Endocrine Abstracts

Introduction: Severe hypercalcaemia is a medical emergency which can result in severe cardiovascular and neurological dysfunction. Pathophysiological mechanisms of hypercalcaemia include increased osteoclastic activity, osteolytic bone metastasis, extra-renal activation/production of 1,25 hydroxyvitamin D and decreased urinary calcium excretion. Understanding these mechanisms is important to guide the diagnostic process and the long-term management of hypercalcaemia.<p cla...

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumour of the adrenal cortex with an incidence of 0.7-2.0 per million per year. The majority are steroid-producing with non-ACTH dependent hypercortisolism the most frequent biochemical abnormality. Around 10-15% of cases are picked up incidentally on abdominal imaging. Management of ACC during the covid-19 pandemic poses specific challenges. We present the case of a 69-year-old man who was found to have a massive ...

Case history: A 39 year old female had a first admission to her local hospital with cough and haemoptysis. She reported palpitations for the previous 6 months and had been previously investigated with an echocardiogram which showed a normal LV function. There was no other past medical history. During this first admission CT Pulmonary Angiogram (CTPA) demonstrated ground-glass opacifications. She was hypertensive and so a 24 hour urine sample was collected for metanephrines but...

A 19 year old Bangladeshi male attended ED with a fractured finger. He was noted to have a severely delayed bone age of 13.5 years, and no facial hair. He had moved to the UK aged 11 and could recall little information regarding his childhood or his parents. He had no significant medical co-morbidities, and in particular no history of mumps, measles or testicular injury. He reported being the shortest in his class, and being unable to keep up with his classmates in physical ac...

Introduction: Moderate hyperprolactinaemia occurring in a patient with a normal pituitary MRI, assuming macroprolactin and stress are excluded, is generally considered to be due to a lesion below the level of detection of the MRI scanner. Most patients with mild-moderate hyperprolactinaemia and a normal MRI respond to dopamine agonist therapy. We describe a patient who had prolactin elevation typical of a prolactin-secreting macroadenoma, but with a normal MRI, and in whom the...

Introduction: Multi-modal therapy for adrenocortical carcinoma (ACC) includes surgery, therapy with the adrenolytic agent mitotane and systemic chemotherapy. Achievement of therapeutic mitotane concentrations (≥14 mg/l) has been related to improved outcomes.Aim: To evaluate the effectiveness of a defined* high dose protocol mitotane therapy in patients with advanced ACC (stages III and IV).Methods: Review of patients presenti...