Endocrine Abstracts

Rapid diagnosis and treatment of Cushing’s syndrome (CS) is essential for good outcomes. Current standards for appropriate timelines for referral are under review by NHSE. Data are required to substantiate standard setting. Knowledge of current referral pathways/processes are required to explore delays in accessing definitive surgical treatment. An audit of referral processes at Queen Elizabeth Hospital Birmingham was undertaken and further expanded to 4 additional tertia...

Case history: 37F presented with 4 years history of amenorrhea. In addition, she had fatigue, low mood and joint pains. She also had history of polyuria and nocturia. Investigations: Her investigations revealed FSH 2.4 IU/l, LH 1.1 IU/l, Oestradiol < 92 pmol/l, T4 <5 pmol/l, TSH 1.5 mIU/l, IGF-1 13.3 nmol/l (8.5- 30.07), Cortisol 65 nmol/l, Prolactin 68 mIU/l. She was started on Hydrocortisone and levothyroxine. Pituitary MRI revealed a 15 mm les...

Case history: We present a case of 36Y old male who presented with worsening leg edema, leg ulceration and poor mobility leading to admission in intensive care due to sepsis and hemodynamic instability. Found to have metabolic alkalosis with hypokalaemia. Clinically, moon-like facies, low proximal muscle mass, skin hypopigmentation (mainly hands), broken skin fingers and legs, abdominal fat distribution. Investigations:Random cortisol 2348nmol/l, post 1mg dexamethasone cortiso...

(1) 30-year-old woman presenting at 34 weeks of pregnancy with symptoms of persisting headaches, diplopia and nausea. She presented again 4 years later with similar symptoms in a subsequent pregnancy at 35 weeks with additional complaints of blurred peripheral vision. (2) During her first pregnancy biochemistry revealed marked prolactin elevation (14,000 mIU/l). A non-contrast MRI scan of the pituitary revealed significant enlargement of the gland (22 x 14.4 x 12.5mm) bey...

A 46 year old female presented with 12 months history of secondary amenorrhoea. Prolactin was 4746 mIU/l without macroprolactin complexes, LH & FSH were low, oestradiol was undetectable. She had normal visual fields. No other clinical or biochemical features of pituitary dysfunction. She had no regular medication. Pituitary MRI was normal. She was started on cabergoline 250 mcg twice weekly which was subsequently increased to 500 mcg twice weekly. Repeat serum prolactin 5 ...

Background: Pituitary apoplexy is uncommon in childhood and adolescence. Typical clinical features are acute confusion, headache, vomiting and visual disturbance. It is caused by haemorrhage into the pituitary gland. Its association with cerebral infarction is rare. We report an unusual case associated with a cerebral infarction secondary to internal carotid artery compression.Case: 16 year old male was referred to the ‘Stroke Team’ with acute ...

Background: Phaeochromocytoma and paraganglioma (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla and paraganglia. Biochemical assessment relies on demonstrating elevated concentrations of catecholamines and their metabolites. Analytical methods for catecholamine and metanephrine measurement vary in sensitivity and specificity. We reviewed our biochemical work-up in order to optimise patient diagnosis.Methods: This retrospective au...

Background: Metyrapone inhibits 11-β hydroxylase and causes a subsequent rise in the cortisol precursor, 11-deoxycortisol. Cortisol measurements by immunoassays are susceptible to interference and reagent antibody cross-reactivity with cortisol precursors when used in patients receiving metyrapone treatment. Clinicians rely on clinical and biochemical features of cortisol excess for dose titration of this medical blockade. The extent of this interference remains unclear. ...

Background and ObjectiveData on the epidemiology, effects of dopamine agonists and long term outcome of prolactinoma in children and adolescents have been gradually accumulating but are still scarce. We conducted a systematic review and meta-analysis of published literature (1994 – 2019) to study the epidemiology of prolactinoma in patients < 20 years old, and determine the management strategies adopted.Methods: Relevant ...

Objective: Mitotane (o,p’DDD) is an effective adrenolytic agent for treatment of advanced adrenocortical carcinoma (ACC). Suppression of cortisol biosynthesis, including inhibition of 11β-hydroxylation, has been described. Decreased cortisol bioavailability is indicated by increased dose requirement for hydrocortisone replacement during mitotane treatment. Urinary excretion of common cortisol metabolites (CM) has been reported to be normal but with increase of 6&#946...