Endocrine Abstracts

A 25 year old female presented with a two year history of secondary amenorrhoea and expressible galactorrhoea. There was no history of headache or visual disturbance, and the patient took no regular medication. Examination, including formal perimetry, was normal. Investigations revealed a moderately elevated prolactin 1,029 (NR 59-619 mU/ml), 9am cortisol 366 nmol/L, remainder of pituitary profile normal. An MRI pituitary revealed a macroadenoma with stalk deviation and bowing...

Primary hyperaldosteronism (PHA), accounts for 5–10% of all hypertensive patients and is associated with increased cardiovascular risk. However, making the diagnosis is not always straightforward.A 50-year-old male was admitted with an acute myocardial infarct. He was markedly hypertensive (BP 190/100 mmHg) and hypokalemic. He was commenced on beta-blockers and an Angiotensin converting enzyme inhibitor (ACEI). Plasma aldosterone concentratio...

A case of ectopic ACTH with severe opportunistic infectionECI Hatfield, S Pal, K Meeran, G Williams, JF Todd.Endocrine Unit, Imperial College, Hammersmith Hospital, London, UKA twenty six year old female presented with symptoms and signs suggestive of Cushing's Syndrome. Initial investigations showed hypokalaemia (potassium 2.3nmol/L), elevated urinary free cortisols, (3400, 18,000, 31,000 nmol/24 hour (NR <270)), diabetes (fasting glucose =9 mmol/L), loss of di...

A 56 year old female on treatment for colonic Tuberculosis was referred for investigation of possible Cushing's Syndrome. She initially presented with hypertension, hypokalaemia, and proximal myopathy. Repeated Urinary Free Cortisols were elevated at 730, 738, 520 nmol/L, (normal range= 55-270 nmol/L). The patient failed to suppress on low dose dexamethasone suppression, LDDST, (0.5 mg 6 hourly for 48 hours), baseline cortisol= 390 nmol/L, 48hour cortisol = 595 nmol/L, but sup...

A 56 year old female on treatment for colonic Tuberculosis was referred for investigation of possible Cushing's Syndrome. She initially presented with hypertension, hypokalaemia, and proximal myopathy. Repeated Urinary Free Cortisols were elevated at 730, 738, 520 nmol/L, (normal range= 55-270 nmol/L). The patient failed to suppress on low dose dexamethasone suppression, LDDST, (0.5 mg 6 hourly for 48 hours), baseline cortisol= 390 nmol/L, 48hour cortisol = 595 nmol/L, but sup...

Background: Hyperprolactinaemia accounts for 1 in 7 patients presenting with amenorrhoea. Recent data suggests that prolactin acts at the hypothalamus to reduce GnRH-pulsatility. Conditions in which GnRH-pulsatility is reduced, such as hypothalamic amenorrhoea, favour FSH over LH secretion from the pituitary gland. We examined gonadotrophin secretion in hyperprolactinaemic patients as a surrogate marker of GnRH-pulsatility.Methods: A retrospective analys...

We describe a case of pituitary apoplexy in a patient with a known non- functioning macroadenoma. A 57 year old female was incidentally found to have a 20 x 16 mm solid and cystic pituitary mass abutting the optic chiasm on MRI scanning. She had gonadotrophin deficiency on endocrine testing and normal visual fields. Although repeat perimetry 12 months later revealed a mild superior bi-temporal hemianopia, the patient elected not to have surgery.Several m...

We report two patients (AB 41 years, LS 55 years) presenting with symptoms of hyperprolactinaemia. Prolactin levels were moderately elevated: 1539 (AB), 1186 (LS) (NR 59-619 mU/L). The remainder of the pituitary profile was normal. Neither patient had visual field defects. MRIs (without contrast) reported pituitary macroadenoma with suprasellar extension but no optic chiasm compression. The initial diagnosis was of probable non-functioning adenoma causing stalk compression. Bo...

A 60-year-old gentleman who had previously undergone a right nephrectomy for renal cell carcinoma was admitted electively for a left adrenalectomy due to metastatic disease. Prior to this he had been treated with immunotherapy (Sunitinib) and radiotherapy for pulmonary and bony metastases respectively. He was given perioperative cover with hydrocortisone. A short synacthen test (SST) performed the morning after discontinuing hydrocortisone showed a baseline cortisol of 406 nmo...