Endocrine Abstracts

Hyperaldosteronism is a significant cause of secondary hypertension, but there are often delays in obtaining the diagnosis. The recent BES publication of Guidelines for the investigation and management of this condition represent a move to standardise the work-up of these patients.We present an audit of cases, dating back to 2000, with confirmed biochemical hyperaldosteronism (on the basis of plasma aldosterone/renin activity ratio or lack of aldosterone...

MEN2B is the most aggressive form of MEN2. Consequently, the new American Thyroid Association guidelines recommend prophylactic thyroidectomy early in the first year of life. Ninety-seven percentage of MEN2B cases result from a germline methionine to threonine mutation at codon 918 (M918T) of the RET proto-oncogene. In addition, an exceedingly rare alanine to phenylalanine mutation at codon 883 (A883F) has been reported in 4 unrelated adults. In each case metastatic MTC and th...

A 69-year-old lady presented with pancreatitis, which was managed conservatively and resolved. However, imaging identified a 4 cm left adrenal lesion. She had no features of Cushing’s syndrome, and was normotensive, but serum potassium was low. Renin:aldosterone ratio was normal. She failed a low dose dexamethasone suppression test (LDDST). She underwent laparoscopic adrenalectomy. Histology showed an adrenocortical carcinoma extending into the adjacent adipose tissue. Si...

Primary hyperparathyroidism (HPT) in pregnancy is an uncommon phenomenon, mostly occurring in the 2nd or 3rd trimester. HPT in pregnancy may cause complications affecting both the mother (renal stones, pancreatitis) and fetus (neonatal tetany, seizures, intra-uterine growth retardation and preterm labour). We report two recent cases that highlight the potential risks.Results: The patients, 37 and 35 years old at presentation respectively, both presented ...

Introduction: The traditional approach to mediastinal ectopic parathyroid adenomas has been through a median sternotomy. With improved localization techniques it has become possible to use less invasive approaches to access the mediastinum. We present our recent experience of three cases of mediastinal parathyroid adenomas successfully treated using a manubriotomy approach which provides good access to the superior and anterior mediastinum.Method: All pa...

A 77 year old gentleman was referred to the endocrinology team following the incidental finding of an adrenal nodule on computer tomography (CT) colonography. Following this, dedicated CT of the adrenal showed a 4cm nodule with an attenuation of 30 Hounsfield Units. Biochemical investigation found no evidence of adrenal insufficiency or functional hormone production. Subsequent imaging by magnetic resonance imaging (MRI) and further CT showed stable appearances in size of the ...

BackgroundThyrotoxicosis with Graves’ Disease is treated with thionamide, radio-iodine treatment and thyroidectomy. Surgery is an important choice, especially when Graves’ Disease is complicated by thyroid orbitopathy. Pre- and post-operative protocols for thyroidectomy are imperative.Aims1) To assess pre-operative preparation of patients, with potassium iodide, vitamin D, beta blockade, and the pre...

Introduction: Phosphatase and tensin homolog gene (PTEN) gene encodes a lipid phosphatase that plays a central role in cell-cycle processes. PTEN hamartoma tumour syndrome (PHTS), caused by the mutation of the PTEN gene, is a diverse multi-system disorder. PHTS is characterised by the hamartomatous growths, increased risk of breast, thyroid, and renal cancers. In terms of thyroid presentation of PHTS, there is up to 75% risk of multinodular goitre and the life...

Introduction: Adrenal Venous Sampling (AVS) is considered the gold standard to identify surgically treatable primary aldosteronism (PA) subtypes. Current guidelines suggest using plasma cortisol concentrations to confirm successful adrenal vein (AV) cannulation and lateralisation, but cortisol co-secretion by adrenal adenomas can lead to diagnostic misinterpretation. Plasma metanephrines (MN) have a half-life of 3 to 6 min and are not affected by cortisol co-secretion, and the...

A 38-year male with background history of Tetralogy of Fallot which had been surgically corrected, presented with symptomatic supraventricular tachycardia in July 2015. This required amiodarone therapy. Thyroid function was normal prior to starting amiodarone. Amiodarone therapy was discontinued in July 2017 when he converted to sinus rhythm. Seven months after stopping treatment, he presented to A&E with signs and symptoms of hyperthyroidism. His TSH was <0.03 mU/l (0...