Endocrine Abstracts

A 51-year-old gentleman presented in June 2022 with pneumobilia, staph liver abscesses and rapidly conducted atrial fibrillation requiring ITU admission. He had a 2-year history of typical Cushingoid features and hypogonadism, 4 agent hypertension since 2012, fragility fractures, previous renal calculi, pulmonary emboli and diabetes. He had not been able to walk unaided for a year (was mobilising with crutches on admission). In retrospect, he had previously had a cortisol of 7...

History: A 63 year old female presented with nausea, vomiting and loss of balance. She had no other symptoms. An MRI of the brain revealed a large incidental pituitary lesion occupying both the sella and suprasellar region, causing distortion of the optic chiasm and tracts. She had no headache, visual disturbance, tiredness, thirst or daytime frequency although she had long standing nocturia.Examination: Visual fields showed mild bitemporal desaturation ...

Background: Endoscopic endonasal transsphenoidal hypophysectomy is an alternative to microscopic transsphenoidal hypophysectomy. The technique may provide a safer, quicker and more effective treatment.Objectives: To assess preliminary results of this technique when introduced at a single centre with a single surgeon.Methods: A retrospective analysis of 62 patients who underwent transsphenoidal surgery, 33 microscopic and 29 endosco...

Background: Hypopituitarism is often part of the presenting clinical manifestation for patients with non-functioning pituitary macroadenomas (NFPMs). Rate of recovery of hypothalamic-pituitary endocrine axes following therapy is uncertain with no clear predictive factors.Aims: The aim of this study was to assess the degree of hypopituitarism recovery following surgery and radiotherapy in patients with NFPMs. Methods: All patients t...

Background: Non-functioning pituitary macroadenomas (NFPMs) may present with hypopituitarism. Pituitary surgery and radiotherapy pose an additional risk to pituitary function.Aims: The aim of this study was to assess the incidence of hypopituitarism pre-operatively and the impact of surgery and radiotherapy on pituitary function. Methods: All patients treated with surgery and radiotherapy for NFPMs between 1987 and 2018 with more t...

Case summary: A 55 year-old lady was referred by ophthalmology following diagnosis of bilateral central serous retinopathy, an accumulation of sub-retinal fluid at the fundus associated with Cushing’s syndrome. She also had proximal myopathy, bruising, centripetal weight gain and hypertension. Cushing’s was confirmed by 1 mg overnight DST (cortisol 581 nmol/L) and 48 hr-LDDST (407 nmol/L). 24 hr UFC was raised at 2666 nmol/L (12...

Case summary: A 55 year-old lady was referred by ophthalmology following diagnosis of bilateral central serous retinopathy, an accumulation of sub-retinal fluid at the fundus associated with Cushing’s syndrome. She also had proximal myopathy, bruising, centripetal weight gain and hypertension. Cushing’s was confirmed by 1 mg overnight DST (cortisol 581 nmol/L) and 48 hr-LDDST (407 nmol/L). 24 hr UFC was raised at 2666 nmol/L (12...

Background: Following pituitary surgery, dynamic testing with insulin tolerance (ITT) or glucagon stimulation testing (GST) is used to identify patients with secondary hypocortisolism who require glucocorticoids. High glucocorticoid replacement doses are associated with adverse effects, and the optimal replacement dose is unknown.Aim: We aimed to assess the interpretation of dynamic testing post pituitary surgery in clinical practice and its relation wit...

Background: After pituitary surgery patients require HPA axis assessment, that is achieved with postoperative cortisol measurements and, in selected patients whose post-operative cortisol measurements are inconclusive, with the insulin tolerance test (ITT) and the glucagon stimulation test (GST).Aim: We aimed to assess the performance of the day 2/3 post-operative cortisol in predicting the HPA axis sufficiency as assessed by the ITT and the GST.<p c...

Introduction: Hyponatraemia is a relatively common complication following pituitary surgery. However, there is sparse data about its optimal management and impact on clinical outcomes.Aims: To review the treatment and patient outcomes of hyponatraemia following pituitary surgery.Methods: A retrospective single-centre study included all inpatients who developed serum sodium (sNa) ≤ 132 mmol/l following pituitary surgery f...