Endocrine Abstracts

Case summary: A 55 year-old lady was referred by ophthalmology following diagnosis of bilateral central serous retinopathy, an accumulation of sub-retinal fluid at the fundus associated with Cushing’s syndrome. She also had proximal myopathy, bruising, centripetal weight gain and hypertension. Cushing’s was confirmed by 1 mg overnight DST (cortisol 581 nmol/L) and 48 hr-LDDST (407 nmol/L). 24 hr UFC was raised at 2666 nmol/L (12...

Case summary: A 55 year-old lady was referred by ophthalmology following diagnosis of bilateral central serous retinopathy, an accumulation of sub-retinal fluid at the fundus associated with Cushing’s syndrome. She also had proximal myopathy, bruising, centripetal weight gain and hypertension. Cushing’s was confirmed by 1 mg overnight DST (cortisol 581 nmol/L) and 48 hr-LDDST (407 nmol/L). 24 hr UFC was raised at 2666 nmol/L (12...

Introduction: Ectopic ACTH syndrome is rare but is frequently severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. It should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment (1). Etomidate, an imidazole-derivative anesthetic a...

Introduction: Contrary to US guidelines, recent European guidelines do not recommend tolvaptan for the treatment of SIADH.Methods: Retrospective data collection of all inpatients treated with tolvaptan for SIADH in two UK hospitals between November 2010 and February 2014. All values were calculated as mean±S.D.Results: This case series included 61 patients (33 females, 28 males) aged 74.4±15.3 years with se...

Performing water deprivation test (WDT) and prolonged water deprivation test (PWDT) is some of the roles undertaken by endocrine nurse in specialist endocrine units. These tests need to be done in a safe and control environment.Objectives: To provide safe information to patients to avoid fluids overload when they arrive for the tests. Can the specialist endocrine nurse make clinical decision to terminate the test base on clinical evidence and at what poi...

Adrenal incidentalomas are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in a number of investigations usually conducted in the Endocrinology clinic.In 2011 we audited the prevalence and management of adrenal incidentalomas identified on abdominal CT imaging over one calendar month in our centre. Consequently, a decision pathway for new adrenal lesions was introduced in the Radi...

The HIV protease inhibitor (PI) ritonavir is used in conjunction with other antiretroviral treatments as a pharmacokinetic booster due to its potent inhibition of hepatic cytochrome P450 3A4 (CYP3A4). Co-administration of glucocorticoids metabolized by CYP3A4, with ritonavir leads to accumulation of these glucocorticoids, markedly increasing the risk of iatrogenic Cushing’s syndrome and suppression of the Hypothalamic-Pituitary-Adrenal axis. We present 11 patients receivi...

Adrenal masses discovered incidentally during imaging (adrenal incidentalomas) are common and constitute a common reason for referral in the Endocrinology clinic. Our aim was to audit the prevalence of adrenal masses discovered in all computerised tomography (CT) abdominal imaging done over one calendar month in our centre. A secondary aim was to identify the underlying diagnosis and fate of the discovered adrenal nodules. All 690 CT scans done in March 2011 in our centre that...

Background: Adrenal masses discovered incidentally during imaging studies (adrenal incidentalomas – AIs) are common and prompt investigations to exclude secretory lesions and malignancy. Uncertainty exists over the best management strategy of AI.Objective: To monitor the current practice against the local protocol and existing guidelines; to identify the biochemical and imaging outcomes in a single centre cohort.Methods: Retro...

A 47 year old Macedonian Personal Trainer presented with 4 days of vomiting, abdominal pain and profuse sweating. He admitted abusing anabolic steroids 20 years previously but never insulin. The presenting capillary blood glucose (CBG) was 1.7 mmol/L, blood pressure (BP) 182/106 mmHg, pulse 62 bpm. On examination, he was sweaty, pale and cold. Blood was drawn for measurement of insulin, C-peptide, glucose, cortisol and thyroid function tests. He was treated with 50% dextrose a...