Endocrine Abstracts

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: 11C-Metomidate (MTO)-PET/CT has recently found utility as an alternative to adrenal vein sampling for lateralisation in primary aldosteronism. MTO binds with high affinity to 11b-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) and can be considered an adrenocortical-specific tracer. We and others have therefore hypothesised that combining MTO-PET/CT with 18F-FDG(FDG)-PET/CT would permit indeterminate adrenal lesions ...

Case History: In 2011, an asymptomatic 63-year-old professor was found to have isolated hypokalemia. He was normotensive and his only past medical history was hypercholesterolaemia. Investigations were suggestive of Primary Hyperaldosteronism (PHA): aldosterone 1055 pmol/L, renin mass 10 mU/L, Na+137 mmol/L, K+3.2 mmol/L, bicarbonate 31 mmol/L. A CT scan was reported as normal, but a 12mm nodule was subsequently noted contiguous with the left adrenal. A m...

Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition characterised by the predisposition to hyperplasia or the development of solitary adenomas of multiple endocrine gland. MEN1 related disease is responsible for death in two thirds of patients with this hereditary condition and the mean age at death is 55 years. This associated mortality necessitates a vigorous surveillance protocol, however all recommendations for radiological surveillance are based on non-pr...

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 ...

Introduction: Primary aldosteronism (PA) is a common and potentially reversible cause of secondary hypertension, characterised by resistance to standard antihypertensive therapy and possible hypokalaemia. Lateralisation investigations, including adrenal vein sampling (AVS), are required to distinguish between unilateral or bilateral disease, with unilateral disease representing a potentially surgically curable form of PA. The majority of patients proceeding to adrenalectomy re...

Case history: A 41 year old female was admitted following development of severe hypertension (226/146 mmHg), complicated by heart failure and acute kidney injury. She otherwise had no relevant past medical history. On clinical examination she was obese (BMI 51.94 kg/m2). As part of her cardiac investigations, she underwent a cardiac magnetic resonance imaging (MRI) which detected a 3 cm right sided adrenal nodule. An adrenal biochemical screen identified an elevated...

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...

Case history: A 66-year-old man presented with a 1 month history of a productive cough, in the context of a 20 pack-year smoking history. CT chest revealed minor bronchiectasis and an incidental 3 cm right adrenal lesion. He was referred to the endocrine clinic for further evaluation. On questioning, he reported no symptoms suggestive of adrenal hormone hypersecretion and, aside from a short history (<1 month) of sweating episodes at night, he described no other constituti...