Endocrine Abstracts

Background: Accurate assessment of GH & IGF1 status in acromegaly is crucial for informing management to minimise excess morbidity/mortality. Expert panels have differed with respect to recommended testing modalities and thresholds – the most recent being the Endocrine Society 2014 guidelines. We evaluated their simplified algorithm, which minimises the need for day-case testing, against other more resource-intensive measures.Methods: A retrospe...

Case history: A 38-year-old man was referred with a 12-month history of recurrent bouts of transient hyponatraemia (serum sodium ranging from 115 to 125 mmol/l). Citalopram, which he was taking for depression, was discontinued, but the episodes continued.Initial investigations: Whilst symptomatic, and clinically euvolaemic, his biochemical profile was consistent with a syndrome of inappropriate antidiuresis (SIAD): sodium 124 mmol/l, potassium 4.5 mmol/l...

Background: Thyrotropinomas (TSHomas) are traditionally considered a rare albeit important cause of thyrotoxicosis, accounting for ∼1% of all pituitary adenomas. Although early case series reported a preponderance of macroadenomas, emerging evidence suggests microadenomas are being increasingly diagnosed. In addition, the clinical/biochemical phenotype appears to be more variable than previously suspected. We therefore examined the clinical, metabolic, biochemical and ra...

Corepressors and coactivators of thyroid hormone receptor-mediated function facilitate repression and transactivation of positively-regulated target genes respectively, but their role in negative regulation is not understood. A 13 yr old boy, born at 31 weeks gestation, was jittery at birth, with neonatal respiratory distress. Childhood features included poor weight gain, heat intolerance, tachycardia and hyperactivity. Ongoing problems are low frequency hearing loss, poor sig...

Background: The recently published ‘Consensus on Criteria for Cure of Acromegaly’ (Giustina et al. JCEM, 2010) highlighted concerns regarding the quality of currently available insulin-like growth factor 1 (IGF1) immunoassays which may contribute, at least in part, to the discordance between GH and IGF1 that is observed in up to 30% of patients with acromegaly after treatment. The development of mass spectroscopy (MS)-based technology has been proposed ...

Metyrapone (MT) is used in the medical management of Cushing’s syndrome as it decreases serum cortisol (CT) levels by inhibiting adrenal β-hydroxylation of 11-deoxycortisol, the final step in CT synthesis. CT precursors, in particular 11-deoxycortisol (DOC), increase following MT therapy. Monitoring glucocorticoid replacement in patients taking MT could therefore be confounded as DOC cross-reacts in commonly used immunoassays (IA) for serum CT. Serum CT results from ...

TRAB antibody is specific for diagnosis of Grave’s disease. We have conducted an audit to on our practice on parameters which TRAB could influence.Method: TRAB (NR 0–1 IU/l) positive patients were identified from biochemistry laboratory form April 2003 to February 2004. Sixty case notes were randomly selected for reviewed. Data were analysed subsequently.Result: 46 cases (77%) were female. Mean age was 42, range 6 to 78 y...

Primary hyperparathyroidism in pregnancy is reported as being rare rare. It can be associated with significant complications. Maternal complications include symptomatic hypercalcaemia, renal calculi, hyperemesis, muscle weakness, and pre-eclampsia. Fetal complications include IUGR, low birth weight, preterm delivery, intrauterine death, neonatal tetany and fits.Patient 1 presented with asthma and was found to have primary hyperparathyroidism, corrected c...

A 44 yr old IT systems analyst, presented in 2003 with a six month history of weight gain, diabetes and hypertension. On examination he was floridly Cushingoid. Investigations showed raised 9AM cortisol (1887 nmol/l) with failure to suppress following low and high dose dexamethasone, together with elevated 24 h urinary free cortisol (3300 nmol) and circulating ACTH (130 ng/l) levels. CT scan demonstrated a complex 11.5×9 cm lesion in the left lobe of liver and biopsy indi...

Background: Image reconstruction is a key step for the accurate interpretation of positron emission tomography (PET) scans. Nuclear medicine phantoms play a critical role in this process. However, existing phantoms (based on simple geometric shapes) do not reflect the complexity of sellar/parasellar anatomy. We therefore created a novel pituitary phantom and examined the impact of image optimisation on the detection of microadenomas, using 11C-methionine PET s...