Endocrine Abstracts

A 64 year old female presented to A&E with a 3 month history of general decline, low mood and 8 kg weight loss. On examination there was facial plethora, thin skin with generalised bruising and peripheral oedema. Initial blood tests showed raised inflammatory markers, low potassium (2.6 mmol/l) and deranged liver function tests. A CT chest/abdomen/pelvis found a 2 cm lesion in the left lung with extensive liver metastases but no nodal deposits in the abdomen so this was fe...

Carcinoid tumours are low grade neoplasms usually arising from neuroendocrine cells of the bronchial and gastrointestinal tracts. Carcinoid tumours metastasise in 50–75% of patients, most commonly to lymph nodes, liver, and bones, but intra-orbital metastases have only rarely been reported. Here, we describe a patient who presented with an intra-orbital neuroendocrine tumour which was successfully treated with surgery and radiotherapy. A 70-year-old female patient present...

We present three cases of ACTH-dependent Cushing’s syndrome, successfully managed with osilodrostat.Case 1: A 42-year-old woman diagnosed with ACTH-dependent Cushing’s disease was initially treated with osilodrostat dose-titration approach, as MRI of the pituitary did not identify a clear surgical target. By week five, serum cortisol levels fully normalised. Salivary and 24 hr urinary free cortisol (UFC) normalised on a mainten...

Background: Adrenal vein sampling (AVS) is the gold-standard for localizing the site of autonomous aldosterone production in patients with primary aldosteronism (PA). The procedure is technically challenging with a reported success rate of 50-95%.Aim: To audit the success rate of AVS at a regional referral unit.Standards: No set standard exists. 80% success rate was taken as the minimum acceptable standard for a tertiary referral c...

Introduction: The association of central diabetes insipidus (CDI) and acute myeloid leukaemia is rare. The onset of CDI is variable during the disease course and can be a presenting feature of AMLCase: : A 75 years old Caucasian male patient presented with acute right sided abdominal pain. His initial CT abdomen was normal. He had normocytic anaemia, thrombocytosis and monocytosis. A repeat CT scan 3 days later showed bilateral swollen adrenal glands and...

Background: IgG4-related disease is a rare immune-mediated inflammatory condition associated with extensive multi-organ involvement. Little is known about the epidemiology of pituitary involvement as a part the IgG4-related disease spectrum.Objectives: We aimed to identify patients with pituitary involvement amongst those with systemic IgG4-related disease, and to compare these individuals to patients with isolated ...

Background: IgG4-related disease is a rare immune-mediated inflammatory condition associated with extensive multi-organ involvement. Little is known about the epidemiology of pituitary involvement as a part the IgG4-related disease spectrum.Objectives: We aimed to identify patients with pituitary involvement amongst those with systemic IgG4-related disease, and to compare these individuals to patients with isolated ...

Case history: A 66 year old lady presented with abdominal pain, new onset diabetes and hypertension. She was diagnosed with Cushing’s syndrome and was found to have a large heterogeneous left adrenal mass of 11.4 × 9.3 cm in size with no disease elsewhere. She underwent a left open adrenalectomy and the histology confirmed an adrenocortical carcinoma (Weiss score of 7) with focal vascular invasion, no extra-capsular spread and clear resection margins. Following surge...

Introduction: Pituitary – dependent Cushing’s disease accounts for approximately 80% of endogenous Cushing’s syndrome but a target lesion is only detectable on MRI in 60% of cases. 11C-methionine PET CT improves detection of indeterminate pituitary lesions. Osilodrostat is a novel steroidogenesis inhibitor which reduces cortisol levels with resultant rise in ACTH and may further enhance the sensitivity of 11C-methionine PET CT in difficult cases...

Adrenal vein sampling (AVS) is used to differentiate between unilateral and bilateral subtypes of primary aldosteronism (PA). However, AVS results may be misinterpreted due to a procedural artefact resulting in low aldosterone levels at the inferior vena cava (IVC), thus making an interpretation of aldosterone to renin ratios difficult. We investigated whether this artefact was due to patients’ being supine before and during AVS, given aldosterone varies with posture, and...