Searchable abstracts of presentations at key conferences in endocrinology

ea0059cc8 | Featured Clinical Cases | SFEBES2018

Clinical and biochemical acromegaly associated with pituitary FSHomas

Huang Doran Isabel , Koulouri Olympia , Oddy Sue , Halsall David , O'Donovan Dominic , Roncaroli Federico , Mannion Richard , Allinson Kieran , Gurnell Mark

Acromegaly is a clinical manifestation of excessive peripheral growth hormone (GH) action. Most cases result from pituitary somatotroph adenomas displaying varying degrees of GH immunoreactivity. Occasionally, GH is cosecreted with a second hormone from adenomas containing mixed cell populations (e.g. somatolactotroph tumours). Coexistence of multiple discrete adenomas, identical or distinct in hormone secretion, is infrequent. In very rare cases, acromegaly results from neuro...

ea0037gp.20.09 | Pituitary – Hypopituitarism | ECE2015

Thyrotropinoma: diagnosis and management of a rare but increasingly recognised pituitary tumour – novel insights from a large prospective UK study

Koulouri Olympia , Moran Carla , Powlson Andrew , Antoun Nagui , Donnelly Neil , Mannion Richard , Pickrd John , Halsall David , Chatterjee Krish , Gurnell Mark

Background: Thyrotropinomas (TSHomas) are traditionally considered a rare, albeit important cause of thyrotoxicosis. Although early case series reported a predominance of invasive macroadenomas, emerging evidence suggests microadenomas are being increasingly diagnosed, and the clinical/biochemical phenotype appears to be more variable than previously suspected. We therefore performed detailed phenotyping of patients referred to our centre with a diagnosis of TSHoma over a 4-ye...

ea0037gp.21.02 | Pituitary – Diagnosis of Cushing's disease | ECE2015

Bilateral inferior petrosal sinus sampling reliably differentiates pituitary from ectopic Cushing's, but frequently fails to predict pituitary tumour location, especially when lateralizing to the right

Koulouri Olympia , Nigam Nishita , Powlson Andrew , Donnelly Neil , Mannion Richard , Pickard John , Koo Brendan , Halsall David , Gurnell Mark

Background: BIPSS remains the gold standard for differentiating pituitary and ectopic sources in ACTH-dependent Cushing’s syndrome. A pituitary:peripheral ACTH ratio >2 in the basal state, and/or >3 following CRH stimulation, is considered indicative of pituitary Cushing’s, with a range of sensitivities and specificities cited in the literature. In addition, in Cushing’s disease a peak interpetrosal gradient of >1.4 has been reported to predict the s...

ea0034p304 | Pituitary | SFEBES2014

Disordered sleep architecture is a common finding in acromegaly

Powlson Andrew S , Bala Laksha , Annamalai Anand K , Koulouri Olympia , Webb Alison , Moir Samantha , Shneerson John M , Gurnell Mark

Sleep disordered breathing (SDB), including obstructive sleep apnoea (OSA), is associated with excessive daytime somnolence, and impacts significantly on quality of life in affected individuals. It also predisposes to premature cardiovascular (hypertension, congestive cardiac failure, myocardial infarction, sudden death, and stroke) and metabolic (diabetes mellitus and dyslipidaemia) dysfunction.SDB is a well-recognised complication of acromegaly. In mos...

ea0034p310 | Pituitary | SFEBES2014

The effect of somatostatin analogues on the hypothalamo-pituitary-thyroid axis and peripheral thyroid hormone dependent tissues in patients with thyrotropin secreting pituitary tumours

Koulouri Olympia , Moran Carla , Powlson Andrew , Antoun Nagui , Cheow Heok , Hoole Andrew , Halsall David , Chatterjee Krishna , Gurnell Mark

Background: Thyrotropin secreting adenomas (TSHoma) are considered to be rare pituitary tumours. However, improvements in imaging techniques and greater use of more sensitive thyrotropin (TSH) assays has led to a recent increase in the detection rate of TSHomas and, specifically, the identification of more microadenomas. Surgery is considered the mainstay of treatment, however, primary medical therapy with somatostatin analogues is an emerging alternative therapeutic option.</...

ea0034p365 | Steroids | SFEBES2014

11C-metomidate PET–CT in primary hyperaldosteronism: a valuable alternative to AVS

Powlson Andrew S , Koulouri Olympia , Challis Benjamin G , Cheow H K , Buscombe John , Koo Brendan , Brown Morris J , Gurnell Mark

Although adrenal vein sampling (AVS) remains the gold-standard for distinguishing unilateral and bilateral disease in primary hyperaldosteronism (PHA), it is technically demanding and not always feasible. Metomidate (MTO), a potent inhibitor of CYP11B1 and CYP11B2, can be C11H3-labelled as a PET tracer (11C-MTO), and we have previously shown it to be an alternative to AVS for localising unilateral aldosterone-producing adenomas (APAs) (Burton <...

ea0034p423 | Thyroid | SFEBES2014

Autoimmune thyroid disease in the presence of resistance to thyroid hormone or TSH-secreting pituitary tumour: a diagnostic challenge

Moran Carla , Koulouri Olympia , Talbot Fleur , Mitchell Catherine , Schoenmakers Nadia , Lyons Greta , Gurnell Mark , Chatterjee V K K

Background: Hyperthyroxinaemia with non-suppressed TSH, due to resistance to thyroid hormone (RTH) or TSH-secreting pituitary tumour (TSHoma), can be difficult to diagnose, particularly with coincident autoimmune thyroid disease (AITD).Methods: To determine presentation patterns of AITD coincident with RTH or TSHoma, we analysed our cohort of cases with dual diagnoses.Results: Nine patients with RTH had AITD. Six had Graves’ d...

ea0028p267 | Pituitary | SFEBES2012

Potential pitfalls in the management of thyrotropinoma

Koulouri Olympia , Kandasamy Narayanan , Moran Carla , Melvin Alison , Donnelly Neil , Mannion Richard , Pickard John , Halsall David , Chatterjee Krishna , Gurnell Mark

Case Report: A 49-year-old man presented with a two-year history of thyrotoxic symptoms for which he had been investigated on several occasions. He had a past medical history of dilated cardiomyopathy, which had been attributed to excess alcohol consumption, and had also suffered episodes of non-sustained ventricular tachycardia. His family history was strongly positive for autoimmune thyroid disease. Eventually, he was found to have an elevated fT4 (53 pmol/L, RR 12–22) ...

ea0021p287 | Pituitary | SFEBES2009

Patients with pituitary disease are at risk of under-replacement with levothyroxine

Koulouri Olympia , Auldin Mohammed A , Agarwal Ravi , Kieffer Veronica , Robertson Carole , Smith James Falconer , Levy Miles J , Howlett Trevor A

Introduction: Achieving optimal levothyroxine replacement is more difficult in TSH deficiency compared to primary hypothyroidism because of the inability to be guided by TSH. A combination of clinical symptoms and free thyroxine levels (fT4) are typically used to monitor replacement. We reviewed adequacy of levothyroxine replacement in our patients with pituitary disease, and compared with fT4 levels in patients with primary thyroid disease.<p class="...

ea0082p25 | Poster Presentations | SFEEU2022

An exception to the rule: transformation of an adrenocortical lesion with benign radiological characteristics

MacFarlane James , Lau Eunice , Palma August , Koulouri Olympia , Harper Ines , Stokes Victoria , Challis Ben , Shaw Ashley , Aloj Luigi , Mendichovszky Iosif , Cheow Heok , Bashari Waiel , Gurnell Mark , Casey Ruth

Section 1: Case history: A 69 year old man with chronic obstructive pulmonary disease was admitted with acute onset shortness of breath. A CT pulmonary angiogram revealed no focal lung abnormality but identified an incidental 40 x 32 mm left-sided adrenal lesion. An unenhanced CT, undertaken to characterise the lesion, showed a homogeneous, well-circumscribed appearance with a radiodensity of 4 Hounsfield units. Prior to involvement of the Endocrinology team, a dedicated MRI w...