Endocrine Abstracts

Adrenal gland anomalies are common incidental findings when imaging tests are performed for other reasons, but are usually unilateral. We present a case where bilaterally abnormal adrenal glands held the key to a rare diagnosis. A 79 year old female ex-smoker with a background of Type 2 Diabetes Mellitus and hypertension presented to our emergency department with a four month history of falls and progressive decline in mobility. Examination revealed evidence of weight loss, wi...

Introduction: The familial risks of carcinoids are not clear. There has never been a report of gastrointestinal carcinoid coexisting with horseshoe kidney.Case presentation: We present the case of a 15 mm well differentiated metastatic small bowel NET with vascular and perineural invasion and three of four positive lymph nodes (Ki67: 1.9%, ENETS stage: pT4 pN1 pMX R1) in a 75-year-old British male with episodes of diarrhea and 24 h urinary 5HIAA: 48 (&#6...

We present the case of assumed ectopic GHRH from residual bronchial carcinoid on the basis of an elevated serum GH, an elevated IGF-1 impaired glucose tolerance and an acromegalic appearance. The patient was diagnosed with a left bronchial carcinoid in 1985, aged38 years. Treated with a left pneumonectomy. She remained well until she presented in 1994 with an oesophageal variceal bleed. She had no evidence of portal hypertension or liver disease. CT chest revealed a mediastina...

Fasting blood glucose is key to diagnosing diabetes, whilst the Oral Glucose Tolerance Test (OGTT) is a valuable adjunct when diagnosis is borderline or inconclusive. The OGTT is often used to detect early changes in glucose tolerance and predict a likely path to overt Diabetes Mellitus for example in gestational diabetes.A 42 year old female, referred to the Endocrine services for episodes of symptomatic hypoglycaemia. Past medical history included pylo...

IntroductionCurrent guidelines recommend a single elevated prolactin measurement drawn without excessive venepuncture stress as sufficient for diagnosing hyperprolactinaemia. However, previous studies have demonstrated that the cannulated prolactin test is more reliable at eliminating stress-induced hyperprolactinaemia, thus avoiding unnecessary additional investigations. We routinely perform morning serial prolactin sampling immediately after brachial v...

BackgroundSomatostatin receptor ligands (SRL) are commonly used in patients with acromegaly to control insulin growth factor 1 (IGF1) concentrations. Biliary sludge or gallstone formation are well-recognised biliary adverse events (BAE) from SRL therapy. Our current practice is to routinely monitor patients with acromegaly on SRL with ultrasound scanning (USS). Once BAE are detected, ursodeoxycholic acid (UDCA) therapy is initiated.<p class="abstext"...

Background: Diagnostic work-up for Cushing ’s syndrome (CS) can be challenging, with variable performance characteristics on screening tests. We were recently referred a young female patient with Cushing’s disease (CD) due to a microadenoma. She presented with a seizure and initial biochemical work-up included a Synacthen stimulation test (SST). Her peak cortisol rose to over 1,000 nmol/l. Exaggerated response during SST is expected in hyperestrogenic states due to e...

Background: Acromegaly is a rare condition characterised primarily by tumourous production of excess Growth Hormone (GH) from a pituitary adenoma. The Octreotide Challenge Test (OCT) has been used in the RVI to predict short term efficacy of long-acting Somatostatin Analogue (SSA) therapy.Aims: We retrospectively reviewed the OCT results of all patients with acromegaly treated at RVI from 2005 to 2021 to evaluate its clinical utility.<p class="abstex...

Background: Acromegaly is a rare condition characterised primarily by tumourous production of excess Growth Hormone (GH) from a pituitary adenoma. Clinical management aims at normalising serum IGF1 levels within sex and age-adjusted reference parameters. Treatment options include pituitary surgery, medical therapy with somatostatin analogue (SSA), cabergoline, pegvisomant or radiotherapy. A combination of treatment modalities is common for the majority of patients.<p class...

Background: Congenital adrenal hyperplasia (CAH) is the commonest genetic endocrine disorder, affecting 1 in 18 000 UK births. The 2010 CaHASE Study identified a myriad of health problems associated with CAH and its treatment, and a lack of consensus on treatment strategies in adults. Endocrine Society guidelines (2010, revised 2018) have since been published to support management. As one of the original CaHASE centres, we have audited our recent practice against these new sta...