Endocrine Abstracts

There have been few reports of long term remission rates after transsphenoidal surgery for Cushing's disease which incorporate both initial failure rates and later relapse rates. We have studied this in patients diagnosed and treated between 1979 and 2000. An early post-operative 0800h serum cortisol was measured 24h after the last dose of hydrocortisone, in addition to a low dose dexamethasone suppression test. Of the initial 63 patients, 18 did not achieve remission after su...

Primary hyperparathyroidism (PHP) during pregnancy is associated with high risk of maternal, foetal and neonatal mortality. Maternal and foetal complications have been reported in 67 and 80% of cases respectively. Guidelines for the management of PHP in adults exist, but there is no clear consensus regarding optimal management of PHP during pregnancy. We describe a case of PHP managed conservatively during pregnancy, resulting in the delivery of a healthy baby.<p class="ab...

Aberrant and upregulated eutopic receptors have been identified in vitro in patients with primary aldosteronism (PA). We previously identified an exaggerated aldosterone response to synacthen in patients with PA versus healthy controls. In this study we aimed to evaluate whether the synacthen test differentiates between patients with PA and essential hypertension (EH).The 250mcg intramuscular synacthen test was performed after 30 minutes recumbenc...

There is limited evidence on the effect of potassium (K+) supplementation on endothelial function. Three studies suggest a beneficial effect in healthy volunteers and mild hypertensives. However potassium increases aldosterone due to a direct effect on the adrenal gland and there is evidence that aldosterone excess is detrimental to cardiovascular health. We therefore aimed to determine the effect of potassium supplementation on endothelial function in patients with >10% c...

A 59 year old man was admitted with epistaxis. Blood pressure on admission was 213/110 mmHg. Past medical history included hypertension (3 years) and a cerebrovascular accident 5 years previously. Drug therapy included an ACE inhibitor, beta-blocker and thiazide diuretic. He denied thirst, polyuria or weight loss. He was an ex-smoker. On examination he was not Cushingoid. There were no diabetic complications.On block analysis potassium was 2.2mmol/l and ...

A 52 year old man presented with a 4 week history of heartburn and epigastric pain. On examination 6 centimetres of irregular heptomegaly were palpable extending across to the epigastrium. Ultrasound of the abdomen demonstrated multiple liver metastases. Percutaneous liver biopsy was consistent with a neuroendocrine tumour (NET) with positive staining for CAM 5.2, chromogranin, PGP 9.5 and S100 but negative for alpha fetoprotein and CEA. Gamma glutamyl transpepitdase was eleva...

Objective: to evaluate the role of pre-operative insulinoma localisation using selective intra-arterial calcium gluconate stimulated hepatic venous sampling.Method: Calcium gluconate (0.025 milliEquivalents Ca per kilogram) is used as a secretagogue to promote insulin secretion. Simultaneous catheterisation of right hepatic vein and pancreatic arterial supply were performed. The secretagogue was infused into the gastroduodenal, splenic, common hepatic an...

Background/Aims: Prognosis in midgut carcinoid tumours (MGCs) is difficult to predict. Studies of traditional clinical parameters give conflicting results. This is a large retrospective survival analysis of both clinical and biochemical data collected at diagnosis before treatment.Methods: Sequential cases of MGCs were identified using a database in Belfast from 1978. Clinical notes and pre-treatment plasma Neurokinin A (NKA) concentrations, were reviewed for each patient ...

From a group of 41 patients with acromegaly, the majority of whom had pituitary surgery as primary therapy, we have compared growth hormone responses to a test dose of octreotide across 8 hours with a 3 year random growth hormone in 22 patients who at the 3 year assessment were receiving at least 600mcg octreotide daily subcutaneously or 20mg LAR monthly intramuscularly and in 2 other patients who had achieved 3 year GH of <5 mU/l on smaller doses. Seven patients had a basa...

Radioactive iodine scanning and ablative radioactive therapy (RAI) are mainstays of follow-up and therapy in patients with differentiated thyroid carcinoma. TSH levels of 30 or greater are recommended as the levels required for effective use of RAI (see recent British Thyroid Association guidelines).To clarify our own practice we have studied 20 consecutive patients undergoing ablative RAI for thyroid carcinoma (10 papillary, 8 follicular and 2 mixed). The fourteen who had...