Endocrine Abstracts

External beam radiotherapy has been used in the management of hormonally active and non-functioning pituitary adenomas for nearly a century. Administered postoperatively, radiotherapy significantly reduces the likelihood of tumour re-growth following surgery for non-functioning pituitary adenomas. In patients with acromegaly, Cushing’s disease and resistant prolactinomas, conventional fractionated radiotherapy suppresses functional hypersecretion. However, over the years,...

A 73 year old man presented in 1995 with impotence and a bitemporal field loss. Endocrine testing revealed hyperprolactinaemia (2741 mU/L) and hypogonadotrophic hypogonadism. Pituitary imaging confirmed the presence of a macroadenoma with significant suprasellar extension. He underwent uncomplicated transsphenoidal surgery, which was successful in decompressing the optic chiasm. Histology revealed a pituitary adenoma that immunostained weakly for prolactin only. In 1998 routin...

Due to the infrequency of pituitary apoplexy, there are no robust evidence-based guidelines for optimum care of these patients. The key controversy surrounds the role of acute neurosurgical intervention. Over recent years we have adopted a relatively conservative approach and the aim of this study was to determine whether this 'non-intervention' affected long-term outcome in a recent cohort of patients. 19 patients (8 female) presented between 1994-2001. Mean age at diagnosis ...

Debate surrounds the optimal biochemical assessment in the follow-up of patients withacromegaly, particularly with the introduction of GH receptor antagonists to the treatment algorithm. Consensus statements suggest target values for GH of < 1microgram per litre with normal age and sex matched IGF-1 values. A number of groups have reported on the correlation between IGF-1 and GH levels in small cohorts of acromegalic patients. We retrospectively<p...

Increased mortality in patients with acromegaly has been confirmed in a number of retrospective studies, but causative factors and relationship to serum IGF1 remain uncertain. The West Midlands Acromegaly database contains details of 419 patients (178 males). Serum IGF1 data from the Regional Endocrine Laboratory was available for 338 patients (81%). At diagnosis mean age was 47 years (range 12-84) and mean GH was 70plus/minus5.4 milliunits per litre. 61% were treated by surge...

The number of patients treated for malignant disease in childhood surviving into adulthood is increasing, but success is tempered by long-term side-effects of chemotherapy and radiotherapy; 40% develop one or more endocrinopathy. ALL is a common childhood malignancy treated with chemotherapy and cranial irradiation. The latter causes anterior pituitary hormone deficiencies, most frequently GH deficiency.We have determined GH status in 13 patients treate...

65-year-old lady presents to GP with 3-month history of fatigue, weight loss and nausea with background of stable Chronic Lymphocytic Leukaemia (CLL). GP started Levothyroxine 25 mg OD due to low T4 of 5.9 pmol/l (12-22) and low TSH of 0.25 mU/l (0.27-4.2). As she continued to feel tired, random cortisol was requested which was low at 25nmol/l leading to admission. Admission cortisol was 55nmol/l with an inappropriately normal ACTH of 11.6 ng/l (7.2-63.3). Pituitary profile sh...

Acromegaly and hypopituitarism are associated with elevated standardised mortality ratios (SMR) of between 1.3–3 and 1.2–2.17, respectively. There is little data on the role of hypopituitarism and in particular ACTH deficiency on mortality in patients with acromegaly and less still known about the role of hydrocortisone (HC) replacement. There is data to suggest that previous HC regimens may have overestimated normal cortisol production rates and recent data that hig...

Background: The risk of a second brain tumour following radiotherapy for pituitary adenoma or craniopharyngioma in adults is currently unclear. Studies are methodologically limited by small patient sample size, few case events, selection biases or the use of inappropriate controls.Objective: To ascertain whether radiotherapy delivered to adults with pituitary adenoma or craniopharyngioma is associated with an increased second brain tumour risk using appr...