Endocrine Abstracts

Background: Current guidance for the management of macroprolactinomas recommends full pituitary profile at baseline and subsequently only if symptomatic. Pituitary adenomas that co-secrete growth hormone and prolactin at presentation are well-recognised. Case reports of acromegaly after prolactinoma treatment are associated with symptomatic acromegaly. We present two patients with asymptomatic acromegaly years after diagnosis of macroprolactinoma.Patient...

A 37-year-old woman was referred to the endocrine team for the assessment of her adrenal axis, as she had been taking high dose prednisolone (20-40 mg) for several years for the management of her brittle asthma. Drug history included inhaled Symbicort 200/6 (SMART regime), tiotropium and montelukast. Her respiratory symptoms improved with the introduction of theophylline, thus enabling her prednisolone to be switched to oral hydrocortisone, with appropriate ’sick- day&#14...

Introduction: Ipilimumab (Yervoy, BMS) is a human monoclonal antibody increasingly used in oncology. It targets cytotoxic T lymphocytes antigen 4 (CTLA-4) promoting their proliferation and augmenting an anti-tumour response. It is licensed for the treatment of unresectable or metastatic melanoma and multiple clinical trials using this medication for other malignancies are ongoing. Ipilimumab related adverse reactions are mainly autoimmune and occur in 61% of patients, of which...

Introduction: Bilateral 3rd nerve palsy is known in conditions such as diabetes mellitus, neurosarcoidosis, Guillain-Barre syndrome, multiple sclerosis, anterior or posterior communicating artery aneurysm or mesencephalic bleed/trauma. There are only single cases reported in association with pituitary adenoma or carcinoma, usually in the context of apoplexy. We describe a patient with Cushing’s disease and bilateral 3rd nerve palsy secondary to apoplexy in pituitary macro...

Case history: A 34-year old Caucasian nurse presented to her GP with a 7 month history of abdominal pain. She was found to have PTH-dependent hypercalcaemia with Stage 3A chronic kidney disease (corrected calcium 3.43 mmol/l, phosphate 0.62 mmol/l, total vitamin D 32 nmol/l, PTH 214.9 pmol/l, creatinine 117 μmol/l and eGFR 45 ml/min/1.73m2). On direct questioning, she reported fatigue, generalised weakness and intermittent joint pains affecting her lower back and bo...

Background: Familial hypocalciuric hypercalcaemia (FHH) is a rare benign autosomal dominant condition which causes life-long mild to moderate hypercalcaemia. It is usually underdiagnosed due to lack of symptoms in majority of patients and low rate of screening even among endocrinologists. Recent NHS England National Genomic Directory testing criteria for FHH recommend testing patients presenting with hypercalcaemia and calcium creatinine clearance ratio (CCCR)...

Background: Short Synacthen test (SST) is commonly used for the assessment of the hypothalamus-pituitary-adrenal (HPA) axis after pituitary surgery. In our centre, patients are discharged on hydrocortisone on day 3 post-surgery and 9am cortisol on day 8 post-surgery is measured. Hydrocortisone is stopped if cortisol is ≥350 nmol/L on day 8. Six weeks post-surgery SST is performed and treatment adjusted. We aimed to assess the perfor...

Background: Short Synacthen test (SST) is commonly used for the assessment of the hypothalamus-pituitary-adrenal (HPA) axis after pituitary surgery. In our centre, patients are discharged on hydrocortisone on day 3 post-surgery and 9am cortisol on day 8 post-surgery is measured. Hydrocortisone is stopped if cortisol is ≥350 nmol/L on day 8. Six weeks post-surgery SST is performed and treatment adjusted. We aimed to assess the perfor...

Background: Primary hyperparathyroidism may severely manifest with an adjusted calcium >3.5mmol/l and increased risk of prolonged postoperative hypocalcaemia. Formal consensus on preoperative optimisation appears lacking, especially around the utility of parenteral bisphosphonate treatment. Bisphosphonate therapy has been demonstrated to cause prolonged hypocalcaemia when given to patients with a history of parathyroidectomy....

Background : Adrenocortical cancer (ACC) is a very rare but aggressive tumour with annual incidence of 2 cases per million populations. Hypercalcaemia is a commonly encountered paraneoplastic manifestation of certain cancers such as lung, breast, kidney, gynaecological and neuroendocrine tumours but very rare in ACC. So far, there are only two cases of ACC and PTHrP-related hypercalcaemia reported in the literature.Case report: 32-year-old man presented ...