Endocrine Abstracts

Introduction: Cushing’s disease (CD) is a rare but devastating condition, caused by hypersecretion of adrenocorticotropic hormone (ACTH) from a corticotroph adenoma in the anterior pituitary. CD is associated with a five-fold excess mortality and clinical features including hypertension, diabetes mellitus, osteoporosis, and depression. First-line treatment is transsphenoidal surgery, but this is effective in only 65% of cases and the relapse rate is high. Other treatment ...

Introduction: Patients with acromegaly have increased mortality, primarily related to cardiovascular/cerebrovascular disease. The objective of this study was to evaluate whether GH/IGF-1 excess increases vascular disease by adversely affecting fibrin network characteristics.Methods: In this case–control study, 40 patients with acromegaly (21 males, age 53±13 years, 45% disease remission) and 40 age and gender-matched controls were recruited. Cl...

Background: The enzyme succinate dehydrogenase (SDH) functions in the citric acid cycle and loss of function of this enzyme can lead to the development of phaeochromocytoma/paraganglioma (PPGL), gastrointestinal stromal tumour (GIST) and renal cell carcinoma. A germline mutation in one of the four genes (SDH-A/B/C/D) encoding the SDH complex is the most common mechanism of SDH inactivation causing SDH deficiency and is routinely screened for...

Introduction: Nelson’s syndrome is a significant long-term complication of bilateral adrenalectomy for Cushing’s disease. However, evidence about possible factors that can predict its occurrence, is controversial and limited.Objective: The objective of this analysis was to elucidate the role of various factors in prediction of Nelson’s syndrome and the extent of their modifying effect.Methods: All patients with Cushi...

Purpose: To identify predictive biomarkers of recurrence in NFPTs, we used heat shock protein profiling approach to correlate protein expression profiles with tumor recurrence. Heat shock proteins (HSPs) are synthesized by cells in response to various stress conditions, including carcinogenesis. The expression of HSPs in tumors has been implicated in the regulation of apoptosis. In the current study, we attempted to clarify the significance of HSPs in NFPTs and their correlati...

Hypothalamic–pituitary–adrenal (HPA) axis function after trans-sphenoidal pituitary surgery is commonly assessed using post-operative morning cortisol. We performed a prospective study to determine the sensitivity and specificity of cortisol and ACTH measured within the first 24 h, in predicting glucocorticoid requirement at 6 months both in patients with pre-operative secondary adrenal insufficiency (SAI) and with normal pituitary function. Exclusion criteria includ...

Secondary hormonal deficiency (SHD) is common in patients presenting with nonfunctioning pituitary adenomas (NFA). NFA can either stain for various hormones or be non-hormone staining on immunocytochemistry. To date, no study has assessed the association between staining pattern of NFA and pattern of SHD at presentation. The Halifax Neuropituitary Program has been prospectively collecting comprehensive data on all neuropituitary patients in the province of Nova Scotia, Canada ...

Secondary hormonal deficiency (SHD) in sellar masses (SM) is thought to be partly due to compression of the portal vessels by the enlarging tumour restricting the blood supply to the normal pituitary tissue. However, to date no study has looked at the patterns of SHD in various types of SM and assessed if SHD is related solely to the size of SM or is associated with the underlying pathology. We assessed 914 patients with SM enrolled in our comprehensive pituitary registry sinc...

Objectives: Somatotropinomas can be divided into three subgroups based on their distinct DNA methylation profiles1, one matching sparsely granulated (SG) and the other two matching densely granulated phenotypes (DG-A and DG-B). Sparsely granulated adenomas show fibrous body formation on cytokeratin immunohistochemistry, compared to diffuse staining in densely granulated adenomas. Methylation1 and gene expression data were analysed to identify (i) differen...

Introduction: CACNA1C gene encodes the L-type voltage dependent calcium channels and its variants are associated with susceptibility to psychiatric disorders. We recently provided evidence of a genotype-by-environment interaction of the CACNA1C rs1006737 polymorphism, suggesting that the cortisol awakening response (CAR), an indicator of HPA-axis function, might be increased in non-risk allele carriers (GG) who have experienced childhood trauma (CT). In these...

Neuroendocrine tumours (NETs) presenting as metastatic cancer of unknown primary site (CUP) are suspected to confer poorer prognosis compared to metastatic NETs of known primary site. We performed a retrospective, single centre study to determine the prognostic indicators in CUP-NETs compared to metastatic small intestinal NET (SiNET), before and after adjusting for factors known to affect overall survival. Subjects were selected from a departmental database of 1050 NET patien...

Background: Guanine nucleotide-binding protein, α stimulating (GNAS) gene have been reported to be associated with GH secreting pituitary adenoma. Approximately 40% of patients with acromegaly have GNAS mutation. In this study, we investigated the prevalence of GNAS mutation in Korean acromegalic patients and assessed the correlation with the biochemical or clinical characteristics.Method: We studied acromegalic patients who underwent surgery betwee...

Introduction: Radiotherapy (RT) can achieve tumour control rates of over 90% in patients with pituitary adenomas. The commonest toxicity of irradiation is hypopituitarism. The exact incidence is variable and requires long-term intermittent testing for deficiency of all hypothalamic−pituitary axes (HPA). The aim of this study is to determine the time to onset of individual hormonal deficiencies and establish a time frame for endocrine testing during follow-up post-RT....

Background: Acromegaly is associated with multiple co-morbidities and increased mortality. Surgery is the first-line intervention and remission of acromegaly can restore normal life-expectancy. Pre-operative somatostatin analogues (SSA) may increase the likelihood of remission in large invasive tumours by causing tumour shrinkage prior to surgery.Aims: To audit the management of acromegaly patients at Imperial College Healthcare NHS Trust (ICHNT) against...

Introduction: Silent somatotroph Pituitary Neuroendocrine Tumours (PitNETs) are extremely rare (2−3% of surgically treated pituitary tumours) and data on their natural history and outcomes are scarce.Aim: To review systematically the cases of these tumours presenting in our Centre.Patients and methods: Patients with this diagnosis were identified from our Pituitary Registry and clinical/laboratory/imaging data were collected ...

Endocrine Society guidelines recommend random growth hormone (RGH) <1 mcg/l as indicative of biochemical control of acromegaly. Growth hormone (GH) control may also be determined using the mean GH (MGH) of a growth hormone day curve (GHDC). We report a retrospective analysis of 461 consecutive GHDCs, from 121 patients with treated acromegaly, performed in a single centre between 2009 and 2019. Each GHDC contained 7–9 GH measurements (mean 8.9) taken at regular interva...

Objective: To study O6-methylguanine-DNA methyltransferase (MGMT) immunoexpression to access the efficacy of Temozolamide (TMZ) as a part of multimodality treatment.Background: Aggressive or residual pituitary tumours are associated with substantial morbidity. Treatment options are often limited, and chemotherapy are associated with dismal results. Recent reports have documented the efficacy of TMZ therapy in aggressive pituitary tumors resistant to mult...

Background: Hyperprolactinaemia is the common endocrine disorders. More commonly diagnosed in women due to menstrual irregularity, infertility and galactorrhoea. Hyperprolactinaemia can be due to many physiological stimuli such as stress, sleep, exercise, medications, primary hypothyroidism, renal failure, chest wall lesion. Stress of venepuncture can contribute to hyperprolactinaemia as well.Patient and methods: We conducted a retrospective analysis of ...

Background: Dopamine agonists (DA) are the first-line treatment for macroprolactinomas. However, up to 10% of patients fail to respond to medical therapy.Aim: To assess biochemical resistance rate to DA treatment in a large series of patients with macroprolactinoma and to analyze possibilities to overcome this resistance.Patients and methods: 195 patients with macroprolactinomas, treated with DA for at least 2 years, were retrospec...

Tumour localisation in Cushing’s disease (CD) can be challenging; most are microadenomas and 50% are <5 mm in diameter. They are, therefore, often difficult to detect by conventional MRI. Volumetric MRI (3D-SGE, spoiled-gradient echo 3D sequence) is a high spatial resolution scanning technique which uses very thin slices (1 mm). Theoretically, this increases the probability of finding small pituitary lesions when compared to conventional (spin-echo, SE) MRI techniques...

Introduction: The prevalence of acromegaly in the general population ranges 4−14/100 000. 45−80% of acromegaly patients have obstructive sleep apnoea (OSA). The OSA population might represent a target group for earlier detection of acromegaly, thereby reducing associated long-term morbidity.Methods: Patients attending the sleep service (11/2014−04/2018) were recruited in a prospective multicentre cohort study. All had serum IGF-1 measur...

We present the case of a 64 year old woman who presented with one month history of tiredness and 8 kg weight loss. Severe hypokalemia (2.2 mmol/l) was identified by the GP. Clinically she appeared mildly Cushingoid. Biochemical investigations showed a random cortisol significantly elevated at 2170 nmol/l, 24-hour urinary cortisol was 15 700 nmol/l(0−135). ACTH level was elevated at 7400 ng/l(0−40). The low dose dexamethasone suppression test demonstrated failure to...

Introduction: Cabergoline is one of the medical treatments in acromegaly; it can be used alone or in combination with other available agents.Aim: To review the efficacy of cabergoline in patients with acromegaly treated in our centre.Patients and methods: Patients with acromegaly on cabergoline were identified from our Pituitary Registry. Clinical/laboratory/imaging data were collected and analysed.Results: F...

Background: Patients receiving radiotherapy for residual or recurrent pituitary adenoma require regular surveillance for the development of anterior pituitary axis deficit. Whilst the sequelae of hypopituitarism post cranial irradiation is well recognized, there are relatively varied incidences of new onset hypopituitarism post-conventional radiotherapy, reported in the literature. We aimed to investigate timing and frequency of the individual axis deficits in adults who have ...

Background: Pituitary carcinoma is extremely rare and constitute only 0.1−0.2% of all pituitary tumors. Diagnosis is on evidence of metastasis, although these criteria has been challenged. Majority of pituitary carcinomas are functioning tumours, usually secreting ACTH (42%) or prolactin (33%). Common sites of metastasis include the brain, spinal cord, leptomeninges, bone, liver, lymph nodes and lung. Mean survival after detection of metastasis is around 1−2 years....

Background: Metastatic disease in the pituitary (PM) is uncommon and the published literature mainly involves case reports and small case series. We aimed to analyze presenting manifestations and outcomes of patients diagnosed with PM in our pituitary centre.Methods: Retrospective review of our Pituitary Registry to identify patients with PM from 2006 to present. Clinical, radiological, and pathological data were collected and analysed.<p class="abst...

Patients with sellar masses (SM) undergoing transsphenoidal surgery (TSS) have a significant risk of transient or permanent endocrine dysfunction; therefore, in-hospital endocrinology consultation (IHEC) is recommended for these patients. However, routine assessment of all TSS patients by a specialized team is not feasible outside select centers. We developed an IHEC guide for TSS patients in December 2015 to identify those patients who would require perioperative IHEC. We con...

Non-functioning pituitary macroadenomas (NFPAs) are commonly associated with headaches, visual deficits and hypopituitarism. Urgent transsphenoidal surgery (TSS) should be considered for all patients presenting with visual compromise. We evaluated outcomes in 65 patients with NFPAs undergoing TSS in our unit. Patients who had undergone previous pituitary surgery or prior radiotherapy were excluded from this evaluation, as were those with classical pituitary apoplexy and predom...

Background: Pituitary adenomas are the most common intracranial neoplasm, with a slow-growing, locally invasive phenotype. Some result from syndromes or isolated germ-line mutations, while approximately 60% have no currently identified somatic mutation implicated in tumorigenesis. High throughput technologies such as microarray, RNA sequencing (RNAseq) and next-generation sequencing (NGS, incorporating whole genome- and exome sequencing) have recently been used to identify alt...

Introduction: The study aim was to compare serial Short Synacthen test (SST) results to diagnose secondary Adrenal Insufficiency (AI) in patients with confirmed pituitary diseases.Methods: Serial SST results of patients, tested between 2006 and 2018 in the department of Diabetes and Endocrinology, at a tertiary centre, were reviewed retrospectively. Patient details were obtained from local dynamic test database, maintained by Endocrine Nurse Specialist. ...

Background: Nephrogenic diabetes insipidus (DI) is characterized by polyuria with dilute urine due to the inability of the principal cells of the renal collecting ducts to respond to antidiuretic hormone and concentrate urine. It can be drug-induced and several chemotherapeutic agents, including the platinum derivative cisplatin and the antimetabolite pemetrexed, have been reported to cause nephrogenic DI, presumably via tubular damage.Case presentation:...

Introduction: Pituitary Apoplexy is a rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary gland. Pituitary apoplexy can occur as an initial presentation in patients who are not known to have Pituitary adenomas. Clinical Symptoms vary, however, one should have a high index of suspicion if symptoms such as acute headache, visual loss or ocular palsy occur.Precipitating factors: Hypertension, Preganancy, Head trauma, Dynam...

Prolactinomas are the most common functional pituitary tumours. Therapy is with dopamine agonists (DA). Cabergoline is frequently used as a first line agent; resistance to therapy is seen to other DA. We present a case of a 32 year old woman who moved to our area in the 1st trimester of pregnancy. She was known to have macroprolactinoma (maximal diameter > 1 cm), impinging on the optic chiasm. She was on cabergoline 0.5 mg once daily, but this was discontinued with no complica...

TSH-secreting pituitary tumours are very rare and include two opposite clinical conditions: true thyrotroph neoplasia resulting in secondary hyperthyroidism /central hyperthyroidism and pituitary hyperplasia resulting from longstanding primary hypothyroidism. The diagnosis is suspected in patients presenting with headache / biochemical hyperthyroidism high free T4, free T3 and unsuppressed TSH concentrations, particularly in the presence of clinical features of concomitant hyp...

Background: Hyperprolactinaemia is a common presentation in endocrine clinics. Current guidelines on BMJ best practice recommend evaluation with MRI only if levels are >2000 mU/l or absence of an identifiable secondary cause.Aim: To identify if pituitary pathology would go undetected if pituitary imaging is not performed and determine a suitable threshold for performing pituitary imaging in the diagnosis of prolactinoma.Methods: A ...

Background: Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin leading to hypernatremia. In May 2009 a patient died from diabetes insipidus mismanagement in a London hospital. An NHS England patient safety alert was issued in 2016 highlighting this risk.Method: Inpatients with a serum sodium of 155 mmol/l or greater were prospectively identi...

Introduction: Radiotherapy is an important adjuvant treatment for pituitary and cranial diseases. The aim of the study was to observe response of Radiotherapy (RTX) on Hypothalamic–Pituitary–Adrenal (HPA) axis determined by serial Short Synacthen tests (SSTs). Methods: Patients treated with adjuvant Cranial Radiotherapy between the years 2000 and 2018 in the department of Radiation Oncology and who also underwent serial Short Synacthen tests, i...

Introduction: Syndrome of inappropriate anti-diuretic hormone (SIADH) is the one of the most common causes of hyponatraemia encountered in hospitalised patients. However, there are very few reported cases of SIADH in pregnancy. This case describes such an entity.Case Report: A 21 year old lady who was seven weeks pregnant presented to hospital following episode of new onset seizure. She was involved in a road traffic accident seven months prior with asso...

Background: Familial Diabetes Insipidus is a very rare entity and can have either neurohypophyseal (FNDI) or nephrogenic forms with different transmission patterns. FNDI accounts for less than 5% of the 1:25 000 cases of DI diagnosed in UK. It is usually an autosomal dominant disorder caused by mutations in AVP (arginine vasopressin) gene, which regulates the vasopressin hormone synthesis; its signs and symptoms of polyuria & polydipsia usually become apparent in childhood...

Introduction: Transsphenoidal pituitary surgery (TSPS) may be required either as a treatment for endocrinopathies or because of the risk or consequence of pituitary lesion expansion into adjacent structures, in particular optic chiasm compression. Published literature recommends surgery is performed by dedicated experienced surgeons with anticipated complication rates available as a comparator.Methods: This retrospective audit included all patients diagn...

Acromegaly is a relatively rare disorder with a prevalence of 40 per million. Diagnostic and management process have evolved with time, however lack of statistical facts/data remained an issue.Aims: 1) To look at the cohort of patients who attend our local Endocrine department with a diagnosis of acromegaly. 2) To determine how many are cured with surgery, how many need adjuvant treatment and how many remain uncontrolled despite all treatment modalities....

A 57 year-old gentleman with uncomplicated Type 2 Diabetes Mellitus and 30 pack year smoking history was assessed in outpatient endocrinology clinic with a 4 month history of non-specific symptoms, including dizziness, lack of energy and intermittent bi-frontal headaches described as ‘pressure behind the eyes’. There was no history of exogenous steroid use. Bloods at 0833 h identified deficiency in testosterone (<1 nmol/l; N= 6–30 nmol/l), thyroxine...

66 year old patient was diagnosed with macroprolactinoma and started on treatment with Cabergoline at a dose 250 μg twice weekly. Initial echocardiogram was normal and CT chest showed clear lung fields except mild left upper zone consolidation. During a routine follow up appointment 8 months after the initiation of treatment, the blood tests showed abnormal renal function and prolactin level was controlled. CT KUB showed features suggestive of retroperitoneal fibrosis lea...

A 33 year old primip presented to the local ophthalmic hospital at 34+4 weeks’ gestation with two weeks of blurred vision. Examination revealed a bitemporal hemianopia and reduced visual acuity. She was previously fit and well, and a pre-eclampsia screen was negative. An MRI scan demonstrated a haemorrhagic pituitary lesion extending into the suprasellar cistern with mild compression of the optic chiasm. Pituitary function tests showed a raised prolactin 3844 mU/l, isolat...

Background: Acromegaly is rarely encountered in pregnancy and the lack of data for clinical outcomes limits the development of evidence-based guidelines. We present the case of a pregnancy in a 31-year-old woman with acromegaly due to a pituitary microadenoma.Clinical case: The patient underwent trans-sphenoidal hypophysectomy in 2015 at the age of 28, which was non-curative: post-operative IGF-1 was 533 mcg/l (72–259 mcg/l) (down from 894 mcg/l pre...

Introduction: Functioning gonadotroph adenomas (FGAs) are very rare tumours secreting biologically active gonadotropins. In males, typically, FSH levels are elevated, whereas LH and testosterone are variable. Herein, we present three males with elevated, normal or low testosterone at diagnosis.Cases: Case 1:42-year-old man with two-year history of visual impairment. Bitemporal hemianopia was confirmed. Imaging showed macroadenoma compressing optic chiasm...

Introduction: Hypopituitarism refers to deficiency of one or more of the pituitary hormones. Hypopituitarism is often partial, thus replacement is individualized. Hormonal replacement improves quality of life in these patients.Objective: To describe the demographic characteristics and patterns of hormonal replacement in patients with hypopituitarism attending the Endocrinology clinic of a tertiary hospital in Lagos, Nigeria.Methods...

Background: Hyponatraemia is the most frequent electrolyte disturbance in hospitalised patients and is associated with increased morbidity and mortality as well as increased expenditure. Hyponatraemia is a common reason for referral to Endocrinology in the hospital setting however hyponatraemia has a variety of causes many of which do not come under the remit of ‘Endocrinology’.Aim: To determine the aetiology of severe hyponatraemia in hospital...

A 49 year old male, known to suffer from hypertension, was bein investigated for recurrent occipital headaches. An MR Brain showed a 2.4 cm×2.8 cm×4.2 cm sellar mass with suprasellar extension, optic chiasm compression, infrasellar extension with erosion into the sphenoidal sinus, lateral extension into the left sided cavernous sinus and further extension through the cavernous sinus into the parietal lobe. The tumour contained some cystic areas and moderately enhance...

A 68-year-old male presented with fatigue and acute onset polyuria and polydipsia. There was no history of headaches, visual symptoms, previous cranial radiations, chemotherapy or CNS infections. Investigations revealed normal fasting glucose, urea, creatinine, liver functions and electrolytes including calcium. Further workup including pituitary profile, paired osmolalities and water deprivation test confirmed hypopituitarism and cranial diabetes insipidus (Table 1). The unde...

Background: Sheehan’s syndrome (SS) is rarely encountered in developed countries due to advanced obstetric care but it is still frequent and a major threat to women in developing nations. Anaemia among other risk factors may increase the risk of Sheehan’s syndrome.Case report: 36 year old woman, known sickle cell disease (SCD) patient with previous history of stroke in childhood, presented to the heamatologists on account of generalized body we...

A 30-year-old female presented to her general practitioner with a three-month history of fatigue, visual disturbance, polydipsia and dizziness. She was treated for iron deficiency anaemia, but re-presented two-months later with new-onset headache and worsening visual disturbance. Previously, she had childhood leukaemia, treated in Brazil with no cranial irradiation. On examination there was left eye loss of light/dark perception and right temporal vision loss. She was referred...

Background: With advances in radiological technology, the detection of incidentally discovered pituitary abnormalities is increasing, 90% being secondary to pituitary adenomas. Patient morbidity increases when these lesions are large enough to cause hormone insufficiency or visual field defects, highlighting the importance of appropriate management.Aim: To evaluate management of patients with pituitary incidentaloma in accordance with national guidelines...

Hypogonadism persisting in males with macroprolactinoma requires exogenous testosterone replacement therapy but this may cause secondary elevations of prolactin. We present a case of a 44 year old gentleman who was diagnosed with macroprolactinoma after being investigated for ‘abnormal thyroid function tests’ with a low T4 and a normal TSH. He reported a few years’ history of increasing weight gain, lethargy, generalised aches and pains, occasional headaches and...

Background: Falls are a significant health problem and major burden on healthcare services. Falls are typically associated with ageing-related frailty, but diabetic peripheral neuropathy, postural hypotension and hyponatraemia are recognised risk factors for falling that might be independent of ageing-related factors. We undertook a study to assess the prevalence of these independent risk factors in patients admitted to hospital following a fall.Methods:...

Introduction: Functional amenorhea can appear due to chemical, emotional of physical chronic stress. It is particular pathology with special issues regagring long therm body sustaiment after the occurence of menses cessation. Material comprise 39 young women, with ages between 17 and 34, (mean age of 24.55±6.09 years), 11 adolescents and 28 adult women, with secondary amenorrhea induced by weight loss, there were addressed to our Endocrine Unit, starting January 2014. Inc...

Spindle cell oncocytoma (SCO) is a rare nonfunctioning neoplasm of the anterior pituitary gland .This tumour is often misdiagnosed as pituitary adenoma or pituitcytoma due to it’s location and symptoms. Such tumours are highly vascular radiologically and histologically. We report a 54 year old gentleman who was found to have pituitary adenoma on CT head performed after a fall. Subsequent Pituitary MRI showed 25×18 mm pituitary macroadenoma with optic chiasm compressi...

35y woman presented to haematology with normocytic anaemia and extreme fatigue. Had borderline vitamin B12, but im hydroxocobalamin did not improve Hb. A trial of iv iron was also ineffective. Bone marrow biopsy showed hypocellular bone marrow with suppressed erythropoiesis. In the absence of underlying cause, commenced prednisolone with significant improvement in Hb from 117 to 134 g/l and she felt better. Prednisolone was continued at 5 mg od. Fatigue, musculoskeletal sympto...

35y woman presented to haematology with normocytic anaemia and extreme fatigue. Had borderline vitamin B12, but im hydroxocobalamin did not improve Hb. A trial of iv iron was also ineffective. Bone marrow biopsy showed hypocellular bone marrow with suppressed erythropoiesis. In the absence of underlying cause, commenced prednisolone with significant improvement in Hb from 117 to 134 g/l and she felt better. Prednisolone was continued at 5 mg od. Fatigue, musculoskeletal sympto...

Introduction: Non-Hodgkin lymphoma (NHL) involving the hypothalamus and pituitary gland is rare. Central nervous system involvement by NHL may be either as a primary tumour or from systemic lymphoma. We report an interesting case of aggressive central nervous system (CNS) lymphoma presenting as pituitary macroadenoma.Case report: A 67-year-old Caucasian woman presented with sudden onset of left eye ptosis and diplopia. Examination showed left third nerve...

Introduction: Orthostatic hypertension (OHT) is a phenomenon which may represent increased cardiovascular risk and is less well recognized compared to orthostatic hypotension.Case: A 65 year old gentleman presented with symptoms of lethargy and episodic shaking. He has a history of treated prostate cancer and was not on any regular medications. He noticed consistently elevated blood pressure on standing during home monitoring. His lying BP was 142/82 and...

Pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone may be lifesaving. Apoplexy is often the first manifestation of an underlying pituitary adenoma. We report a case of apoplexy in a patient with an undiagnosed pituitary adenoma who presented with sudden onset headache and subtle neurology in the form of minor left ptosis. A 64-year-old male with a background of hypertension, asthma-COPD overlap syndrome and bronchiectasis presented to A&E w...

A 23-year-old woman was referred with light periods and subfertility with a raised prolactin (1175 miu/l). Remaining pituitary function tests were normal. As she was now pregnant, investigations were postponed until post-pregnancy. Post-partum prolactin was 1823 miu/l and MRI pituitary demonstrated a 13.5 mm pituitary macroadenoma. Cabergoline was commenced but stopped due to a further pregnancy. At 22 weeks gestation she experienced left visual field loss. MRI showed...

A 24 year old gentleman presented following an episode where he became ‘sleepy’ and disorientated whilst driving and had to pull over. He was confused and lethargic and paramedics found blood glucose of 2 mmol/l. He gave a 3-week history of extreme lethargy, nausea, epigastric discomfort, blurring of vision and constant hunger. He denied recent weight changes and had no significant past medical/family history. Biochemical evaluation was as follows; Laboratory glucose...

The co-existence of thyrotropin (TSH) and growth hormone (GH) secreting pituitary adenoma is exceedingly rare. Less than 15 cases having been reported.Case report: A 75 years’ old man presented with new-onset atrial fibrillation. He had high FT4 with normal TSH. His ultrasound scan of the neck showed a solitary nodule. He had ablation twice and was started on bisoprolol and anticoagulant. He had an MRI scan for headaches and this showed a pituitary ...