Endocrine Abstracts

We present a 44-year-old female referred to us with a two year history of episodic palpitations, chest tightness, headaches and pallor associated with hypertension. She had previously been extensively investigated by neurologists and cardiologists including MRI of the brain, renal ultrasonography, 24 h tape and echocardiography – all normal. Given the history, a CT of the adrenals was performed in 2007 which revealed a 1.5 cm nodule in the right adrenal with abnormal enha...

IntroductionYttrium-90 pituitary implants were used in the past as one of the first line treatments for pituitary tumours in many endocrine centres. The procedure involved inserting radioactive rods of Yttrium oxide in to the pituitary fossa. This treatment has been replaced by medical treatment for prolactinomas and transsphenoidal surgery for all other pituitary tumours.AimTo investigate long-term efficacy ...

Non-functioning pituitary adenomas (NFAs) constitute 25-30% of all pituitary tumours. NFAs do not secrete hormones and patients present with clinical features due to mass effects of the tumour such as visual field defects or hypopituitarism. Surgery and radiotherapy (RT) have been considered standard therapy for patients with a non-functioning macroadenoma. However, since MRI scanning has become widely available fewer patients are routinely referred for RT following surgery.</...

Case history: We present a 76-year-old woman with cyclical ACTH-dependent Cushing’s syndrome since 2002. She has two-yearly relapses with proximal myopathy, candidiasis, facial swelling and hypokalaemia that have been biochemically confirmed with Overnight and Low Dose Dexamethasone Suppression tests. Although her initial cycles were brief and uncomplicated, her most recent episodes led to prolonged hospital admissions. During her last admission, she became septic complic...

Due to availability of easy routine blood testing, normocalcaemic primary hyperparathyroidism is increasingly seen. However, due to its mild nature, it often poses diagnostic difficulties. We present a case of 65 year old gentleman who was diagnosed with osteoporosis in 2015. He had a history of traumatic fractures of tibia, fibula and calcaneum in 2013. He was later diagnosed with unexplained osteoporosis in 2015 (T-score of hip −2.5 and T-score of spine −1.2) and...

Endocrinopathies are common complications following cancer therapy and may occur decades later. We present a case of 37 year old lady with a background of chronic myeloid leukaemia (CML) which was treated with sibling allogenic stem cell transplant and total body irradiation in 2002. She was noted to have elevated calcium levels with raised PTH 10 years later. In view of young age, she underwent genetic screening for MEN1 through buccal swab as her lymphocytes were not suitabl...

Hypogonadism persisting in males with macroprolactinoma requires exogenous testosterone replacement therapy but this may cause secondary elevations of prolactin. We present a case of a 44 year old gentleman who was diagnosed with macroprolactinoma after being investigated for ‘abnormal thyroid function tests’ with a low T4 and a normal TSH. He reported a few years’ history of increasing weight gain, lethargy, generalised aches and pains, occasional headaches and...

We present two uncommon cases of cyclical ectopic ACTH-dependent Cushing’s syndrome due to diffuse idiopathic pulmonary neuroendocrine tumour (DIPNECH).Case 1: 62 yr lady presented with rapid onset of muscle weakness, diabetes and hypokalaemia. Random cortisol:1710 nmol/l, ACTH level:610 ng/l. LDDST: failure to suppress cortisol levels. Imaging: normal pituitary gland and bilateral adrenal hyperplasia, consistent with ACTH dependent Cushing’s s...

Endogenous Cushing’s syndrome poses considerable diagnostic challenges. It is recommended to use two screening tests to confirm hypercortisolaemia. While late-night salivary cortisol assessment (LNSC) is reported to have good specificity and sensitivity and deemed to be cost-effective, it is the least widely biochemical tool used both nationally and in Europe. We aim to compare the specificity and sensitivity of LNSC against and in combination with other diagnostic tests,...

A 61 year-old woman presented with a two year history of facial hirsutism and frontal balding. She did not report voice change or acne. Menarche was at age 14 with regular menses until a hysterectomy (with ovarian preservation) for menorrhagia aged 29. She had a past medical history of T2DM and gastric bypass surgery. She was not on androgenic medication. Examination revealed clinical hyperandrogenism with androgenic alopecia and hirsutism (FG score 20) but no cliteromegaly. T...