Endocrine Abstracts

Inpatients with hyponatraemia have a high mortality and longer length of stay. We instituted a system of automatic referral to the endocrinology team where any inpatient with a serum (Na+) ≤125 mmol/l was referred automatically from their biochemical results.Aims: We evaluated the diagnosis, management, and outcome of the patients referred with hyponatraemia over 6 months.Methods: Data were prospectively captured e...

Background and aims: The use of serum calcitonin to screen patients with nodular thyroid disease for medullary thyroid cancer (MTC) remains controversial due to conflicting data regarding its sensitivity, specificity and cost effectiveness. Currently, the use of calcitonin is recommended by the European consensus group but not the American Thyroid Association. We aimed to formally evaluate the utility of calcitonin as a screening tool for MTC in patients presenting to the thyr...

Introduction: Carcinoid heart disease (CHD) develops in patients with small bowel NETs with carcinoid syndrome. Currently NT-proBNP (NTP) is suggested as the best current biomarker to screen for CHD and monitor heart failure. A number of other markers have been investigated for heart failure, however, none of these have been explored in NET patients with CHD or carcinoid syndrome. Galectin-3 (GAL3) promotes fibroblast proliferation and correlates with worse outcomes in heart f...

Adrenocortical carcinoma (ACC) is a rare malignancy, but accounts for up to 11% of adrenal masses investigated in referral centres. Diagnosis remains a challenge. Up to two thirds are biochemically inactive, resulting from de facto enzyme deficiencies in the steroid hormone biosynthetic pathways, as shown by urine steroid profiling by gas chromatography-mass spectrometry. Increased metabolites of pathway intermediates in ACC discriminate it from benign adrenal lesions...

Background: Mitotane is an adrenolytic chemotherapy, currently accepted as first line adjuvant therapy in adrenocortical carcinoma. Mitotane has a narrow therapeutic window. Serum levels of >14 mg/l are required to achieve a cytotoxic effect and levels of >20 mg/l are potentially toxic. There are two strategies for mitotane initiation: a low-dose regimen (3 g) and a high-dose regimen (increase to 6g/day over 4 days and reduce to 4.5 g/day after 10 days).<p class="...

Background: Cushing’s disease is caused by corticotroph tumours of the pituitary gland and the standard first-line treatment is trans-sphenoidal surgery. Published data from other centres describes post-operative endocrine remission achieved in 50–90% of cases.Table 1 Remission (cortisol <50)Cortisol (50–150 nmol/l)<td alig...

Background: Adrenocortical tumours (adenoma or carcinoma) present in well-recognised ways: hormones excess (Cushing’s, Conn’s, virilisation) or hormonally silent with symptoms of mass effect, or found incidentally on imaging. We present 3 cases of adrenal tumours, referred to our regional adrenal multidisciplinary meeting with unusual presenting features.Case 1: post-menopausal bleeding: A previously well 57-year-old female presented with vagin...