Endocrine Abstracts

The potential for primary tumour relapse is an important consideration during GH replacement therapy (GHR). We report 3 cases of relapse of intra cranial germ cell tumour (GCT) during GHR.Patient 1: An 11 year-old female presenting with visual loss and short stature due to a suprasellar malignant teratoma. She was successfully treated with bleomycin, etoposide and cisplatinum (BEP) and intrathecal chemotherapy. She suffered a first relapse two years late...

A 47 year old Macedonian Personal Trainer presented with 4 days of vomiting, abdominal pain and profuse sweating. He admitted abusing anabolic steroids 20 years previously but never insulin. The presenting capillary blood glucose (CBG) was 1.7 mmol/L, blood pressure (BP) 182/106 mmHg, pulse 62 bpm. On examination, he was sweaty, pale and cold. Blood was drawn for measurement of insulin, C-peptide, glucose, cortisol and thyroid function tests. He was treated with 50% dextrose a...

Section 1: Case history: We present the case of a 21-year-old lady known to harbour a homozygous inactivating mutation of the calcium sensing receptor (CaSR) which led to uncontrolled hypercalcaemia in infancy, necessitating emergency total parathyroidectomy. The CaSR plays an important role in calcium homeostasis. Inactivating mutations result in a higher calcium “set-point” and various degrees of hypercalcaemia based on the severity of functional impairment. In the...

Background: Adrenal Insufficiency (AI) is an inadequate production of cortisol hormone from the adrenal glands. The most common form is secondary AI (suppression of the hypothalamic-pituitary-adrenal axis), with a prevalence of approximately 300 cases per million. Patients with AI require lifelong corticosteroid replacement, which poses a risk of a life-threatening adrenal crisis (AC) event. AC presents with low blood pressure, hypoglycaemia and even loss of consciousness. Thi...

A previously fit and well 29-year-old male presented with an 8-month history of progressive facial and peripheral swelling, accompanied by generalised weakness, weight gain, nocturia and a 2 year history of left-sided abdominal pain. He was originally from Ghana and moved to the UK in 2022 with limited family support. On examination he was hypertensive (157/108 mmHg) with facial fullness, dry skin, proximal muscle weakness, conjunctival injection and haematomata at recent vene...

Case History: A 57-year-old lady was referred with a 6-year history of hypertension and hypokalaemia necessitating hospital admission. Her medical background included breast cancer managed with chemotherapy, radiotherapy and surgery. She required Eplerenone 50 mg OD and Amlodipine 5 mg to control her hypertension, and Sando-K 2 tablets TDS to maintain normokalaemia. The patient was enrolled into the MATCH trial comparing adrenal vein sampling (AVS) with [11C]-metomi...

Case history: A 39-year-old gentleman was referred to the Endocrine clinic with a 5-year history of hypertension and intermittent hypokalaemia. He had been seen in the hypertension clinic, screened for secondary causes, and found to have an aldosterone of 604 pmol/l, renin <0.2 nmol/l/hr and potassium 3.7 mmo/l (off interfering medication), in-keeping with a diagnosis of Primary Aldosteronism (PA). His blood pressure was 126/82 mmHg on Ramipril 10 mg, Amlodipine 5 mg OD an...

Background: Primary aldosteronism (PA) is a common, curable and high-risk subset of hypertension, mandating detection. In all but the most severe cases, learned society guidelines recommend confirmatory testing. Whilst a variety of confirmatory tests exist, data describing their safety are limited. Concerns centre around the potential of some tests to precipitate hypokalaemia or a hypertensive emergency in a patient with PA on sub-optimal anti-hypertensive medication. In this ...

Case history: A 74-year-old gentleman with primary aldosteronism (PA) was referred for the ‘MATCH’ study – a prospective comparison of 11C-metomidate PET CT with adrenal vein sampling. He took no exogenous steroids.Investigations: Na 147 mmol/l, K 3.7 mmol/l, aldosterone 496 pmol/l, renin activity <0.17 nmol/l per h, random cortisol 247 nmol/l and concomitant ACTH 9.3 ng/l. Two overnight dexamethasone suppression tests recorded values ...

Primary aldosteronism (PA) is the cause of 5–10% of hypertension, surgically curable in patients with unilateral aldosterone-producing adenomas (APAs). However <1% of patients are currently diagnosed and cured. Newer and simpler modalities of diagnosis and treatment are required. The aim of FABULAS (a feasibility study of endoscopic ultrasound-guided ablation as a non-surgical, adrenal sparing treatment for aldosterone-producing adenomas) is to determine in 30 patient...