Endocrine Abstracts

Background: Treating life-threatening diabetic ketoacidosis (DKA) with a pH of <6.9 is extremely challenging and often refractory to treatment using standard fixed dose insulin DKA management protocols which may not work effectively at this low pH because of increased insulin resistance. I.v. bicarbonate (HCO3) use in this situation can be considered but remains controversial due to the risk of significant side effects as well as limited evidence in literature. ...

Introduction: Cushing’s disease (CD) is very rare in children and is invariably caused by a corticotroph adenoma. However, corticotroph cell hyperplasia has only been convincingly shown in two previous cases of paediatric Cushing’s disease. We report the case of a 7-year-old boy with Cushing’s disease caused by coticotroph cell hyperplasia.Case report: Our patient presented with a 10-month history of obesity, hirsutism and growth retardati...

Oncogenic osteomalacia is a rare paraneoplastic phenomenon characterised by abnormal phosphate metabolism typically caused by discrete benign tumours. Due to the indolent presentation and slow progression, diagnosis is often delayed and localisation of the tumour can prove difficult. We present the case of a 64-years-old gentleman who was investigated by the endocrinology department for hypophosphataemia. Three years prior to this, he had started to experience exertional fatig...

Insulin induced hypoglycaemia is a life threatening complication in T1DM. Sub-optimal counter regulatory response, with hypocortisolemia, threatens the recovery from insulin induced hypoglycaemia. We present a 28-year-old man with polyglandular autoimmune syndrome type 2 and life threatening hypoglycaemia, whose severe hypoglycaemic events were improved following introduction of CSII.The patient was diagnosed with Addison’s disease in 2000 and T1DM ...

Non-islet cell tumour hypoglycaemia (NICTH) is a rare paraneoplastic phenomenon and there is limited guidance regarding different treatment modalities.We present two cases of NICTH focusing on the combined methods used to control hypoglycaemia.The first involves an 89-year-old gentleman diagnosed with a pelvic leiomyoma in 2003. For several years, he had experienced recurrent collapses which briefly improved following tumour emboli...

Adipsic diabetes insipidus (ADI) is a rare condition which has been reported following clipping of anterior communicating artery aneurysms, craniopharyngioma and brain trauma, but not with pituitary adenoma. We report a case of ADI following surgery for a pituitary macroprolactinoma. A 14-year-old boy presented with bitemporal hemianopia due to a large macroprolactinoma. Two debulking surgeries were performed without the development of diabetes insipidus. Following a third rad...

The high dose short Synacthen (corticotropin) test (SST) is widely used to investigate suspected secondary adrenal insufficiency but concern remains about falsely reassuring results with potentially serious clinical consequences.In order to evaluate the long-term safety of the SST, we retrospectively evaluated the clinical outcome in 178 patients who achieved 30-minute cortisol values in the lowest 15th percentile of normal healthy responses. This subgro...

Hypopituitarism has been reported in 28-65% of long-term survivors of traumatic brain injury (TBI). We attempted to define the natural history of post-traumatic hypopituitarism in order to devise guidelines for the optimal timing of patient assessment and hormone replacement.Fifty consecutive patients with severe or moderate TBI were enrolled in a prospective study of pituitary function during the acute phase, at 6 months and, at 12 months following TBI....

Recent evidence suggests a high prevalence of neuroendocrine dysfunction in patients following traumatic brain injury (TBI), but dynamic anterior pituitary assessment were performed in relatively small number of patients and posterior pituitary function remains poorly investigated.We studied 102 consecutive patients (84 males) who had survived severe or moderate TBI [initial Glasgow Coma Scale (GCS) score 3-13] at a mean (+/- standard deviation) of 19 +/...

Acromegalic patients have increased morbidity and mortality, which correlate with post-treatment growth hormone (GH) level. Target post-treatment plasma GH level should be less than 2.5 nanograms per millilitre, which predicts normal life expectancy.We evaluated the prevalence of complications and treatment outcome in 76 acromegalic subjects who attended our unit for surgery between 1978-2002. 60 patients are followed up in a specialised pituitary clinic in Beaumont Hospit...