Endocrine Abstracts

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 ...

Background: Thyrotropin secreting adenomas (TSHoma) are considered to be rare pituitary tumours. However, improvements in imaging techniques and greater use of more sensitive thyrotropin (TSH) assays has led to a recent increase in the detection rate of TSHomas and, specifically, the identification of more microadenomas. Surgery is considered the mainstay of treatment, however, primary medical therapy with somatostatin analogues is an emerging alternative therapeutic option.</...

Background: Acromegaly is associated with significant excess morbidity and mortality. Surgery and radiotherapy (including radiosurgery) aim to reduce the burden of growth hormone excess while preserving normal pituitary function, but their effective deployment is dependent on high quality imaging that allows accurate localization of site(s) of active de novo or residual/recurrent disease. Despite the existence of several comprehensive guidelines on the managem...

Background: Primary aldosteronism (PA) is an important, potentially curable, cause of hypertension. Distinguishing unilateral and bilateral causes is a critical step in determining who should be considered for adrenalectomy. Adrenal vein sampling (AVS) remains the gold standard for lateralisation. However, AVS is technically challenging with limited availability. To address this, we have introduced molecular imaging using PET/CT with the radiotracer [11C]Metomidate ...

Background: In a sub-group of patients with newly diagnosed pituitary adenomas, conventional MRI will fail to confidently localise the tumour. The role of molecular imaging for these patients is increasingly being recognised, both in terms of confirming diagnosis and in guiding targeted therapy; 11C-Methionine PET co-registered with volumetric MRI (Met-PET/MRCR) can enhance decision making in this group of patients. However, in some cases distinguishing t...

Section 1: Case history: A 69 year old man with chronic obstructive pulmonary disease was admitted with acute onset shortness of breath. A CT pulmonary angiogram revealed no focal lung abnormality but identified an incidental 40 x 32 mm left-sided adrenal lesion. An unenhanced CT, undertaken to characterise the lesion, showed a homogeneous, well-circumscribed appearance with a radiodensity of 4 Hounsfield units. Prior to involvement of the Endocrinology team, a dedicated MRI w...

Case history: A previously well 45-year-old lady presented with a 3-year history of hypertension initially diagnosed at a routine health check. Her blood pressure (BP) was 170-180/90-100 mmHg.Investigations: Showed hypokalaemia (K+= 3 mmol/l; NR 3.5-5.3 mmol/l), raised aldosterone (976pmol/l; NR 100-500pmol/l) and supressed renin activity (<0.2nmol/l/h), meeting criteria for diagnosing primary aldosteronism (PA). CT adrenals showed a 2.5 cm left adre...

A 65-year-old Afro-Caribbean gentleman, with a >10-year history of hypertension, frequently recorded blood pressures of >160/80 mmHg. His serum electrolytes showed Na+ 145 mmol/l and K+ 3.2 mmol/l. MRI demonstrated 13 mm left medial-limb adrenal adenoma. His hypertension was uncontrolled on treatment with amlodipine 10 mg OD, spironolactone 50 mg OD, losartan100 mg OD and doxazosin 16 mg OD. Although his quality of life was reduced, and he dislike...

Objective: To determine if an extended lateral approach to trans-sphenoidal surgery (TSS), guided by 11C-Methionine PET/CT co-registered with volumetric MRI (Met-PET/MRCR), can lead to remission in patients with persistent acromegaly due to post-operative lateral/para-sellar tumour remnants.Methods: We identified eight patients with persistent acromegaly following primary intervention [TSS ± medical therapy ± radiotherapy ...