Endocrine Abstracts

Existing treatments for pituitary-dependent Cushing's Syndrome include pituitary or adrenal surgery, pituitary irradiation and medical therapy. Pituitary microsurgery is the usual therapy of first choice but is not always successful in achieving early apparent remission and is associated with significant late relapses. An effective drug therapy for humans would be a major advance as there is significant morbidity and mortality in Cushing's Syndrome. Recent elegant in vitro and...

A 45-year-old lady presented with a 12-month history of blurred vision. Visual assessment revealed a bitemporal hemianopia and CT scan demonstrated a large pituitary tumour with lateral and suprasellar extension. A GTT showed her growth hormone was raised basally at 7.5 milliunits per litre and incompletely suppressed to 5.7 milliunits per litre confirming acromegaly. Transsphenoidal hypophysectomy was performed. Histology confirmed a somatoptroph adenoma. Post operatively she...

A 34-year-old woman, presented to her General Practitioner with hot flushes. Investigations showed her to have a normal LH, FSH, free T4 and TSH. Her prolactin was elevated at 1110 milliunits per litre (NR <350 ). She had a normal menarche age 14 and had regular 28 day menstrual cycles. Before the onset of the hot flushes she had started to take agnus castus, a herbal remedy said to help symptoms of premenstrual tension.Whilst she continued to take ...

A 67 yr old lady was admitted with left ventricular failure, angina, and atrial fibrillation. She was hypokalaemic (2.5mmol/l). There was a 3 year history of hypertension and a new diagnosis of diabetes mellitus. There was a recent history of weight gain, muscle weakness, bruising and facial puffiness. On examination she appeared cushingoid. A 24 hour urine for free cortisol was 1438nmol\/24h (normal<350). A basal 0800h serum cortisol was 1061nmol/l. After low dose dexameth...

Cyclical Cushing’s syndrome is typically detected by collecting sequential daily early morning urine (EMU) samples for cortisol to creatinine ratio over a 28 day period. More recently nocturnal salivary cortisol (NSC) measurement has been shown to be a sensitive means of screening for Cushing’s syndrome. The Endocrine Society have suggested that NSC may be used to assess patients for cyclical Cushing’s however there is limited evidence that it correlates with th...

Aberrant and upregulated eutopic receptors have been identified in vitro in patients with primary aldosteronism (PA). We previously identified an exaggerated aldosterone response to synacthen in patients with PA versus healthy controls. In this study we aimed to evaluate whether the synacthen test differentiates between patients with PA and essential hypertension (EH).The 250mcg intramuscular synacthen test was performed after 30 minutes recumbenc...

Primary hyperaldosteronism secondary to bilateral adrenal hyperplasia (BAH) bears striking similarities pathophysiologically to essential hypertension. During stimulation studies to elucidate possible aberrant aldosterone responses in BAH we measured the aldosterone response to 250mcg iv synacthen after 30 and 60 minutes in 7 patients with BAH and in 20 healthy controls. Patients had diuretics withheld for at least 4 weeks and betablockers and calcium channel blockers withheld...

A 14 year old girl was referred with a diagnosis, made at birth, of congenital adrenal hyperplasia. She had undergone clitoral reduction and vulvovaginoplasty at age 2. Her height had been on 10th-25 th centile, and, at presentation to us, she was taking prednisolone (7.5milligrams in divided doses) and fludrocortisone 0.05 milligrams. At age 14 her height dropped to the 3 rd centile. She was hirsute, obese and had abdominal striae. A variety of steroid regimes only led to an ...

There have been few reports of long term remission rates after transsphenoidal surgery for Cushing's disease which incorporate both initial failure rates and later relapse rates. We have studied this in patients diagnosed and treated between 1979 and 2000. An early post-operative 0800h serum cortisol was measured 24h after the last dose of hydrocortisone, in addition to a low dose dexamethasone suppression test. Of the initial 63 patients, 18 did not achieve remission after su...

Dopamine agonist therapy is an effective long-term treatment in >90% of patients with hyperprolactinaemia, controlling both prolactin secretion and tumour growth. We describe the unusual late emergence of resistance to high-dose dopamine agonist treatment in two recent female patients. Both women presented with secondary amenorrhoea, were shown to have high prolactin levels and a pituitary microadenoma. Each had an excellent initial response to bromocriptine but years late...