Endocrine Abstracts

A 62-year-old lady was referred to our Department with a nine-month history of facial swelling, easy bruising, and centripetal weight gain. She had a longstanding history of depression, hypertension, and osteoarthritis. She was taking citalopram, buspirone, atenolol and bendrofluazide. A few months earlier she had received bilateral intra-articular knee injections at her local hospital for arthritic pain. On examination she had thin skin with multiple bruises, facial puffiness...

Introduction: Metyrapone is used as holding treatment in patients with Cushing’s syndrome awaiting definitive treatment or as adjunctive treatment following pituitary irradiation. The metyrapone day curve is used to assess the adequacy of suppression of cortisol synthesis, and in our institution involves taking four blood cortisol samples at 9 am, 12 pm, 3 pm and 6 pm respectively. A mean result between 200 and 300 nmol/l is deemed satisfactory.Aims...

Background: Insulin-induced hypoglycaemia (ITT) is considered the gold standard method for the evaluation of the hypothalamo-pituitary-adrenal axis. The standard short Synacthen test (SST) has been proposed as an alternative, but it may be associated with falsely reassuring results and potentially serious sequelae.Aim: To compare the serum cortisol response achieved in the SST with the one obtained during the ITT in patients with hypothalamo-pituitary di...

We present a rare case of acute falciparum malaria complicated by hypocalcaemia while having normal renal function.Case: A 64 year old African lady presented with a 2 week history of lethargy, weakness and oliguria. She had returned from Malawi a fortnight previously and had not taken antimalarial prophylaxis. Her malaria screen was positive for Plasmodium falciparum and she was commenced on quinine. On day 5 of her admission she developed perioral pares...

The value of the somatostatin analogues in the treatment of acromegaly is well established. The experience on their efficacy in gigantism is limited involving the administration of octreotide. To our knowledge, no such cases treated by lanreotide have been reported.An 18-year old student presented to the A&E with a month history of blurred vision and headaches. CT showed a suprasellar pituitary tumour with obstructive hydrocephalus. Emergency inserti...

Ectopic ACTH syndrome (EAS) is characteristically associated with neuroendocrine tumours and small cell carcinomas (SCC) typically of the bronchus. We report a rare case of EAS secondary to gastric adenocarcinoma.A 52-year old man presented to our department with a few week history of proximal myopathy, easy bruising, anxiety and weight loss. He was tanned and hypertensive. Laboratory investigations revealed hypokalaemia (2.3 mmol/l), hyperglycaemia and ...

Background: It is well established that patients with acromegaly have compromised quality of life both during active disease, as well as whilst on remission. (1). In the recent years, there has been increasing emphasis on the importance of considering health-related quality of life (QoL) outcomes in the care of patients with acromegaly. The University Hospitals Birmingham NHS Foundation Trust introduced and implemented the use of a holistic needs assessment (HNA) tool in the P...

A 69-year-old man was referred to our Pituitary Service for a 3-month history of progressive right visual loss and a finding of “pituitary enlargement” on brain MRI. He reported erectile dysfunction and his medical history included asthma, DM2 and meningitis (8 years ago). Neuro-ophthalmology review showed visual acuity 6/60, optic neuropathy, marked visual field loss with residual superonasal island in right eye, mild 6th nerve palsy. Pituitary MRI: infil...

Introduction: In children, tumours occupying the pituitary fossa are mainly craniopharyngioma (80–90%) and pituitary adenomas (2–3%). We present two cases of pituitary adenoma and the challenging management when complete surgical resection is not possible. Case 1: A 13.5 year old girl presented with tall stature. Pituitary hormone profile revealed high IGF1 123 nmol/l (24.5–66) and prolactin 722 mU/l (102–496). Growth hormone (GH) was not completely suppres...

Background: It has been proposed that menopause has a beneficial effect on the natural history of hyperprolactinaemia attributed to prolactinoma. Nonetheless, series systematically assessing outcome in females with prolactinoma who have passed through menopause are very limited.Aim: To investigate the impact of menopause on prolactinomas in patients not on dopamine agonist (DA) treatment.Patie...