Endocrine Abstracts

Pituitary hyperplasia is a relatively common condition that occurs in both physiological and pathological states. Pregnancy is the most common condition associated with physiological pituitary enlargement, associated primarily with lactotroph hyperplasia. Pathological hyperplasia has been shown to be associated with end organ insufficiency from primary gonadal insufficiency, primary adrenal insufficiency, and primary hypothyroidism. We present the case of a 33-year-old male wi...

Introduction: Congenital Adrenal Hyperplasia (CAH) is a rare genetic disorder characterised by deficiency of cortisol and/or mineralocorticoid hormones with over production of sex steroids. 21-hydroxylase deficiency is the commonest cause of CAH accounting for 95% of cases. Severe form of classic CAH occurs in 1 in 15 000 live births.Case report: A 30 year old women with CAH diagnosed at birth was on replacement with hydrocortisone and fludrocortisone. S...

Introduction: Primary testicular lymphoma is very rare and constitutes about 2% of all extra nodal lymphomas, mostly in men above the age of 60. Bilateral adrenal masses could be due to metastatic disease, congenital adrenal hyperplasia, bilateral macro-nodular hyperplasia, adrenal adenomas, lymphomas, infiltrative diseases, amyloidosis and infections like tuberculosis. Metastasis occurs most commonly from lung, bowel, breast and pancreatic cancer. Metastasis from lymphomas is...

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: Enzalutamide is a next-generation androgen receptor (AR) antagonist, used as a daily oral agent, in the treatment of castration-resistant prostate cancer. Its suppression of 11β-hydroxysteroid dehydrogenase-2 enzyme has been reported in the literature, leading to hypertension through a relative increase in cortisol concentration at the level of the mineralocorticoid receptors. Enzalutamide is also known to be a potent inducer of drug metabolising enzymes (cyto...

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...

A 41 year-old male was referred urgently from secondary care with high suspicion of Cushing’s syndrome. His past medical history included psychosis and bipolar disorder, previous low impact foot fractures, rib fractures on coughing and spinal wedge fractures on X-ray, all within the last 5 years. He was taking quetiapine 300 mg modified-release and amitriptyline 10 mg daily, and tramadol 50 mg as needed. The patient reported decreasing mobility with increasing back pain, ...

Case history: We describe a case of 35 year old female who presented with abdominal pain, nausea and lower backache. She was initially treated with Trimethoprim for a urinary tract infection. 5 days later, she re-attended hospital with feeling more unwell, ongoing lower abdominal pain and vomiting. On examination, she was haemodynamically stable. She had suprapubic tenderness on abdominal palpation, and the rest of her systemic examination was normal.Inv...

Background and aims: Electrolyte imbalance is common among hospital inpatients, reflecting severity of underlying illness, but also independently contributing to excess morbidity and mortality. However, studies have largely been retrospective, with incomplete data capture. We prospectively evaluated the prevalence of major Na and Ca disorders among inpatients at the Newcastle-upon-Tyne Hospitals.Method: With approval of the Information Guardian, we used ...