Endocrine Abstracts

Although prolactin is well recognised as a cytokine, effects of hypoprolactinaemia on biological endpoints are not well described in humans. In-vitro and clinical studies suggest an influence on humoral and cell mediated immunity and autoimmunity. We studied basal and stimulated immune function in panhypopituitary adults with and without prolactin deficiency and age and gender matched healthy controls. The study was approved by hospital and local research ethics committees. Ni...

A 34-year-old welder presented acutely unwell with a 2-week history of facial puffiness, swollen legs, and weight-gain. His GP had found him to be hypertensive and hypokalaemic and had commenced oral potassium supplements. Clinical examination revealed peripheral oedema (face and legs), BP was 179/100 mmHg, with no Cushingoid features. ECG and CXR were unremarkable. Tests showed leucocytosis but normal CRP, persistent hypokalaemia (2.5 mmol/l), normal venous bicarbonate and gl...

A 68-year-old woman presented with hypertension, oedema, weight gain and moon face. She had signs of proximal muscle weakness, thinning of scalp hair and bruising on her legs. Initial tests showed 24 hour urine free cortisol elevated at 946 nmol (0–300 nmol).Serum cortisol showed no circadian fluctuation (0900: 1094 nmol/l, 2400 hrs: 886 nmol/l) and no suppression by dexamethasone (2 mg/24 h for 48 h: 1067 nmol/l). ACTH levels were slightly raised (...

A 36-year-old male presented to neurologists with tiredness and clumsy gait. Examination revealed normal cranial nerves, spastic paraparesis and bilateral extensor plantar response, absent vibration sense and ataxia. He was thought to have an inherited form of Spino-Cerebellar ataxia. His mother had developed similar neurological problems in her 50 s, and his maternal uncle had Addison’s disease.He was referred to endocrinologists because of the fin...

Pituitary apoplexy is an acute medical emergency but there are no evidence based management guidelines, especially for neurosurgical intervention.A 35-year old male presented with sudden onset severe headache. On examination blood pressure was 180/120 without any lateralising neurological signs. He appeared acromegalic with a short history of enlarging hands & feet. Emergency CT scan and a MR scan later confirmed haemorrhagic pituitary adenoma, 3 cm ...

Management of patients with gender dysphoria (transsexualism) is often difficult, and most patients are routinely managed outwith specialist gender identity clinics. We carried out a retrospective case-note survey of 21 patients attending a routine adult endocrine clinic (ages 24–64 y; 13 male-to-female (MF) and 8 female-to-male (FM)).All MF and 6 of 8 FM patients were on hormonal treatment. 6 of 13 MF patients took oestrogen alone, 6 used oestrogen...

Oestrogens are capable of inducing rat prolactin gene transcription through liganded Oestrogen Receptor (ER) binding a degenerate oestrogen response element (ERE) sequence on the promoter 1440 bp upstream of the transcription start site. ER binding is thought to interact with DNA bound Pit-1 leading to chromatin looping bringing enhancer elements into proximity with the transcription start site. This ERE sequence, TGTCActaTGTCA, differs from the consensus GGTCAnnnTGACC by two ...

Acromegaly is associated with increased morbidity and mortality. Surgical excision of the adenoma remains the best option to attain a cure. The results of surgery in the region were unsatisfactory compared to other European centres as was amply borne out in a 1998 review. As the lack of a dedicated pituitary surgical team was considered contributory, one was developed offering Endoscopic, transsphenoidal, pituitary surgery and their results audited.Sixte...

Surgery is the treatment of choice for GH secreting tumours. Recent papers suggest, early re-exploration of persistently active tumours may be beneficial. Endocrine assessment, to confirm cure, in the immediate post-operative period is difficult. We aimed to ascertain which test of GH excess performed post-operatively is a reliable predictor of longer term cureMethods: 16 consecutive patients (8 males and 8 females: mean age 46.8±13 years) with acti...