Endocrine Abstracts

Background: The ACTH receptor (melanocortin 2 receptor – MC2R) is unique in that it is highly selective for ACTH and excludes all other MSH peptides. This contrasts with all other members of the melanocortin receptor family, which show broader specificity. The specificity of recognition of ACTH by the MC2R appears to depend on the presence of four basic residues, lysine, lysine, arginine, arginine at positions 15–18. Of α-, β- and γ-MSH are either iden...

Introduction: Endogenous cortisol secretion should cease after bilateral adrenalectomy (BAL) and steroid hormone replacement is life sustaining at the regular physiologic dosage. However, there are reports of occurrence of functioning adrenal tissue in the setting of BAL treatment for ACTH dependent Cushing’s syndrome and not the other known indications for BAL.Case report: A 44-year-old lady with functioning adrena...

Background: Generalized glucocorticoid-resistance (GCR) is a broad spectrum and heterogeneous syndrome that may be familial or sporadic caused by mutations in glucocorticoid receptor function and signalling. These patients present with hypercortisolism with enlarged adrenals but no Cushing features. Identification of GCR requires extensive investigations.Case report: An 81-year-old thin-built man of South-East Asian orig...

Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension that can be cured by surgery. Mild autonomous cortisol co-secretion is a recognised feature of PA, which is associated with an increased cardiometabolic penalty and the possibility of adrenal insufficiency postoperatively. There have also been case reports of adrenal crisis post adrenalectomy for this patient subtype. We report our experience of adrenal insufficiency post adrenalectomy ...

A 38 year old woman was admitted with three day history of right sided chest pain, right upper abdominal pain and vomiting. She has anti-phospholipid syndrome (APS) treated with long term lower molecular weight heparin (Dalteparin) for inferior vena cava thrombosis. On presentation, she was hemodynamically stable with haemoglobin of 154 g/l, CRP 170 mg/l, white cell count 15×109/l, platelet of 90×109/l and sodium of 136 mmol/l. CXR showed consol...

Introduction: Correlation of papillary thyroid cancer and lymphocytic thyroiditis is well documented but the incidence of thyroid malignancies in Graves’ disease especially in the absence of nodular thyroid disease is considered to be uncommon.Method: We conducted a retrospective audit of forty-four patients with established diagnosis of Grave’s thyrotoxicosis treated with total thyroidectomy from 2010-2013 (36 months), in a tertiary care centr...

Melanocortin receptor accessory protein (MRAP) is a single transmembrane domain protein, which has been identified as essential for the cell surface trafficking and signalling of the ACTH receptor (melanocortin 2 receptor (MC2R)). MRAP is essential for the function of MC2R, but regulation of its expression remains unclear. This study aims to identify factors regulating MRAP gene expression and whether these factors would affect the signalling of MC2R.The...

Case history: A 59 year old Afro-Carribbean male with a 25 year history of cardiac enlargement and hypertension, on multiple anti-hypertensives, presented with increasing breathlessness and several years of markedly reduced exercise tolerance. He was intolerant of spironolactone and eplerenone. His past medical history included hypertersion, obstructive sleep apnoea, Steven-Johnson syndrome secondary to allopurinol, thyrotoxicosis treated with radio-active iodine, monoclonal g...

We present the case and management of a 76 year old man who developed medication-related osteonecrosis of the jaw (MRONJ) as a result of 12 years of bisphosphonate and denosumab treatment for hypercalcaemia in the setting of metastatic parathyroid carcinoma.Within two years of his original parathyroidectomy, he had metastatic recurrence diagnosed with progressive hypercalcaemia; imaging revealed three pulmonary nodules consistent w...

We present the case and management of a 76 year old man who developed medication-related osteonecrosis of the jaw (MRONJ) as a result of 12 years of bisphosphonate and denosumab treatment for hypercalcaemia in the setting of metastatic parathyroid carcinoma.Within two years of his original parathyroidectomy, he had metastatic recurrence diagnosed with progressive hypercalcaemia; imaging revealed three pulmonary nodules consistent w...