Endocrine Abstracts

TSHoma is rare, with an incidence of 1 per million, and <1% of all pituitary tumours. We reported a case involving a 49-year-old female who was first referred to our endocrine unit in 2006 with excessive lethargy and abnormal TFT’s. She was thought to have thyroid hormone resistance for several years until 2015 when she reported having persistent symptoms and further investigation suggested an alternative diagnosis.Results: Ft4=41.6 pmol/l, TSH=...

Background: Primary aldosteronism (PA) accounts for 5–10% of all patients with hypertension, and an even greater proportion of those with refractory hypertension. Accurate assessment of PA is important both for rationalisation of medical therapy and to identify those patients with unilateral disease who may benefit from surgery. Single timepoint testing may miss patients with intermittent (‘cyclical/periodic’) disease, a phenomenon seen in other endocrine hypers...

Primary hyperaldosteronism usually results from an aldosterone-secreting adenoma of the adrenal cortex (Conn’s adenoma) or bilateral adrenal hyperplasia. Identification of the anatomical adrenal lesion causing hyperaldosteronism typically involves CT or MR scanning, with lateralisation of aldosterone production confirmed by adrenal vein sampling (AVS). The latter is a technically difficult and invasive procedure, but current non-invasive alternatives (e.g. radiolabelled i...

Background: Pleuro-pulmonary inflammatory fibrotic syndrome is a rare but recognised complication of dopamine agonist (DA) therapy in Parkinson’s disease. Here, we describe a case of asymptomatic pulmonary fibrosis, presumed secondary to DA therapy, in a patient treated with cabergoline for an invasive macroprolactinoma.Case report: A 47-year-old previously fit man was admitted as an emergency with a 3 days history of headache followed by collapse. ...

Background: SARS-CoV-2 targets membrane-bound angiotensin-converting enzyme 2 (ACE2) to achieve cellular entry. Resultant loss of ACE2 function may lead to unregulated activation of the renin-angiotensin-aldosterone system (RAAS), contributing to the pathogenesis of hypertension and triggering a proinflammatory cascade. However, evidence to support this is conflicting, with either no change or an increase in the concentration of circulating aldosterone reported in patients wit...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...

Context: Primary aldosteronism (PA) accounts for 5–10% of all hypertension and 20–25% of refractory cases. Diagnosis is important as PA is associated with increased morbidity and mortality compared with ‘essential’ hypertension, and up to 50% of patients may benefit from unilateral adrenalectomy. Screening requires measurement of plasma renin activity (PRA) or concentration (PRC), and plasma aldosterone concentration (PAC), to yield an aldosterone:renin rat...

Background: Cross-sectional imaging (e.g. CT/MRI) can not always reliably identify the site of ACTH secretion in Cushing’s disease (CD) or the ectopic ACTH syndrome (EAS). We report our experience of localising the source of ACTH-dependent Cushing’s syndrome, using functional imaging with 11C-methionine positron emission tomography (Met-PET).Methods: Forty consecutive patients with: (i) de novo ...

Background: BIPSS is considered the gold-standard procedure for differentiating autonomous pituitary [Cushing’s Disease (CD)] and ectopic ACTH syndrome (EAS) sources of ACTH hypersecretion. A basal (i.e. unstimulated) pituitary:peripheral ACTH ratio >2, and/or a CRH stimulated pituitary:peripheral ACTH ratio >3, have been proposed as indicative of CD, with a range of sensitivities and specificities cited in the literature. Ad...