Endocrine Abstracts

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...

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...

Background: Hyperprolactinaemia accounts for 1 in 7 patients presenting with amenorrhoea. Recent data suggests that prolactin acts at the hypothalamus to reduce GnRH-pulsatility. Conditions in which GnRH-pulsatility is reduced, such as hypothalamic amenorrhoea, favour FSH over LH secretion from the pituitary gland. We examined gonadotrophin secretion in hyperprolactinaemic patients as a surrogate marker of GnRH-pulsatility.Methods: A retrospective analys...

A 59-year-old lady presented with significant weight gain, and a history of hypertension for investigation of possible Cushing’s syndrome. Her BMI was 29, with mainly central obesity. Initial tests revealed elevated untimed cortisol on two separate occasions, at 905 nmol/l and 893 respectively with detectable midnight cortisol, at 548 and 481. Of 24-hour urinary free cortisol (UFC) was also elevated on two separate occasions, at 931 nmol/24 h and 827 respectively. ACTH wa...

Antipsychotic induced hyperprolactinaemia, mediated by blockade of dopamine D2 receptors, is much more common than prolactinoma in patients receiving antipsychotic medication. We present two cases of the latter.Case 1: A 47-year-old gentleman with depression treated with amitriptyline, fluoxetine and risperidone presented with headaches and a left sided visual field defect. Pituitary MRI showed a 2 cm macroadenoma abutting the optic chiasm. Prolactin was...

Background: Secondary adrenal insufficiency is a common complication of transsphenoidal hypophysectomy (TSS) for pituitary adenoma. It is therefore imperative to rapidly and accurately identify patients requiring glucocorticoid replacement, thus minimising risks of adrenal insufficiency or unnecessary glucocorticoid exposure. The gold-standard test of HPA axis reserve, the insulin tolerance test (ITT), cannot be performed safely until after post-operative recovery. Nine am cor...

The increased appetite associated with hyperthyroidism is assumed to be secondary to an increased metabolic rate. However, the role of thyroid hormones in appetite regulation is poorly understood. We hypothesised that thyroid hormones directly regulate food intake and studied the effects of peripheral and CNS administration of tri-iodothyronine (T3) on food intake in male Wistar rats in vivo.A single subcutaneous (s.c.) injection of 4.5 nmol per ...

A 55 year old lady presented to our hospital in 1991 with a year's history of diarrhoea, weight loss and abdominal pain. On examination, she had 5cm hepatomegaly. Serum gastrin was elevated (148 pmol per litre NR < 40), as was GAWK (276 pmol per litre NR < 150). Basal gastric acid secretion was increased (39 mmol per hour NR < 5). CT abdomen showed multiple hepatic metastases, confirmed to be neuroendocrine in origin on biopsy. There were no clinical or biochemical fe...