Searchable abstracts of presentations at key conferences in endocrinology

ea0059cmw1.1 | Workshop 1: Aggressive pituitary tumours | SFEBES2018

How and when to use temozolomide in pituitary tumours

Whitelaw Ben

Temozolomide (TMZ) is an oral chemotherapy first used for pituitary tumours in 2006. Over the past 12 years experience and confidence using this treatment has increased. Temozolomide is effective: with about 50% of cases showing a tumour response. This figure rises to 70% if stable disease is regarded as a tumour response. The effectiveness appears to be similar in both aggressive adenoma and carcinoma. Functioning tumours show a better response as compared with non-functionin...

ea0091wa4 | Workshop A: Disorders of the hypothalamus and pituitary | SFEEU2023

A challenging-to-manage biphasic response following pituitary surgery for acromegaly

Ramlochansingh Osada , Whitelaw Ben

A 51F domestic worker presented with classic clinical and biochemical features of acromegaly. This included a long history of arthralgia, increase in hand and foot size, paraesthesia requiring bilateral carpal tunnel release and coarsening of facial features. She was also newly diagnosed with hypertension and diabetes. On examination she demonstrated central adiposity, a prominent supra orbital ridge and nasal bridge, prognathism, interdental spacing, skin tags, and broad hand...

ea0037ep832 | Pituitary: clinical | ECE2015

Who needs pre-operative medical blockade for Cushing's disease?

Trapp Elisabeth , Prague Julia , Whitelaw Ben

The definitive treatment for Cushing’s disease is curative surgery. Patients with severe disease burden will likely require pre-operative medical blockade to reduce the risk of peri- and post-operative complications. The threshold for deciding when to medically block excess cortisol is currently based on clinical judgment. Expert centres may use a different criteria to determine this. There is no widely adopted tool for evaluating the clinical severity of Cushing’s d...

ea0021p394 | Thyroid | SFEBES2009

Treated Grave’s disease? think again!

Srinath Aswathiah , Whitelaw Ben , Ibrahim Sharaf

Forty-seven years old lady presented to another hospital with symptoms of diarrhea and sleep disturbance. She was found to have abnormal thyroid function tests (TFTs) with fT4 44 fT3 12 and TSH 3.4. She had no goiter or thyroid eye signs. Thyroid ultrasound showed a multinodular goiter and an uptake scan was consistent with thyrotoxicosis.She was commenced on carbimazole and in 2001 radio-iodine was administered for a presumed diagn...

ea0028p90 | Clinical practice/governance and case reports | SFEBES2012

IGF-2 Mediated Hypoglycaemia, secondary to Adenocarcinoma of the Prostate

Grant Paul , Prague Julia , Whitelaw Ben , Aylwin Simon

Hypoglycaemia in non-diabetic patients has a multitude of causes from exogenous insulin to paraneoplastic syndromes. We explore the importance of obtaining a ‘golden sample’, a serum blood sample, during the episode of hypoglycaemia, prior to reversal with treatment. The case herein describes a patient with recurrent episodes of unexplained hypoglycaemia which precipitated several hospital admissions. Standard screening tests did not detect any obvious cause for his ...

ea0015p30 | Clinical practice/governance and case reports | SFEBES2008

Hypocalcaemic and non-hypocalcaemic tetany following total thyroidectomy: a case report

Whitelaw Ben , Gurazada Kalyan , Shepherd Anna , Germain Claire , Ogunko Arthur

An elective total thyroidectomy was performed on a previously well 45-year-old nurse for toxic multinodular goitre. The operation was uneventful and the patient was discharged. She was re-admitted two days after the operation, with paraesthesia and muscle spasms affecting the face and hands. She was found to be hypocalcaemic, corrected calcium 1.83 mmol/l. She was treated with intravenous calcium gluconate, oral calcium and 1-alpha calcidol. Parathyroid levels were undetectabl...

ea0065p305 | Neuroendocrinology | SFEBES2019

Can a hypernatraemia alert system protect inpatients with diabetes insipidus?

Hakim Yasmin , Hoque Nahid , Gurung Ankit , Taylor David , Rao Nandini , Whitelaw Ben

Background: Over the past decade there has been increased recognition of the dangers associated with inpatient management of diabetes insipidus (DI) and omission of desmopressin leading to hypernatremia. In May 2009 a patient died from diabetes insipidus mismanagement in a London hospital. An NHS England patient safety alert was issued in 2016 highlighting this risk.Method: Inpatients with a serum sodium of 155 mmol/l or greater were prospectively identi...

ea0044p66 | Clinical biochemistry | SFEBES2016

Audit of plasma catecholamines vs. plasma metanephrines: experience at a tertiary endocrine referral centre

Taylor David R , Alexander Alex , Schweitzer Adam , Stone Colin , Whitelaw Ben , Aylwin Simon , Vincent Royce P

Background: Phaeochromocytoma and paraganglioma (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla and paraganglia. Biochemical assessment relies on demonstrating elevated concentrations of catecholamines and their metabolites. Analytical methods for catecholamine and metanephrine measurement vary in sensitivity and specificity. We reviewed our biochemical work-up in order to optimise patient diagnosis.Methods: This retrospective au...

ea0044p8 | Adrenal and Steroids | SFEBES2016

Full characterisation of adrenal steroidogenesis by liquid-chromatography–mass spectrometry (LC–MS/MS) in metyrapone and/or ketoconazole-treated pituitary/adrenal Cushing’s

Taylor David R , Leong Christine H M , Bhatt Aagna E , Ghataore Lea , Aylwin Simon , Whitelaw Ben , Vincent Royce P

Introduction: Pituitary and adrenal Cushing’s may be managed by pharmacological-inhibition of adrenal steroidogenesis, using metyrapone and/or ketoconazole. Assessment of biochemical control is challenging owing to cross-reactivity in immunoassays (e.g. cortisol and 11-deoxycortisol) leading to over/under-treatment. Off-target effects can also result, e.g. hyperandrogenism/mineralocorticoid hypertension (increased 11-deoxycorticosterone/DOC). LC-MS/MS analysis is free fro...

ea0031p22 | Bone | SFEBES2013

Renal replacement therapy to treat severe hypercalcaemic crisis: case series

Prague Julia , Mustafa Omar , Whitelaw Ben , Jenkins Rebeka , Crown Anna , Vaughan Nick , Schulte Klaus-Martin , Diaz-Cano Salvador , McGregor Alan

Background: The initial management of hypercalcaemia is well described: aggressive intravenous rehydration and subsequent intravenous bisphosphonates if required. Isolated case reports document the use of haemo/peritoneal dialysis and haemofiltration in the management of severe hypercalcaemia. We report three cases that required renal replacement therapy to treat severe hypercalcaemia.Case series: A 21-year-old male presented with abdominal pain and vomi...