Endocrine Abstracts

Background: The 1 mg overnight dexamethasone suppression test (ONDST) is recommended as a first-line test for the investigation of Cushing Syndrome. Measurement of dexamethasone alongside cortisol in a 9am serum sample has been credited with improving diagnostic sensitivity of the test. Previous studies have also looked at the utility of salivary dexamethasone and have observed poor correlation with serum dexamethasone. Herein we introduce the concept of measuring 11-dehydrode...

A 27 year old male patient with severe cardiomyopathy secondary to Epirubicin chemotherapy for rhabdomyosarcoma in infancy was noted to be hypercalcaemic during the course of admission for severe inotrope dependant congestive cardiac failure. Biochemical investigations confirmed a diagnosis of primary hyperparathyroidism (corrected Calcium 3.10 mmol/l, PTH 22 pmol/l, Vitamin D 77 nmol/l).His brother had undergone trans-sphenoidal pituitary surgery for ac...

: We report on 4 patients who acutely presented to our unit and diagnosed with adrenal haemorrhage.Case 1: A 72 year old man presented with generalised abdominal pain, fever and raised CRP a week after hip replacement surgery. CT abdomen showed non-enhancing bilateral adrenal lesions consistent with adrenal haemorrhage. He was taking Apixaban for DVT following hip replacement. SST was performed which confirmed suboptimal cortisol response. Hence, Treated...

Background: Adrenal incidentalomas (AI) are being seen frequently in endocrine clinics due to increased cross-sectional imaging with a prevalence of 4% (7% in patients >70 years) of abdominal CT scans. The majority of these tumours are benign and non-functional, but identifying malignancy and functionality is important. Excess cortisol production is the commonest endocrinopathy associated with AI, with a reported prevalence of ~10%. The overnight 1 mg dexamethasone suppres...

A 51-year-old obese lady was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. She was referred to the endocrine team because of newly-diagnosed type 2 diabetes mellitus. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis (BSAN) led to a clinical diagnosis of Cushing’s syndrome (CS); this was biochemically confirmed as follows: non-s...

Tolvaptan (a selective V2 receptor antagonist) is licensed for the inpatient management of SIADH induced hyponatraemia, a common complication in patients with malignancy. Licensed daily doses start at 15 mg but there is evidence that some patients have a rise in serum sodium (Na) of >12 mmol/l per 24 h in response to this. Lower initial doses (7.5 mg) may therefore be appropriate1,2.Methods: A retrospective case note audit was performed. T...

Case: An 89 year old gentleman was admitted to hospital following a collapse at home. His capillary blood glucose was found to be 1.4 mmol/l by the paramedics. The patient had experienced multiple collapses at home in the preceding 2 weeks. Each time, he had been found to be hypoglycaemic but treated and discharged from A&E. He complained of reduced appetite, weight loss and change in bowel habit. The patient’s past medical history included a large fibroma of the left...

Background: It is estimated that gestational diabetes (GDM) accounts for 87.5% of all diabetes cases in pregnancy and is associated with worse pregnancy outcomes. Macrosomia is one of the main complications of GDM and antenatal management strategies are directed at ensuring normal foetal growth. Ultrasonography is a useful tool for estimating foetal size, but there is little data in the literature correlating foetal abdominal circumference (AC) and birth weight in GDM. Further...

Backgound: Adrenal incidentalomas (AI) are lesions that are incidentally identified while scanning for other conditions. The European Society of Endocrinology guidelines recommend that all patients with AI should undergo an overnight dexamethasone suppression test (ONDST) for the evaluation of autonomous cortisol secretion as defined by failure of suppression of cortisol to < 50 nmol/l. The reported prevalence of this is high (50% of patients in a recent publication) and m...