Endocrine Abstracts

Case report: A 52-year-old woman developed painful anterior neck swelling seven days after receiving the first COVID-19 vaccine AstraZeneca (AZ). Investigations showed TSH 0.14 mIU/l, CRP 34 mg/l and TRAb 0.3 IU/l. A neck Doppler ultrasound scan on day 15 showed features of thyroiditis. On day 21, she was hyperthyroid with TSH <0.02 mIU/l and free T4 70.3 pmol/l. COVID-19 test was negative, and she was advised to start Carbimazole and propranolol but took only the beta-blo...

Introduction: Pituitary apoplexy presents as a medical emergency, and usually occurs in people with pituitary macroadenomas. Immediate multidisciplinary expertise and timely intervention is needed to mitigate the associated morbidity. There is controversy regarding the role and the timing of neurosurgical intervention versus conservative management approach to obtain best visual and endocrine outcomes. Here we present a case of a man presenting with pituitary apoplexy and mana...

Objectives: Glycaemic targets set by diabetes teams appear to have an impact on glycaemic control. Our objective was to identify if there is consensus between and within teams in our network on glycaemic targets and whether this correlates with HbA1c outcomes.Methods: An online survey was sent to all network members requesting an independent response on the diabetes self-management advice given to families. Three patient groups were considered: children ...

36-year-old gentleman referred by his GP with poor libido and erectile dysfunction associated with hypogonadotrophic hypogonadism. 0900 h testosterone 0.3 nmol/l (10–35), LH <0.2 IU/l, FSH 0.1 IU/l, prolactin 71 mIU/l (50–500).Symptoms started at time of break up of his marriage in 2011. No other symptoms of hypogonadism or of pituitary disease. Previously fit and well. Teetotal. On no medication. Patient an avid fitness fanatic. He had nev...

A 22 years old woman, with secondary infertility, was found to have secondary hypothyroidism and referred to endocrinology. On review her symptoms consisted of headache for 6 months, amenorrhoea, weight gain and progressive loss of vision in the left eye for 6–9 months, which had been investigated by opticians and opthalmologists. Other history includes Von Willebrand disease type2. Clinical examination confirmed total loss of vision of the left eye and complete temporal ...

Little has been published on the long-term management of thyrotoxicosis with antithyroid drugs (ATDs). We analysed 376 thyrotoxic subjects on the Morriston database since 2002. 170 had Graves’ disease, 181 toxic multinodular goitre (TMNG); in 25 the diagnosis was not recorded. When euthyroid subjects were requested to have annual thyroid function testing 42 (11%) had died. 111(30%) did not have TFT’s done in last two years. 135 graves’s cases were given ATDs whi...

Background: Adrenal incidentalomas (AI) are a common radiological finding (estimated prevalence 4%). Guidelines from the American Association of Clinical Endocrinologists (AACE) and the American Association of Endocrine Surgeons (AAES) recommend radiological evaluation at 3–6 months then annually for 1–2 years, and hormonal evaluation by measurement of plasma aldosterone/renin (ARR) activity, 24 h catecholamines/metanephrines (CATS), and 1 mg overnight dexamethasone ...

Background: A functioning Hypothalamo-pituitary-adrenal (HPA) axis is essential for life. Prolonged high circulating levels of glucocorticoids inhibit pituitary Pro-opiomelanocortin (POMC) gene expression. Repression continues even in the absence of continued glucocorticoid exposure. To date there are no molecular explanations for this observation.Hypothesis: Long-term exposure to glucocorticoids causes de-novo DNA methylation of the pituit...

Background: Management of ACTH-dependent Cushing's syndrome (ACTH-CS) remains a challenge. In the past 2 decades open bilateral adrenalectomy, associated high morbidity and long post-operative in-patient stay, has usually been reserved for cases of failed transsphenoidal surgery (TpS) and radiotherapy (RT), or where the source of ACTH is not found. Laparoscopic adrenalectomy is a significant advance with low morbidity and mortality.Aim: To assess the eff...

Ectopic secretion of adrenocorticotropin (ACTH), from sites such as small cell lung cancer (SCLC), results in severe Cushing's syndrome. ACTH is cleaved from pro-opiomelanocortin (POMC). The syndrome occurs when the highly tissue-specific promoter of POMC is activated. This promoter lies within a defined CpG island. CpG islands are usually considered to be unmethylated in all tissues. We hypothesised that changes in promoter DNA methylation might direct aberrant express...