Endocrine Abstracts

Introduction: Polycystic ovarian syndrome (PCOS) is a common cause of hyperandrogenism in women of reproductive age but rarely causes very high testosterone levels and frank virilisation which is associated with ovarian or adrenal tumours. We present a rare case of progressively increasing testosterone levels causing virilisation from a histologically confirmed right polycystic ovary. Complete cure was achieved by right salpingo-oophrectomy.Case: A 32 ye...

Pharmacological treatment with synthetic glucocorticoids, which are widely prescribed for the treatment of numerous inflammatory and autoimmune diseases, can also affect the way the adrenal gland produces cortisol. Indeed, patients undergoing synthetic glucocorticoid treatment can develop adrenal insufficiency. This condition is characterised by reduced responsiveness of the adrenal to ACTH stimulation, and adrenal crisis/shock can occur in response to acute physiological stre...

G protein-coupled receptors (GPCRs) are the largest family of mammalian receptors, modulating most aspects of endocrine homeostasis. GPCRs can associate to form dimers and higher order oligomers, acting to diversify receptor functionality. Most studies have explored the functional significance of GPCR dimerization in vitro and we have recently demonstrated the functional relevance of GPCR dimerization in vivo. Using the LH receptor (LHR), we have shown that t...

Background: Thorough history taking and clinical examination is vital in the assessment of all medical patients. However, diagnosis of endocrine disease also relies on appropriate biochemical tests. Previously in our unit, tests were only performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted.Method: In 2009 clinicians, nurses and chemical pathology representatives reviewed av...

Background: The gold standard investigation for suspected spontaneous hypoglycaemia is the supervised 72 h fast. This aims to ‘capture’ a hypoglycaemic episode, to confirm Whipple’s triad, and to measure simultaneous insulin and C-peptide levels. These should confirm or refute endogenous hyperinsulinaemia.75% patients with confirmed insulinoma actually develop hypoglycaemia within 24 h of fasting. However, some confirmed cases require sign...

A 26 year old lady presented with a 4/12 history of abdominal distension and lethargy. PMH included learning difficulties and congenital hypotonia and she was in long-term foster care.Diabetes had been diagnosed requiring insulin a few months previously. Examination revealed her to be extremely unwell, with proximal myopathy, purple striae, hirsutism and a firm nodular thyroid gland. She was hypokalaemic (2.8 mmol/l) and alkalotic. Cushing’s assessment(table) revealed ACT...

Introduction: Discordance between growth hormone (GH) and insulin-like growth factor 1 (IGF1) is observed in up to 30% patients with acromegaly, with the most common finding being high IGF1 with normal GH levels. Recently published guidelines recommended a nadir GH of 0.4 μg/L rather than 1.0 during growth hormone suppression test as being indicative of controlled disease. This may lead to reduced discordance between GH and IGF1. Methods We measured nadir GH (Beckman Coul...

Introduction: Growth hormone (GH)-deficiency in adults is associated with a range of adverse outcomes that improve with GH replacement. Pituitary adenomas and their treatment account for a large proportion of patients with adult GH-deficiency. However, safety fears have arisen due to the mitogenic effect of excess GH on pre-malignant colonic polyp formation in individuals with acromegaly. This, along with anecdotal suggestions of pituitary tumour recurrence, has prompted furth...

Background: The Royal College advises 500–800 MBq of Radioiodine(RAI) for toxic multinodular goitres (MNG), and 400–800 MBq RAI for euthyroid MNG. In our institution, a standard low dose of 370 MBq has traditionally been given to all patients with benign thyroid disease. This audit examined whether outcomes are optimal with low dose therapy, and whether a variable dose protocol should be adopted.Patients and Methods: We analysed 49 patients at ...

A 28-year old Lithuanian woman presented with a 6-week history of firm anterior neck swelling. There were no symptoms of local obstruction, invasion, or thyroid dysfunction, and no past medical history, medication use or relevant family history. On initial assessment, she was euthyroid, with a 6 cm hard mass replacing the right lobe of the thyroid, a 2 cm lymph node lateral to it, but no other lymphadenopathy. No cellular material could be obtained on initial clinical and ultr...