Endocrine Abstracts

A 19-year-old Cushingoid lady was referred with significant hirsutism requiring daily facial shaving despite previous laser epilation and regular waxing. She had a background history of PCOS, polycythaemia, hypertension and had been labelled as having a ‘Cushingoid appearance’. Extensive investigations elsewhere (UFCs, MR pituitary, and CT adrenals) had failed to diagnose the syndrome. She was taking metformin to regulate menses and lercanidipine and bisprolol. Spiro...

The prevalence of gallstones (GS) is increased in acromegaly and is further increased by somatostatin analogue (SA) therapy. The incidence has variously been reported to be between 10 and 63%, but they are often asymptomatic and rarely require definitive management. However, there is evidence suggesting that discontinuation of SA therapy may precipitate acute biliary problems.We have analysed our experience of symptomatic gallstones in all 44 patients (2...

Cardiovascular outcomes are better predicted by 24 hour ambulatory BP monitoring than random clinic BP (mmHg). In acromegaly, hypertension is common and cardiovascular disease is the principal cause of death. We investigated prevalence and characteristics of hypertension in 44 patients (26 male, mean age 53.1 ± 14.2), 17 of whom were receiving treatment for hypertension. A random clinic BP (normal <140/90) and IGF-I were measured prior to 24 hr ABPM assessment (Astra...

Seventy six year old man presented with sudden onset headache for 3 days. He was seen by the GP and treated for migraine. But no improvement in his headache and he developed drooping of left eyelid and blurring of vision. No other neurological symptom.On examination left ptosis with normal visual fields to confrontation method. Initial differential diagnosis was isolated 3rd nerve palsy probably due to posterior communicating artery aneurysm. He was on a...

An 18-year-old male referred to endocrine department 3 years ago with symptoms of tremor in both hands and query thyrotoxicosis. Presenting TFTs showed raised T3 and T4 levels with normal TSH (FT4 – 45 pmol/l, FT3 – 3.3 pmol/l and TSH of 1.4 mU/l). There was family history of thyroid disease with both the patient’s father and grandmother diagnosed with overactive thyroid. Patient’s TFTs were reproduced with differ...

In patients with pituitary disease stimulation tests, such as the insulin tolerance test, are performed as tests of the HPA axis and widely used as the basis for commencing hydrocortisone replacement therapy.We conducted a pilot study to investigate the relationship between the peak cortisol response to insulin-induced hypoglycaemia and daily CPR. Isotopic CPRs were studied in 10 patients (5 male, mean age 44±13 years) with pituitary disease and a s...

Patients with acromegaly die prematurely from CVD. Hypertension is more prevalent with increased peripheral vascular resistance thought to be due to structural remodelling of resistance vessels.We investigated structural properties and reactivity of small arteries in 20 healthy controls(55±11 years, 10 m) and 43 patients with acromegaly (55±14 years, 29 m), split into active disease (AD, n=17, 56±15 years, 13 m) or remission (CD, <i...

Without adequate treatment patients with acromegaly die prematurely from cardiovascular disease (CVD); however the contribution of atherosclerosis in this process is controversial. Increased carotid IMT is an early morphological marker of atherosclerosis and predictor of subsequent cardiovascular events. Contradictory data exist regarding IMT in patients with acromegaly.We measured carotid IMT in 79 patients with acromegaly (47 male, mean age 55±14 ...

We have previously reported comparisons of ACROQOL, a disease-specific questionnaire for QOL in patients with acromegaly, with the non-disease-specific generic tools Psychological General Well-Being Schedule (PGWBS) and EUROQOL and disease-specific signs and symptoms score (SSS). ACROQOL comprises 22 questions (subdivided into physical and psychological classes, total score out of 110 quoted as percentage, higher scores = better QOL). SSS rates 5 features of acromegaly each ra...

We report the efficacy, safety, and effects on glucose homeostasis of converting patients with acromegaly from slow release octreotide (OT, treated for >3 months) to pegvisomant (Peg), a GH receptor antagonist. 52 patients (median age 49, range 23-81, 13 with diabetes) who had previously participated in a Peg clinical trial and subsequently treated with OT were enrolled in a 32-week, open-label, multicentre study. Peg 10 mg/d was started 4 weeks after the last dose of OT (w...