Endocrine Abstracts

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 diagnosis of Cushing’s Syndrome (CS) requires demonstration of excess circulating cortisol. Measurement of late night salivary cortisol (LNSF) has been advocated as a simple, non-invasive and reliable outpatient diagnostic tool for patients with suspected CS but the usefulness of its metabolite cortisone (LNSE) remains unclear. LNSE levels are approximately six times higher than LNSF in saliva due to the rapid action of 11β-hydroxysteroid dehydrogenase type 2 (11...

Introduction: Chordomas are rare slowly growing locally aggressive neoplasms of the bone arising from embryonic remnants of notochord. These tumours typically occur in the axial skeleton and have a proclivity for the spheno-occipital region of the skull base. Parasellar/clivus chordomas account for one third of all chordomas.Methods: We conducted a retrospective chart review of 4 patients with chordomas of the clivus treated in Beaumont Hospital between ...

Transsphenoidal surgery is the first-line treatment for non-functioning pituitary macroadenomas (NFPAs) causing pressure symptoms. However, the approach to asymptomatic NFPAs is unclear due to the limited data on their natural progression. This study retrospectively analysed data from patients with NFPAs who underwent conservative management for at least six months. The study screened 175 individuals treated at the National Neurosurgery/Pituitary Centre at Beaumont Hospital be...

TSH-secreting pituitary adenomas (TSHomas) are rare. Previously, the reported prevalence was one case per million populations although this is probably an underestimate. A recently published study reported a prevalence of TSHomas in Sweden of 2.8/million inhabitants.Methods/design: Observational study conducted in four tertiary referral centres in Ireland. We retrospectively collected data on the prevalence, demographics, hormonal profile, tumour charact...

Pituitary patients with different aetiologies of hypopituitarism exhibit differing phenotypes despite optimal replacement therapy. We hypothesised that differential regulation of the isoenzyme 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1), which mediates the autocrine conversion of cortisone to cortisol in adipose tissues and liver may play a role.We prospectively studied 11β-HSD1 activity through analysis of 24 h urine cortisol/cortisone ...

IgG4 related hypophysitis is a recently described entity belonging to the IgG4 related diseases. It is characterised by markedly elevated serum IGG4 levels and tissue infiltration by IgG4 positive plasma cells. To date, 34 cases of IgG4 related hypophysitis have been described but only a handful were in women or biopsy proven. We describe a case of a 58 year old woman who presented with transient headache. She also complained of polyuria and nocturia. She had a thyroidectomy f...

Neck ultrasound (US) can facilitate minimally invasive parathyroidectomy by providing fine anatomical detail of enlarged parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). The role of neck MRI in US negative/equivocal cases remains unclear. We aimed to evaluate the performance of neck MRI in parathyroid tumour localisation in the setting of negative or equivocal neck US.We performed a retrospective review of a consecutive series of...

Acromegalic congestive cardiac failure (CCF) is a serious and late complication of untreated acromegaly with associated high morbidity and mortality.1 Spontaneous recovery of end stage acromegalic CCF following autoinfarction of a somatotroph adenoma has not been previously reported.We report the case of a 61-year-old woman who presented with features of severe biventricular CCF and an acromegalic phenotype. Echocardiography revealed poor LV f...