Endocrine Abstracts

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...

IntroductionYttrium-90 pituitary implants were used in the past as one of the first line treatments for pituitary tumours in many endocrine centres. The procedure involved inserting radioactive rods of Yttrium oxide in to the pituitary fossa. This treatment has been replaced by medical treatment for prolactinomas and transsphenoidal surgery for all other pituitary tumours.AimTo investigate long-term efficacy ...

Non-functioning pituitary adenomas (NFAs) constitute 25-30% of all pituitary tumours. NFAs do not secrete hormones and patients present with clinical features due to mass effects of the tumour such as visual field defects or hypopituitarism. Surgery and radiotherapy (RT) have been considered standard therapy for patients with a non-functioning macroadenoma. However, since MRI scanning has become widely available fewer patients are routinely referred for RT following surgery.</...

BackgroundTSHomas are a rare cause of hyperthyroidism, and account for 0.5 to 3% of pituitary tumours. Incidence=0.15 per million per year. Prevalence=1 per million. Our limited experience of this condition can result in diagnostic and treatment challenges. Here we describe a case treated surgically lead to successful outcomesCase35 years old female referred to our service with secondary amenorrhea for the la...

When patients with type 1 diabetes present with hyponatremia, Addison’s is an important condition to exclude. It is however important to consider other causes, and a trial of hydrocortisone is not part of the diagnostic test for adrenal failure. A 43-year-old lady, with a background of Type 1 Diabetes and depression, presented unwell with hyponatremia. Her basal cortisol was low 162 nmol/l along with an ACTH 16.2 ng/l. A short synacthen test (SST) revealed a baseline cort...

Background: Before radioiodine (RAI) therapy patients undergo a technetium 99m thyroid uptake scan and anti-thyroid medication is stopped prior to treatment following clinical review with the nuclear medicine team. Once treated, patients are followed up in the post-radioiodine telephone clinic. Thyroid function is checked at 3, 6, 9 and 12 weeks. Levothyroxine is started once the fT4 is <14 pmol/l.Purpose: To assess ...

A 33 year old white European patient presented at 32 weeks gestation with a three day history of severe epigastric pain radiating to left flank with vomiting. She had pre-existing hypertension, controlled with labetalol. On admission, her BP dropped from 170/100mmHg to 90/70mmHg. Abdominal examination revealed epigastric tenderness without peritonism. There were no Cushingoid features. An abdominal ultrasound scan was normal. An MRI scan showed a bulky left adrenal gland, with...

Case history: We present a 76-year-old woman with cyclical ACTH-dependent Cushing’s syndrome since 2002. She has two-yearly relapses with proximal myopathy, candidiasis, facial swelling and hypokalaemia that have been biochemically confirmed with Overnight and Low Dose Dexamethasone Suppression tests. Although her initial cycles were brief and uncomplicated, her most recent episodes led to prolonged hospital admissions. During her last admission, she became septic complic...

Background: Hydrocortisone day curves (HCDCs) are commonly used to assess hydrocortisone replacement for patients with adrenal insufficiency (AI).Methods: HCDCs were obtained for 216 adrenally insufficient patients between 2004 and 2012 at Imperial College Healthcare NHS Trust. The area under the curve (AUC) was calculated for each patient’s day profile. Lipid profiles and glycated haemoglobin (HbA1c) values were recorded for each patient at both th...

Background: Glucocorticoid-induced osteoporosis is one of the major clinical concerns of long-term steroid treatment. Previous studies have shown that immunosuppressive doses of glucocorticoid can lead to osteoporosis. This study investigated whether there is a relationship between cortisol exposure and the development of osteoporosis in patients receiving replacement doses.Methods: Hydrocortisone day curves (HCDCs) performed a...