Endocrine Abstracts

Background: Patients taking hydrocortisone replacement for primary or secondary adrenal failure require individual adjustment of their dose. Previous observations in our department suggest that total serum cortisol levels achieved following an afternoon or evening dose of 5 mg hydrocortisone are almost as high as those that result from a 10 mg dose in the early morning; and that the ‘area under the cortisol curve’ (AUC) generated by an evening 5 mg dose is broader th...

Cinacalcet is a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma. Multiple endocrine neoplasia type 1 (MEN1) patients may benefit considerably from cinacalcet. Affected patients have hyperplasia of multiple parathyroid glands, rather than a single resectable adenoma. Surgical cure requires removal of all parathyroid tissue, which is often unsuccessful, resulting in multiple neck explorations and hypoparathyroidism. Cinaca...

Section 1: Case history: A 23-year-old female presented to the Emergency Department with a 3-month history of intermittent chest pain and palpitations. She was found to be hypokalaemic and hypocalcaemic. On direct-questioning she reported 3 weeks of perioral paraesthesia and muscle spasms. She had an unrestricted diet and no other personal or family history of note. She was normotensive with a sinus tachycardia and normal QT-interval, Chvostek’s negative, with no features...

Volume 82, Issue 1, January 2015, Pages 2–11. DOI: 10.1111/cen.12603...

The potential for primary tumour relapse is an important consideration during GH replacement therapy (GHR). We report 3 cases of relapse of intra cranial germ cell tumour (GCT) during GHR.Patient 1: An 11 year-old female presenting with visual loss and short stature due to a suprasellar malignant teratoma. She was successfully treated with bleomycin, etoposide and cisplatinum (BEP) and intrathecal chemotherapy. She suffered a first relapse two years late...

Introduction: We present the outcome for the first 21 patients undergoing neuronavigation–guided, endoscopic transphenoidal surgery for pituitary dependent Cushing’s disease in our centre since August 2001. All operations were consecutive, and undertaken by the same neurosurgeon and endoscopic nasal surgeon.Methods: Records are available for 20 cases. Pre and post operative management of cases was led by the endocrine team with standard assessm...

Pituitary patients with different aetiologies of hypopituitarism exhibit differing phenotypes despite optimal replacement therapy. We hypothesised that differential regulation of the isoenzyme 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1), which mediates the autocrine conversion of cortisone to cortisol in adipose tissues and liver may play a role.We prospectively studied 11β-HSD1 activity through analysis of 24 h urine cortisol/cortisone ...

Selective transsphenoidal adenomectomy remains the accepted first line treatment for Cushing’s disease (CD), until recently by microscopic (sublabial) transsphenoidal pituitary surgery. Endonasal transsphenoidal endoscopic surgery is emerging as a novel, less invasive treatment for pituitary adenomas with lower postoperative complications and morbidity. The safety of endoscopic surgery has been extensively reviewed in adult patients and is now considered best practice for...

Background/objective: Published data suggest that growth hormone replacement (GHR) may be safely given to patients with hypopituitarism consequent upon a pituitary/peri-pituitary tumour. However, to date, these series have included a preponderance of patients treated with external pituitary irradiation. We have performed a retrospective study to evaluate the recurrence rate in a group of patients with pituitary/peripituitary tumours treated with GHR.Meth...

Background: The low dose dexamethasone suppression test (LDDST) is an important investigation for suspected Cushing’s syndrome (CS). The traditional definition of normal suppression of serum cortisol to ≤50 nmol/l (0.5 mg 6 hrly × 48 hrs) comes from a time when biochemical auto analysers did not routinely detect very low values. Previous studies reported 5.1–8.3% of patients with Cushing’s disease (CD) suppressed to <50 nmol/l at 48 hrs. Many clin...