Endocrine Abstracts

Objective: Our aim was to identify and treat sleep disorders in asymptomatic patients with craniopharyngioma and to identify co-existing respiratory disease.Methods: 5 patients (1 male) with a diagnosis of craniopharyngioma, were identified from the local pituitary database and admitted for polysomnography (Alice 4, Respironics), as part of a study of hypothalamic disease in craniopharyngioma. Sleep disturbance was defined as an apnoea index (AHI) of &#6...

A 56-year-old male presented in 2017 with acute symptomatic hyponatraemia. He was admitted with a seizure and a plasma sodium of 112 mmol/l. His past medical history was notable for alcohol excess and smoking. The acute presentation was managed with 3% hypertonic saline infusion in ITU. Plasma osmolality was 240 mOsm/Kg, urine osmolality 327 mOsm/kg and sport urine sodium 28 mmol/l. CT TAP showed some oesophageal thickening only; endoscopy was normal. He made a good recovery f...

Introduction: Some patients complain of excessive daytime somnolence following pituitary surgery.Aim: To investigate the presence of obstructive sleep apnoea (OSA) following surgery for non functioning pituitary adenomas (NFPA).Design and methods: We assessed the prevalence of OSA in 16 routinely selected patients following surgery for NFPA and 13 obese controls attending a tertiary referral centre, by means of the Epworth Sleepine...

Hyponatraemia is commonly encountered in neurosurgical units. Salt wasting syndrome is rare, and thought to occur due to ANP- and BNP-mediated natriuresis, leading to hypovolemic hyponatraemia. A 31 year old male was transferred to the National Neurosurgical Unit with a 12 hour history of back pain, progressive lower limb weakness and sensory loss. MRI demonstrated an epidural haematoma, extending from C7 to T3, and he underwent emergency decompressive laminectomy. Vasopressin...

Transsphenoidal surgery (TSS) to resect a corticotroph adenoma is the first-line treatment for Cushing’s disease (CD); remission rates of up to 80% have been reported in cases of microadenomas. Endocrine Society guidelines define post-operative biochemical remission as morning serum cortisol <138 nmol/L within seven days of surgery. Our practice is to use a cut-off of <50 nmol/L at day 3 post-op to indicate biochemical remission. If serum cortisol on day 3 is 50&#...

A 24 year old man presented with gait instability, myalgia, and cognitive decline, after a holiday in Crete; his alcohol intake exceeded 200 units/week. He had marked facial dysmorphism, with frontal bossing, and global muscle weakness. He had hypernatraemic dehydration (plasma sodium 175 mmol/l urea 16.9 mmol/l), but denied thirst. Urine concentration was 894 mOsm/kg, excluding diabetes insipidus. CK was elevated at 15,540 U/l. CT brain shown marked hydrocephalus. Rhabdomyoly...

Introduction: The natural history of adipsic diabetes insipidus (ADI) is not completely understood. Isolated case reports suggest occasional recovery of adipsia. We present the follow up of a cohort of 12 patients with ADI.Setting: National pituitary unit with interest in diabetes insipidus.Methods: ADI was identified by demonstrating absent thirst and AVP responses to hypertonic saline infusion. Results 12 patients with ADI were i...

Introduction: Excess mortality due to hyponatraemia is well documented but it is not clear whether the mortality associated with SIADH is different to that associated with non-SIADH hyponatraemia (NSH).Methods/design: Prospective evaluation of all patients admitted with or developing hyponatraemia in a tertiary hospital (pNa <130 mmol/l) in January 2015. Diagnosis of SIADH was based on standard clinical and biochemical criteria (pNa, spot urine sodiu...

Patients with craniopharyngioma have increased mortality attributed to cardiorespiratory disease, when compared to other hypopituitary populations. There is little data on the cause for excess of fatal respiratory disease in this condition. Clinical observation had identified sleep apnoea in some craniopharyngioma patients in our cohort. Sleep apnoea increases cerebrovascular and cardiovascular morbidity and mortality. Our hypothesis was that sleep apnoea could be a contributo...

Context: The syndrome of inappropriate antidiuresis(SIAD) is the commonest cause of hyponatraemia. Data on the aetiology of SIAD is mainly derived from retrospective studies, often with poor ascertainment of minimum criteria for correct diagnosis. Although central adrenal insufficiency(CAI) is known to cause euvolaemic hyponatraemia, the incidence of undiagnosed CAI in SIAD is unknown.Objective: To establish the incidence of CAI in SIAD.<p class="abs...