Endocrine Abstracts

Context: Primary aldosteronism (PA) accounts for 5–10% of all hypertension and 20–25% of refractory cases. Diagnosis is important as PA is associated with increased morbidity and mortality compared with ‘essential’ hypertension, and up to 50% of patients may benefit from unilateral adrenalectomy. Screening requires measurement of plasma renin activity (PRA) or concentration (PRC), and plasma aldosterone concentration (PAC), to yield an aldosterone:renin rat...

Case history: We present a 71 year old man, with a 3 year history of problematic hypertension (BP exceeding 190/100 on treatment), incidentally found to be hypokalaemic (K 1.8 mmol/l) during investigations for leg weakness. He had no clinical features to suggest an endocrinopathy. Investigations at his local centre revealed hypokalaemia dating back over 3 years.Investigations: Biochemistry:Na 142 mmol/l (135–145 mmol/l)<p ...

Background and aims: We have previously reported an increased prevalence of gallbladder polyps in treatment-naive acromegaly when compared with the general population (29 vs 4.6%), with potential implications for future malignant transformation and screening. However, little is known about biochemical markers of liver function in active acromegaly, or in response to treatment. Furthermore, somatostatin analogue (SSA) therapy is associated with the development of gallstones. He...

Background: Accurate assessment of GH & IGF1 status in acromegaly is crucial for informing management to minimise excess morbidity/mortality. Expert panels have differed with respect to recommended testing modalities and thresholds – the most recent being the Endocrine Society 2014 guidelines. We evaluated their simplified algorithm, which minimises the need for day-case testing, against other more resource-intensive measures.Methods: A retrospe...

Case history: A 38-year-old man was referred with a 12-month history of recurrent bouts of transient hyponatraemia (serum sodium ranging from 115 to 125 mmol/l). Citalopram, which he was taking for depression, was discontinued, but the episodes continued.Initial investigations: Whilst symptomatic, and clinically euvolaemic, his biochemical profile was consistent with a syndrome of inappropriate antidiuresis (SIAD): sodium 124 mmol/l, potassium 4.5 mmol/l...

Background & Aims: The aims of transsphenoidal surgery (restoration/preservation of vision and amelioration of hormonal excess) are balanced against the risk of inducing new post-operative pituitary deficits. This study aims to assess the rate of new anterior hormonal deficits following transsphenoidal pituitary adenoma surgery in our centre and to assess whether the visibility of normal pituitary gland on pre-operative imaging predic...

Background & Aims: The aims of transsphenoidal surgery (restoration/preservation of vision and amelioration of hormonal excess) are balanced against the risk of inducing new post-operative pituitary deficits. This study aims to assess the rate of new anterior hormonal deficits following transsphenoidal pituitary adenoma surgery in our centre and to assess whether the visibility of normal pituitary gland on pre-operative imaging predic...

Case history: A 66-year-old man presented with a 1 month history of a productive cough, in the context of a 20 pack-year smoking history. CT chest revealed minor bronchiectasis and an incidental 3 cm right adrenal lesion. He was referred to the endocrine clinic for further evaluation. On questioning, he reported no symptoms suggestive of adrenal hormone hypersecretion and, aside from a short history (<1 month) of sweating episodes at night, he described no other constituti...

Background: Primary aldosteronism (PA) is responsible for 5-10% of all cases of HTN. The current gold standard test for determining the side of aldosterone hypersecretion is adrenal vein sampling (AVS). 11C-Metomidate PET/CT (METO-PET) has recently emerged as a potential non-invasive alternative to AVS. As 11C-Metomidate is concentrated within ‘hyperfunctioning’ nodules, METO-PET potentially not only identifies the side, but the exact site of al...

Background: Prolactinomas are the commonest hormone-secreting pituitary adenomas. First-line treatment is dopamine agonist (DA) therapy. However, side-effects are increasingly recognised, leading to an increasing consideration of transsphenoidal surgery (TSS) and/or radiotherapy. Co-registration of 11C-methionine Positron Emission Tomography (Met-PET) imaging with Spoiled Gradient Recalled Acquisition MRI (SPGR MRI), referred to in combination as Met-PET/MRI, can aid accurate ...