Endocrine Abstracts

A case of ectopic ACTH with severe opportunistic infectionECI Hatfield, S Pal, K Meeran, G Williams, JF Todd.Endocrine Unit, Imperial College, Hammersmith Hospital, London, UKA twenty six year old female presented with symptoms and signs suggestive of Cushing's Syndrome. Initial investigations showed hypokalaemia (potassium 2.3nmol/L), elevated urinary free cortisols, (3400, 18,000, 31,000 nmol/24 hour (NR <270)), diabetes (fasting glucose =9 mmol/L), loss of di...

INTRODUCTION: Gastrinomas usually arise in pancreas or duodenum and may be small and difficult to localize. These tumours are multiple in 50% of sporadic cases but in MEN1 this figure rises to 90%.CASE REPORT: Our patient presented aged 24 with a neck mass. Investigations confirmed primary hyperparathyroidism and four-gland parathyroidectomy confirmed hyperplasia. When normocalcaemic, her fasting plasma gastrin level was noted to be 129 pmol/l (NR<40)...

A 56 year old female on treatment for colonic Tuberculosis was referred for investigation of possible Cushing's Syndrome. She initially presented with hypertension, hypokalaemia, and proximal myopathy. Repeated Urinary Free Cortisols were elevated at 730, 738, 520 nmol/L, (normal range= 55-270 nmol/L). The patient failed to suppress on low dose dexamethasone suppression, LDDST, (0.5 mg 6 hourly for 48 hours), baseline cortisol= 390 nmol/L, 48hour cortisol = 595 nmol/L, but sup...

Transphenoidal hypophysectomy is often carried out to remove ACTH-secreting tumours of the pituitary. A postoperative serum cortisol of <50nmol/l usually indicates cure of the disease but after other audits found persistent cases, 'remission' is thought to be a more appropriate term.Charing Cross Hospital is the tertiary neurosurgical centre for West London where a single, dedicated pituitary surgeon was appointed in 1995. We analysed the success of e...

Midnight Cortisol RevisitedD Noimark, MT Barakat, K. Meeran, JF ToddEndocrine Unit, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, LondonBackground: The diagnosis of Cushing's syndrome must be established before any attempt at differential diagnosis. The diagnosis of Cushing's syndrome can be made initially on an outpatient basis with the measurement of 24 hour urinary free cortisol ...

Midnight Cortisol RevisitedD Noimark, MT Barakat, K. Meeran, JF ToddEndocrine Unit, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, LondonBackground: The diagnosis of Cushing's syndrome must be established before any attempt at differential diagnosis. The diagnosis of Cushing's syndrome can be made initially on an outpatient basis with the measurement of 24 hour urinary free cortisol ...

A 56 year old female on treatment for colonic Tuberculosis was referred for investigation of possible Cushing's Syndrome. She initially presented with hypertension, hypokalaemia, and proximal myopathy. Repeated Urinary Free Cortisols were elevated at 730, 738, 520 nmol/L, (normal range= 55-270 nmol/L). The patient failed to suppress on low dose dexamethasone suppression, LDDST, (0.5 mg 6 hourly for 48 hours), baseline cortisol= 390 nmol/L, 48hour cortisol = 595 nmol/L, but sup...

We are reporting a rare case of ectopic ACTH secreting tumour causing cyclical Cushing’s syndrome. A 63-year-old lady presented in March 2013 with tiredness and bilateral leg swelling and weakness associated with easy bruising. She was admitted to local hospital in April 2013 with worsening proximal myopathy and peripheral oedema. Her midnight cortisol was elevated at 1710 nmol/l. ACTH 610 mU/l, prolactin 476 mU/l, GH 0.21 IU/l, TSH 0.73 mU/l, free T4 of 11.0 p...

A 31-year-old man presented with a two month history of sweating, right-sided abdominal pain and supraclavicular swelling. CT scanning showed widespread lymphadenopathy with multiple retroperitoneal lymph nodes. Biopsy of a left supraclavicular node resulted in a diagnosis of metastatic paraganglioma. Raised urinary catecholamine as well as urinary metanephrine levels further confirmed the diagnosis.A normocytic anaemia requiring repeated blood transfusi...

A 59-year-old lady presented with significant weight gain, and a history of hypertension for investigation of possible Cushing’s syndrome. Her BMI was 29, with mainly central obesity. Initial tests revealed elevated untimed cortisol on two separate occasions, at 905 nmol/l and 893 respectively with detectable midnight cortisol, at 548 and 481. Of 24-hour urinary free cortisol (UFC) was also elevated on two separate occasions, at 931 nmol/24 h and 827 respectively. ACTH wa...