Endocrine Abstracts

The FGF signalling pathway regulates cell proliferation, differentiation, migration and cell specification in mutliple developing and adult tissues. It has also been implicated in tumor development and progression with a significant role in the cancer pathobiology of several malignant tumors including melanoma, breast, pancreas, head and neck and non-small lung cell cancer. FGF signalling plays a major role in the postnatal hypothalamic-pituitary (HP) axis, with dysregulation ...

Objective: Arthropathy is the commonest morbidity in acromegaly and the main determinant of quality of life in these patients. Most of current knowledge is derived from studies using conventional x-rays. This study aims to characterise acromegalic arthropathy using modern imaging techniques.Methods: Case control study comprising of 60 acromegaly patients (29 males, mean age 54.8± 12.9yrs) and 300 age/gender-matched controls from the publicly availab...

Paltusotine is a once-daily, oral selective nonpeptide somatostatin receptor type 2 (SST2) agonist, which is in clinical development for the treatment of acromegaly. Maintenance of insulin-like growth factor 1 (IGF-1) control and toleration was demonstrated in phase 2 studies evaluating paltusotine in biochemically controlled (IGF-1 ≤1xULN) [ACROBAT Evolve (NCT03792555)] and uncontrolled (1> IGF-1 ≤2.5xULN) [ACROBAT Edge (NCT03789656)] patients with acromegaly ...

Introduction: Although acromegaly and pituitary gigantism have the same pathological cause, they have different disease characteristics.Aim: To study tumour size, treatment course and the most common comorbidities in a population with young-onset acromegaly.Materials and Methods: UK Acromegaly Register (UKAR, 22 centres, 1997-2017) retrospective analysis, enriched with patients from the FIPA-consortium. We defined gigantism as diag...

Background: It is apparent that COVID-19 may cause persistent symptoms beyond 12 weeks (‘long COVID’). However its underlying pathophysiology is unclear. Several symptoms of long COVID draw similarities to that of endocrine diagnoses. We recently observed that adrenal and thyroid function were normal in survivors of COVID-19 at follow-up. Here we assess additional endocrine axes that could plausibly have a role in long COVID to determine their relationship to ongoing...

Introduction: Water deprivation testing (WDT) is considered the gold standard test in differentiating between craniogenic diabetes insipidus (DI), nephrogenic DI and primary polydipsia. However, it requires day case admission for monitoring of sodium and osmolality. Copeptin, derived from pre-provasopressin, is secreted in an equimolar amount with arginine vasopressin and has a potential role in facilitating the diagnosis of DI and reducing the need for WDT. Copeptin was gradu...

Insulin resistance is one of the metabolic pathogenesis of Type 2 diabetes mellitus which cause neurodegeneration, due to its effects on insulin signaling pathway. The present study focused on the intracerebroventricular administration of streptozotocin (STZ) to induce insulin resistance directly in brain, accounting for alteration in insulin signaling pathway and thus the possible therapeutic effect of Cinnamomum Zeylanicum on the impairment hippocampus of diabetic r...

Background: The clinical presentation of non-functioning pituitary adenomas (NFAs) can range from an incidental finding on imaging to pituitary hormone deficiencies and visual compromise.Objective: To assess the clinical presentation of patients who had undergone surgical resection of histologically proven NFAs.Methods: Patients presenting to the University Hospital of Wales, Cardiff, with non-functioning pituitary adenomas (histol...

A 69-year-old man was referred to our Pituitary Service for a 3-month history of progressive right visual loss and a finding of “pituitary enlargement” on brain MRI. He reported erectile dysfunction and his medical history included asthma, DM2 and meningitis (8 years ago). Neuro-ophthalmology review showed visual acuity 6/60, optic neuropathy, marked visual field loss with residual superonasal island in right eye, mild 6th nerve palsy. Pituitary MRI: infil...

We report a 33 year old female who presented at 23 weeks gestation with rapid onset polyuria and polydipsia. Fluid input and output was approximately 12 litres per day. She denied any other symptoms. She did not have signs of hypopituitarism, Acromegaly or Cushing’s syndrome. Visual fields were normal to confrontation. Her standard glucose tolerance test, Hba1c, creatinine and calcium were normal. Gestational Diabetes Insipidus was (GDI) suspected. Given her pregnancy, a ...

The hippocampus is majorly involved in memory formation. The insulin pathway regulates the level of GSK-3β, which is involved in the formation of amyloid beta and Tau. Allium sativumhas been shown to reduce amyloidogenesis and increase brain insulin sensitivity. 32 male Wistar rats were used in this experiment. They were grouped into 4, each with 8 rats. Group A (Sham), B (3 mg/kg of streptozotocin), group C (3 mg/kg of streptozotocin +300 mg/kg of Allium sat...

Background: Current guidance for the management of macroprolactinomas recommends full pituitary profile at baseline and subsequently only if symptomatic. Pituitary adenomas that co-secrete growth hormone and prolactin at presentation are well-recognised. Case reports of acromegaly after prolactinoma treatment are associated with symptomatic acromegaly. We present two patients with asymptomatic acromegaly years after diagnosis of macroprolactinoma.Patient...

Introduction: Hyponatraemia is a common biochemical abnormality, complicating up to 15% of all hospital admissions and associated with increased mortality. Hypernatraemia, occuring less frequently, is strongly associated with mortality and is almost always due to a free water deficit. There is limited data about hospital healthcare burden of these two relatively common electrolyte imbalances. We analysed the length of stay, for acute admissions, with reference to the admission...

A 31-year-old man without previous medical history presented to his local hospital with one week history of generalised severe headache. Brain CT was reported as negative for acute intracranial pathology. Five weeks later, he re-presented with worsening headache and blurring of vision. Brain CT revealed a large area of hypodensity centred on the left thalamus/basal ganglia and subsequent MRI with contrast showed a medium size pituitary cyst with suprasellar extension and two c...

Context: Serum IGF-binding protein-3 (IGFBP-3) and molar IGF-I to IGFBP-3 ratio can aid the diagnosis of GH-related diseases. However, their clinical utility is limited by lack of validated reference intervals.Objectives: To establish age-, gender- and Tanner stage-specific reference intervals for IGFBP-3 and IGF-I to IGFBP-3 ratio for Indian ethnicity.Setting and Participants: We conducted a cross-sectional epidemiological study (...

Background: Knowledge of glucocorticoid use during acute illness is widely known, however, knowledge of Diabetes Insipidus (DI) is suboptimal amongst healthcare professionals. In 2009, a series of medical and management failures led to the death of 22 year old from DI in a London hospital. Since then increased efforts have been made to raise awareness about the inpatient management of DI and dangers associated with delay and/or omission of desmopressin. An NHS England patient ...

Background: Pituitary abscess is a rare entity which is often not suspected in pituitary lesions differential diagnoses; arising de novo or as a consequence of sinus infection, meningitis, or haematogenous spread. The diagnosis is challenging and mostly made during surgery.Case Report: A 54-year-old male patient presented with 3 days of severe headaches, vomiting, and left eyelid drooping. He was afebrile, BP 90/61mmHg, and had a left third nerve palsy w...

Background: Pituitary apoplexy is a relatively rare but important clinical syndrome which may be associated with acute headache, visual compromise and hypopituitarism. It can be the initial presentation of a previously unsuspected pituitary macroadenoma. Recognised risk factors include hypertension and the use of antiplatelet agents and/or anticoagulant therapy. It may be life-threatening, requiring emergency endocrine (e.g hydrocortisone) replacement therapy[1] and...

Empty sella is an incidental finding characterised by the herniation of subarachnoid space into the sella turcica with resultant flattening of pituitary gland to varying extent. It was considered benign. But recent reviews have shown its association with some neuroendocrinopathies.Aims and Objectives: To determine if patients with radiological diagnosis of PESS were;1. Referred to Endocrinology team?2. What p...

Background: Incidence of non-functioning pituitary macroadenoma (NFPMA) is very rare in pregnancy. We describe a case of complicated non-functioning pituitary macroadenoma presented during pregnancy. 26 year old female at 21 weeks gestation presented to emergency services with worsening headaches, nausea and vomiting for 2-3 months. This was associated with transient double vision and confusion since 2 days. She was admitted to emergency department 3 weeks ago with vomiting an...

Case History: 17 year old boy presented with a six week history of polyuria, polydipsia, headaches and easy fatiguability. Further investigations confirmed hypopituitarism with low early morning urine osmolality. MRI brain revealed soft tissue mass arising from tectal plate extending into cerebral aqueduct resulting in hydrocephalus with normal pituitary gland. Hydrocortisone, Levothyroxine and Desmopressin were started and urgent in-patient transfer to Neurosurgical unit in t...

Background: Pituitary apoplexy is one of the rare endocrine emergencies. Most series indicate that incidence is between 2-7% based on clinical, surgical and histopathological evidence.1-3 Usually presents with severe headaches that may be associated with nausea vomiting, ocular palsies, fever, photophobia. Predisposing factors are pre-existing pituitary conditions, hypertension, major surgery, anticoagulation therapy, pregnancy, radiotherapy. Appropriate endocrine, ...

We present a case series of patients admitted to our hospital with various manifestations of Cushing’s. 71 male, known type 2 diabetes, hypertension referred for adrenal incidentaloma. Cushingoid features with non suppressed ACTH. Low dose dexamethasone test (LDSST): no suppression. 4 cm pituitary microadenoma (likely co-secretory as gonadotropins elevated). Offered IPSS and pituitary surgery. Declined the same due to fears of COVID opted for medical therapy with metyrapo...

Introduction: Pituitary apoplexy is a rare clinical syndrome secondary to abrupt haemorrhage or infarction of the pituitary gland. It complicates 2-12% of pituitary tumour, most commonly in the setting of non-functioning adenomas 1. We are reporting a case on the evolving apoplexy. A 28-year-old male with sudden onset stabbing type frontal headache at night. He described this as the worst headache in his life. CT scan of head at presentation showed a 1.9 m lesion in the pituit...

There is growing recognition within Endocrinology physician and patient groups of morbidity and mortality in association with prescribing errors and dysnatraemia, in hospitalised patients with cranial diabetes insipidus (CDI). The aims of this study were firstly, to assess outcomes in hospitalised patients with CDI by review of electronic records from 2012-2021, and secondly, to assess the same patient cohort’s perceptions of their care via telephone questionnaire. 109 pa...

Hyponatraemia is associated with an increased morbidity and mortality. Despite having a hyponatraemia algorithm (pdf format) on our hospital intranet, it was rarely accessed and a wide variation in care was noticed. A novel digital hyponatraemia diagnostic toolkit (hyponatraemia.wordpress.com) for Foundation doctors (FDs) was introduced to assess our aims if it: A) increases the awareness of FDs to start investigating when serum Sodium is <130 mmol/l B) increases FD...

Non-functioning pituitary adenomas (NFPAs) are the second most common subtype (15-43%) of all clinically presenting pituitary adenomas. Although the primary treatment of symptomatic NFPAs is surgery, gross total resection is achieved only in about 66% of the cases, and 20% of gross total resected tumours recur after 10 years. Despite recent advances in medical management of pituitary tumours, NFPAs remain the only subtype with no widely accepted pharmacological treatment. Expr...

Aims: The lowest licensed dose of tolvaptan for treatment of hyponatraemia is 15 mg. There is little data on lower doses. Our study aimed to evaluate the safety of an initial dose of 7.5 mg tolvaptan.Methods: We retrospectively reviewed data from a London teaching hospital over a 6-year period. All adults administered a first dose of 7.5 mg tolvaptan were included. Three different timeframes were reviewed: 4-12, 12-18 and 18-30 hours. We analysed respons...

Background: The incidence of neuroendocrine neoplasms (NENs) in younger populations (<50 years) is increasing and was 1.8 per 100,000 persons in 2011. There is limited data on NENs and pregnancy.Methods: A retrospective analysis was performed on pregnant women with NENs managed in an ENETS Centre of Excellence. The objectives of the study were to describe the tumour characteristics, pregnancy outcomes, treatment and the tumour behaviour intra-pregnan...

Background: World Gastroenterology Organisation (WGO) quotes gallstones prevalence of 9-21%, incidence of 0.63/100 persons/year in Europe; 10-15% of UK population have gallstones (1). Acromegaly patients’ prevalence is 8.3% and 35% developing incidental gallstones during somatostatin analogue (SSA) treatment (2).Objective: To evaluate the prevalence of gallstones in SSA treated Acromegaly patients in University Hospitals of Leicester (UHL).<p cl...

Introduction: NETs are regarded as rare endocrine malignancies, which often present late. The COVID-19 pandemic may have affected this and patient care. The impact will have been felt in health service delivery and patient experiences. To understand NET patient perspectives and optimise care, we conducted a survey to review patient perception of: telemedicine-based care, delays to imaging, treatment, and the impact of COVID-19.Method: 70 NET patients tre...

Background: Radiotherapy is a third line treatment in Acromegaly. Pituitary radiotherapy (RT) is known to have cardiovascular complications (MI/IHD, CCF & CVA) due to radiation effects on normal pituitary and surrounding structures over and above the excess Growth hormone risk on metabolism (1).Objective: To compare RT vs non-RT treated Acromegaly cohorts’ cardiovascular (CV) outcomes in unselected consecutive Acromegaly patients.<p class="a...

Background: Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) secretion is the most common cause of hyponatremia in cancer patients. About 14% of hyponatremia in medical inpatients is due to underlying tumor-related conditions. We performed an audit to evaluate prevalence of lung malignancy in patients newly diagnosed with SIADH and to assess proportion of patients having radiological evidence of lung cancer through chest x ray and/or CT chest imaging six months after es...

Introduction: The term “pituitary apoplexy” (PA) describes the appearance of abrupt hemorrhage and/or ischaemia of the constituents of sella turcica, usually in a pre-existing pituitary tumor. The presentation of this syndrome may be acute or subclinical.Objective: This study aims to assess clinical, imaging and hormonal features and the outcomes following surgery or conservative treatment among pituitary adenoma patients presenting with PA.</p...

Introduction: Anterior pituitary cells are characterised by functional lineages based on the expression pattern of transcription factors. Functional differentiation in the form of pituitary adenomas co-secreting ACTH and growth hormone is very rare. We report a case of multiple cell line pituitary adenoma resulting in acromegaly and ACTH dependent Cushing’s.Case: A 52-year-old woman of Ghanian origin (BMI of 57.5 kg/m2) presented with pro...

Introduction: There is a clinical need to develop better biomarkers for the monitoring of patients with neuroendocrine tumours (NETs), including for patients with multiple endocrine neoplasia (MEN). Chromogranins are widely used, as are individual hormones for specific syndromes. Neurone specific enolase (NSE), however, is measured less commonly and its utility is debatable.Aims: To assess the value of measuring NSE in the clinical management of patients...

Pathogenic variants in the SDHx genes are responsible for ~20% of familial Phaeochromocytoma/Paraganglioma (PPGL) tumours. Metastatic disease is lower in SDHD in comparison to SDHA, B and C mutations. Although the genotype-phenotype relationship is not well established it is considered that truncating SDHD pathogenic variants have a higher risk of causing disease in comparison to missense variants. We present two cases of metastatic paraganglioma in patients with heterozygous ...

Context: To diagnose and monitor GH-related disorders, serum IGF-I is a cornerstone, but Indian ethnicity based data, following consensus criteria for establishment of normative data are not available.Objectives: To generate normative IGF-I data for chronological age, bone age (BA) [Greulich & Pyle] and Tanner stage for both genders.Setting and Participants: We conducted a cross-sectional epidemiological study for children (age...

Approximately 15-20% of phaeochromocytomas and paragangliomas (PPGL) are metastatic. Metastatic spinal cord compression (MSCC) has been reported infrequently. We present three cases of MSCC secondary to metastatic PPGLs. MSCC can occur in patients with PPGLs and should be considered in patients with either spinal symptoms or spinal metastases on imaging. Our series has shown radiotherapy followed by therapeutic MIBG to be effective in treating spinal metastases. Each case shou...

Introduction: The use of Inferior Petrosal Sinus Sampling (IPSS) to differentiate between central and ectopic ACTH dependent Cushing’s, although requires expertise, is widely available. The value of adding prolactin measurement to that of ACTH to improve IPSS diagnostic accuracy remains controversial. We evaluated the impact of adding prolactin measurement to IPSS procedures at a large academic center.Methods: Leftover samples from patients who were...

Introduction: Pituitary tuberculosis (TB) is a rare form of intracranial TB and remains a diagnostic challenge in the absence of systemic TB. A limited number of cases has been reported in the literature.Case: A 47-year-old south Asian man presented to the accident and emergency department with complete isolated left third nerve palsy which had developed gradually over the course of a week. Brain magnetic resonance imagining (MRI) revealed a 15 mm inflam...

Ectopic Cushing’s syndrome (CS) is commonly caused by malignancy, often behaves aggressively and may not clinically manifest with features of hypercortisolism due to its rapid course and associated cachexia. This may mislead clinicians into discounting the diagnosis in patients with more indolent features of CS. We present a 41 year old woman with an 8 year history of Cushingoid features with associated hypertension, obesity and Type 2 Diabetes. Investigations confirmed C...

Carney complex is a rare autosomal dominant syndrome characterized by multiple pigmented lesions on the mucosae and skin, cardiac myxoma, endocrine and non-endocrine tumours. It is caused by mutations of the PRKAR1A gene on chromosome 17q. We present a 24-year-old gentleman with Carney’s complex PRKAR1A gene positive. He has a strong family history of Carney complex- He also has a sister and 3 half- brothers who were also affected. One of his half-brothers has primary adr...

Background: Pituitary metastasis (PM) is a rare occurrence in malignancy, associated with poor prognosis. Only 7% of patients are symptomatic. High index of suspicion and prompt investigation are essential. We report a case of PM, highlighting challenges in diagnosis and management.Case Report: Sixty-six year old male was referred to endocrinology due to headaches and hyponatremia. He had metastatic colorectal carcinoma, treated with bowel, liver and lun...

We present a 60-year-old man who was referred to endocrine clinic with fatigue and a random cortisol of 136nmol/l . He had clear renal cell carcinoma and had right radical nephrectomy 7 years ago. Surveillance scans revealed involvement of mediastinal lymph nodes, pancreas and small bowel and he has pancreatic and small bowel resection in four years ago. He had recurrence a year ago and received Ipilimumab and Nivolumab. Biochemistry revealed low fT4 and inappropriately normal...

Case History: 69 years old gentleman was referred to endocrinology for investigation of a benign appearing left incidental adrenal adenoma (1cm) after being investigated for abdominal pain. He had a past medical history of an abdominal aortic aneurysm (AAA), type 2 diabetes mellitus and hypertension.Investigations: Initial endocrine investigations revealed normal 24h urinary free cortisol levels (twice), metanephrines and ARR. His overnight dexamethasone...

Background: Non-functioning pituitary tumours can be associated with a modestly elevated prolactin. Response to dopamine agonist therapy in such cases is unusual. Large macroprolactinomas are associated with much higher prolactin levels and respond well to dopamine agonists.Case: We report a 41-year-old man with a pituitary macroadenoma associated with an elevated prolactin of around 2000mIU/l who developed marked resolution in his pituitary MRI images r...