Endocrine Abstracts

During pregnancy there are a number of physiological changes in the regulation of the hypothalamo-pituitary-adrenal (HPA axis). These changes make the diagnosis of adrenal insufficiency and management of patients with known adrenal insufficiency challenging in pregnancy. The management of patients with known adrenal insufficiency needs to be altered during pregnancy and the management of labour and delivery needs MDT input. This session will review the physiological changes th...

Approximately 1% of the population are on some form of long-term glucocorticoid therapy, either as an immunosuppressant or as replacement therapy for adrenal suppression. In recent years, it has become increasingly evident that many of these patients (even those on inhaled steroids) develop adverse consequences of this therapy with the development of iatrogenic Cushing’s syndrome (and its adverse metabolic profile) and associated tertiary adrenal insufficiency due to hypo...

Disorders of salt and water homeostasis are common following traumatic brain injury. Diabetes insipidus is a well-recognized complication of TBI. Polyuria occurs immediately after significant brain injury in up to 22% of cases, nearly always occurring within the first 2–3 days. The great majority of cases resolve spontaneously, and cross-sectional studies of long-term survivors of TBI report low rates of chronic diabetes insipidus. It is likely that in the absence of form...

Acute adrenal insufficiency, also termed adrenal crisis, is a life-threatening endocrine emergency due to a lack of production of the adrenal hormone cortisol (and also aldosterone in primary adrenal insufficiency). Patients with both primary (PAI) and secondary adrenal insufficiency (SAI) are at risk of adrenal crisis. PAI is caused by loss of function of the adrenal gland itself resulting in both glucocorticoid and mineralocorticoid deficiency. SAI is caused by alterations i...

Pituitary adenomas/ tumours remain the commonest cause of growth hormone deficiency (GHD; indeed recent studies from the UK and Belgium have reported higher than previously estimated prevalence of clinically significant pituitary adenomas). However, the aetiological spectrum of pituitary dysfunction has changed in recent years with endocrinologists increasingly reviewing patients with pituitary dysfunction secondary to radiation injury, traumatic brain injury and subarachnoid ...

Adrenocortical carcinoma (ACC) is a rare malignant tumour arising from the adrenal cortex, with an estimated annual incidence of one to two patients per million. Ectopic ACCs are extremely rare. They are believed to arise from cortical fragments arrested during embryologic migration and have been found close to the adrenal gland or along the path of gonadal descent. The majority of ACCs are sporadic, however, ACC has been linked with genetic disease processes, including multip...

A 34 year old male diagnosed with congenital adrenal hyperplasia (21 hydroxylase deficiency, salt wasting variety) shortly after birth. Initial presentation was poor feeding with hypoglycemia, pigmented scrotum with elevated 17-OH progesterone. He had a right orchidopexy at age 9 for undescended testis. He was admitted multiple times with adrenal crises during his childhood. He went through puberty and achieved height of 177 cm which is 75th centile. His sister also has CAH. H...

A 56-year-old male presented in 2017 with acute symptomatic hyponatraemia. He was admitted with a seizure and a plasma sodium of 112 mmol/l. His past medical history was notable for alcohol excess and smoking. The acute presentation was managed with 3% hypertonic saline infusion in ITU. Plasma osmolality was 240 mOsm/Kg, urine osmolality 327 mOsm/kg and sport urine sodium 28 mmol/l. CT TAP showed some oesophageal thickening only; endoscopy was normal. He made a good recovery f...

Introduction: Prader–Willi syndrome (PWS) is a genetic syndrome usually diagnosed in childhood. Its reported prevalence ranges from one in 8000 to one in 45 000 with geographical variation. Clinical manifestations include obesity, hyperphagia, short stature, incomplete sexual development, and cognitive disabilities. The majority of published data regarding PWS comes from paediatric populations.Materials and methods: This is a retrospective observati...

Cyclophosphamide is an alkylating agent used in the treatment of malignant and autoimmune diseases. Severe hyponatraemia is a serious electrolyte disorder with life threatening neurological sequelae. We report a case of recurrent severe, symptomatic hyponatraemia that developed in a 61 year old female with systemic vasculitis and Sjogrens syndrome following low-dose cyclophosphamide.Case report: A 61 year old lady, with ANA positive systemic vasculitis p...