Endocrine Abstracts

Case history: A 19 year old lady presented with amenorrhoea, fatigue and headaches. She had normal pubertal growth spurt with an appropriate height for mid-parental height. Her menarche was at age 17, another bleed at 18 but amenorrhoeic since. There was right sided galactorrhoea only on expression. In her teens she had an eating disorder, periods of self-harm and low mood. No treatment except for St. John’s Wort occasionally. No visual disturbance was present.<p clas...

A 51-year-old man presented to an optometrist with a 3-week history of visual impairment following a minor headache. He was found to have reduced visual acuity 6/24 in both eyes and a dense bitemporal hemianopia and was referred urgently to Musgrove Park Emergency Department. MRI brain showed a cystic bleed from a pituitary macroadenoma, 30 mm in diameter, with compression of the optic chiasm. He had no clinical features of Cushing’s or other hormone excess or deficiency ...

Case History: 69 years old gentleman was referred to endocrinology for investigation of a benign appearing left incidental adrenal adenoma (1cm) after being investigated for abdominal pain. He had a past medical history of an abdominal aortic aneurysm (AAA), type 2 diabetes mellitus and hypertension.Investigations: Initial endocrine investigations revealed normal 24h urinary free cortisol levels (twice), metanephrines and ARR. His overnight dexamethasone...

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: Rathke’s cleft cysts (RCC) are benign intrasellar cysts that originate from the remnants of Rathke’s pouch and contain mucoid material. Most are asymptomatic, but some may compress adjacent structures leading to visual disturbances and endocrinopathies.Case Report: A 20-year-old gentleman had an MRI Head in view of headaches. This showed a 17.7 mm peripherally enhancing suprasellar lesion with no intrinsic T1 high signal pre- contra...

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...

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...

Tumour localisation in Cushing’s disease (CD) can be challenging; most are microadenomas and 50% are <5 mm in diameter. They are, therefore, often difficult to detect by conventional MRI. Volumetric MRI (3D-SGE, spoiled-gradient echo 3D sequence) is a high spatial resolution scanning technique which uses very thin slices (1 mm). Theoretically, this increases the probability of finding small pituitary lesions when compared to conventional (spin-echo, SE) MRI techniques...