Endocrine Abstracts

There have been enormous advances in the medical and surgical management of pituitary tumours in recent years. Stereotactic radiotherapy has also allowed the use of more focused fractionated radiotherapy in the hope of minimising bystander damage and the long term sequelae of radiotherapy to the surrounding normal brain tissue.With these advances, the number of patients requiring salvage treatment of any kind is reducing, and concerns persist about the l...

Focussed radiotherapy or radiosurgery has been a disappointing alternativeto surgery as a primary treatment for pituitary adenomas. Our departmenthas delivered stereotactic multiple arc radiotherapy (SMART) through anadapted conventional linear accelerator (LINAC) for pituitary adenomas notcured by conventional therapy. We have treated 21 patients with biochemicaland/or radiological evidence of persisting disease despite maximalconventional therapy: all patients had undergone ...

This practical and interactive session will explore the difficult clinical presentation of sweating.This problem is very commonly encountered in primary care, and can present a major diagnostic and management challenge. In practise, although there are multiple endocrine causes for excessive sweating, in the majority of cases presenting with this symptom alone, no endocrine cause is found.An overview of the most important aspects of...

The molecular mechanisms underlying adrenal adenomas have not yet been elucidated. Many groups have sought mutations within the ACTH receptor as well as its downstream signalling pathway, although none have yet been identified. However, mutations in the alpha regulatory subunit of the cAMP dependant Protein Kinase A (PRKAR1A) have recently been described in more than 50% of patients with Carney complex. This syndrome is characterised by nodular adrenocortical hyperplasia as we...

The molecular mechanisms underlying adrenal adenomas have not yet been elucidated. Many groups have sought mutations within the ACTH receptor as well as its downstream signalling pathway, although none have yet been identified. However, mutations in the alpha regulatory subunit of the cAMP dependant Protein Kinase A (PRKAR1A) have recently been described in more than 50% of patients with Carney complex. This syndrome is characterised by nodular adrenocortical hyperplasia as we...

Two identical twins aged 20 were referred for investigation and treatment of delayed puberty. They were otherwise fit and well, with no significant past medical history. On presentation, both were tall, eunuchoid with no secondary sexual characteristics. Twin A had undergone orchidopexy for an undescended testicle, but had a normal sense of smell on testing. Twin B had normal pre-pubertal external genitalia, but reported anosmia. Neither exhibited synkinesis, abnormal dentitio...

Cushing’s syndrome in pregnancy is rare and is associated with increased fetal and maternal morbidity. It has previously been described in the presence of ectopic LH receptor expression, and has been associated with gestational diabetes and preeclampsia but to our knowledge has never been associated with any other endocrine pathology.We here report a 34-year-old woman, who presented with hypertension, weight gain, fluid retention and easy bruising a...

A 33 year old male presented with a two year history of fatigue, headaches, loss of libido, insomnia, depression and hypertension. On examination, he was floridly Cushingoid with central obesity, proximal muscle weakness and purple striae. A bilateral temporal, superior quadrantanopia was noted on formal perimetry. Investigations revealed markedly elevated prolactin levels at 56560mIU/L, hypogonadotropic hypogonadism and secondary hypothyroidism. He also had elevated urinary c...

Supervised 72 h fast is historically the gold standard screen for spontaneous hypoglycaemia. Consensus guidelines published in 2009 suggested that β-hydroxy-butyrate levels be measured every 6 h, and the glucose response to an i.v. injection of glucagon be assessed at the time of documented hypoglycaemia, or at the end of the 72 h fast. We incorporated these recommendations into our protocol, and here examine the results of the first 10 cases.A rise...