Endocrine Abstracts

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

A 39-year-old man presented with thyrotoxicosis and was diagnosed with Graves’ disease. Despite high doses of anti-thyroid medication for 18 months, he remained biochemically and clinically hyperthyroid. Therefore, a thyroidectomy was planned. Four days before surgery, he developed double vision and was referred for urgent Neurosurgical review at our centre. On further questioning, he reported a 12-month history of lethargy and low libido. On examination, he had right 6th...

Cabergoline has long been used to treat prolactinomas for symptomatic, radiological and biochemical resolution of pituitary tumours. As clinicians we are well-versed at screening for physical side effects, but are we holistic enough? We present two cases illustrating the damaging social consequences of cabergoline treatment for prolactinomas.Case 1A 49-year-old married father of two presented with a seizure in April 2018. MRI showe...

Lithium increases retention of Iodine-131 in the thyroid gland and inhibits thyroid hormone release following radioactive iodine (RAI) administration. However, outcomes of studies of the effects of lithium on the efficacy of RAI are conflicting. The aim of this study was to assess whether adjuvant lithium increases the efficacy of RAI treatment in hyperthyroidism. A retrospective cohort study was performed of 204 hyperthyroid patients (163 Graves’ disease, 26 toxic multin...

Introduction: Prolactinomas are the commonest type of secretory pituitary tumours. In current practice, dopamine agonists (DA) remain the mainstay treatment. However, treating physicians are increasingly aware of DA-associated impulse control disorders (ICD) in their patients. We describe 4 individuals with prolactinomas, who either developed ICD on DA or deemed at ‘high risk’, successfully managed surgically with preservation of pituitary function. All decisions for...

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Background: Correct identification of patients with HPA axis dysfunction following trans-sphenoidal pituitary surgery is important. Our centre measures post-operative day 5 0900 h serum cortisol (24 h after the last dose of glucocorticoid) to identify the need for glucocorticoid replacement. This is given if post-operative day 5 0900 h cortisol concentration is <300 nmol/l, until dynamic pituitary function assessment occurs.Methods: Data were reviewe...

A 33 year old primip presented to the local ophthalmic hospital at 34+4 weeks’ gestation with two weeks of blurred vision. Examination revealed a bitemporal hemianopia and reduced visual acuity. She was previously fit and well, and a pre-eclampsia screen was negative. An MRI scan demonstrated a haemorrhagic pituitary lesion extending into the suprasellar cistern with mild compression of the optic chiasm. Pituitary function tests showed a raised prolactin 3844 mU/l, isolat...