Endocrine Abstracts

A 55-year-old post-menopausal female presented with hirsutism and increased libido. Testosterone was elevated at 9.7 (RR <1.8 nmol/l). LH/FSH were appropriate post-menopause (LH 28.8; FSH 54.1U/l). DHEAS, androstenedione and 17-hydroxyprogesterone were unremarkable. GnRH analogue suppression testing (GnST) appropriately suppressed LH/FSH and testosterone (testosterone 0.2 nmol/l), suggesting an LH-dependent source of testosterone. Pelvic MRI suggested a left ovarian tumour...

Background/aims/method: Evaluation/management of adrenal incidentalomas (AI) is an increasingly prevalent challenge. CT/MRI characteristics may be useful in determining whether a lesion is a benign adenoma and forthcoming ESE-ENSAT guidance suggests a role for 18F-FDG-PET/CT in distinguishing benign vs malignant lesions. We have previously demonstrated the utility of 11C-metomidate (MTO), which binds CYP11B1/B2, in localising aldosterone-producing adenoma...

Background: Primary aldosteronism (PA) accounts for 5–10% of all patients with hypertension, and an even greater proportion of those with refractory hypertension. Accurate assessment of PA is important both for rationalisation of medical therapy and to identify those patients with unilateral disease who may benefit from surgery. Single timepoint testing may miss patients with intermittent (‘cyclical/periodic’) disease, a phenomenon seen in other endocrine hypers...

Background: Immune checkpoint (CTLA-4, PD-1) inhibitors are increasingly used to treat cancers including advanced melanoma. Although endocrine immune related adverse events (IRAEs) are now well reported, the frequency and type of thyroid and pituitary dysfunction reported varies considerably, with hypophysitis after CTLA-4 inhibitors reported in 2–16%, and thyroid dysfunction after PD-1 inhibitors in 2–39%. In addition, recove...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...

Context: Primary aldosteronism (PA) accounts for 5–10% of all hypertension and 20–25% of refractory cases. Diagnosis is important as PA is associated with increased morbidity and mortality compared with ‘essential’ hypertension, and up to 50% of patients may benefit from unilateral adrenalectomy. Screening requires measurement of plasma renin activity (PRA) or concentration (PRC), and plasma aldosterone concentration (PAC), to yield an aldosterone:renin rat...

Background: Immune checkpoint (CTLA-4, PD-1) inhibitors are increasingly used to treat cancers including advanced melanoma. Although endocrine immune related adverse events (IRAEs) are now well reported, the frequency and type of thyroid and pituitary dysfunction reported varies considerably, with hypophysitis after CTLA-4 inhibitors reported in 2–16%, and thyroid dysfunction after PD-1 inhibitors in 2–39%. In addition, recove...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...