Endocrine Abstracts

A 79-year-old lady presented with a 6 months history of confusion and slurred speech and was found to have recurrent spontaneous hypoglycaemia (plasma glucose 1.3, 1.8 and 2.6 mmol/l). Pituitary and adrenal function were normal, and raised insulin (102 pmol/l) and C-peptide (630 pmol/l) levels confirmed the diagnosis of insulinoma, which was identified as a solitary 2 cm mass in the head of pancreas. Treatment with diazoxide 100–150 mg tds led to normalisation of g...

We describe below a 16-year-old male referred with neonatal hypothyroidism. He was commenced on levothyroxine at the age of 3 weeks. The TSH was >100 IU/l (normal: 0.27–4.7) and Total T4 was <10 nmol/l (normal: 60–150) and there was no uptake on thyroid isotope scanning. He was diagnosed as having congenital absence of thyroid tissue and given levothyroxine and the dose adjusted to maintain normal thyroid function. His mother was diagnosed with hypothyroidism...

Background: Radioiodine ablation is an effective curative treatment for hyperthyroidism in virtually all patients with single or multiple doses. The dosage of radioiodine used in the treatment of thyrotoxicosis has varied widely according to local experience and practice. Administration of low doses could lead to inadequate or delayed response, while using larger doses is associated with the risk of increased incidence of hypothyroidism.Introduction: In ...

Urinary catecholamine assessment is one of the screening tests for phaeochromocytoma but false positives results can occur. The pretest probability for phaeochromocytoma is 0.5% (1 in 200 patients tested) in the presence of hypertension and suggestive symptoms. We present two cases of elevated urinary catecholamines in hypertensive subjects treated with serotonin and noradrenaline re-uptake inhibitors (SNRI).Case1: A 27 year old male presented with palpi...

We present the case of a 76 year old woman who was admitted to our hospital with severe Cushings syndrome, in association with hair loss and hypokalaemia. Plasma cortisol levels were elevated, and did not suppress with high dose dexamethasone. ACTH levels were detectable throughout the HDDST. MRI pituitary and CT adrenals were normal, but CT of chest revealed an area of nodularity in the right lung. With no specific treatment her symptoms settled, and her biochemistry returned...

Glucocorticoids (GCs) are potent anti-inflammatory agents, but a variable therapeutic response occurs. We have used microarray analysis to explore the basis for inter-individual differences in the GC sensitivity of a healthy volunteer population, and identified genes predictive of response to GCs. Three such discriminating genes were then selected to be investigated for their potential to interact with the Glucocorticoid Receptor (GR). These are the Bone Morphogenetic Protein ...

Aims: A study looking at the incidence, presentation, diagnosis, management strategies and outcomes following anti-thyroid drug treatment and radio-iodine therapy in a cohort of patients presenting with hyperthyroidism.Methods: Retrospective longitudinal study of all patients (n=442) who received treatment for a new diagnosis of hyperthyroidism (Grave’s disease (GD), multinodular goitre (MNG), Toxic nodule) in a secondary care outpatient se...

11β-hydroxysteroid dehydrogenase type 1 (HSD-1) controls the intracellular cortisol pool that has access to cytosolic glucocorticoid and mineralocorticoid receptors. HSD-1 activity is elevated in patients with Cushing’s syndrome (CS).1 Patients with CS and constitutionally low HSD-1 activity showed no hypercortisolism-related symptoms despite very high 24-hour urine free cortisol.2, 3 A recent pilot trial of a HSD-1 inhibitor in patients with classical or mild CS sho...

Section 1: Case history: A 62 year old man presented with a three month history of abdominal bloating and discomfort, loose stools and weight loss. This progressed to hypoglycaemic symptoms that occurred initially after exercise. Symptoms included confusion and light-headedness, fatigue, cold sweats and shakiness. The patient had to eat regularly to prevent hypoglycaemia which resulted in weight gain. Hypoglycaemic episodes increased in frequency to the point where the patient...

Current cortisol dosing regimes for patients with adrenal insufficiency are unable to accurately replicate the physiological profile of healthy patients. This work is part of an interdisciplinary study with the aim of using mathematical approaches to understand the treatment strategies for patients with adrenal insufficiency. We also aim to then tailor treatments specific to an individual or situation. We present a simplified model of hydrocortisone delivery via intravenous bo...