Endocrine Abstracts

Introduction: Cushing’s disease is usually caused by functional corticotroph microadenomas of the pituitary. Crooke’s cell adenomas are rare, representing approximately 2% of corticotroph adenomas and mostly present as aggressive macroadenomas. Pituitary adenomas showing immunoreactivity for both ACTH and GH are also very uncommon. We present two cases of Cushing’s disease caused by macroadenomas with Crooke’s cell cha...

Introduction: Avascular necrosis of the femoral head (AVN) is most commonly a consequence of glucocorticoid excess and is believed to be due to osteocyte apoptosis. It can also be due to vascular occlusion or trauma. We describe a patient with congenital adrenal hyperplasia secondary to 17-hydroxylase deficiency who presented with osteoporotic vertebral fractures and atraumatic avascular necrosis of the femoral head. She was also found to have mild cardiomyopathy.<p class=...

Toxic adenomas nodules rarely harbour cancer. Fine needle aspiration (FNA) is often not done due to the rarity of these lesions being cancer, the difficulty in interpreting cytology in hyperthyroid patients and the rarely reported instance of precipitating thyrotoxicosis. Here, we present two young Caucasian female patients with toxic adenomas, who underwent hemithyroidectomy and the histology unexpectedly revealed differentiated follicular cancer. The first is a 29-year-old p...

Background: The overnight dexamethasone (DEX) suppression test is useful for the investigation of hypercortisolism, however several factors may influence its performance. Intestinal uptake of DEX, inactivation by conversion by CYP3A4 in the liver and renal clearance can all affect test variability. It is also known that several drugs can either reduce or accelerate CYP3A4 activity, thereby affecting blood DEX concentrations. Interpretation of the test would be greatly enhanced...

Aims/hypothesis: Bone turnover markers mainly reflect three processes: bone remodelling, linear growth, and bone modelling. These occur at different rates depending on age. Oestradiol levels, a mediator of all processes of bone turnover, vary according to sex and age whereas, parathyroid hormone levels, an important regulator of bone remodelling, vary with age. We hypothesised that gender and age differences in the bone formation marker, serum amino terminal propeptide of type...

Objective: The diagnosis of subclinical Cushing’s syndrome in patients with incidentalomas is not always straight forward and a number of different criteria have been used. The 1 mg overnight dexamethasone suppression test has been recommended as a screening test, followed up by other tests of the hypothalomo–pituitary–adrenal axis to confirm the diagnosis. In this study we investigate whether the low-dose dexamethasone suppression test offers additional informa...

Background: Prolactinomas are usually highly sensitive to dopamine agonists. We report the use of temozolomide in a 47-year-old gentleman with MEN 1 and a highly dopamine agonist-resistant, and aggressive prolactinoma.Case summary: He presented in 2001 with a 3rd nerve palsy and recurrent headaches. MRI revealed a pituitary tumour extending into the left cavernous sinus. Prolactin levels were 29 000 mU/l. (NR<360). Primary hyperparathyroidism, a lesi...

Background: Mild autonomous cortisol secretion (MACS) in patients with adrenal incidentalomas has been associated with elevated cortisol levels during the nocturnal period resulting in a disturbed cortisol rhythm. We hypothesised that administration of nocturnal metyrapone, an 11-beta-hydroxylase inhibitor, previously shown to restore cortisol rhythm in MACS patients, could reduce metabolic complications in this patient group.Met...

Background: Diamond Blackfan anaemia (DBA) is a condition caused by mutations in ribosomal protein genes. After the first year of life, the mainstay of treatment is corticosteroids whilst red blood cell transfusions are used for patients who do not respond.Case: We present a case of a 20-year-old woman with a history of DBA (RPS19 mutation), initially treated with courses of prednisolone, who aged 3 developed steroid-ind...

Background: The hypothalamic-pituitary-adrenal (HPA) axis can be suppressed by long-term exogenous glucocorticoids, resulting in tertiary adrenal insufficiency (AI). International expert consensus suggests that during weaning, prednisolone be converted to hydrocortisone to allow HPA axis reactivation(1). There is, however, little evidence to support this practice.Aim: To compare HPA axis recovery during treatment with prednisolone and immediat...