Endocrine Abstracts

We report the case of a 57-year-old woman who presented with headache of sudden onset and with blurring of vision in the right eye. This had been preceded by a week's history of fever, rigors and coryzal symptoms which had been treated as malaria and had subsequently settled. Examination demonstrated proptosis and complete ophthalmoplegia of the right eye with 6/60 acuity. Baseline investigations included normal urea and electrolytes, clotting screen and full blood count, with...

Overt primary adrenocortical failure is preceded by several stages of subclinical hypoadrenocorticolism. Individuals with type 1 diabetes (T1D) or who have other autoimmune conditions are at risk for the development of Autoimmune Addison's disease (AAD). These at risk individuals can be identified by the detection of adrenal autoantibodies (AAb).The aim of this study was two fold: firstly, to evaluate the sensitivity of early morning cortisol: ACTH ratio...

A 25 year old female presented with a two year history of secondary amenorrhoea and expressible galactorrhoea. There was no history of headache or visual disturbance, and the patient took no regular medication. Examination, including formal perimetry, was normal. Investigations revealed a moderately elevated prolactin 1,029 (NR 59-619 mU/ml), 9am cortisol 366 nmol/L, remainder of pituitary profile normal. An MRI pituitary revealed a macroadenoma with stalk deviation and bowing...

Graves’ disease typically follows a relapsing and remitting course. Most patients with recurrent hyperthyroidism after withdrawal of antithyroid drugs (ATDs) are offered definitive treatment with radioactive iodine. This retrospective study aimed to identify clinical and biochemical indices that predict relapse following ATD withdrawal, which could allow earlier definitive treatment to be initiated.We studied 70 patients with Graves’ disease wh...

We assessed whether the hypothalamic-pituitary-adrenal (HPA) axis is affected after withdrawal of oral steroids in patients who have been on steroids for at least ten years. Recent advances in treatment of patients with severe asthma with inhaled fluticasone propionate, and the use of steroid sparing drugs such as methotrexate has allowed the withdrawal of long term oral steroids in patients who otherwise had steroid dependant disease.We performed a 250 ...

A 50 year old lady undergoing elective surgery for pyloric stenosis secondary to chronic ulceration, was diagnosed with primary hyperparathyroidism (calcium 3 mmol/l), elevated parathyroid hormone (PTH). Following exploratory parathyroidectomy, left and right superior parathyroid adenomas were removed. 2 years later she re-presented with hypercalcaemia (Calcium 2.74 mmol/l, PTH 26.5 pmol/l (1.1–6.8 pmol/l)) and appeared Cushingoid. Investigations confirmed Cushing’s ...

IntroductionThe Epworth Sleepiness Scale (ESS) is a validated simple method of measuring subjective daytime sleepiness in a variety of situations whereby patients are asked to score the probability of dozing as no chance, slight, moderate or high chance. An ESS>10 is regarded as excessive daytime sleepiness which may be a result of sleep apnoea or sleep disorders. The British Thoracic Society advise that patients who have ESS>10 or sleepiness in ...

In ACTH-dependent Cushing’s syndrome, the high dose dexamethasone suppression test (HDDST) has been traditionally used to identify differentiate between pituitary-dependent Cushing’s disease and ectopic ACTH production. However, more recently, concerns regarding the diagnostic accuracy of the HDDST have led to many centres abandoning this test in preference to bilateral inferior petrosal sinus sampling (IPSS). We aimed to establish current consensus in the UK for the...

IntroductionRadioactive iodine (RAI) is a well-established treatment for relapsed Graves and toxic nodular hyperthyroidism. Lithium reduces the release of organic iodide and thyroid hormones from the thyroid gland, which results in a reduction of urinary radioiodine excretion. Previous studies have shown lithium may improve the effectiveness of radioiodine therapy; however research in this area is limited.Objective<p class="abs...

Background: Measurement of mean serum growth hormone (GH) during an oral glucose tolerance test (OGTT) is currently used for determination of disease activity in patients with acromegaly post-treatment. In contrast to normal subjects, GH secretion in acromegalic patients is largely non-pulsatile, even after treatment.Aim: To determine if random serum GH correlated with mean serum GH during OGTT in patients with acromegaly post-treatment. Furthermore, we ...