Endocrine Abstracts

There are two issues: i) dopamine agonist (DA) safety for mother and baby, and ii) risk of oestrogen-induced prolactinoma enlargement. Bromocriptine (BC) and Cabergoline (CAB) are both safe for ovulation induction but the safety database is larger for BC (6239 pregnancies) than for CAB (789). Neither drug causes increases in miscarriage, premature delivery, multiple births or congenital malformations, compared to data for normal pregnancy. Risk of symptomatic tumour enlargemen...

A 55-year-old lady was referred by her GP to the acute medical unit with a 4-week history of fatigue, generalised swelling and weight gain of a stone, together with a potassium 2.8 mmol/l and sodium 146 mmol/l. Her blood pressure was 211/85 mmHg and she was suspected of having Conn’s syndrome. Treatment was started with Amlodipine 5 mg daily and Spironolactone 25 mg daily which was increased to 100 mg daily on subsequent follow-up in the acute medical unit. She remained u...

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity characterized by seizures (91.7%), headache (83.3%), visual disturbance (62.5%),encephalophathy (29.2%), and paralysis (8.3%). Co-morbidities included systemic lupus erythematous (29.2%), kidney disease (20.8%), eclampsia(20.8%), renal artery stenosis (12.5%), Takayasu arteritis (4.2%), Sheehan's syndrome(4.2%), and acute intermittent porphyria (AIP) (4.2%). We report a 31-year-old woman w...

In 2011 is the 40th anniversary of prolactin (PRL) characterisation as a distinct hormone. Only 30 years ago most patients with large pituitary tumours received primary surgery (often transcranial) followed by routine radiotherapy – treatments associated with significant morbidity and hypopituitarism. Much therapeutic progress has been made; effective medical treatments now exist for many pituitary tumour subtypes, particularly the use of long-acting dopamine agonists (DA...

Background: Adrenal incidentalomas are becoming increasingly common due to the improvements in imaging techniques, increasing numbers of radiological investigations and an aging population. The current follow-up protocols are designed to avoid missing clinically relevant lesions (e.g. malignancy or hormone hypersecretion) by recommending repeated radiological and biochemical investigations. Large amounts of money are spent on patients who as it seems mostly have benign and non...

The human adrenal gland develops from around 4 weeks gestation and undergoes distinct changes throughout pre- and post-natal life. Defects in these processes can cause adrenal hypoplasia and result in adrenal insufficiency. Adrenal hypoplasia can be: i) secondary to abnormal pituitary function, ACTH synthesis or splicing; ii) the result of ACTH resistance (familial glucocorticoid deficiency; triple A syndrome); or iii) due to a primary defect in adrenal development itself (pri...

Hypocalcaemia following thyroidectomy may be temporary or permanent, usually occurring within 14–72 h. The British Association of Endocrine Surgeons 2009 audit reported long-term hypocalcaemia rates of 7%. Total thyroidectomy for Graves’s disease carries the greatest risk (reported in 6–30% of cases) and currently there is no national consensus on management of this complication.We present three healthy young women who underwent total thyr...

Following seminal observations published nearly 20 years ago, it is apparent, increasingly, that patients with pituitary disease have excess mortality due to cardiovascular, cerebrovascular and respiratory causes; with women having a worse outcome than men. Patients with craniopharygioma have the greatest risk. There does not appear to be an overall excess of death due to malignancy. Despite large retrospective and prospective database cohort analyses, the precise reasons for ...

Cushing’s disease (CD) is often severe and debilitating and is caused by a POMC-expressing corticotrope tumour autonomously secreting ACTH to cause chronic hypercortisolism. Untreated CD is associated with excess mortality. The mainstay of management remains transsphenoidal surgery, but the overall long-term remission rate is a disappointing 55–60%. Compared to surgery for other states of pituitary hormone hypersecretion, there is an excess of new hypopituitarism, it...

We present an unusual case of painful gynaecomastia due to a large adrenocortical tumour secreting oestradiol and other steroid hormones.A 46 years old man presented with a 6 months history of progressive, painful gynaecomastia. He had no other specific symptoms and had previously been well. Alcohol intake was not excessive. Interestingly, his sister had presented with a phaeochromocytoma 2 years previously.Examination demonstrated...