Endocrine Abstracts

Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH). Retrospective data suggests that the Syndrome of Inappropriate Antidiuresis (SIAD) is the most common cause, although glucocorticoid deficiency and rarely cerebral salt wasting may also cause hyponatraemia.We prospectively studied 100 patients (61% female, median age 53 (range 16–82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (p...

Differentiation between non functioning pituitary macroadenomas (NFPA) and prolactinomas may be difficult as hyperprolactinaemia can also be present at diagnosis in NFPA cases due to pituitary stalk compression (disconnection hyperprolactinaemia). Some authors suggested that prolactin >2,000 mIU/l is almost diagnostic of a prolactinoma, while others use a higher cut-off of >5000 mIU/l. Our aim was to identify the level of prolactin above which a prolactinoma was more l...

Studies on the probability of recurrence of surgically treated but radiotherapy (RT) naïve non-functioning pituitary adenomas (NFPA) are inconsistent and selective as cases deemed to be at high risk of recurrence were prophylactically irradiated. We traditionally used very low rate of post-operative RT leaving us with a largely unselected cohort.We identified 223 surgically resected, histology-proven NFPA cases. Only 9% received post-operative RT an...

The differential diagnosis of raised circulating thyroid hormones with normal TSH includes familial dysalbuminaemic hyperthyroxinaemia (FDH), a benign, inherited disorder caused by a variant albumin with increased affinity for thyroxine (T4) or triiodothyronine (T3). Three different albumin gene mutations, generating mutant proteins with increased affinity for either T4 (R218H,R218P) or T3 (L66P) have been commonly described. Typically, serum total T4 is raised and free T4 mea...

The effect of growth hormone (GH) replacement on thyroid function in hypopituitary patients has only been studied in small groups of children and adults with conflicting results.We aimed to define the effect and clinical significance of adult GH replacement on thyroid status in a large cohort of 243 patients with hypopituitarism due to various causes. 84 patients were considered euthyroid before GH treatment and 159 patients had central hypothyroidism an...

Renal resistance to vasopressin has been demonstrated in type 1 diabetes, and in type 2 diabetes with nephropathy. However, renal response to vasopressin in type 2 diabetes without nephropathy, has not been studied.We studied 10 subjects with poorly controlled type 2 diabetes (PCDS, HbA1c > 9 %), 10 subjects with well-controlled type 2 diabetes (WCDS, HbA1c < 7 %), and 10 matched non-diabetic control subjects (NDCS), during a euglycaemic 8-hour wat...

Hyponatraemia is a well-recognised neurosurgical complication, but the incidence and complications are unknown.Objective : We aimed to define the incidence, pathophysiology and effects of significant hyponatraemia following neurosurgical admissions.Methods: All neurosurgical patients with significant hyponatraemia (plasma sodium <130 millimol per litre) between January 2002 and September 2003 were identified from computerised la...

Hyponatraemia occurs in 25-40% of patients with subarachnoid haemorrhage (SAH) but the pathogenesis is unclear.Objective: We aimed to establish the incidence, pathophysiology and consequences of hyponatraemia following SAH.Methods: A retrospective case note analysis of all patients with radiologically-proven SAH admitted to Beaumont Hospital between Jan 2002 and September 2003. Of 580 patients coded as SAH on HIPE records, 316 were...

Microprolactinomas are considered not to cause pituitary hormone dysfunction, but there is little data available on the prevalence of hormone deficiencies. We aimed to establish the frequency of pituitary hormone dysfunction in patients with hyperprolactinaemia.We examined the casenotes of 124 consecutive patients (85 females) with documented hyperprolactinemia from our pituitary data-base. 52 patients had macroadenomas (tumour > 1cm diameter), 64 mic...

The insulin tolerance test (ITT) is the gold standard for assessing growth hormone (GH) and cortisol production in pituitary disease, However it is potentially hazardous, requires medical supervision and adequate hypoglycemia may not be achieved. We retrospectively examined the records of 185 consecutive patients aged 14-76 years with pituitary disease who underwent the ITT over 18 months. Testing was performed in the endocrine day ward by an experienced endocrine nurse. Absol...