Endocrine Abstracts

Introduction: Pituitary adenomas are the most common pituitary tumours, but in 18% of cases we can find other rare tumours like: Rathke’s cleft cyst, craniopharingyomas, chordomas, meningiomas, infiltrative or infectious disease. Meningeal melanocytoma is a benign neoplasm of central nervous system, commonly located in the base of the brain, cerebellopontine angle and the pineal body, difficult to differentiate from a nonfunctional p...

A 79-year-old man presented with a fall and vomiting. The finding of significant postural hypotension associated with severe hypotonic hyponatraemia (Na 114 mmol/L, Osmolarity 244 mmol/L) mandated a Short Synacthen Test (cortisol 98 mmol/L at baseline and 238 mmol/L 30-minute post synacthen) and ACTH (6 ng/L) which confirmed central hypoadrenalism. This led to revelation of multiple pituitary axes involvement: hypogonadism (testosterone 1...

This 22 year old lady presented with Haemophilus Influenza meningitis. Given an unusual organism, she had an MRI which revealed an incidental pituitary macroadenoma extending into the right cavernous sinus and breaching the anterioinferior wall of the pituitary fossa. Thyroid function showed raised T4 (24.7 pmol/L) and T3 (8.3 pmol/L) with unsuppressed TSH (1.75 munit/L). IGF-1 was also raised at 56.7 nmol/L (12–50.1 nmol/L).<p c...

A 33-year-old Caucasian female presented with ten-months history of amenorrhea and two months history of spontaneous galactorrhoea. She had a successful IVF pregnancy with embryo transfer 3 years previously for unexplained infertility. Her Body Mass Index was 37. No symptoms or signs suggestive of hypercortisolism or acromegaly. Her pituitary profile showed prolactin: 1698 IU/ml (40-500) and raised IGF1: 416 mcg/l (109–324), with nor...

Introduction: Tolosa Hunt Syndrome (THS) is a steroid-responsive idiopathic inflammatory condition affecting cavernous sinus and/or orbital apex causing painful ophthalmoplegia. We present a rare case of THS resulting in hypopituitarism.Case: 45-year-old female presented with 10-day history of headache, periorbital pain and diplopia. Past medical history included bipolar disorder and bilateral below knee amputation ...

Introduction: Cushing’s disease is usually caused by functional corticotroph microadenomas of the pituitary. Crooke’s cell adenomas are rare, representing approximately 2% of corticotroph adenomas and mostly present as aggressive macroadenomas. Pituitary adenomas showing immunoreactivity for both ACTH and GH are also very uncommon. We present two cases of Cushing’s disease caused by macroadenomas with Crooke’s cell cha...

A 22-year-old female first presented in 2008 with a six-month history of galactorrhoea and irregular menses. She had hyperprolactinaemia (2401 mIU/L), a negative macroprolactin screen and her pituitary MRI scan demonstrated a 4 mm microadenoma. Her cannulated prolactin levels were >1500 mIU/L. TFTs, IGF-1, cortisol and remaining pituitary profile were within normal range.Cabergoline was commenced and gradually i...

Case: A 79 years old frail lady with history of dementia and hypertension presented with refractory hypoglycaemia over a period of 3 months requiring multiple admissions. During her most recent admission, she required continuous dextrose infusion to maintain euglycaemia. The severe spontaneous hypoglycaemia in this non-diabetic lady, warranted a series of investigations. TFT and Short Synacthen Test excluded thyroid dysfunction and hypoad...

Lymphocytic hypophysitis (LyH) is a rare condition often associated with pregnancy (usually presenting in the last month of pregnancy or in the first two post-partum months). We describe a very rare case of recurrent LyH during two pregnancies.A 25-years old woman presented in 7/2003 with a 6-week history of headaches and a 2-week history of visual deterioration whilst 38 weeks pregnant. Bitemporal hemianopia was co...

Introduction: Herein we provide clinical, biochemical, histological and radiological evidence of a rare case of a male patient who was diagnosed with pituitary macroadenoma (prolactinoma), phaeochromocytoma and a lung typical-carcinoid tumour on a background of SDH gene mutation encoding the succinate dehydrogenase enzyme.Presentation of case: A 42 year old male individual, was initially diagnosed with a pi...

We report a case of 43 year old gentleman who had surgery in 1998 for left glomus typanicum, leaving him with complete left lower facial nerve palsy. Incidentally he was noted to have had labile blood pressure during this surgery. He had gradual growth of residual tumour which required fractionated radiotherapy in 2012. He has had ongoing problems with headaches with profuse left-sided rhinorrhoea and intermittent episodes of sweating. In...

Familial isolated pituitary adenoma (FIPA) is an increasingly recognised cause of familial pituitary tumours with autosomal dominant inheritance. An increased population risk of AIP mutations has recently been reported in Ireland. We present the cases of three siblings, with likely AIP related disease, attending endocrinology clinics in Glasgow. Patient one has been confirmed to be an AIP mutation carrier.Patient 1 ...

Background: The use of opioids in non-cancer patients has increased dramatically over the past few years. The most common endocrine dysfunction with opioid use is hypogonadism, but it has been reported in a small number of cases that adrenal insufficiency and adult growth hormone deficiency can also occur.Clinical case: A 39 year old male presented with general fatigue, loss of libido and sweating for about six mont...

A 21 year old Asian woman presented with relapse of Neuromyelitis Optica (NMO) spectrum disorder, diagnosed aged 16. She had headache, dizziness, right hand weakness and severe hyponatraemia (serum sodium [Na+] 116 [135–145]). Emesis, dominant in previous relapses, was absent – she was euvolaemic. Serum (Seosm) and urine (Uosm) osmolalities were 250 and 468 mosm/kg respectively, thyroid function ...

Paraneoplastic Cushing's syndrome is a rare disease and is usually associated with small lung cancer or bronchial carcinoid tumour. In this case report we present an unusual case of metastatic neuroendocrine tumour of the pancreas presenting with florid Cushing's syndrome. A 45-year-old female presented with four-month history of worsening blurred vision, dry mouth and lethargy. In the hindsight, for the past three ...

Paragangliomas are rare neuroendrocrine tumours arising from extra-adrenal paraganglia of the autonomic nervous system and excess catecholamine secretion is associated with higher cardiovascular morbidity and mortality. We present the case of a 56-year old male referred to our outpatient clinic with symptoms of sympathetic-hyperactivity, including excessive sweating, palpitations and diastolic hypertension (140/100 mmHg). He had undergone...

Ipilimumab is a monoclonal antibody that had been shown significantly to improve survival in cases of metastatic melanoma. It blocks cytotoxic T-lymphocyte antigen 4(CTLA4) resulting in T-cell activation, proliferation and antitumor response. However recently an emerging clinical entities of different endocrinopathies have been reported in patients on ipilimumab. These are mainly related to lymphocytic hypophysistis causing anterior hypop...

We report a rare case of 19 year old lady who was referred to us with galactorrhoea associated with hyperprolactinemia (PRL-1049 mU/L). MRI, arranged by GP, had revealed an enlarged pituitary with a 14×8 mm macroadenoma slightly distorting the optic chiasma. Visual fields were normal on confrontation but showed restricted fields in both eyes on Goldman perimetry. She was commenced on cabergoline to which her galactorrhoea responded q...

Ectopic Cushing's syndrome is rare, accounting for 5–10% of all cases of Cushing's. The majority are casued by small cell lung cancer and neuroendocrine tumours.We report a case of a 59 year old male who presented with osmotic symptoms after newly diagnosed diabetes, hypokalaemia and metabolic alkalosis with clinical features suggestive of Cushing's. Initial random cortisol was >2000 nmol/l and 24 hour urin...

Introduction: Significant hypoglycaemia is a rare but well recognised presenting feature of secondary adrenal insufficiency. Such hypoadrenalism may be caused by intrinsic hypothalamo-pituitary disease (pituitary adenoma), exogenous steroid therapy, and uncommonly by hypophysitis and pituitary secondaries from malignant disease.Case presentation: A 73-year-old woman presented acutely with confusion, agitation, and a...

Introduction: Cushing’s syndrome is caused by an extended exposure to increased levels of endogenous or exogenous glucocorticoids. It is a syndrome that can be extremely challenging to diagnose as many symptoms and signs are also indications of other disease processes.Case: A 76 year old man presented to hospital with a six month history of immobility and falls. Proximal muscle weakness was also noted. The pati...

Background: A case report of Nigeria male who presented on account of bilateral gynaecomastia and was found to be azoospermic on investigation with a view to draw attention of clinicians to underling endocrine problems associated with gynaecomasia.Methodology: A case report of a 32 year old Nigeria man with progressive-bilateral breast enlargement was reviewed.Case report: A 32 year old Nigeri...

The short stature can be feature of uncontrolled diabetes due to low portal insulin levels causing decrement of IGF-1 and IGFBP-3 concentrations.We describe the case of a 14 yrs old boy with Type 1 diabetes, who was admitted at our hospital in April, 2017 for the evaluation of short stature. He was the youngest of the nine older, normal statured siblings and was the shortest amongst his class-mates. He had not start...