Endocrine Abstracts

Background: National osteoporosis guideline group recommend routine measurement of thyroid function tests. However it is well recognised that abnormal thyroid function tests done during acute hospital stays is not always suggestive of thyroid dysfunction and that they need to be repeated to determine the need for further management.Aim: To identify and assess the follow up of thyroid function tests (TFTs) done between June 2009 and Feb 2010 in the orthop...

Targets such as the ‘18 week wait’ may help reduce diagnostic and treatment delay. However, we report two cases of supposed non-classic congenital adrenal hyperplasia (CAH) that perhaps highlight the benefit of time and hindsight as diagnostic tools.Case 1 A previously unknown 61-year-old contacted our department requesting alternatives to biphosphonate therapy. ‘Mild’ CAH had been diagnosed in 1974 on the basis of elevated urinary 17...

A 39 yr-old female with a past medical history of a non-metastatic ductal breast carcinoma, presented to hospital with a two-week history of vomiting and dizziness. Clinical examination was essentially normal apart from pigmentation of her mastectomy scar, palmar creases and buccal mucosa. Investigations revealed a plasma sodium (Na) 102 mmol/l, potassium 4.9 mmol/l, plasma osmolality 219 mOsm/kg, urine osmolality 173 mOsm/kg and urine Na 36 mmol/kg. She was treated with fluid...

Adrenal suppression and iatrogenic Cushing’s secondary to concomitant inhaled steroid and itraconazole is a potentially common and serious drug interaction. A 55 year old patient with bronchiectasis and asthma developed an exacerbation of allergic bronchopulmonary aspergillosis (ABPA). He had been on inhaled fluticasone for over 2 years. He was commenced on itraconazole. The patient was on holiday 6 weeks after itraconazole was commenced when he noted that his face had be...

Clinical CaseA 19-year old ethnic Pakistani presented with severe, longstanding hirsutes without virilisation. Menarche had occurred at age 14, following which she had experienced 4-6 periods a year. She had always been “underweight” by UK/WHO criteria and, given a BMI of 16.5 kg.m−2, there were concerns about hypothalamic oligomenorrhoea.InvestigationsFasting glucose 5.5 mmol/L &#...

Paragangliomas are rare tumours that arise from extra-adrenal chromaffin cells within the sympathetic paraganglionic axis. While neoplasms of the adrenal medulla, (phaeochromocytomas) are normally characterized by catecholamine (CA) hypersecretion, paragangliomas can be nonfunctional. We report our findings from 5 patients (4 males, 1 female) with paragangliomas. In 4 out of 5 patients the initial presentation was related to the space-occupying effect of the tumour. Episodic s...

Bilateral laparoscopic adrenalectomy is a treatment option for ACTH-dependent Cushing's syndrome after failed pituitary surgery (Cushing's disease) or when the ACTH source cannot be resected or localized (ectopic ACTH syndrome). It has not, to our knowledge, been reported in the treatment of ectopic ACTH secretion in patients with small cell lung cancer.A 47 year old presented with haemoptysis and a right hilar mass, biopsy of which confirmed inoperable ...

The ACE I/D polymorphism is associated with resting ACE activity such that DD>ID>II. The D allele is strongly associated with increased exercise-induced left ventricular hypertrophy (LVH) and cardiovascular risk.Objective: Examine the relation between ACE genotype, exercise, circulating ACE and angiotensin II.Ethical approval was obtained and 17 (9DD, 8II) healthy, male (22.9+/-1.9 years, 178.6+/-2.8cm, 71.9+/-2.2kg) Caucasi...

Background: The ACE I/D polymorphism of the ACE gene, associated with cardiovascular risk and athletic performance, accounts for half the variation in resting ACE. DD subjects have the greatest, ID intermediate, and II subjects the lowest serum ACE. Exercise stimulates the renin-angiotensin system, producing a rise in angiotensin II. 3 small (n=6-8) lab studies suggest serum ACE does not change with exercise, despite a rise in angiotensin II, whereas 2 other studies have demon...

Background: We have previously demonstrated that the natriuretic peptides BNP and NT-proBNP rise with ascent to high altitude (HA). Both peptides are classically markers of congestive cardiac failure but have also recently been found to be associated with pulmonary hypertension at sea-level (SL). As pulmonary hypertension is central to the risk of high altitude pulmonary oedema we aimed to establish if there was any association between high pulmonary artery systolic pressure (...