Endocrine Abstracts

Hyponatraemia is commonly encountered in neurosurgical units. Salt wasting syndrome is rare, and thought to occur due to ANP- and BNP-mediated natriuresis, leading to hypovolemic hyponatraemia. A 31 year old male was transferred to the National Neurosurgical Unit with a 12 hour history of back pain, progressive lower limb weakness and sensory loss. MRI demonstrated an epidural haematoma, extending from C7 to T3, and he underwent emergency decompressive laminectomy. Vasopressin...

Transsphenoidal surgery (TSS) to resect a corticotroph adenoma is the first-line treatment for Cushing’s disease (CD); remission rates of up to 80% have been reported in cases of microadenomas. Endocrine Society guidelines define post-operative biochemical remission as morning serum cortisol <138 nmol/L within seven days of surgery. Our practice is to use a cut-off of <50 nmol/L at day 3 post-op to indicate biochemical remission. If serum cortisol on day 3 is 50&#...

Idiopathic Isolated ATCH deficiency (IIAD) is a rare cause of secondary adrenal insufficiency characterised by ACTH deficiency with otherwise intact pituitary function. Our objective was to describe the presentation, the autoimmune associations and diagnostic findings observed in IIAD. We present a case series of 19 cases of idiopathic Isolated ACTH deficiency which were identified from the National Pituitary Register in Ireland. A chart and biochemical review was performed to...

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of poli...

A 24 year old man presented with gait instability, myalgia, and cognitive decline, after a holiday in Crete; his alcohol intake exceeded 200 units/week. He had marked facial dysmorphism, with frontal bossing, and global muscle weakness. He had hypernatraemic dehydration (plasma sodium 175 mmol/l urea 16.9 mmol/l), but denied thirst. Urine concentration was 894 mOsm/kg, excluding diabetes insipidus. CK was elevated at 15,540 U/l. CT brain shown marked hydrocephalus. Rhabdomyoly...

Introduction: Fine needle aspiration cytology (FNAC) is a valuable and cost-effective pre-operative investigation for thyroid nodules. The British thyroid association (BTA) previously recommended two non-neoplastic results 3–6 months apart in aspirates to exclude neoplasia1. However, in recently updated BTA guidelines, repeat aspirates were recommended when there are clinical or ultrasound suspicions2.Aim: The aim of our study ...

Introduction: Ultrasound (US) is an extremely sensitive examination for thyroid nodules. Fine needle aspiration (FNA) cytology samples taken with ultrasound guidance, increases accuracy and reduces rates of unsatisfactory samples1. In addition, the immediate assessment of the sample for adequacy by onsite cytopathology is shown to reduce inadequacy rates by most reports2.Aim: The aim of this study was to compare the inadequacy (Thy1...

Introduction: Adrenal haemorrhage is rare. There is a broad spectrum of clinical presentation and aetiology of the condition making it challenging to diagnose. Endocrine dysfunction frequently complicates cases of adrenal haemorrhage. Failure to recognise the condition or its complications can lead to devastating consequences for the patient.Methods: All patients referred to our centre with adrenal haemorrhage between 2004 and 2014 were included in this ...

Introduction: A weekly endocrinology–radiology multidisciplinary (MDT) meeting has been recently introduced in our hospital to discuss indications and suitability of thyroid nodules for fine-needle aspiration (FNA). In a recent 5 years retrospective audit, 80% of thyroids FNAs were performed under ultrasound (US) guidance in our institution with an overall inadequacy (Thy1) rate of 11.1%.Objectives: The aim of this study was to assess whether such a...

Background: Thyroid fine-needle aspiration (FNA) is a safe, valuable and cost effective procedure and is now regarded as the investigation of choice for preoperative assessment of thyroid nodules. The reported sensitivity of thyroid FNA varies from 65 to 98% and the specificity from 73 to 98%.Aim: The aim of this study was to assess the accuracy of this procedure correlating cytology with histological outcomes, and to audit our practice against standard ...