Endocrine Abstracts

Case History: Case 1: A 37-year-old lady with relapsing-remitting multiple sclerosis was initiated on Alemtuzumab and symptoms of sweats and heat intolerance arose. Hyperthyroidism was confirmed with free T4 30.1 pmol/l (12–22) and suppressed TSH. Symptoms settled without antithyroid medication and within 2 months T4 had fallen to 10.2 pmol/l with TSH 6.95 mIU/L. After a further 6 weeks T4 was 9.8 with TSH 20.35 and levothyroxine was initiated. Anti-TPO was raised at 442 ...

Background: The Northern Ireland Clinical Research Network (NICRN) is a regional research platform, established in 2008 to support clinical trials. NICRN comprises 10 groups, one of which is diabetes and all are supported by government funding.Objective: To outline the development and achievements of this research network.Methods: The organisational structure is built around a hub and spoke design. The network is manage</st...

A 37-year-old woman presented with a short history of left arm pain. X-ray indicated a lytic lesion of the scapula. Calcium was elevated at 3.25 mmol/l (normal 2.2–2.6) with parathyroid hormone (PTH) 936 pg/ml (5–70). Upon questioning she reported nocturia, polydipsia and dyspepsia. Magnetic resonance imaging revealed brown tumours in the scapula, clavicle and hand. A superior parathyroid adenoma was excised with normalisation of calcium. Bone biopsy of the scapular ...

A 26yr old man presented to haematology with a short history of easy bruising. There was no spontaneous bleeding. Past medical history was unremarkable. Family history of clotting disorders was negative. On examination there was significant lower limb bruising.Initial investigations revealed platelets of 238 (150–450), prothrombin time (PT) of 12.0 (12.0–17.0 s) and elevated activated partial thromboplastin time (APTT) of 41.0 (24.0–38.0 s...

Hypopituitarism usually is the result of a pituitary tumour or its treatment. If, however, pituitary imaging is negative then an alternative diagnosis should be sought. We present two patients initially diagnosed as idiopathic hypopituitarism in whom the underlying diagnosis was delayed with potentially serious consequences.The first case was of a 32 year old male who presented with symptoms and signs of hypogonadism. Serum testosterone (<0.7 nmol/L)...

Intranasal presentations of pituitary tumours are rare. Management can be difficult and delayed due to their location and extension. Macroprolactinomas are uncommon and can often pursue an aggressive clinical course, including invasion into the nasopharynx.We describe three cases of prolactinomas that initially presented to the ENT Department as nasal polyps. Table 1 highlights their clinical features and response to treatment. Recurrence of nasal polyps...

Nocturnal salivary cortisol (NSC), urinary free cortisol (UFC) and overnight dexamethasone suppression testing (ODS) are recommended screening tests for Cushing’s syndrome (CS). Individual centers differ in their screening approach; UFC being the test of choice in Northern Ireland with ODS in patients with adrenal incidentalomas. NSC, which measures free cortisol, is not routinely used. The aims of this study were to 1. Evaluate the utility of NSC in the diagnosis of CS; ...

An adrenal incidentaloma is defined as an adrenal mass >1 cm diameter, discovered serendipitously on radiological imaging done for another reason. They are important because a percentage will turn out to be malignant or secrete excess hormones. The aim of the current study was to ascertain if these lesions were being investigated and followed appropriately compared to American Association of Clinical Endocrinologists guidelines. All imaging reports for the calendar year 20...

Recent Endocrine Society guidelines advocate IGF-1, random GH and nadir GH after oral glucose tolerance test (OGTT) for assessment in acromegaly. In our regional centre the 24 h GH profile has also been used partly because of changing IGF-1 assay methodology but also because of concerns that IGF-1 may not adequately reflect partial therapeutic success. We evaluated 58 GH profiles in 35 patients from April 2008 to November 2012 when both GH and IGF-1 assays remained unchanged. ...

Pituitary surgery frequently leads to one or more anterior pituitary hormone deficiencies but the incidence of GH deficiency is unclear. The aim of our study was to establish the incidence of GH deficiency in patients post hypophysectomy. Current NICE guidelines recommend GH replacement in severely GH deficient patients who have one or more other pituitary hormone deficiencies and diminished QoL by AGHDA.Thirty-five patients (M:F 15:20; age range 23&#150...