Endocrine Abstracts

Background: Regulation of core body temperature (Tc) can cause significant cardiovascular strain, leading to impaired performance, incapacitation and occupational hazard during work in the heat. Where continuous Tc and heart rate (HR) monitoring is not possible (e.g. during firefighting or on military operations), safer working could result from intermittent sampling of an integrated measure of physiological strain.Aims: To assess the relationship betwee...

Background: Aberrations in the timing of puberty may result in significant adverse health outcomes, including cancers, cardiovascular and neurological pathologies. Self-limited delayed puberty (DP) (i.e. constitutional delay of puberty) runs in families with either autosomal dominant or complex inheritance patterns in >70% of families, indicating a strong genetic basis of the trait. However, only a few genes have been identified underlying DP so far....

The purpose of the study: To examine the incidence of neuroendocrine complications after RT of pituitary somatotropinomas.Materials and methods: Thirty patients surveyed after receiving radiation therapy (RT) at a dose of 45 g in 25 fractions a day. Of these, 21 (70%) females, 9 (30%) men. The age of patients ranged from 36–71 years. 37% of them had pituitary macroadenoma with para-, supra-, infrasellar growth. Duration of illness was on average 15 ...

Chronic exposure to hypobaric hypoxia (HH) causes neurodegeneration and loss of memory. The underlying mechanisms of HH-induced memory impairment have been attributed to prolonged elevated corticosterone level in hippocampus leading to augmented glutamate excitotoxicity, oxidative stress, alteration of neurotransmitter level or their receptors and calcium mediated signaling. Whether this corticosterone mediated neurodegenerative effect occurs through overstimulation of glucoco...

Background: Cranial diabetes insipidus (CDI) is characterised by arginine vasopressin (AVP) deficiency. Oxytocin (OT) is structurally related to AVP and is synthesised in the same hypothalamic nuclei, but a clinical syndrome of OT deficiency is not currently recognised. Psychological research has demonstrated that OT influences social and emotional behaviours, particularly empathic behaviour.Aim: We hypothesised that patients with acquired CDI and anteri...

Background: Hyperprolactinaemia is common in patients presenting with polycystic ovary syndrome (PCOS). Recent studies suggest that each condition has an independent aetiology, hence appropriate investigation of hyperprolactinaemia in the context of PCOS is required, for which separate treatment may then be provided. Appropriate investigation includes a serum macroprolactin screen, a specific drug history for drug-induced hyperprolactinaemia (DIH), blood tests to exclude secon...

Introduction: Clinically non-functioning pituitary adenoma (NFPA) represents up to 30% of pituitary tumours. Management is dictated by their size or mass effect. The natural progression of NFPA attracts debate as the evidence-base is limited.Methods: Conservatively managed NFPA patients were included. A single radiologist reviewed all images to avoid bias.Results: Forty-six patients were identified, 21 female. Four presented acutel...

Epigenetic modifications and chromatin remodelling have been demonstrated to play a key role in the development, and progression of multiple cancers, and compounds regulating these mechanisms represent a novel class of anti-cancer drugs. Menin, which is encoded by the MEN1 gene, whose mutations result in a syndrome characterised by pituitary, parathyroid and pancreatic islet tumours, binds histone modifying enzymes, including the histone methyltransferase MLL1. Furthe...

Introduction: Current literature suggests that the incidence of GH deficiency (GHD) post subarachnoid haemorrhage (SAH) ranges from 0 to 37%. We present the results from a large single centre study and discuss factors that should be considered when testing for GHD in this population.Method: One hundred survivors of SAH were screened with a glucagon stimulation test (GST) for pituitary hormone deficiency. Participants with isolated GHD were required to un...

Introduction: Incidental pituitary adenoma (IPA) is found in 10–20% autopsy and radiological series. These are being increasingly detected as access to sensitive imaging modalities improves.Methods: Patients with incidental pituitary findings between 2012 and 2016 were identified from local database. Referral details, clinical features and radiological findings were analysed. A single radiologist reviewed all images to avoid bias.<p class="abste...

Pituitary dysfunction is a common, treatable consequence of traumatic brain injury (TBI), and is associated with poorer outcomes. Identifying prognostic factors that allow targeted endocrine testing will ensure that patients at higher risk of pituitary dysfunction are identified and screened.Analysis of 176 adults at least 6 weeks after TBI attending the multidisciplinary Imperial TBI clinic found an overall prevalence of pituitary dysfunction of 13.7% (...

Context: Disease processes that affect the pituitary stalk are broad, ranging from indolent lesions requiring simple observation to severe lesions with significant implications. Diagnosis and management of these lesions remains unclear.Objective: The aim of this study was to assess the clinical presentation, biochemical and pathology characteristics of pituitary stalk thickening lesions and their association with specific MRI features in order to provide...

Morvan’s syndrome is a rare autoimmune disease characterised by peripheral nerve hyper excitability, CNS symptoms and autonomic dysfunction which can mimic other endocrine presentations with symptoms including hyperhidrosis, weight loss, neuromyotonia and insomnia. Morvan’s is associated with malignancy, in particular thymomas, suggesting paraneoplastic aetiology. This case is the first to associate Morvan’s with renal carcinoma and proposes insulin like growth ...

Background: Heightened awareness, as well as frequent thyroid function testing, have contributed to a recent rise in the incidence of thyrotropinomas. Microadenomas are now increasingly being recognized. The classical textbook description of thyrotropinomas is based on historically reported features in patients who typically had large/invasive lesions. The phenotype of microTSHomas could therefore differ.Methods: We reviewed the records of all TSHomas re...

Background: The University Teaching Hospital Trust has a regional neuroendocrine tumour (NET) service that requires a database exclusively for NET patient information. UK and Ireland NET Society (UKINETS) guidelines for gastroenteropancreatic (GEP) NETs recommend plasma Chromogranin-A (Cg-A) and 24 h urinary 5-hydroxyindoacetic acid (24 h Ur 5-HIAA) as baseline investigations. This audit investigated both guideline adherence and the value of these tests in making the diagnosis...

Background: Craniopharyngioma is a rare epithelial tumor of the central nervous system, affecting both children and adults and associated with significant morbidity.Objective: To study the potential differences in the clinical and radiological presentation of craniopharyngioma in children versus adults in a large mixed cohort.Material and methods: We performed a retrospective review of craniopharyngioma patients evaluated in the Na...

Introduction: Non-functioning pituitary adenomas (NFPAs) constitute a large proportion of pituitary adenomas and can lead to hypopituitarism and visual field defects. Trans-sphenoidal surgery is the treatment of choice but as a consequence patients may suffer from long-term hormone deficiencies and diabetes insipidus. We sought to examine clinical, pathological, and imaging characteristics of those presenting with NFPAs and subsequent post-surgical outcomes.<p class="abste...

Background and aims: We have previously reported an increased prevalence of gallbladder polyps in treatment-naive acromegaly when compared with the general population (29 vs 4.6%), with potential implications for future malignant transformation and screening. However, little is known about biochemical markers of liver function in active acromegaly, or in response to treatment. Furthermore, somatostatin analogue (SSA) therapy is associated with the development of gallstones. He...

Background: Patients with heterozygote germline mutations in the aryl-hydrocarbon receptor interacting protein (AIP) gene (AIPpos) develop often aggressively growing tumours in early teenage years. The mechanism of this behaviour is not clear.Aim: The role of the microenvironment in the invasive phenotype of AIPpos pituitary tumours.Methods and results: We established that AIPpos GH-secreting tumours are infiltrated by a large numb...

Pituitary adenomas (PA) comprise a commonly underestimated pathology in terms of incidence and associated morbi-mortality. Although somatostatin analogs and dopamine antagonists constitute the main medical treatments for PAs, an appreciable subset of patients are resistant or poorly responsive to these drugs and hence is crucial the search for new therapies. Biguanides such as metformin (MF; commonly used to treat type-2 diabetes), phenformin (PF) and buformin (BF) have been s...

Introduction: Patients with mutations in the Succinate Dehydrogenase Complex Subunit B (SDHB) gene are predisposed to neuroendocrine tumours such as parangangliomas, phaeochromocytomas and gastrointestinal stromal tumours. Individuals who are carriers but have no manifestation of disease require regular surveillance. Our tertiary endocrine service provides follow up/surveillance for these patients and we cover a wide geographical area throughout the West of Scotland.<p cla...

Pituitary and adrenal gland assessment, is one of the most important aspects of the management of a pituitary and adrenal adenoma.Clinical practice varies widely with regard to assessment of pituitary and adrenal status pre- and post-operative. Pre-operative testing includes dynamic testing to assess function which is not practical in the immediate post-operative period. Instead a single morning serum total hormones are measured while a more definitive a...

Introduction: In patients with neuroendocrine tumours (NETs), the urinary concentration of the serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) is used to monitor disease progression or response to treatment. The sensitivity and specificity in the presence of the carcinoid syndrome are approximately 70 and 90%, respectively. However, there are problems with the accurate meaurement of a 24-h collection, and this is often inconvenient for patients. In addition, serotoni...

Introduction: Skeletal complications are among most persistent and invalidating systemic impacts of acromegaly. Assessment of bone health in acromegaly by dual-X-ray absorptiometry (DXA) alone might be insufficient or even misleading.Patients and methods: Patients with acromegaly (n=170) were classified as active (n=104), operatively cured (n=34) or medically controlled (n=32). We excluded patients with metabolic bone ...

Introduction: Somatotroph adenomas are GH producing pituitary adenomas. There are two main types based on granulation pattern: sparsely and densely granulated. Each type also has their own fibrous body pattern. Sparsely granulated (SG) have a ‘dot-like’ fibrous body pattern and the densely granulated (DG) have a ‘perinuclear’ fibrous body pattern. The fibrous bodies are mainly composed of keratin 8. Previous microarray analysis revealed six differentially e...

Background: Untreated Cushing’s disease has a high mortality rate. Transsphenoidal surgery is usually first line treatment and in the hands of a skilled experienced surgeon can achieve a cure rate of up to 80%. For those with recurrent or un-resectable disease, a combination of external beam radiotherapy, stereotactic radiotherapy, repeat transsphenoidal surgery, bilateral adrenalectomy and chemotherapy may be used. We investigated the safety and efficacy of stereotactic ...

Folliculostellate (FS) cells constitute around 10% of the adenohypophyseal cell population. Various functions of these non-endocrine cells have been elucidated, including the paracrine control of the function of local endocrine cells. FS cell development is currently very poorly understood. In this study FS cell appearance during embryonic chick development between pre-natal stages (st)17-37 was examined. Gene and protein expression of the FS marker proteins annexin A1 (AnxA1)...

Olfactory neuroblastoma (ONB) is a rare neuroendocrine tumour arising within the sino-nasal cavity. It occurs world wide, affecting both sexes, all ages and all races with no underlying predilection having yet been identified. ONB exhibits a range of phenotypes from indolent to very aggressive, and up to 5% cases are associated with ectopic hormone secretion. Despite current gold-standard treatment of surgical resection (either endoscopic or craniofacial resection) followed by...

Actions of the stress hormone, glucocorticoid (GC), are essential for the modulation of implicated biological processes such as synaptic transmission. In disease paradigms that feature a hormone hyper-secretion phenotype (e.g. neurocognitive disorders), the normalcy of receptor signaling is compromised.The pro-cognate role of Glucocorticoid receptor (GR) inhibition via hormone analogues bearing anti-glucocorticoid properties is well described. A key exam...

Introduction: Heterozygous mutations in the AIP gene are associated with young-onset pituitary adenomas while homozygous loss of AIP in animal models is lethal. As early diagnosis could lead to better outcomes, family members of AIP mutation-positive patients need follow up. The R304Q variant is commonly described as pathogenic based on clinical assessment. However, it is also present in the general population (minor-allele-frequency (MAF) 0.0007&#15...

Complementary therapies are becoming a recognised adjunctin cancer care as they address the psychological burden of coping with cancer. When provided in addition to standard treatments they can help provide patient centred holistic care. Patients with pituitary conditions may develop debilitating symptoms that are not easily addressed despite appropriate medical treatment.Aim: To determine whether Complementary therapies lead to improvements in Quality o...

Aim: The aim of the study was to assess the differences between patients in remission in acromegaly and those with active ongoing disease, using cumulative GH measurement as risk factor for various complications.Methods: A retrospective observational analysis of all patients with acromegaly treated at a tertiary referral centre since the initiation of service (~50 years) was conducted. Cumulative GH exposure was calculated as a sum of averages of GH leve...

Introduction: In 2003, the UK National Institute for Clinical Excellence (NICE) established guidelines on the use of GH in adults. These guidelines state that recombinant GH should be used only for adults with a severe GH deficiency that severely affects their quality of life. To assess current practice in relation to these guidelines, a review of patients receiving GH treatment was performed. The aims were to assess if adults with GH deficiency met NICE criteria for GH therap...

The medial amygdala (MeA) is crucial for sexual behavior; kisspeptin (Kiss1) also plays a role in sexual function. Kisspeptin receptor (Kiss1r) knockout mice display no sexual behavior. Recently Kiss1 and Kiss1r have been discovered in the posterodorsal subnucleus of the medial amygdala (MePD). We hypothesized that Kiss1 in the MePD may have an influence on male sexual behavior. To test this we bilaterally cannulated the MePD and infused kisspeptin-10 in male rats. This caused...