Endocrine Abstracts

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: Ipilimumab (Yervoy, BMS) is a human monoclonal antibody increasingly used in oncology. It targets cytotoxic T lymphocytes antigen 4 (CTLA-4) promoting their proliferation and augmenting an anti-tumour response. It is licensed for the treatment of unresectable or metastatic melanoma and multiple clinical trials using this medication for other malignancies are ongoing. Ipilimumab related adverse reactions are mainly autoimmune and occur in 61% of patients, of which...

A 37-year-old woman was referred to the endocrine team for the assessment of her adrenal axis, as she had been taking high dose prednisolone (20-40 mg) for several years for the management of her brittle asthma. Drug history included inhaled Symbicort 200/6 (SMART regime), tiotropium and montelukast. Her respiratory symptoms improved with the introduction of theophylline, thus enabling her prednisolone to be switched to oral hydrocortisone, with appropriate ’sick- day&#14...

Introduction: Bilateral 3rd nerve palsy is known in conditions such as diabetes mellitus, neurosarcoidosis, Guillain-Barre syndrome, multiple sclerosis, anterior or posterior communicating artery aneurysm or mesencephalic bleed/trauma. There are only single cases reported in association with pituitary adenoma or carcinoma, usually in the context of apoplexy. We describe a patient with Cushing’s disease and bilateral 3rd nerve palsy secondary to apoplexy in pituitary macro...

Case history: A 34-year old Caucasian nurse presented to her GP with a 7 month history of abdominal pain. She was found to have PTH-dependent hypercalcaemia with Stage 3A chronic kidney disease (corrected calcium 3.43 mmol/l, phosphate 0.62 mmol/l, total vitamin D 32 nmol/l, PTH 214.9 pmol/l, creatinine 117 μmol/l and eGFR 45 ml/min/1.73m2). On direct questioning, she reported fatigue, generalised weakness and intermittent joint pains affecting her lower back and bo...

Background: Short Synacthen test (SST) is commonly used for the assessment of the hypothalamus-pituitary-adrenal (HPA) axis after pituitary surgery. In our centre, patients are discharged on hydrocortisone on day 3 post-surgery and 9am cortisol on day 8 post-surgery is measured. Hydrocortisone is stopped if cortisol is ≥350 nmol/L on day 8. Six weeks post-surgery SST is performed and treatment adjusted. We aimed to assess the perfor...

Background: Short Synacthen test (SST) is commonly used for the assessment of the hypothalamus-pituitary-adrenal (HPA) axis after pituitary surgery. In our centre, patients are discharged on hydrocortisone on day 3 post-surgery and 9am cortisol on day 8 post-surgery is measured. Hydrocortisone is stopped if cortisol is ≥350 nmol/L on day 8. Six weeks post-surgery SST is performed and treatment adjusted. We aimed to assess the perfor...

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...

Background and aims: HNF1A-MODY causes monogenic diabetes with a lean, insulin sensitive phenotype. Altered glucocorticoid (GC) metabolism has been implicated in the pathogenesis of type 2 diabetes (T2D) and inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) which regenerates active cortisol from inactive cortisone have been trialled as a therapeutic approach. 11β-HSD1 is down-regulated in hepatocytes from Hnf1a knock-out mice but the role...

Background and aims: HNF1A-MODY causes monogenic diabetes with a lean, insulin sensitive phenotype. Altered glucocorticoid (GC) metabolism has been implicated in the pathogenesis of type 2 diabetes (T2D) and inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) which regenerates active cortisol from inactive cortisone have been trialled as a therapeutic approach. 11β-HSD1 is down-regulated in hepatocytes from Hnf1a knock-out mice but the role...