Endocrine Abstracts

We present a case of 71-year-old gentleman who presented with bitemporal hemianopia in 2008 with pituitary apoplexy compressing the optic chiasm. Prolactin was 55287MU/l, with deficiency of all other anterior pituitary hormones. He underwent transphenoidal adenectomy (TSA). Prolactin was 35633MU/l post-operatively and cabergoline was commenced. Histology was consistent with a lactotroph adenoma with MiB-1 index of 3–5%. Visual fields recovered and prolactin was normal unt...

We present the case of a 51-year-old woman who attends the NET service at the Oxford University Hospitals Trust with multiple known secretory paragangliomas (predominantly 3-methoxythyramine), including a carotid body tumour and, most recently, an intrapericardial paraganglioma. She is SDHC mutation positive. Multiple surgical resections of paragangliomas, at sites other than the cardiac lesion, had previously been undertaken. Due to disease progression and symptomati...

The dexamethasone suppression test (DST) is a common screening test in Cushing’s syndrome but associated with false positive result in 10-20%. One cause of false positivity is inadequate dexamethasone absorption. An assay to measure serum dexamethasone concentration can be used to validate the accuracy of the DST result.Aims: To audit 1) Use of the dexamethasone assay in DSTs 2) How frequently dexamethasone levels are inadequate 3) ...

Background: Diabetes insipidus (DI) is a recognised complication of pituitary surgery, with current diagnosis requiring clinical observation aided by plasma and urine electrolytes and osmolalities. Copeptin, a 39 amino acid glycopeptide secreted in equimolar quantities to ADH, is a stable surrogate marker of ADH release and has potential to facilitate prompt diagnosis of post-operative DI. This assay has been shown to accurately predict which patients are likely to develop DI ...

Background: Patients receiving radiotherapy for residual or recurrent pituitary adenoma require regular surveillance for the development of anterior pituitary axis deficit. Whilst the sequelae of hypopituitarism post cranial irradiation is well recognized, there are relatively varied incidences of new onset hypopituitarism post-conventional radiotherapy, reported in the literature. We aimed to investigate timing and frequency of the individual axis deficits in adults who have ...

Rathke’s cleft cysts (RCC) arise from the embryonic remnants of Rathke’s pouch in the anterior pituitary gland. The majority are asymptomatic and incidentally diagnosed when the pituitary is imaged for other reasons. RCCs can progress to requiring surgical intervention for hormonal and structural effects. It is unclear what factors determine RCC enlargement and over what period this occurs, hence need for long term follow-up is uncertain. We analysed our conservative...

Transsphenoidal adenomectomy (TSA) is the recommended primary therapy in most patients with acromegaly and results in remission for majority of microadenomas and a proportion of macroadenomas depending on extent of surgically accessible disease. Acromegaly is associated with significant mortality and morbidity, hence a combination of treatment modalities may be needed to achieve disease control.Methods: A retrospective casenotes review was conducted and ...

Inpatients with hyponatraemia have a high mortality and longer length of stay. We instituted a system of automatic referral to the endocrinology team where any inpatient with a serum (Na+) ≤125 mmol/l was referred automatically from their biochemical results.Aims: We evaluated the diagnosis, management, and outcome of the patients referred with hyponatraemia over 6 months.Methods: Data were prospectively captured e...

Case history: A 38-year-old woman presented with blepharospasm, cramping of the hands, and paraesthesia primarily affecting the face and hands. Symptoms had been present for 10 years but had been progressive over the previous 12 months. Symptoms were consistent with neuromuscular instability. Hypocalcaemia and elevated Parathyroid hormone (PTH) were confirmed. Past medical history was notable for anorexia nervosa in remission. Family history was non-contributary. Hypocalcaemia...

Case history: A 57-year-old male with well controlled primary hypertension presented with acute onset severe headache while exercising, associated with nausea and vomiting. He had no visual or other neurological symptoms. The pain settled with analgesics in ED. He reported four transient similar episodes during the preceding 18 months. There were no symptoms suggestive of pituitary or other endocrine dysfunction, including hyperprolactinaemia. Clinical examination was unremark...