Endocrine Abstracts

Headaches associated with acromegaly are common even after hypophysectomy. Medical treatment with dopamine agonists and Somatostatin analogues often help. We report two cases when pharmacological therapy failed but further surgical removal of residual pituitary tissue cured the headaches.A 38 year-old lady presented with an eight year history of headaches, unresponsive to simple analgesia. Acromegaly was confirmed by a raised serum growth hormone (GH) 33...

Transphenoidal hypophysectomy is often carried out to remove ACTH-secreting tumours of the pituitary. A postoperative serum cortisol of <50nmol/l usually indicates cure of the disease but after other audits found persistent cases, 'remission' is thought to be a more appropriate term.Charing Cross Hospital is the tertiary neurosurgical centre for West London where a single, dedicated pituitary surgeon was appointed in 1995. We analysed the success of e...

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 definition of early cure post transphenoidal surgery (TSS) for Cushing’s disease continues to be debated. The low dose dexamethasone suppression test with corticotrophin releasing hormone (LDDST-CRH) is a test for diagnosis of Cushing’s; however it has not been validated in early post TSS to determine remission. The aim of this study was to determine whether the combined LDDST-CRH test could be used in post TSS patients.The combined LDDST-C...

Eliciting an accurate diagnosis of Cushing's disease before transphenoidal hypophysectomy is essential to avoid unnecessary surgery. Localisation of the tumour increases the chance of operative success.In the right hands, Inferior Petrosal Sinus Sampling (IPSS) can provide invaluable information in distinguishing ectopic ACTH from pituitary Cushing's and localising the tumour in patients who are known to have Cushing's syndrome. Due to the invasive natur...