Endocrine Abstracts

Beclere first described the use of pituitary radiotherapy in 1909. Despite this long history of use, there is debate surrounding its role in the modern management of patients with pituitary disease. Whilst treatment with conventionally fractionated external beam radiotherapy (RT) is used infrequently as primary therapy in patients with pituitary adenomas, it is commonly administered following non-curative pituitary surgery. In acromegaly, Cushing's disease/Nelson's syndrome, a...

Pituitary radiotherapy (RT) causes hypopituitarism that is associated with a doubling in standardised mortality ratio. Other potential complications of pituitary RT are less clearly defined. Retrospective observational studies have estimated the risks of secondary intracranial tumour formation to be as high as 1-2% following conventional pituitary RT but these figures have been calculated against background normal population data. The majority of cases of intracranial tumors f...

A 73 year old man presented in 1995 with impotence and a bitemporal field loss. Endocrine testing revealed hyperprolactinaemia (2741 mU/L) and hypogonadotrophic hypogonadism. Pituitary imaging confirmed the presence of a macroadenoma with significant suprasellar extension. He underwent uncomplicated transsphenoidal surgery, which was successful in decompressing the optic chiasm. Histology revealed a pituitary adenoma that immunostained weakly for prolactin only. In 1998 routin...

In 2006, responding to the Government White Paper, ‘Our future, our inheritance’, a project commenced promoting genetics in mainstream medicine.By 2008, the original project framework has evolved to address logistical constraints, patient preference and cost effectiveness, offering a streamlined service for clients with inherited endocrine disorders. Recognised patient pathways and a dedicated endocrine genetic clinical nurse specialist (EGCNS)...

A 41 year old woman presented with a 4 month history of oropharyngeal spasms precipitated by eating, yawning or talking. Such manouvres caused her to fear for her life due to profound choking and 'going blue';as a result she had stopped eating. On direct questioning she complained of circumoral tingling, paraesthesia and carpopedal spasm. She described profuse diarrhoea over the preceding year and had lost 15 kilograms. She was taking no drugs to interfere ith calcium homeosta...

Transsphenoidal surgery (TSS) is the most common first-line treatment for Cushing's disease (CD). We have examined the outcome of this intervention to identify pre-operative clinical factors that predict good surgical outcome and to determine the risk of adverse events.We performed a case-notes review of 30 consecutive patients, 20 (67%) female, treated by a single surgeon over a 14-year period. The mean (SE) age was 34.2 (2.1) years and median (range) ...

Due to the infrequency of pituitary apoplexy, there are no robust evidence-based guidelines for optimum care of these patients. The key controversy surrounds the role of acute neurosurgical intervention. Over recent years we have adopted a relatively conservative approach and the aim of this study was to determine whether this 'non-intervention' affected long-term outcome in a recent cohort of patients. 19 patients (8 female) presented between 1994-2001. Mean age at diagnosis ...

Background: Studies of memory function in patients treated for pituitary adenoma demonstrate deficits in immediate memory (IM) regardless of whether surgery or radiotherapy was received. We have previously shown variability in IM between patients who received the same treatment. The present study was designed to identify changes in the neurological pathways associated with memory function in patients treated for non-functioning pituitary adenoma (NFA) using functional magnetic...

Much has been written on the attributes of preoperative localisation and minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism. A recent 'summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century' (Bilezikian et al, 2002) suggested however that in experienced hands, conventional open parathyroidectomy with visualisation of all four glands was still the gold standard. In light of this we have carried o...

Glucocorticoids (GCs) mediate many of their physiological effects through inhibition of cell proliferation. More contentious is the antiproliferative action of GCs and their possible tumour-modifying effects in neoplastic tissues. However, in recent studies we have shown that 'prereceptor' metabolism of GCs by the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD) is a pivotal determinant of cell proliferation and tumour formation. Two isozymes of 11beta-HSD interconvert ...