Endocrine Abstracts

Primary hyperparathyroidism (PHPT) is a common condition, affecting approximately 1% of the general population. In women of childbearing age, the correct diagnosis and management is particularly important since PHPT is associated with miscarriage, pre-eclampsia, intrauterine growth restriction, preterm delivery and postpartum neonatal hypocalcaemia. We describe a case series of six women diagnosed with PHPT and their management during pregnancy. In four cases, the PH...

A 37-year-old lady was referred to the endocrine clinic with a raised serum calcium of 2.73 mmol/l in the presence of an inappropriately raised parathyroid hormone of 8.7 pmol/l. Calcium:creatinine clearance ratio was elevated at 0.018, excluding familial hypercalcaemic hypocalciuria. Past medical history revealed an episode of renal stones 17 years ago but a renal ultrasound excluded nephrocalcinosis.A diagnosis of primary hyperparathyroidism was made.<...

Establishing failure of trans-sphenoidal surgery (TSS) to cure Cushing’s disease in the immediate post-operative period is essential for early surgical re-exploration. However, there is no consensus regarding the definition of apparent cure. We studied whether the dexamethasone-suppressed corticotrophin-releasing hormone test (LDDST-CRH test) immediately following TSS could accurately identify those with Cushing’s disease requiring further definitive treatment.<p...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fevers and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Stre...

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

Background: Determining post-operative remission in Cushing’s disease is challenging. There is no consensus for the post-operative serum cortisol value which reliably predicts remission of Cushing’s disease following trans-sphenoidal surgery. Traditionally, an early post-operative serum cortisol of below 50 nmol/L has been used to predict remission, but achieving this is often at the expense of hypopituitarism.<p class="abst...

Case history: A 44-year-old gentleman presented to A&E with a 2-week history of fevers and rigors. He gave a background history of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response, and a new diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. A vegetation identified on the mitral valve led to an unexpected diagnosis of infective endocarditis. Antibiotic treatment for infective endocarditi...

Introduction: Acromegaly is commonly associated with numerous cardiovascular manifestations such as left ventricular hypertrophy, hypertension and ischemic heart disease. However, initial presentation with dilated cardiomyopathy is relatively rare. Dilated cardiomyopathy in patients with acromegaly usually result from an extended and excessive exposure of the myocardium to growth hormone.Case presentation: 51-year-old female with background medical histo...

A 57-year-old woman was referred in 2012 following an incidental finding of a pituitary macroadenoma. It measured 17×9 mm and was confined to the sella. There was no clinical or biochemical evidence of pituitary dysfunction. In 2017, she was found to have proximal myopathy, plethoric facies and purple abdominal striae. She was also on medication for hypertension and type 2 diabetes. There was no history of sleep apnoea, fractures or use of exogenous steroids. An MRI showe...

Background: Acromegaly is associated with multiple co-morbidities and increased mortality. Surgery is the first-line intervention and remission of acromegaly can restore normal life-expectancy. Pre-operative somatostatin analogues (SSA) may increase the likelihood of remission in large invasive tumours by causing tumour shrinkage prior to surgery.Aims: To audit the management of acromegaly patients at Imperial College Healthcare NHS Trust (ICHNT) against...