Endocrine Abstracts

Activation of the hypothalamo-pituitary-gonadal axis, from the third trimester of pregnancy to the first post-natal months in males, results in serum concentrations of gonadotrophins and testosterone approaching adult levels. This phase, known as male mini-puberty, represents a key window of opportunity to identify congenital GnRH deficiency in early childhood.We present a case to illustrate the diagnostic efficiency of screening for mini-puberty in a ma...

Turner’s syndrome (TS) results from a genetic abnormality in phenotypical female individuals where the second X chromosome is either absent or present in a mosaic form. The most obvious consequences are short stature and primary amenorrhoea, although there are often dysmorphic features as well as cardiovascular and genitourinary complications. 90% of TS patients experience primary amenorrhoea with subsequent infertility. Spontaneous recovery of ovarian function in patient...

Introduction: Thyroid Ultrasound (US) is the recommended first line investigation of suspected thyroid nodules. Specific radiological features, such as micro-calcification, low echogenicity, solid consistency, heterogeneity and ill-defined margins, raise the possibility of underlying malignancy. These findings together with fine needle aspiration cytology guide the management of thyroid nodules. The aim of this audit was to evaluate the quality and adequacy of thyroid US repor...

Introduction: Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic workup and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms of catecholamine excess and all patients were well established on beta-blockers on presentation. All three patients had an adren...

A 27 year old lady presented in 2016 with a 3 month history of intermittent headache and visual disturbance, 3.5 months post-partum. She had a past medical history of cluster headache; treated with verapamil and short courses of oral steroids (she had no recent steroid courses prior to presentation). She was found to have a partial right sixth nerve palsy but normal visual fields on Goldmann’s testing. She had biochemical evidence of secondary adrenal insufficiency (sodi...

Objective: The 250 µg short Synacthen stimulation test (SST) is the most commonly used dynamic assessment to diagnose adrenal insufficiency (AI). There are challenges to the use of the SST in routine clinical practice, including staff and resource limitation in the current COVID-19 pandemic and Synacthen cost. We aimed to investigate the value of basal cortisol level for predicting AI in our selected cohort of patients at risk of secondary adrenal insufficiency from pitui...

Rapid diagnosis and treatment of Cushing’s syndrome (CS) is essential for good outcomes. Current standards for appropriate timelines for referral are under review by NHSE. Data are required to substantiate standard setting. Knowledge of current referral pathways/processes are required to explore delays in accessing definitive surgical treatment. An audit of referral processes at Queen Elizabeth Hospital Birmingham was undertaken and further expanded to 4 additional tertia...

Background: The COVID-19 pandemic has resulted in widespread disruption to delivery of emergency and elective care in the last 2 years. Nevertheless, healthcare systems have quickly readapted to accelerate use of novel pathways for delivering clinical services. We reviewed the impact of COVID-19 pandemic on our time from community referral to definitive surgery in patients with Primary Hyperparathyroidism (PHPT).Methods: We retrospectively reviewed the w...

Background: Prevalence of Addison’s disease (AD) among patients with Type 1 diabetes mellitus (T1DM) is estimated at 0.2%, whilst prevalence of T1DM among patients with AD can be up to 14%. Residual adrenal function in patients with established AD may be present in up to 30% of cases but its clinical significance is not fully clear.Aims: To evaluate the prevalence of AD with preserved glucocorticoid function in patients with T1DM at Newcastle Diabet...

Background: Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessments. Once steroid excess is biochemically confirmed, the diagnostic serum ACTH threshold for determining ACTH-independent Cushing is debatable. A threshold of less than 15 ng/l has been adopted in our regional guidelines.Aims: To investigate serum ACTH levels in patients with proven adrenal Cushing and to assess the clinical utilit...