Endocrine Abstracts

Background: Phaeochromocytomas & paragangliomas (PPGL) are rare neuroendocrine tumours presenting with symptoms of sympathetic overactivity, hypertension, or as adrenal incidentalomas.Study and results: A 24-year retrospective review of a U.K. single-centre PPGL service (2009 -2023) identified 61 cases (53 phaeochromocytomas/8 paragangliomas). Among these, 35 (57%) were females. Mean age of diagnosis was 56.35±16....

Introduction: Aryl hydrocarbon receptor interacting protein (AIP) is a multifunctional co-chaperone protein with wide-ranging effects. It acts as a tumour suppressor in the pituitary, but may have other roles including oncogenic function in other tissues. To explore the molecular mechanisms, we have performed transcriptomic and phosphoproteomic analysis of Aip-knockout mouse embryonic fibroblasts (Aip-KO MEFs) cells and integrated these data sets.<p class=...

We present three cases of ACTH-dependent Cushing’s syndrome, successfully managed with osilodrostat.Case 1: A 42-year-old woman diagnosed with ACTH-dependent Cushing’s disease was initially treated with osilodrostat dose-titration approach, as MRI of the pituitary did not identify a clear surgical target. By week five, serum cortisol levels fully normalised. Salivary and 24 hr urinary free cortisol (UFC) normalised on a mainten...

Introduction: Hypopituitarism is the most frequent side effect of radiation or gamma knife radiosurgery (GKRS) for sellar diseases. There is a paucity of literature on the impact of GKRS on the hormonal profile of non-sellar diseases, even though the impact of radiation on pituitary hormones has been widely explored in sellar as well as non-sellar pathologies. In patients receiving treatment for non-sellar diseases, we assessed the effect of GKRS on hormonal p...

Introduction: Distinguishing arginine vasopressin deficiency (AVD) from primary polydipsia (PP) can be challenging in clinical practice. Copeptin is produced in equimolar amount to AV and is considered diagnostic biomarker to establish the diagnosis of AVD with and without provocative testing.Methods: Patients referred with polydipsia, hypotonic polyuria (>3L/day) and normonatraemia had overnight fasting plasma copep...

Background: While growth hormone (GH) is involved in oncogenic transformation and IGF1 inhibits apoptosis, studies and case reports have shown an association between prolactin (PRL) and prostate cell proliferation, breast, gynecological, colorectal and hematopoietic cancer.Aim: To compare the cancer rates in prolactinomas vs. acromegaly.Methods: Retrospective study by analyzing the...

Background: Acromegaly is associated with significant excess morbidity and mortality. Surgery and radiotherapy (including radiosurgery) aim to reduce the burden of growth hormone excess while preserving normal pituitary function, but their effective deployment is dependent on high quality imaging that allows accurate localization of site(s) of active de novo or residual/recurrent disease. Despite the existence of several comprehensive guidelines on the managem...

Background: Despite current efforts in trying to accurately identify determinants of impaired quality of life (QoL) in acromegalic patients, studies on this topic are still conflicting and more research is needed in order to improve the well-being of these patients.Methods: We conducted a cross-sectional study, administering two standardized questionnaires (AcroQol and EuroQol-5D) to 38 acromegalic patients and examined ...

Background and objective: The purpose of this study was to retrospectively analyse the clinical, imaging and hormonal features, as well as the therapeutic outcomes in a series of consecutive patients presenting with pituitary apoplexy (PA).Design: We retrospectively reviewed 71 case-records of patients with PA admitted during 2019 in a single tertiary endocrinology center.Results: ...

Macroprolactinaemia, a common phenomenon variably expressed in different assays, influences interpretation of prolactin results, as recognised since 1978. The degree of macroprolactinaemia manifest over time is less well described. We examined how macroprolactin status (based on polyethylene glycol(PEG) precipitation prolactin % recovery) varied over serial measurements in hyperprolactinaemic individuals.Methods: All serum total prolacti...

Background: Cranial Diabetes Insipidus (CDI) or Arginine-Vasopressin Deficiency (AVP-D) is a potentially life-threatening condition requiring treatment with desmopressin. Omission or delay in desmopressin can result in serious patient harm.Aims: Evaluation of desmopressin prescription/administration practice and implementation of an action plan to improve patient safety.Methods: Re...

Background: An estimated 462 million individuals are affected by type 2 diabetes mellitus (T2DM), corresponding to 6.28% of the world’s population. Many epidemiological studies have indicated that T2DM may be a risk factor for neurodegenerative diseases, including Parkinson’s disease (PD). Whilst research suggests there are common molecular mechanisms underlying the conditions, studies investigating the epidemiological association have revealed conflicting res...

A 16-year-old female presented with secondary amenorrhoea. Menarche was age 14 years and periods were less frequent over the preceding 12 months. There was no galactorrhoea, headache or visual field disturbance and no known family history of pituitary disease, tall stature or infertility. There were no clinical signs of Cushing’s disease or acromegaly and visual fields were full to confrontation. Height was 160 cm. Investigations showed a prolactin of 2,452 mIU/l (RR 102-...

It is well established that the majority of the immunohistochemically confirmed gonadotroph adenomas are hormonally silent, accounting almost 64% of all clinically nonfunctioning pituitary adenomas. Whereas clinically functioning gonadotroph adenomas (FGA) are very rare and the exact prevalence is not known. We present the case of a FGA in a premenopausal. A 31-year-old female presented in the ED with oligomenorrhea for 11 months, abdominal pain and distention over the precedi...

Pituitary metastases are reportedly uncommon. Here we report two cases illustrating metastases responding to systemic anticancer therapy (SACT). A 49-year-old woman with metastatic renal cell carcinoma treated with combination ipilimumab and nivolumab immunotherapy was referred for hypocortisolaemia (morning cortisol 74 nmol/l). Biochemical screening revealed an adrenocorticotropic hormone of 16ng/l (0-46), thyroid-stimulating-hormone 0.1mU/l (0.55-4.78), free thyroxine 7 pmol...

Background: While dopamine agonists (DAs) are used for managing residual/recurrent non-functioning pituitary adenomas (NFPAs), guidance on patient selection, drug dosing, follow-up imaging and response criteria is lacking.Methods: Retrospective review of NFPAs treated with DAs at a U.K single centre. 14 patients on Cabergoline (November 2011-2022) were identified. Radiological response was based on 2 follow-up (FU) scans...

Introduction: Multiple myeloma (MM) is a haematological disorder characterised by an aberrant rise in monoclonal paraprotein. Intrasellar plasmacytomas can be infrequent MM manifestations. They are challenging to diagnose and frequently mimic pituitary adenomas; however rarely present with pituitary apoplexy. We describe a patient with pituitary apoplexy-like symptoms, subsequently diagnosed with MM, whose intrasellar mass entirely resolved after chemotherapy....

A 19-year-old gentleman, with Coffin-Siris-Syndrome(CSS)(ARID1B:c.6157dup gene-mutation), was referred to our endocrinology clinic, with rapid weight-gain and recent onset of Type-2-Diabetes. He was of short stature, he had central-adiposity, facial plethora, proximal myopathy and gynaecomastia. Endocrine testing revealed ACTH:61ng/l, Cortisol:772nmol/l, Total-Testosterone:2.8nmol/l, FSH:6.3U/l, LH:2.2U/l, Prolactin:87mU/l, IGF-1:61ug/l, TSH:0.18mU/l, T4:10.3 pmol/l, HbA1C:84m...

Introduction: Prevalence of prolactinoma is approximately 10/100,000 (men) and 30/100,000 (women) and dopamine agonists remain pharmacological treatment of choice. Cabergoline, an effective dopamine agonist, is preferred due to better tolerability withhigher efficacy in lowering prolactin and reducing tumour size in comparison with bromocriptine. Digital vasospasm, known adverse effect of Bromocriptineis mediated by activation of α1 adrenergic receptors. ...

Lactation is under the control of the anterior and posterior pituitary via prolactin and oxytocin release. A number of galactogogues, including dopamine antagonists, have been described and used with success in lactation induction. To date, there are no reports in the literature of their use in patients with panhypopituitarism. We present the case of a forty-year-old female known to endocrinology services with a background of anterior panhypopituitarism and AVP deficiency asso...

Background: Cushing’s syndrome is rare (1.8-3.2 cases/million population)1, with Cushing’s disease (CD) accounting >70%. We seek to highlight a rare complication, spinal epidural lipomatosis (SEL), rare cause of spinal compression (prevalence-2.5%2), commonly related to exogenous steroid use with 3 reported cases secondary to CD3,4,5.Case: 36-years old man, background asthma and alcohol excess presented wit...

Introduction: Ipilimumab is an efficient medication used for the management of melanoma. However, it has been associated with endocrine dysfunctions such as hypophysitis, thyroid disorders (hypo- or hyperthyroidism), and adrenal insufficiency.Case report: We report the case of a 65-year-old male diagnosed with melanoma (Clark V). In 2022, he was operated and received treatment with ipilimumab 3 mg/kg. Three weeks after t...

Introduction: pituitary duplication is a rare congenital malformation. It has been mainly reported in the pediatric and neonatal population with few reported cases in the adult population. In this case we will be discussing the presentation of an adult female patient with pituitary stalk duplication and empty Sella causing hyponatremia.Case Presentation: A 46-year-old female presented with severe euvolemic hyponatremia. ...

Case: This 23-year-old lady initially presented in 2013 with headaches, galactorrhoea and secondary amenorrhoea. Visual fields were normal to confrontation. Prolactin levels were elevated at 3028miu/l. MRI pituitary revealed a 14x13x15mm adenoma pushing the pituitary stalk posteriorly, and compressing the left side of the optic chiasm.Initial Management: Cabergoline was commenced (250mg twice weekly), with good clinical ...

Silent corticotroph adenomas are a distinctive subgroup of nonfunctioning pituitary tumours without biochemical or clinical evidence of Cushing’s disease. They are diagnosed after surgery by positive immunostaining for ACTH. They are usually macroadenomas with more aggressive behaviour. On rare occasions, they transform into active Cushing’s disease, with elevated serum ACTH levels. I report a case of a 44 years old lady I first examined in the postoperative neurosur...

Ectopic posterior pituitary is a rare congenital pituitary anatomical defect of complex inheritance resulting in heterogeneous clinical and radiological phenotypes. Presentation is primarily in paediatric patients with growth and development effects. We present a rare adult presentation patient. A 33 year old male presented with low libido and paucity of facial hair. Previous medical history was limited to a left undescended testis. He took no regular medications, anabolics or...

Background: Arginine Vasopressin Deficiency [AVP-D] can occur as consequence of any abnormality or injury at one or more of the sites involved in the Antidiuretic hormone [ADH] secretion. AVP-D is one of the presenting features of suprasellar lesions with panhypopituitrism. The natural course of the disease differs based on the underlying aetiology. It is likely to be transient post-operatively. Idiopathic DI is usually permanent however DI can be reversible w...

Introduction: There are many causes of central diabetes insipidus including trauma, drugs, metastatic tumor, lymphoma, leukemia, inflammation, virus infection and gene mutation. They’re very few cases in England reported as pituitary involvement of NHL [no-Hodgkin lymphoma] Approximately about 31 cases were reported in the literature as NHL of the pituitary as in Pub medicine, however in these series of cases the most common presentation among them was ce...

The pulse mode of gonadotrophin-releasing hormone (GnRH) release from the hypothalamus and following luteinising hormone (LH) pulses from the pituitary induce follicular development in female animals. Kisspeptin neurons in the hypothalamic arcuate nucleus (ARC) are suggested to be the GnRH pulse generator. Adrenomedullin (AM) is a secretory peptide expressed in various tissues, including the hypothalamic paraventricular nucleus, but its functions in the central regulation of r...

Introduction: Patients with hypopituitarism often report poor quality of life (QoL) despite adequate hormonal replacement therapy. Oxytocin, a peptide hormone produced in the hypothalamus and released by the posterior pituitary, has been known for its role in social and emotional behaviour. Our aim was to investigate the relationship between oxytocin and QoL domains in patients with hypopituitarism under optimal hormonal replacement therapy.<p class="abste...

Acromegaly is caused by excessive growth hormone (GH) and insulin-like growth factor (IGF-1) secretion. Arthropathy is a leading cause of morbidity and impaired quality of life in acromegalic patients, often persisting despite therapeutic interventions and biochemical control. This cross-sectional study aimed to characterise the extent and impact of arthropathy in terms of pain and functional impairment. Validated questionnaires, including DASH (Disabilities of the Arm, Should...

Background: Secretory pancreatic neuroendocrine tumours (PanNET) are common in MEN1. The MEN1 Clinical Practice guideline (Thakker, 2012) recommends annual assessment of fasting gut hormones (FGH) with annual pancreatic imaging for routine NET surveillance in MEN1.Study aim: To determine whether FGH (gastrin, glucagon, somatostatin, pancreatic polypeptide, VIP, insulin, chromogranin-A) in a cohort of asymptomatic individ...

Background of Study: Polycystic ovarian syndrome (PCOS) is an endocrine disorder, contributing to increased neurodegenerative disorders including hypothalamic disturbance. Short chain fatty acid (SCFA) has been reported to regulate metabolic health. However, its therapeutic nature in hypothalamic dysfunction, especially in PCOS individuals is unknown. This study hypothesized that SCFA reverses hypothalamic injury and its related abnormalities in experimentally...

Background: Cranial diabetes insipidus (DI) is characterised by the inability to produce ADH (antidiuretic hormone) also known as AVP (arginine vasopressin) resulting in uncontrolled diuresis. Desmopressin is a synthetic form of AVP used to treat this. Treatment errors can lead to dehydration and hypernatremia which can be life-threatening. In view of recent literature suggesting current concerns with Desmopressin administration worldwide, Diabetes Insipidus i...

Delayed hyponatraemia(DH) is a well-known complication following trans-sphenoidal pituitary surgery (TSS), varying in incidence from 9–36% and occurs between post-operative days(POD) 4 to 14. Various studies have demonstrated that post-operative fluid restriction after TSS reduces the incidence of DH.Objective: to assess whether a fluid restriction protocol from POD5 to POD14 following TSS reduces the incidence of post-operative DH ...

Background: Hyperprolactinemia is one of the most common endocrine disorders of the hypothalamic-pituitary axis. It is difficult to differentiate between stress induced hyperprolactinemia and true hyperprolactinaemia and may result in patients having unnecessary imaging.Methods: We have collected data for 46 patients who had a cannulated prolactin test between January 2017 and June 2023 in the Royal United Hospital of Ba...

A proportion of prolactinomas exhibit aggressive features (including invasiveness, relevant growth despite adequate dopamine agonist treatment, and recurrence potential) and few may exhibit metastasizing potential (carcinomas). We present an uncommon case of intra-orbital spread from a large infiltrative prolactinoma, with excellent response to temozolomide and a systematic review of the literature. A 55y.o male patient presented with generalized weakness and hyponatraemia. Fu...

Background: There is increasing evidence that dopamine agonists used to treat hyperprolactinaemia may cause psychiatric side effects. Male patients have been identified to be at increased risk. This study aimed to establish the incidence of cabergoline-induced psychiatric side effects, potential risk factors for their development and to determine the prevalence of counselling and monitoring for these side effects.Methods:</strong...

Background: Cranial Diabetes insipidus (CDI) is a rare condition but is potentially life-threatening if there is a delay or omission of desmopressin. Recent patient safety alerts highlighted the need to raise awareness to avoid mortality and morbidity. The baseline knowledge of the health care professional (HCPs) is very important to avoid deleterious outcomes.Aim: Qualitative survey to determine the baseline knowledge a...

Pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is a consequence of long term untreated or uncontrolled primary hypothyroidism. The proliferation of thyrotrophs in the pituitary gland, due to the lack of negative feedback on the hypothalamus from low circulating thyroid hormone levels, causes elevated thyroid stimulating hormone (TSH) levels. Hyperprolactinaemia can also be present due to the stimulatory effect of TSH on lactotrophs. Pituitary hyperplasia caus...

A 65-year-old female with PTEN Hamartoma Tumour Syndrome, Follicular thyroid carcinoma, and Endometrial Carcinoma, presented at a tertiary centre due to an asymptomatic adrenal lesion. Previous genetic testing for phaeochromocytoma and paraganglioma in 2020 showed no pathogenic variants in multiple genes (FH, MAX, MEN1, SDHx, SDHAF2, TMEM127, VHL, RET gene). Recent imaging revealed a 9 cm left supra-renal lesion that had been gradually increasing in size since 2010. Plasma nor...

Introduction: The most common sellar and suprasellar lesions are pituitary adenomas, craniopharyngiomas and benign cysts. Rathke’s cleft cyst (RCC) is a benign developmental sellar or suprasellar cystic lesion, which is rarely symptomatic.Case HistoryWe present the case history of 21-year-old woman with a suprasellar RCC, causing early optic chiasmal compression and associated with hyperprolactinemia. Past medical history included neurofibromatosis type 1...

A 45-year-old female developed clinical and biochemical recurrent Cushings’ Disease 2.5 years after transsphenoidal hypophysectomy for 2cm pituitary macroadenoma. Past medical history included Type 2 Diabetes mellitus, asthma, hypertension, grade 3 obesity, dyslipidaemia, depression and sleep apnoea. MRI showed residual pituitary tissue with left sphenoid sinus extension. MDT advised repeat transphenoidal surgery over radiotherapy due to presence of a clearly visible surg...

Background: In the UK, adults with growth hormone deficiency (GHD) are treated with recombinant Growth Hormone (GH) therapy according to NICE guidelines (TA64). Provided that patients show an initial improvement in their quality-of-life score, assessed using the Quality-of-Life Assessment of GHD in Adults (Qol-AGHDA) questionnaire, they can continue with their GH treatment long-term. However, in clinical practice, many patients are observed to discontinue GH r...

Introduction: Ovarian metastasis from neuroendocrine tumours is rare with < 80 reported cases. We describe a case of bilateral ovarian metastases from a primary ileal carcinoid tumour managed with somatostatin receptor agonist (SSA) therapy and surgery.Case report: A 68-year-old lady presented with abdominal pain, distension, and episodic facial flushing. Echocardiography done to investigate left bundle branch block ...

Introduction: Hypophysitis is the inflammation of the pituitary gland, characterised by hypopituitarism and pituitary enlargement. It can occur as primary (commonly lymphocytic, granulomatous or xanthomatous) or secondary to systemic disease, immunotherapy or sella-based pathologies.Case Presentation: A 30-year-old female was admitted to hospital with headache, fatigue, low mood and blurred vision, 3 months after having ...

A 76-year-old lady with a background of Crohn’s disease (ileostomy in 1991) was referred to endocrinology in March 2022. Her 9-am cortisol level was <50 nmol/l, with a sodium of 130 mmol/l. These were done as she reported tiredness, lethargy and dizziness since November 2021. She had also lost 7 lb of weight. No evidence of hyperpigmentation. She had then been empirically started on hydrocortisone (10 mg-morning, 5 mg-afternoon and 5 mg-evening) pending evaluation of ...

Background: Immunotherapy has become one of the standard interventions to treat various malignancies and auto-immune conditions with favourable responses to the treatment. However, the immune related adverse events of these medications are diverse which may include a variety of endocrinopathies, like Hypo cortisol, Hypophysitis, hypo and hyperthyroid states.Case report: A 62 year old female with a background of Metastati...

Arginine vasopressin resistance (AVP-R) (previously termed nephrogenic diabetes insipidus) is well known to be associated with lithium treatment. However, cases are usually mild and patients can almost always compensate for their polyuria with excessive fluid intake. We present the case of a moribund patient who required intensive care admission secondary to AVP-R, developing hypernatraemia to 183mmol/l and serum osmolality of 394mmol/kg. A 68 year old gentleman, on lithium tr...

Key words- Cushing’ Disease, Aortic DissectionBackground: Cushing’s syndrome is a rare endocrine disorder. It is frequently presented with obesity, type 2 diabetes, or hypertension with an increased cardiovascular risk. The association of Cushing’s syndrome with aortic dissection is rare. We report a young man who presented with hypertensive emergency and aortic dissection. He was later found to have Cushing’s disease...

MEN1 is a rare hereditary tumor syndrome characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, enteropancreatic, and anterior pituitary origin and non endocrine tumor. Here we will discuss a case of 36 yrs. old male who was referred for high calcium on routine blood test. Subsequent investigations confirmed primary hyperparathyroidism. His serum calcium level was 2.71, PTH 7.5 Pmol/l, and vitamin D 57.4 nmol/l on presentation and was...

Background: ACTH concentrations remain typically elevated in patients with Addison’s disease. We present a case of an extremely potent oral contraceptive pill (OCP) induced increase in total cortisol resulting in inhibition of ACTH secretion that was normalized on OCP withdrawal.Case Presentation: A 20-year old female was diagnosed with Addison’s disease [cortisol 1.59 µg/dl, ACTH>500 pg/ml (0-65)] and...

An NHS Patient Safety Alert in 2016 warned “Risk of severe harm or death when desmopressin (DDAVP) is omitted or delayed in patients with cranial diabetes insipidus”. Endocrinologists added “It (DDAVP) needs to be continued in all situations with the assistance of endocrine teams”.Case report: A 63 year old male was referred with a sodium of 116 mmol/l following a re-do hip replacement 2 weeks earlier. A progressive d...

Introduction: More than 95% of cases of Acromegaly are caused by pituitary adenomas that present with insidious onset of symptoms due to local mass effects or due to excess of GH/IGF-1. It is often diagnosed late and results in high morbidity and mortality.Case: We present a case of a woman in her fifties with atypical presentation of acromegaly with a left sided headache for 2 years with no associated visual symptoms an...

Background: Acromegaly is a rare Endocrine condition caused by excessive secretion of growth hormone; in 2022, there were approximately 3500 people with a known diagnosis in the UK. Patients with Acromegaly can achieve successful remission of the disease with medical therapy, pituitary surgery and radiotherapy (sometimes a single treatment, sometimes combination). However, these treatment options have associated risks, including side effects, late effects of r...

29 year old African lady with a background of PCOS and type 2 diabetes, who was under the care of preconception clinic, presented to A&E with sudden onset headache associated with spontaneous closure of right eyelid. CT brain was suggestive of pituitary fossa lesion and pituitary MRI revealed pituitary necrosis. She was diagnosed with pituitary apoplexy and was commenced on appropriate hormone replacement. Examination revealed right complete third nerve palsy and reduced v...

Self-limited delayed puberty (SLDP) is characterized by an onset of puberty that is more than 2-2.5 standard deviations later than the population mean age and is often familial with strong genetic determinants. The reproductive axis is regulated by gonadotropin-releasing hormone (GnRH), which plays a crucial role in initiating puberty and maintaining fertility through its pulsatile secretion. Disruption in GnRH neuron development or hypothalamic function can lead to delayed pu...

Introduction: According to the FDA, narrow therapeutic index (NTI) medications are those in which small differences in dosage orblood concentration can lead to serious therapeutic failures and/or adverse reactions that can endanger the patient’s life or result inpersistent or significant disability or incapacity. A literature not have studies about used this medication use in endocrinology pediatric population. OBJECTIVE: Establish the prescription profil...

Neurosteroids are synthesized locally within the central nervous system and play essential roles in modulating neuronal activity and various brain functions. They can have a wide range of effects, including anxiolytic, sedative, analgesic, and neuroprotective actions. Understanding their distribution in the brain and how they interact with neurotransmitter systems is of significant interest to researchers studying brain function and related disorders. We aim to construct a 3D ...

A 44 years old lady with history of suspected psychogenic polydipsia (2021), presented with acute on chronic abdomen pain. She complained of lethargy, intermittent vomiting, abdomen pain, weight loss (four stones) over last six months associated with confusion and visual hallucination since two weeks. She mentioned feeling always thirsty and drinks around 4-5 litres of water per day. Her blood pressure was 87/61 mmHg, heart rate 74/min and U&Es were normal (serum sodium 14...

Background: Pituitary adenomas are broadly classified based on size (microadenomas and macroadenomas) and functionality. While their management has established national and international guidelines based on these two classifications, we aim to evaluate the same in a post-pandemic era, when health care resources are already stretched and have a significant backlog to deal with.Aim: To carry out a retrospective analysis of...

Introduction: Acromegaly links to cardiomyopathy and potential cardiac failure, if untreated. Mechanisms involved in acromegalic cardiomyopathy are incompletely understood. We investigated the effects of growth hormone (GH) excess and somatostatin receptor ligands (SRLs) on cardiac fibrosis using an acromegalic mouse model with pituitary-specific deletion of the Aip gene coding aryl hydrocarbon receptor interacting protein (AipFlox/Flox;Hesx1<su...

Adult growth hormone deficiency (AGHD) is a metabolic syndrome characterised by osteoporosis, increased visceral fat, adverse lipid profiles, decreased muscle mass and reduced energy levels. As such, it is associated with reduced quality of life (QoL) and increased mortality from cardiovascular disease. Synthetic growth hormone (GH) can be given to replace natural GH; however, treatment is costly at around £3350 per patient per year and could cause side effects including ...

Acromegaly is a rare endocrine disorder mostly caused by a growth hormone (GH)-secreting pituitary adenoma. The aim of treatment is to normalize GH/IGF1 levels to limit disease burden. Growth hormone hypersecretion is associated with an increased cancer risk; cases of Acromegaly complicated by lymphoma have been reported. We share a clinical case characterized by suboptimal treatment, potentially leading to advancing orbital lymphoma. This 49-year-old man was diagnosed with Ac...

Temozolomide has an established role as first line chemotherapy for aggressive pituitary adenoma and carcinoma. There are mixed reports whether the MGMT (methylguanine methyltransferase) and mismatch repair protein (MSH2/6) status of a tumour, assessed by immunohistochemistry (IHC) can predict response to temozolomide. This is the first series to assess combined MGMT and MSH2 status. We analysed a retrospective case series of patients treated with temozolomide at our tertiary ...

Background: Langerhans cell histiocytosis (LCH) is an uncommon myeloproliferative disorder characterised by inflammatory lesions and accumulation of histiocytes leading to the destruction of affected tissues. LCH has a variable presentation and can occur as a single indolent lesion or can affect multiple organs such as the pituitary gland, bones, CNS, liver, lungs, lymph nodes, spleen, skin, heart and gastrointestinal tract. LCH of the pituitary gland most com...

35-year lady with BMI of 43 was admitted to local hospital after acute shortness of breath. History of Right calf pain and swelling was evident which raised suspicion of VTE with high likelihood of Pulmonary Embolism. Subsequent CT Pulmonary Angiogram confirmed the same with origin of clot from her leg DVT. She had successfully thrombolysis in intensive care as per hospital protocol. Her high body mass index was thought to be risk factor for blood clots. Her periods were regul...

Transsphenoidal surgery is the first-line treatment for non-functioning pituitary macroadenomas (NFPAs) causing pressure symptoms. However, the approach to asymptomatic NFPAs is unclear due to the limited data on their natural progression. This study retrospectively analysed data from patients with NFPAs who underwent conservative management for at least six months. The study screened 175 individuals treated at the National Neurosurgery/Pituitary Centre at Beaumont Hospital be...

Hyperprolactinaemia is a common referral reason from primary and secondary care for contrast-enhanced pituitary magnetic resonance imaging (MRI). This retrospective study at University Hospitals of North Midlands, Stoke-on-Trent reviewed the records of new patients referred for pituitary MRI between 1 June 2021 and 31 May 2023 with hyperprolactinaemia as indication. 71 patients were identified. 82% of the cohort were women. Age ranged between 18-87 years; the majority were bet...

Loss of gonadotropin-releasing hormone (GnRH) and cognitive deficits have recently been demonstrated by our group in conditions including Down syndrome and Alzhiemer’s disease. In some patients with COVID-19, olfactory and cognitive alterations persist, and persistent hypotestosteronemia in SARS-CoV-2-infected men could be a consequence of deficient GnRH. To understand whether neuroinvasion of GnRH system by SARS-CoV-2 could explain some post-COVID symptoms and thus resul...

Introduction: Hyponatremia from SIADH secondary to undiagnosed Myelomas are extremely rare and we present one such case.Clinical case: 63 year old woman with background of MGUS under regular haematology review/ILD/NAFLD/IHD presented with severe constipation on top of weakness, weight loss and tingling in the peripheral extremities. She was euvolemic on admission with Serum Sodium 124mmol/l, Potassium 4.3 mmol/l, Urea 3....

A 44 years old lady was reviewed by endocrinology team in January 2020 for weight gain, increased fat deposition around the neck, constant fatigue and decreased libido. She denied usage of exogenous steroids. She was normal BMI, normotensive and did not display signs of Cushing’s syndrome in first visit. Although overnight dexamethasone suppression was failed to suppress: cortisol of 141 nmol/l and ACTH 78 ng/l, Low dose dexamethasone suppression test (LDSST) was adequate...

Pituitary apoplexy is an uncommon, but well recognised clinical syndrome, which usually results from ischaemic or haemorrhagic necrosis of pituitary gland, which is frequently precipitated by an existing pituitary adenoma. Early diagnosis of this condition is essential as prompt management may be life and vision saving. We are highlighting a case of Pituitary apoplexy on long term Cabergoline for Prolactinoma.Case report: A 62 year old l...

Paltusotine is a once-daily, oral, selectively-targeted SST2 agonist in development for the treatment of acromegaly. PATHFNDR-1 (NCT04837040) enrolled patients with acromegaly who had an IGF-1 ≤1xULN on a stable (>12 weeks) dose of lanreotide or octreotide. Patients were randomized 1:1 to receive paltusotine 40 mg/day or placebo for 36 weeks. During the first 24 weeks, the paltusotine dose was titrated (range 20-60 mg) based on IGF-1 and tolerance. Dose changes were ...