Endocrine Abstracts

Context: Surgery is the first-line treatment option for thyrotropinomas, but medical therapy with somatostatin receptor ligands (SRL) may be used as neoadjuvant treatment and to facilitate safe surgery.Objectives: To determine the extent to which neoadjuvant SRL (i) corrects clinical, laboratory and tissue hyperthyroidism in thyrotropinomas, (ii) induces tumour shrinkage in macroadenomas, and (iii) aids microadenoma detection by 11C-methionine...

Objective: To determine if an extended lateral approach to trans-sphenoidal surgery (TSS), guided by 11C-Methionine PET/CT co-registered with volumetric MRI (Met-PET/MRCR), can lead to remission in patients with persistent acromegaly due to post-operative lateral/para-sellar tumour remnants.Methods: We identified eight patients with persistent acromegaly following primary intervention [TSS ± medical therapy ± radiotherapy ...

Tumours caused by mutations in the SDH enzyme complex have a unique tumour metabolome due to a truncated citric acid cycle. The accumulation of the onco-metabolite succinate is believed to drive tumourigenesis. The aim was to investigate the role of MRI spectroscopy (H-MRS) to detect in vivo succinate elevations in suspected SDH deficient tumours including GIST, phaeochromocytoma/paraganglioma (PPGL) and pituitary adenomas (PA). Suitable patients were identified based...

Background: Heightened awareness, as well as frequent thyroid function testing, have contributed to a recent rise in the incidence of thyrotropinomas. Microadenomas are now increasingly being recognized. The classical textbook description of thyrotropinomas is based on historically reported features in patients who typically had large/invasive lesions. The phenotype of microTSHomas could therefore differ.Methods: We reviewed the records of all TSHomas re...

Background: Congenital, isolated, central, hypothyroidism (CCH), is rare and evades diagnosis on TSH-based congenital hypothyroidism screening programmes in the UK. Genetic ascertainment is therefore paramount in enabling prompt diagnosis and treatment of familial cases. Recognised causes include TSHB and IGSF1 gene defects, with only two previous reports of biallelic, highly disruptive (nonsense; R17X, in-frame deletion and missense; p.S115-T117del+T118), mu...

Background: Congenital, isolated, central, hypothyroidism (CCH), is rare and evades diagnosis on TSH-based congenital hypothyroidism screening programmes in the UK. Genetic ascertainment is therefore paramount in enabling prompt diagnosis and treatment of familial cases. Recognised causes include TSHB and IGSF1 gene defects, with only two previous reports of biallelic, highly disruptive (nonsense; R17X, in-frame deletion and missense; p.S115-T117del+T118), mu...

Background: Adrenal vein sampling (AVS) remains the gold-standard for distinguishing unilateral and bilateral disease in primary aldosteronism (PA). However, it is invasive, technically demanding, and may yield inconclusive or equivocal results. 11C-Metomidate PET-CT (11C-MTO-PET-CT) is a non-invasive alternative to AVS for localising unilateral aldosterone-producing adenomas (APAs).Methods/patients: We report a retrospective analys...

Background: Endocrine Society guidelines classify macroprolactinomas as ‘resistant’ if there is failure to normalise prolactin, or to achieve radiological tumour shrinkage of >50%, on standard doses of dopamine agonist. In this context, escalation of treatment to maximal tolerable doses and/or referral for surgery is advised. However, we have recently observed several ‘discordant responders’, where tumour shrinkage lags significantly (>6 months) beh...

Subclinical hypercortisolism (SH) occurs in 5–30% of incidentally-detected adrenal adenomas (AIs). Common screening tests for ACTH-independent hypercortisolism have significant false positive rates, mandating further investigations that are both time and resource intensive. We investigated whether a low basal DHEAS level is a sensitive and specific screening test for the detection/exclusion of SH in patients with newly-diagnosed AI. We recruited 185 consecutive patients w...

Although MRI remains the investigation of choice for pituitary imaging, it does not provide information about ‘functionality’ of lesions (e.g. residual adenoma vs post-surgical scar tissue) and cannot reliably identify all microadenomas.We hypothesised that i) imaging with the PET ligand 11C-methionine, which is taken up at sites of peptide/protein synthesis, would permit more reliable identification of functioning pituitary adenoma ...