Endocrine Abstracts

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...

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...

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...

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...

Background: Correct identification of patients with HPA axis dysfunction following trans-sphenoidal pituitary surgery is important. Our centre measures post-operative day 5 0900 h serum cortisol (24 h after the last dose of glucocorticoid) to identify the need for glucocorticoid replacement. This is given if post-operative day 5 0900 h cortisol concentration is <300 nmol/l, until dynamic pituitary function assessment occurs.Methods: Data were reviewe...

A 28-year-old woman presents with a one-year history of marked weight gain of 18 kg, increasing hirsutism and night sweats. Clinically, hyperandrogenism and Cushing’s syndrome were suspected. A diagnosis of Polycystic ovarian syndrome was made based on Rotterdam criteria and Metformin was initiated. Initial testing for Cushing’s syndrome demonstrated a high 24 h urinary free cortisol (306 nmol/l) with incomplete cortisol suppression on an overnight dexamethaso...

A 33 year old primip presented to the local ophthalmic hospital at 34+4 weeks’ gestation with two weeks of blurred vision. Examination revealed a bitemporal hemianopia and reduced visual acuity. She was previously fit and well, and a pre-eclampsia screen was negative. An MRI scan demonstrated a haemorrhagic pituitary lesion extending into the suprasellar cistern with mild compression of the optic chiasm. Pituitary function tests showed a raised prolactin 3844 mU/l, isolat...

Background: The management of craniopharyngiomas remains controversial.Objective: This study sought to examine temporal trends in the management of craniopharyngioma and their impact on long-term patient outcomes, with focus on endocrine consequences.Methods: This was a cross sectional, multicentre study. Patients treated between 1951 and 2015 were identified and divided into four quartiles based on the date of initial surgery. Pat...

Non-functioning pituitary adenomas (NFPAs) are the second most common subtype (15-43%) of all clinically presenting pituitary adenomas. Although the primary treatment of symptomatic NFPAs is surgery, gross total resection is achieved only in about 66% of the cases, and 20% of gross total resected tumours recur after 10 years. Despite recent advances in medical management of pituitary tumours, NFPAs remain the only subtype with no widely accepted pharmacological treatment. Expr...