Endocrine Abstracts

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...

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...

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...

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...

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 ...

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...

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...

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...

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...

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...