Endocrine Abstracts

Primary Aldosteronism (PA) is the commonest secondary cause of hypertension. Multiple studies worldwide suggest a prevalence of approximately 10% in an unselected hypertensive cohort and up to 20% in resistant hypertension. This does not correlate with real world experience and PA remains a significantly under-recognised condition. There is a myth that the biochemical diagnosis of PA is complex and requires significant alterations to drug therapy and v...

A 24-year-old woman presented at 33 weeks gestation with severe left-sided abdominal pain and orthopnoea. Ventilation-perfusion scan demonstrated two segmental mismatched defects consistent with bilateral pulmonary embolism. Anticoagulation with enoxaparin was commenced. MRI abdomen, carried out in view of abdominal pain, revealed a 4.5 cm left adrenal mass containing a fluid level. Appearances were in keeping with acute left adrenal haemorrhage. Imp...

A 24-year-old woman presented at 33 weeks gestation with severe left-sided abdominal pain and orthopnoea. Ventilation-perfusion scan demonstrated two segmental mismatched defects consistent with bilateral pulmonary embolism. Anticoagulation with enoxaparin was commenced. MRI abdomen, carried out in view of abdominal pain, revealed a 4.5 cm left adrenal mass containing a fluid level. Appearances were in keeping with acute left adrenal haemorrhage. Imp...

Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard investigation in Cushing’s disease for identifying the pituitary as the ACTH source. This technique aims to demonstrate a gradient of central:peripheral ACTH levels of >2:1 in such patients, or >3:1 after CRH stimulation. In patients without significant pituitary MRI abnormalities this facilitates neurosurgical exploration.The test is limited by difficulties in achieving...

Introduction: Gas chromatography/mass spectrometry based steroid profiling has been proposed as a tool for differentiating adrenocortical carcinoma (ACC) from benign adrenocortical adenoma (ACA). We retrospectively examined urinary steroid profiles from ten patients with ACC and 14 patients with ACA to determine, if the steroid profiles were predictive in distinguishing benign from malignant disease.Methods: Patients who had undergone adrenalectomy for r...

Phaeochromocytomas (PHAEOs) and extra-adrenal paragangliomas (PGLs) are rare neuroendocrine tumours. As many as 35% may have an identifiable germline mutation, most commonly in the genes encoding RET, VHL or subunits of succinate dehydrogenase (SDHx).[123I]-labelled metaiodobenzylguanidine (123I-MIBG) scintigraphy is used to localise PHAEOs/PGLs, while 131I-MIBG is used as therapy in malignant disease. Uptake of radioisot...

Introduction: The diagnosis of Cushing’s syndrome (CS) can be challenging and there is no single gold standard diagnostic test. Endocrinologists rely on a combination of plasma cortisol (before and after dexamethasone), midnight salivary cortisol and urinary free cortisol (UFC) to make the diagnosis. Assessment of urinary corticosteroids and their metabolites, measured by gas chromatography–mass spectrometry (GC–MS), provide a comprehensive picture of corticoste...

Primary aldosteronism (PA) accounts for up to 15% of cases of hypertension, and associates with increased cardiovascular morbidity. Specific treatment options include mineralocorticoid antagonists or adrenalectomy; the latter offers cure although reported rates vary between 20–60%. The role of adrenal vein sampling (AVS) in diagnosing PA remains controversial. By reviewing casenotes of PA patients treated surgically and comparing with matched medically managed PA patients...

Approximately 10% of essential hypertension cases is attributed to primary aldosteronism (PA), where inappropriately high levels of aldosterone are secreted. Almost half of these PA cases result from aldosterone-producing adenoma. microRNAs are single-stranded, short non-coding RNAs that negatively regulate gene expression post-transcriptionally. In a previous study, we showed that microRNAs directly modulate CYP11B2 (aldosterone synthase) gene expression and aldoster...

Introduction: Patients with mutations in the Succinate Dehydrogenase Complex Subunit B (SDHB) gene are predisposed to neuroendocrine tumours such as parangangliomas, phaeochromocytomas and gastrointestinal stromal tumours. Individuals who are carriers but have no manifestation of disease require regular surveillance. Our tertiary endocrine service provides follow up/surveillance for these patients and we cover a wide geographical area throughout the West of Scotland.<p cla...