Endocrine Abstracts

Although MRI remains the investigation of choice for pituitary imaging, it does not reliably identify all secretory microadenomas, and cannot always discriminate residual tumour from post-surgical change following hypophysectomy. We hypothesised that i) imaging with the PET ligand 11C-methionine, which is taken up at sites of peptide/protein synthesis, would permit more reliable identification of functioning pituitary adenoma, and ii) co-registration of PET–CT ...

Case history: A 20-year-old man was referred to the metabolic bone clinic following a left sided neck of femur fracture (sustained after a simple fall whilst roller skating). He was otherwise well with no past medical history; systemic enquiry was unremarkable. A DEXA scan revealed osteoporosis (Z scores: total hip −2.97; lumbar spine −3.1), and bone turnover markers were significantly raised. Unexpectedly, the patient was found to have an elevated serum t...

Background: Thyrotropinomas (TSHomas) are traditionally considered a rare, albeit important cause of thyrotoxicosis. Although early case series reported a predominance of invasive macroadenomas, emerging evidence suggests microadenomas are being increasingly diagnosed, and the clinical/biochemical phenotype appears to be more variable than previously suspected. We therefore performed detailed phenotyping of patients referred to our centre with a diagnosis of TSHoma over a 4-ye...

Background: BIPSS remains the gold standard for differentiating pituitary and ectopic sources in ACTH-dependent Cushing’s syndrome. A pituitary:peripheral ACTH ratio >2 in the basal state, and/or >3 following CRH stimulation, is considered indicative of pituitary Cushing’s, with a range of sensitivities and specificities cited in the literature. In addition, in Cushing’s disease a peak interpetrosal gradient of >1.4 has been reported to predict the s...

Case Report: A 49-year-old man presented with a two-year history of thyrotoxic symptoms for which he had been investigated on several occasions. He had a past medical history of dilated cardiomyopathy, which had been attributed to excess alcohol consumption, and had also suffered episodes of non-sustained ventricular tachycardia. His family history was strongly positive for autoimmune thyroid disease. Eventually, he was found to have an elevated fT4 (53 pmol/L, RR 12–22) ...

Background: In a sub-group of patients with newly diagnosed pituitary adenomas, conventional MRI will fail to confidently localise the tumour. The role of molecular imaging for these patients is increasingly being recognised, both in terms of confirming diagnosis and in guiding targeted therapy; 11C-Methionine PET co-registered with volumetric MRI (Met-PET/MRCR) can enhance decision making in this group of patients. However, in some cases distinguishing t...

Although MRI remains the investigation of choice for pituitary imaging, it does not provide information about ‘functionality’ of lesions (e.g. residual adenoma vs post-surgical scar tissue) and cannot reliably identify all microadenomas.We hypothesised that i) imaging with the PET ligand 11C-methionine, which is taken up at sites of peptide/protein synthesis, would permit more reliable identification of functioning pituitary adenoma ...