Endocrine Abstracts

Patients with Addison’s or adrenal insufficiency require regular steroid replacement usually in the form of oral hydrocortisone. Standard advice is given on how to deal with intercurrent illness and special situations such as surgery. Organisations such as the Addison’s disease self-help group provide authoritative guidelines for patients. Several of our patients with adrenal insufficiency have asked how their steroid replacement treatment should be adjusted for expe...

A 39-year-old lady presented with chest infection and was found to be hyponatraemic (114 mmol/l) during her third pregnancy. Short synacthen test (SST) revealed inappropriately low ACTH (39 ng/l) with adrenocortical failure (cortical 163, 355, 503 at 0, 30 and 60 min respectively). She was started on replacement hydrocortisone. Adrenal autoantibodies were negative. Other tests showed IGF-1 14.8 (13–50 ηmol/l), growth hormone <0.1 (<10 mU/l), prolactin 677 (&#...

A 34-year-old African woman presented with a 4-month history of profound lethargy, weight loss and a 3-day history of vomiting, fever, confusion, and drowsiness. She had given birth to her third child 6 months previously. Her pregnancy and delivery were uncomplicated and she had breastfed for 5 months prior to discontinuing due to exhaustion.Investigations showed severe hypercalcaemia (4.94 mmol/l) and undetectable PTH. Hypercalcaemia was unresponsive to...

Background: Cranial diabetes insipidus (DI) is characterised by the inability to produce vasopressin leading to uncontrolled diuresis. Management includes administering synthetic vasopressin analogue desmopressin (DDAVP). Recently, there have been several national reports of DDAVP omission causing serious patient harm. This study aims to evaluate the feasibility of an automated alert system using Natural Language Processing (NLP) in electronic health records (EHR) to detect DI...

Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin. An NHS England patient safety alert was issued in 2016 highlighting this risk.Method: Using electronic prescribing records we reviewed all desmopressin prescriptions and omissions over a 12 month period in a large teaching hospital.Results: Ninety-seven inpatients wer...

Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin. An NHS England patient safety alert was issued in 2016 highlighting this risk.Method: Using electronic prescribing records we reviewed all desmopressin prescriptions and omissions over a 12 month period in a large teaching hospital.Results: Ninety-seven inpatients wer...

Background: Lack of expression of MGMT (O-6-methylguanine-DNA methyltransferase) is associated with a better tumour response to temozolomide. There are no systematic studies of MGMT expression in pituitary tumour series.Aim: We introduced MGMT immunohistochemistry for all pituitary adenoma specimens in 2011. In this study we investigated the immunohistochemical expression of MGMT in a large series of pituitary adenomas, in order to determine (1) the over...

Background: The initial management of hypercalcaemia is well described: aggressive intravenous rehydration and subsequent intravenous bisphosphonates if required. Isolated case reports document the use of haemo/peritoneal dialysis and haemofiltration in the management of severe hypercalcaemia. We report three cases that required renal replacement therapy to treat severe hypercalcaemia.Case series: A 21-year-old male presented with abdominal pain and vomi...

Background: Mitotane is an adrenolytic chemotherapy, currently accepted as first line adjuvant therapy in adrenocortical carcinoma. Mitotane has a narrow therapeutic window. Serum levels of >14 mg/l are required to achieve a cytotoxic effect and levels of >20 mg/l are potentially toxic. There are two strategies for mitotane initiation: a low-dose regimen (3 g) and a high-dose regimen (increase to 6g/day over 4 days and reduce to 4.5 g/day after 10 days).<p class="...

Background: Pituitary metastases are a rare complication of systemic malignancy. The most common presentations of pituitary masses include visual field defects, headaches, and hypopituitarism, but cranial nerve palsies and diabetes insipidus are also recognised although unusual. We aimed to determine if these were more frequently associated with pituitary metastasis.Methods: We conducted a review of 944 patients undergoing pituitary surgery from a teachi...