas

We report a rare case of a patient presenting with headaches and almost complete bilateral hemianopia during her third trimester of pregnancy. This lady presented with headaches and vomiting 2 years prior, with a pituitary MRI initially reporting an acute pituitary haemorrhage. This time, due to progression of her visual field defects, it was decided in a multidisciplinary meeting to perform a Caesarean section at 37 weeks and start Cabergoline post-operatively, as the patient...

ea0037ep1204 | Clinical Cases–Pituitary/Adrenal | ECE2015

Familial SDHC mutation associated with prolactin/gh-secreting pituitary adenoma and paraganglioma

Barigou Mohammed , Buffet Alexandre , Bennet Antoine , Pigny Pascal , Bellec Laurent , Caron Philippe , Vezzosi Delphine

Introduction: SDH genes mutations are associated with hereditary phaeochromocytoma and paraganglioma syndromes. We describe the case of a patient with SDHC related familial paraganglioma and pituitary adenoma.Case: A 65-year old man consulted for an incidentally discovered 7 cm abdominal mass on CT-scan, lateral to the right kidney, invading inferior vena cava, associated to a retroperitoneal adenomegaly and a lesion on the body of L2 vertebra with spina...

ea0037ep1205 | Clinical Cases–Pituitary/Adrenal | ECE2015

Bilaterally slipped capital femoral epiphysis in growth hormone–deficient patient: osteosynthesis also needs the oestrogen epiphyseal fusion- case report

Tesic Dragan , Mitrovic Milena , Vlaski Jovan , Damjanovic Svetozar , Popovic Vera

Introduction: Growth without growth hormone is seen also in patient with craniopharyngioma. We just speculate what anabolic factors might be involved in this process. However, oestrogen through its receptors lead to epiphyseal fusion. In this case report we would like to present the patient with bilateral slipped femoral epiphysis (SFE) and interventions made at tertiary health care level.Case report: 20-years-old female, operated from craniopharyngioma ...

ea0037ep1206 | Clinical Cases–Pituitary/Adrenal | ECE2015

Effectiveness of octoreotide administration before surgery for GH-TSH co-secreting pituitary adenoma with thyrotoxicosis: a case report

Kimura Shihori , Isozaki Osamu , Fukuda Izumi , Morimoto Satoshi , Seki Yasufumi , Yamashita Kaoru , Takano Noriyoshi , Otsuki Akiko , Kaneshige Terumi , Bokuda Kanako , Watanabe Daisuke , Ando Takashi , Hizuka Naomi , Amano Kosaku , Komori Takashi , Okada Yoshikazu , Ichihara Atsuhiro

Introduction: TSH-secreting pituitary adenoma (TSHoma) sometimes brings on rare cause of hyperthyroidism because of its excessive TSH secretion. Though the first line of treatment for TSHoma is surgical removal of tumour, hyperthyroidism often causes perioperative thyroid storm. Here, we report a case of GH-TSH pituitary adenoma whose thyrotoxicosis was controlled by 5 days’ octoreotide (OCT) subcutaneous administration before surgery.Case report: A...

ea0037ep1207 | Clinical Cases–Pituitary/Adrenal | ECE2015

Cushing's syndrome secondary to aberrant hormone receptors in a patient with macronodular adrenal hyperplasia ACTH-independent

Vega Maria Molina , Medina Jose Antonio Lopez , Garach Araceli Munoz , Pareja Isabel Cornejo , Perdigones Cristina Diaz , Perez Ana Gomez , Madueno Francisco Tinahones

Introduction: Cushing’s syndrome (CS) due to macronodular adrenal hyperplasia ACTH-independent (MAHAI) is rare. Regulation of cortisol secretion by G-protein-coupled receptors (GPCRs) aberrantly expressed is frequently found in MAHAI. Various aberrant receptors have been reported, mostly: GIP, vasopressin, beta-adrenergic, LH/hCG and serotonin.Case report: 61 years old woman. Medical history: type 2 diabetes, hypertension, obesity, dyslipidaemia and...

ea0037ep1208 | Clinical Cases–Pituitary/Adrenal | ECE2015

Complicated investigation of adrenal incidentaloma in a critically ill patient – a case study

Kratochvilova Simona , Wohl Petr , Hoskova Lenka , Kettner Jiri , Vrbska Jana , Kudla Michal , Brunova Jana

Adrenal incidentaloma is frequently encountered in endocrinological praxis, however in specific situations the proper investigation is almost impossible. A 60-years old patient was admitted to our intensive care unit with a myocardial infarction in cardiogenic shock requiring ionotropic support and intraaortic balloon counterpulsation. On account of ejection fraction 15–20% an urgent pretransplantation investigation was started. Abdominal ultrasound displayed a hypoechoge...

ea0037ep1209 | Clinical Cases–Pituitary/Adrenal | ECE2015

An underactive hypothalamo-pituitary-adrenal axis in a shift worker with chronic fatigue syndrome

Marina Ljiljana , Vujovic Svetlana , Ivovic Miomira , Tancic-Gajic Milina , Arizanovic Zorana , Rakovic Dragana , Zarkovic Milos , Lalic Tijana , Nikolic-Djurovic Marina , Jemuovic Zvezdana , Micic Dragan

Introduction: Chronic fatigue syndrome is characterised by a state of chronic fatigue that persists for more than 6 months and has no clear cause.Case report: A 38-year-old male was referred to our Clinic due to chronic fatigue, unrefreshing sleep, substantial impairment in concentration, headaches and postexertional malaise lasting from 6 to 9 months for 9 years. As a mechanical engineer he was working in shifts 12 h day/24 h break/12 h night/72 h break...

ea0037ep1210 | Clinical Cases–Pituitary/Adrenal | ECE2015

A case of pleomorphic adenoma and acromegaly: a coincidence or a pathophysiological association?

Topaloglu Oya , Polat Sefika Burcak , Ozturk Cemaleddin , Bavbek Murat , Muderris Togay , Ersoy Reyhan , Cakir Bekir

Introduction: Acromegaly is a chronic disease caused by excessive secretion of growth hormone (GH), and as a result, of insulin-like growth factor-1 (IGF1). Although controversial, frequency of both benign and malignant neoplasm formation is thought to be increased in acromegalic patients. Pleomorphic adenoma is the most common arising tumour from the parotid salivary gland. Here we report the case of a 33-year-old woman with acromegaly and also who presented with a swelling o...

ea0037ep1211 | Clinical Cases–Pituitary/Adrenal | ECE2015

Primary hyperaldosteronism: case presentation

Petris Rodica , Dumitrache Constantin , Paun Sorin , Poiana Catalina , Ganescu Roxana , Carsote Mara , Paun Diana

Introduction: We should consider testing for primary aldosteronism in the presence of hypertension and hypokalaemia, resistant hypertension, onset of hypertension at a young age (<20 year), severe hypertension and whenever considering secondary hypertension.Case report: We presented the case of a 38 years old woman who was admitted in the National Institute of Endocrinology C.I. Parhon Bucharest for the evaluation of high blood pressure. She has high...

ea0037ep1212 | Clinical Cases–Pituitary/Adrenal | ECE2015

Hyperprolactinaemia and breast abscess: is there a link?

Rojbi Imen , Haouat Emna , Kandara Hajer , Saada Basma , Hachmi Leila Ben Salem , Slama Claude Ben

Introduction: Hyperprolactinemia is a common endocrine condition causing galactorrhoea. Breast abscess is a frequent complication of the post partum period and breast feeding but it rarely occurs out of these two situations. We report the case of a patient presenting with tumoural hyperprolactinaemia associated with a breast abscess.Case report: A 34 years-old patient presented with galactorrhoea, spaniomenorrhoea and headache for six months. She had not...

ea0037ep1213 | Clinical Cases–Pituitary/Adrenal | ECE2015

5 years complete clinical remission after single adrenalectomy for severe occult ACTH-dependent Cushing's syndrome

Grigorie Daniel , Caragheorgheopol Andra , Hortopan Dan , Sucaliuc Alina

Introduction: Complete long-term clinical remission in occult ectopic ACTH syndrome after a single adrenalectomy is unexpected.Case report: 5 year ago, a 54-year-old man was admitted because of resistant HTA, multiple severe vertebral fractures, muscle weakness and cushingoid features of at least 1 year. Adrenal tests were diagnostic of ACTH-dependent Cushing’syndrome: ACTH=263 pg/ml, high plasma (62 μg/dl) and urinary free cortisol (UFC=1256 &...

ea0037ep1214 | Clinical Cases–Pituitary/Adrenal | ECE2015

Aberrant expression of serotonin receptors in an aldosterone- and cortisol-producing adenoma

Lytrivi Maria , Brisbois Denis , Corvilain Bernard , Demetter Pieter , Garcia Camilo , Lucidi Valerio , Moreno-Reyes Rodrigo , Vudu Stella , Duparc Celine , Wils Julien , Lefebvre Herve , Louiset Estelle , Driessens Natacha

Introduction: Aberrant expression of serotonin receptors has been described to be involved in the pathophysiology of both aldosterone-producing and cortisol-producing adrenal adenomas.Case report: A 46-year-old woman was referred for evaluation of severe hypertension associated with hypokalaemia. Primary aldosteronism with concurrent subclinical Cushing’s syndrome was diagnosed. A CT-scan identified a lesion of 4 cm in the right adrenal gland and a ...

ea0037ep1215 | Clinical Cases–Pituitary/Adrenal | ECE2015

‘Idiopathic'- the truly unknown or yet another hiding place for autoimmunity? A case of central diabetes insipidus in a young woman with Hashimoto thyroiditis

Nila Alexandra , Serbanescu Cristina , Epure Mihaela , Betivoiu Minodora , Martin Sorina , Fica Simona

Introduction: Central diabetes insipidus is a rare, chronic disease characterized by polyuria and polydipsia due to a partial or total vasopressin deficiency (hypothalamic – neurohypophysial system damage). The aetiology can be familial (autosomal dominant inheritance, X-linked recessive traits; mutation of the vasopressin – neurophysin II genes), secondary (tumours, infections, infiltrative diseases, trauma, vascular lesions) and idiopathic (10–30%).<p clas...

ea0037ep1216 | Clinical Cases–Pituitary/Adrenal | ECE2015

ARMC5 mutation in a family with Cushing syndrome due to bilateral macronodular adrenal hyperplasia

Rego Teresa , Fonseca Fernando , Agapito Ana , Espiard Stephanie , Perlemoine Karine , Bertherat Jerome

Introduction: Bilateral macronodular adrenal hyperplasia (BMAH) is a rare aetiology of Cushing syndrome. Familial clustering suggests a genetic cause that was recently confirmed, after identification of inactivating germline mutations in armadillo repeat containing 5 (ARMC5) gene.Clinical case: A 70 years old female admitted due to femoral neck fracture in May 2014, presented central obesity, rubeosis and hypertension. Laboratory work up reveale...

ea0037ep1217 | Clinical Cases–Pituitary/Adrenal | ECE2015

Successful pregnancy outcome in recurrent phaeochromocytoma: a clinical case report

Praneviciene Evelina , Zilaitiene Birute , Barsiene Lina , Radzeviciene Lina , Birzietis Tomas , Verkauskiene Rasa

Introduction: Phaeochromocytoma in pregnancy is very rare and potentially dangerous situation for mother and foetus. Failure to diagnose this condition or suboptimal management can be disastrous for mother and/or foetus, because of raised catecholamine levels.Case: A 22-year-old pregnant woman (8 weeks’ gestation) with hypertension and a suspected recurrence of phaeochromocytoma was referred to the Endocrinology Department in March 2014. The pregnan...

ea0037ep1218 | Clinical Cases–Pituitary/Adrenal | ECE2015

Rare aetiology for primary adrenal failure: ACTH resistance

Hristov Ioana , Gherasim Simona , Hreniuc Ana , Ungureanu Maria Christina , Preda Cristina , Vulpoi Carmen , Mogos Voichita , Leustean Letitia

Introduction: ACTH resistance syndromes are rare, autosomal and genetically heterogeneous diseases that include familial glucocorticoid deficiency and triple A syndrome. These are characterised by early onset of primary adrenocortical insufficiency associated with hypoglycaemia, convulsions and skin pigmentation.Case report: We present the case of primary adrenal failure in a boy diagnosed at the age of four, during a decompensation episode with hypoglyc...

ea0037ep1219 | Clinical Cases–Pituitary/Adrenal | ECE2015

Autoimmune hypophysitis: from pituitary expansion to empty sella: description of four cases

Marconcini Giulia , Lupi Isabella , Manetti Luca , Cosottini Mirco , Urbani Claudio , Martino Enio , Marcocci Claudio , Bogazzi Fausto

Four patients with autoimmune hypophysitis were followed since the diagnosis of the disease. All presented with severe headache, decreased libido, astenia. Case 1 and 3 presented polyuria and polydipsia. At MRI pituitary was enlarged, with high gadolinum uptake and stalk enlargement.Case 1, male 41 years. MRI volume: AP 13 mm, CC 7 mm. Hormonal assessment: central hypothyroidism, hypoadrenalism, hypogonadism, normal GH and IGF1, hyperprolactinemia, centr...

ea0037ep1220 | Clinical Cases–Pituitary/Adrenal | ECE2015

Occurrence of liver failure in post-surgery hypopituitaric patients

Lo Preiato Valentina , Ribichini Danilo , Baccini Margherita , Pasquali Renato , Pagotto Uberto

Multiple pituitary hormone deficit and hypothalamic obesity are common complications after brain surgery for childhood tumors. Despite adequate replacement hormone therapy, obesity develops equally, but liver failure is not usually described. In this study, four subjects who had undergone surgery for brain tumors involving the peri-hypothalamic area when they were nursing or as youths (9 months, 6 years, 9 years and 20 years). They were referred to our Unit when they were 19, ...

ea0037ep1221 | Clinical Cases–Pituitary/Adrenal | ECE2015

Two treatment patterns of thyrotropinomas with over 3-year follow-up

Coculescu Mihail , Vintila Madalina

Introduction: Thyrotropinomas are rare pituitary tumours. Neurosurgery is considered the first-line treatment, followed by medical therapy with somatostatin analogues or radiotherapy.Case reports: We present two cases of thyrotropinomas with different therapeutic approaches. Case 1: A 63-year old man presented with severe thyrotoxicosis. Biochemical evaluation showed inappropriate TSH secretion (TSH=7.5 mU/l, FT4=45.5 pmol/l); computed tomogra...

ea0037ep1222 | Clinical Cases–Pituitary/Adrenal | ECE2015

Glucocorticoid resistance syndrome: case report

Neves Ana Carolina , Fonseca Fernando , Agapito Ana

Introduction: Glucocorticoid resistance syndrome (GRS) is a rare familial or sporadic condition, caused by mutations in glucocorticoid receptor gene. It is characterised by generalised partial resistance of target tissues to cortisol action and compensatory elevation of ACTH with subsequent hypersecretion of cortisol, mineralocorticoids and androgens. Its clinical spectrum is broad and it may occur with high blood pressure (HBP) metabolic alcalosis, hypokalaemia and virilisati...

ea0037ep1223 | Clinical Cases–Pituitary/Adrenal | ECE2015

Bilateral adrenal haemorrhage: a rare complication of anti phospholipid syndrome

Akavarapu Sriranganath , Michael Yee

Introduction: Bilateral adrenal haemorrhage is a rare potentially life-threatening event that occurs either in traumatic or non traumatic conditions. We present a rare case report of bilateral adrenal haemorrhage due to anti-phospholipid antibody syndrome.Case report: A 54 year old Iranian origin male presented with abdominal pain and collapse. His past history includes unprovoked DVT 6 months ago and off the warfarin recently. CT abdomen showed bilatera...

ea0037ep1224 | Clinical Cases–Pituitary/Adrenal | ECE2015

Cushing's disease in a patient with complicated varicella

Saavedra Ana , Belo Sandra , Costa Maria Manuel , Nogueira Claudia , Freitas Paula , Santos Ana , Santos Lurdes , Carvalho Davide

Introduction: Immunossupression is a possible consequence of hypercortisolism, putting these patients in a state of increased risk of infections.Case report: Female, 19 years old. In July 2014 she seek for medical care because she became feverish and developed an erythematous rash on her face/trunk with subsequent widespread to the entire body. She was admitted in the ICU with the diagnosis of severe varicella with acute cholestatic hepatitis and conflue...

ea0037ep1225 | Clinical Cases–Pituitary/Adrenal | ECE2015

Anaesthesia during petrosal sinus sampling and possible interference with ACTH levels

Keil Margaret , Lodish Maya , Lyssikatos Charalampos , Bhutani Jaikrit , Belyavskaya Elena , Stratakis Constantine

Background: General anaesthesia and surgical intervention in humans are known to affect the function of the hypothalamic–pituitary–adrenal axis (HPA). In the literature there are conflicting reports about the effect of propofol, a commonly used intravenous anaesthetic agent, on HPA function.Case reports: We report two males (11 and 12 years) with ACTH-dependent Cushing syndrome (CS) who underwent inferior petrosal sinus sampling (IPSS) with gen...

ea0037ep1226 | Clinical Cases–Pituitary/Adrenal | ECE2015

A case of IgG4 related hypophysitis in a Caucasian female

Hannon Anne Marie , Gupta Saket , Slattery Dave , McGurran Karen , Kinsley Brendan , Javadpour Moshen , Brett Francesca , Agha Amar

IgG4 related hypophysitis is a recently described entity belonging to the IgG4 related diseases. It is characterised by markedly elevated serum IGG4 levels and tissue infiltration by IgG4 positive plasma cells. To date, 34 cases of IgG4 related hypophysitis have been described but only a handful were in women or biopsy proven. We describe a case of a 58 year old woman who presented with transient headache. She also complained of polyuria and nocturia. She had a thyroidectomy f...

ea0037ep1227 | Clinical Cases–Pituitary/Adrenal | ECE2015

Difficulties of acromegaly treatment in young patients: clinical case

Florescu Alexandru , Sandru Andra , Condrea Adrian , Moisii Liliana , Galesanu Corina

Transsphenoidal surgery still appears to be the best option for most of the patients with GH secreting adenomas. In many cases the biochemical cure targets are not reached and the patient needs adjuvant therapy. Alternatives include medical therapy with somatostatin analogues, GH-receptor antagonists and dopamine agonists. These drugs can be used alone or in combination. Radiation therapy with conventional fractionated photons or radiosurgery with proton beam could also be eff...

ea0037ep1228 | Clinical Cases–Pituitary/Adrenal | ECE2015

Successful systemic treatment of Xanthoma disseminatum with cyclophospamide: an interesting case with endocrine and gastrointestinal involvement

Ersoy Reyhan , Polat Sefika Burcak , Ercan Karabekir , Ogmen Berna , Ustun Huseyin , Ersoy Osman , Cakir Bekir

Introduction: Xantoma disseminatum (XD) is a rare non-Langerhans cell histiocytosis (NLCH) which is often resistant to treatment. In this report, we presented a case with extensive cutaneous, hypothalamohypophysial, cerebral and gastrointestinal system involvement, which responded well to cyclophosphamide.Case: A 16-year-old female patient admitted to our hospital with the complaints of amenorrhoea, weight gain, polidipsia, poliuria, yellow-brownish papu...

ea0037ep1229 | Clinical Cases–Pituitary/Adrenal | ECE2015

Hyponatremia in secondary adrenal insufficiency after transsphenoidal surgery for pituitary adenoma: case report

Pemovska Gordana , Prosheva Tatjana Bajraktarova , Mishevska Sasha Jovanovska

Introduction: Hyponatremia is rarely reported as a delayed complication of transsphenoidal resection of pituitary adenoma. Severe hyponatraemia can cause potentially fatal conse-quences.Material and methods: A 34 year old patient was admitted as an urgent case at the Clinic of Endocrinology, with symptoms and signs of Addisonian crisis (dizziness, headaches, nausea, vomiting, hypotension), with muscular weakness and muscle aches, tingling hands and confu...

ea0037ep1230 | Clinical Cases–Pituitary/Adrenal | ECE2015

Cushing's disease in a 7-year-boy due to corticotroph cell hyperplasia

Dineen Rosemary , McGurren Karen , Javadpour Mohsen , Costigan Colm , Agha Amar

Introduction: Cushing’s disease (CD) is very rare in children and is invariably caused by a corticotroph adenoma. However, corticotroph cell hyperplasia has only been convincingly shown in two previous cases of paediatric Cushing’s disease. We report the case of a 7-year-old boy with Cushing’s disease caused by coticotroph cell hyperplasia.Case report: Our patient presented with a 10-month history of obesity, hirsutism and growth retardati...

ea0037ep1231 | Clinical Cases–Pituitary/Adrenal | ECE2015

Phaeochromocytoma patient successfully treated after seven myocardial infarctions

Marczewski Krzysztof , Ciuba Iwona , Kleinrok Andrzej , Romanowicz Tomasz , Boniek-Poprawa Dorota

Introduction: Although pheochromocytoma with fatal myocardial infarction has been described over 50 years ago, diagnostics focused on catecholamine secretion is not a routine procedure post myocardial infarction.Case report: A 49-year-old man, previously healthy, was admitted to the hospital in June 2003, with severe pulmonary oedema. Myocardial infarction was diagnosed on the basis of an increase in markers of myocardial necrosis. There was also found a...

ea0037ep1232 | Clinical Cases–Pituitary/Adrenal | ECE2015

Primary hyperaldosteronism by Conn's syndrome: clinical case discussion

Coelho Claudia , Monteiro Ana Margarida , Fernandes Vera , Souto Selma B , Manso Fernando , Marques Olinda

Introduction: Primary hyperaldosteronism (PA) is a disturbance caused by the autonomous production of aldosterone by the adrenal gland. The most frequent causes are due to bilateral supra-renal gland hyperplasia and aldesterone producing adenoma. It is most frequent amongst women aged between 30 and 50 years of age. It is clinically characterised by hypertension (HTN), resistant to therapy. Hypokalaemia, which is known as a ‘classical marker’ is found in less than a ...

ea0037ep1233 | Clinical Cases–Pituitary/Adrenal | ECE2015

Acute renal failure in a patient with hypopituitarism and rhabdomyolysis

Kaluzna Malgorzata , Piatek Katarzyna , Ziemnicka Katarzyna , Sowinski Jerzy , Ruchala Marek

Introduction: Hyponatremia can be a life-threatening emergency. Severe hyponatremia may occur in patients with hypopituitarism and secondary adrenal insufficiency and hypothyroidism. The acute decompensation of pituitary insufficiency can also lead to accompanying rhabdomyolysis and acute renal failure (ARF).Case report: A 67-year-old woman complaining of general fatigue, dizziness, nausea, feeling cold and numbness of limbs and tongue was admitted to th...

ea0037ep1234 | Clinical Cases–Pituitary/Adrenal | ECE2015

Hemangiopericytoma associated hypoglycaemia and concomitant secondary adrenal insufficiency

Kiyici Sinem , Topyildiz Figen , Polat Bunyamin , Hunuk Ahmet

Introduction: Hemangiopericytomas (HPC) are rare vascular tumours that may be associated with hypoglycaemia. Here we report a case of HPC with multiple metastases, accompanying severe recurrent hypoglycaemia due to the combination of different aetiologies.Case report: A 21 year-old woman was hospitalised due to loss of consciousness. The patient has been diagnosed as HPC by tibia mass biopsy 1 year ago. Tumour embolization was made several times. On admi...

ea0037ep1235 | Clinical Cases–Pituitary/Adrenal | ECE2015

An unusual case of possible cyclic Cushing's disease in a young man with Klinefelter syndrome

Christoffersen Thea , Jarlov Anne Elisabeth , Juul Anders , Poulsgaard Lars , Rasmussen Aase Krogh , Feldt-Rasmussen Ulla

Introduction: Cyclic Cushing’s syndrome (CS) is a rare disorder, characterised by alternating periods of normo – and hypercortisolism.Case report: An 18-year-old young man was followed at the Department of Growth and Reproduction due to Klinefelter and received androgen replacement since the age of 12. As he was shifted to i.m. injections his liver enzymes increased and liver damage due to androgen replacement was suspected. A liver biopsy show...

ea0037ep1236 | Clinical Cases–Pituitary/Adrenal | ECE2015

Accelerated sarcopenia as an initial manifestation of Cushing's disease

Pichaipillai Lakshminarayanan , Kumar Mohit , Pathmanathan Sivatharshya , Tiong Denise , Higham Claire

Introduction: Cushing’s syndrome usually presents with a phenotype including central obesity, striae, hypertension and diabetes. We report a case of Cushing’s syndrome presenting in an atypical manner.Case: A 73 year old lady was referred to neurology with a year’s history of progressive limb wasting, weakness and recurrent falls. The neurology team diagnosed accelerated sarcopenia. Investigations included CK (normal), EMG (suggested myopa...

ea0037ep1237 | Clinical Cases–Pituitary/Adrenal | ECE2015

Grossly elevated plasma metanephrine levels due to midodrine, an α1 receptor agonist, in a patient presenting with postural orthostatic tachycardia syndrome

Farah George , Grossman Ashley , Lulsegged Abbi , Gall Nick

While phaeochromocytomas are rare tumours, their identification is essential to avoid morbidity and mortality; their biochemical identification is crucial. Plasma and 24 urinary metanephrines are used as first line investigations, with plasma metanephrines increasingly used first due to its simplicity and high sensitivity/specificity. False positive results, however, can be as high as 20%, particularly secondary to medications; their exclusion is essential to avoid unnecessary...

ea0037ep1238 | Clinical Cases–Pituitary/Adrenal | ECE2015

Adrenal crisis due to steroid withdrawal

Salehmohamed Muhammad Ridhwaan , Cuesta Martin , Thompson Chris

Introduction: Hen corticosteroids are utilised for their anti-inflammatory properties, adrenocortical atrophy may result. Abrupt steroid withdrawal or intercurrent illness can precipitate acute adrenal crisis. We report two cases of adrenal crisis which resulted from withdrawal of immunosuppressive steroid therapy.Case report: i) A 74-year-old gentleman was admitted with hypotension (BP 80/40), severe hyponatremia (Na:118 mmol/l) and acute renal failure ...

ea0037ep1239 | Clinical Cases–Pituitary/Adrenal | ECE2015

A cystic lesion of the adrenal gland mimicking hydatid cyst

Kacem Faten Hadj , Ammar Mouna , Maalej Ayman , Cheikrouhou Nesrine , Charfi Nadia , Abid Mohamed

Introduction: Adrenal cystic lesions are uncommon and mostly identified incidentally during radiological investigations or at surgery for unrelated reasons. Its incidence varies between 0.064 and 0.18%. Adrenal cysts are classified as endothelial cysts, pseudocysts, epithelial cysts, and parasitic cysts.Case report: A 45-year-old female with a past medical history of systemic hypertensive disease for 2 years, presented with recurrent abdominal pain durin...

ea0037ep1240 | Clinical Cases–Pituitary/Adrenal | ECE2015

Pituitary state during conservative treatment of prolactinomas

Gusova Anna

Prolactinomas are the most common hormone-secreting pituitary tumors. They have good response for conservative treatment. In the time of diagnosis large pituitary tumors unrarely can cause hypopituitarism. We have two cases of partially or totally recovery of hypopituitarism in consequence of effective dopamine agonists use. The 24-years man with large prolactinoma (prolactin 52 times higher) and laboratory markers of panhypopituitarism had total recovery in 1 year of cabergol...

ea0037ep1241 | Clinical Cases–Pituitary/Adrenal | ECE2015

Pituitary apoplexy in Cushing's disease after a standard low-dose dexamethasone suppression test

Mezoued Mouna , Meskine Djamila , Habouchi Amine

Introduction: Pituitary apoplexy is caused by an infarction or a haemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies.Case report: We describe here a case of a 25 years old woman, followed in our institute for a Cushing disease, and who underwent a pituitary apoplexy 24 h after a standard low-dose dexamethasone supp...

ea0037ep1242 | Clinical Cases–Pituitary/Adrenal | ECE2015

Hypopituitarism after miscarriage: a case report

Monteiro Ana Margarida , Alves Marta , Marques Olinda

Introduction: Sheehan’s syndrome (SS) is a cause of partial or total hypopituitarism that occurs after postpartum pituitary infarction, in the context of serious bleeding and/or hypotension. With the advancement of obstetric care, it has become a rare disease in developed countries, but its prevalence may be underestimated. Clinical presentation is dependent on the severity of hormonal deficits, is often nonspecific and many women may be asymptomatic for years. These reas...

ea0037ep1243 | Clinical Cases–Pituitary/Adrenal | ECE2015

Acromegaly caused by atypical pituitary adenoma

Costa Maria Manuel , Saavedra Ana , Castro Ligia , Basto Margarida , Pereira Josue , Vinha Eduardo , Carvalho Davide

Introduction: Atypical pituitary adenomas have higher risk of aggressive behaviour in particular by the higher growth, local invasion and high risk of recurrence after surgery. In acromegaly the resistance to somatostatin analogues may be another manifestation of these adenomas since higher levels of Ki-67 are associated with poor response to therapy.Case report: A 41-year-old woman presented to our consult with history of headaches, growth of the hands,...

ea0037ep1244 | Clinical Cases–Pituitary/Adrenal | ECE2015

Slipped upper femoral epiphysis: a rare clinical manifestation of MEN2: a case report

Slattery Laura , Doherty Jayne , O'Shea Donal , McKenna Malachi , Crowley Rachel

Introduction: Multiple endocrine neoplasia type 2 (MEN2) comprise a group of heritable disorders that result from mutations in the RET proto-oncogene on chromosome 10. MEN2 is sub classified into MEN2A and MEN2B; these syndromes are characterised by the development of tumours at multiple sites. MEN2A is characterised by medullary thyroid cancer, phaeochromocytoma, and primary parathyroid hyperplasia.Description/case presentation: The index case is a 49 y...

ea0037ep1245 | Clinical Cases–Pituitary/Adrenal | ECE2015

Simultaneous diagnosis of Graves' hyperthyroidism and adrenal insufficiency

Kostoglou-Athanassiou Ifigenia , Kostakis Ervin , Dermentzoglou Alexandros , Xanthakou Eleni

Introduction: Patients with autoimmune diseases are known to develop other autoimmune conditions. Adrenal insufficiency of autoimmune etiology is known to coexist with autoimmune diabetes mellitus, Hashimoto’s thyroiditis and vitiligo. However, Graves’ disease in the context of adrenal insufficiency of autoimmune etiology is rare.Aim: The aim was to describe the case of a patient who presented with fatigue and was diagnosed to have hyperthyroid...

ea0037ep1246 | Clinical Cases–Pituitary/Adrenal | ECE2015

Fatigue as the presenting symptom of multiple endocrine neoplasia of type 2A

Gul Nurdan , Kubat-Uzum Ayse , Yenidunya-Yalin Gulsah , Tanakol Refik , Aral Ferihan

Clinical spectrum of phaeochromocytoma syndromes are very heterogeneous. Sometimes life threatening hypertensive attacks may be the presenting symptom or the clinical picture may be subtle that a nonspecific symptom like fatigue can lead to diagnosis. We herein present two phaeochromocytoma cases with distinct clinical features.Case 1: A 20-year-old female patient admitted to emergency department with blurred vision and headache. She experienced headache...