Endocrine Abstracts

Fasting hypoglycaemia may occasionally be caused by non islet cell tumours (NICTH). Mostly they are large retroperitoneal, intra-abdominal or intrathoracic tumours that are slow growing though malignant. We report a case of recurrent hypoglycaemia associated with metastatic ovarian carcinoma.About 66-year-old lady was admitted with increasing abdominal distension and shortness of breath over 6 weeks duration. There was no significant past medical history...

A 56 year old lady presented with a short history of neuromuscular weakness. She was dehydrated but conscious, alert and oriented and without focal neurology. Her initial blood results revealed a corrected calcium 5.02 mmol/L, phosphate 1.49 mmol/L, alkaline phosphatase 152 iu/L, urea 31.8 mmol/L and creatinine 266 micromol/L.Intravenous rehydration with normal saline and 90 mg of pamidronate was given. She received 4 litres of normal saline daily and her renal functions norma...

Case: We present an interesting case of pituitary hypophysitis following ipilimumab therapy. A 66 year old lady previously diagnosed with left ocular melanoma in 2006 was under oncology follow up, when routine surveillance scan showed recurrence in segment six of the liver. She underwent laparoscopy and was found to have multiple liver metastases following which she was commenced on ipilimumab. Four weeks after completing her second cycle of ipilimumab, she developed severe he...

Introduction: Insulin stress test (IST) has long been the gold standard for testing the hypothalamus-pituitary–adrenal (HPA) axis. There are concerns about the safety of IST as hypoglycaemia can give rise to various symptoms including seizure and coma although this is rarely seen in clinical practice. Hyperinsulinaemic hypoglycaemic clamp is a common research procedure used to induce hypoglycaemia in a step-wise fashion to study the effect of hypoglycaemia.<p class="a...

Introduction: Pituitary apoplexy (PA) remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of evidence in the management of this condition. We present our experience of 23 current cases.In classical acute PA, headache is the commonest presenting symptom. We found that a significant proportion (36%) of patients presented with subacute pituitary tumour apoplexy (SPA) – a term used to describe intra-adenomatous pituitary ha...

Pituitary apoplexy whether due to haemorrhage or infarction remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of published evidence in the management of this condition. We present our experience of 12 current cases (nine males, three females).Eleven cases were managed conservatively (91.6%), one patient required urgent pituitary surgery. None of the above cases required pituitary radiotherapy.Present...

A 73-year-old man was referred to the general medical clinic with a 3-year history of shortness of breath and wheeze. During assessment he commented that over the same period he had also had intermittent sweats, flushing and redness of the face especially after eating and taking red wine. Echocardiogram and urinary 24-h 5-hydroxyindoleacetic acid (5-HIAA) were arranged. Surprisingly two of three urinary 24-h urinary 5-HIAA were positive (43 and 47.5 μmol/24 h and 30 &#956...

The short synacthen test (SST) is the first-line test of adrenal insufficiency. Different centres have varying protocols for cortisol response. At Derriford Hospital cortisol is measured at 0, 30 and 60 min post-synacthen 250 μg (i.m./i.v.). A normal response is judged with a measured cortisol >550 nmol/l.A recent national audit questioned the bias created by the discrepancy between true cortisol (measured by mass spectrometry) and many laborato...

Introduction: Meningitis is a recognized complication of the treatment of pituitary adenoma. It is usually considered as a peri-operative problem but does need to be considered as a potential complication at other points in the treatment pathway. We present two patients with meningitis where the link to pituitary pathology was originally unrecognized.Case report:Patient 2: 41 years old lady, presented with a history of nasal drip u...

Introduction: The insulin stress test (IST) used to assess the hypothalamic–pituitary–adrenal (HPA) and growth hormone axes requires blood glucose to fall below 2.5 mmol/l. This level of hypoglycaemia is considered safe for selected patients but blood glucose levels below this are associated with increasing risk. We reviewed the depth and length of hypoglycaemia in a cohort of patients undergoing IST.Method: Between October 2004 and 2008, 138 I...