Endocrine Abstracts

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: Existing biomarkers have limited ability to discriminate indolent non-functioning pituitary adenomas (NFPAs) from those with a propensity to recur following primary surgery. Radiomics, the extraction of quantitative data from medical imaging, is increasingly recognised as a tool to augment clinical decision making.Methods: 39 patients who underwent primary trans-sphenoidal surgery for an NFPA between January 2007 and April 2017, were enrolled...

Background: Sporadic non-functioning pituitary adenomas (NFPAs) are described as having quiet mutational landscapes. Genes with recurrent somatic alterations have not been identified by previous studies examining heterogeneous pituitary tumour populations. Existing biomarkers have limited ability to discriminate NFPAs with a predisposition for regrowth from those that will follow a more indolent course after primary surgery. We undertook somatic sequencing, in an enriched coho...

Background: Clinically relevant pituitary adenomas (Pit PA) affect approximately 1:1200 of the general population, and may manifest with hormone hypersecretion, hypopituitarism and compression of the visual pathways. Primary aldosteronism (Adr PA) is now recognised to account for 5–14% of all cases of hypertension and is associated with excess morbidity when compared with primary hypertension. Here, we report a patient who was noted to have a history suggestive of Adr PA ...

Background: 11C-Metomidate (MTO)-PET/CT has recently found utility as an alternative to adrenal vein sampling for lateralisation in primary aldosteronism. MTO binds with high affinity to 11b-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) and can be considered an adrenocortical-specific tracer. We and others have therefore hypothesised that combining MTO-PET/CT with 18F-FDG(FDG)-PET/CT would permit indeterminate adrenal lesions ...

Case history: We present a 71 year old man, with a 3 year history of problematic hypertension (BP exceeding 190/100 on treatment), incidentally found to be hypokalaemic (K 1.8 mmol/l) during investigations for leg weakness. He had no clinical features to suggest an endocrinopathy. Investigations at his local centre revealed hypokalaemia dating back over 3 years.Investigations: Biochemistry:Na 142 mmol/l (135–145 mmol/l)<p ...

Case history: A 20-year-old man was referred to the metabolic bone clinic following a left sided neck of femur fracture (sustained after a simple fall whilst roller skating). He was otherwise well with no past medical history; systemic enquiry was unremarkable. A DEXA scan revealed osteoporosis (Z scores: total hip −2.97; lumbar spine −3.1), and bone turnover markers were significantly raised. Unexpectedly, the patient was found to have an elevated serum t...

Background and aims: We have previously reported an increased prevalence of gallbladder polyps in treatment-naive acromegaly when compared with the general population (29 vs 4.6%), with potential implications for future malignant transformation and screening. However, little is known about biochemical markers of liver function in active acromegaly, or in response to treatment. Furthermore, somatostatin analogue (SSA) therapy is associated with the development of gallstones. He...

Introduction: Familial dysalbuminemic hyperthyroxinemia (FDH) is characterized by artefactual hyperthyroxinemia caused by enhanced binding affinity of thyroxine to the mutant albumin. However little is known about how FDH affects the measurement of thyroid hormones, especially FT3, across many assay platforms.Methods: Forty-eight genetically confirmed FDH patients (R218H mutation) had FT4 and FT3 measured with 1-step (ADVIA CENTAUR®, Siem...

Background: Although, the diagnostic accuracy of magnetic resonance imaging (MRI) has increased in recent years, it may fail to detect secretory adenoma in a few patients with GH excess. Managing such patients with acromegaly can be challenging. We present a case where 11C-methionine PET/CT co-registered with SPGR/volume MRI proved to be helpful in identifying GH secreting pituitary adenoma.Case history: A 42-year-old male was referred by surg...