Endocrine Abstracts

BackgroundTSHomas are a rare cause of hyperthyroidism, and account for 0.5 to 3% of pituitary tumours. Incidence=0.15 per million per year. Prevalence=1 per million. Our limited experience of this condition can result in diagnostic and treatment challenges. Here we describe a case treated surgically lead to successful outcomesCase35 years old female referred to our service with secondary amenorrhea for the la...

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

A 57-year-old woman was referred in 2012 following an incidental finding of a pituitary macroadenoma. It measured 17×9 mm and was confined to the sella. There was no clinical or biochemical evidence of pituitary dysfunction. In 2017, she was found to have proximal myopathy, plethoric facies and purple abdominal striae. She was also on medication for hypertension and type 2 diabetes. There was no history of sleep apnoea, fractures or use of exogenous steroids. An MRI showe...

Background: Acromegaly is associated with multiple co-morbidities and increased mortality. Surgery is the first-line intervention and remission of acromegaly can restore normal life-expectancy. Pre-operative somatostatin analogues (SSA) may increase the likelihood of remission in large invasive tumours by causing tumour shrinkage prior to surgery.Aims: To audit the management of acromegaly patients at Imperial College Healthcare NHS Trust (ICHNT) against...

A 39-year-old man presented with thyrotoxicosis and was diagnosed with Graves’ disease. Despite high doses of anti-thyroid medication for 18 months, he remained biochemically and clinically hyperthyroid. Therefore, a thyroidectomy was planned. Four days before surgery, he developed double vision and was referred for urgent Neurosurgical review at our centre. On further questioning, he reported a 12-month history of lethargy and low libido. On examination, he had right 6th...

Introduction: Prolactinomas are the commonest type of secretory pituitary tumours. In current practice, dopamine agonists (DA) remain the mainstay treatment. However, treating physicians are increasingly aware of DA-associated impulse control disorders (ICD) in their patients. We describe 4 individuals with prolactinomas, who either developed ICD on DA or deemed at ‘high risk’, successfully managed surgically with preservation of pituitary function. All decisions for...

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Case history : A 44-year-old female presented with 6-week history of gradual deterioration in her left vision associated with eye pain. She saw an ophthalmologist who noted that she had reduced visual acuity (6/24) and colour vision (Ishihara colour vision score 3/15) in her left eye with left relative afferent pupillary defect (RAPD). It was thought that she may have a left retrobulbar neuritis so she was advised to attend A&E for an urgent neurology assessment. On examin...