Endocrine Abstracts

Increased use of abdominal imaging has resulted in vast numbers of adrenal incidentalomas being identified (Bovio et al., 2006). Guidelines exist for identifying hormone excess and diagnosing malignancy but there is little evidence about how to manage phaeochromocytoma in patients who are poor surgical candidates. We present the case of a frail 88 year-old lady who was found to have a right adrenal incidentaloma during assessment for abdominal pain. Mrs R is able to m...

A 51-year-old man presented to an optometrist with a 3-week history of visual impairment following a minor headache. He was found to have reduced visual acuity 6/24 in both eyes and a dense bitemporal hemianopia and was referred urgently to Musgrove Park Emergency Department. MRI brain showed a cystic bleed from a pituitary macroadenoma, 30 mm in diameter, with compression of the optic chiasm. He had no clinical features of Cushing’s or other hormone excess or deficiency ...

GH influences multiple metabolic pathways. Excess GH (acromegaly) causes a distinct form of cardiomyopathy, which may progress to fulminant heart failure. AMPK is an energy conservation enzyme that modulates multiple areas of the cell stress response, inhibiting anabolism and promoting catabolism. AMPK is activated by phosphorylation at Thr172 and measurement of Thr172 phosphorylation is thought to correlate with enzyme activity. We investigated the influence of GH on cardiac ...

Initial clinical trials with pegvisomant at doses of up to 80 mg once weekly led to a 30% fall in IGF-I. Subsequently, daily administration of up to 40 mg/day (280 mg/week) achieved an IGF-I within reference range in 97% of patients. Pegvisomant’s half-life is >70 h suggesting weekly dosing may be possible using higher doses than in the original trials.We performed a two-centre, open-label prospective study in seven patients (4M, 3F, mean age 57...

There is limited evidence for the role of screening for Cushing’s syndrome (CS). Patients referred to the specialist medical weight management service at Musgrove Park Hospital have routinely been screened for CS with either an overnight dexamethasone suppression test (ODST) or two 24hour urinary free cortisol (UFC) if evidence of dysglycaemia. We retrospectively analysed the results of all patients referred to the service between 2013–2016. 794 patients were seen as...

A 37-year-old woman, 30 weeks pregnant, presented with palpitations and abdominal cramps. Ultrasound demonstrated a supra-renal abnormality and MRI showed a 10 cm heterogeneous left adrenal mass. For five years she had experienced episodes of palpitations, shaking, sweating and chest tightness. She was investigated by a neurologist and diagnosed with temporal lobe epilepsy. During pregnancy the frequency of episodes increased. Lamotrigine was started, but at each dose increase...

A 24-year-old woman presented with stridor resulting from a large, firm, anterior neck mass. At age six she had been treated for acute lymphoblastic leukaemia (ALL) with vincristine, prednisolone, daunorubicin, asparaginase, prophylactic cranial radiotherapy and intrathecal methotrexate. She also had primary hypothyroidism with strongly positive thyroid peroxidase antibodies.The mass had been gradually enlarging for 6 months, causing exertional breathles...

Background: In patients with phaeochromocytoma, sudden and/or chronic exposure to catecholamines may predispose to cardiac pathology, including left ventricular (LV) hypertrophy, myocardial infarction, stress-induced cardiomyopathy and heart failure. We conducted the first prospective, multicentre study using cardiovascular magnetic resonance (CMR) imaging to describe the variety and incidence of cardiac abnormalities in phaeochromocytoma.Methods: Fifty ...

Acromegaly causes a distinct cardiomyopathy. Growth hormone deficiency (GHD) limits cardiac response to exercise and increases cardiac mortality. Cardiac magnetic resonance imaging (CMR) is considered the gold standard for assessment of cardiac mass and provides data on function, fibrosis, valves and ischaemia. Twenty-three patients with abnormal GH levels (acromegaly, n=13; adult-onset GHD, n=10) and 23 matched controls underwent CMR. Patients had repeat CMR at ...