Endocrine Abstracts

We report the use of Gamma knife radiosurgery (GK) to 15 somatotroph adenomas. Eight patients had refractory acromegaly despite maximal conventional treatments: all had undergone conventional radiotherapy (CRT), mean interval between CRT and GK 15.6 years. Six had undergone surgery, two on more than one occasion. Five were receiving somatostatin analog therapy, one was receiving dopamine agonist therapy, one was on pegvisomant alone. All had radiologically defined disease, wel...

We report a rare case of acute myeloid leukaemia (AML) with high risk cytogenetics and associated hypothalamic diabetes insipidus (HDI).A 48-year-old female presented to her GP with a 3-month history of tiredness and lethargy. Full blood count revealed haemoglobin 7.0 g/dl (MCV 103fl), white cell count 12.1×109/l (neutrophils 1.33×109/l), platelets 91×109/l; circulating blast cells were evident on the perip...

Non-islet cell tumour hypoglycaemia (NICTH) is a syndrome associated with overproduction of pro-IGF-II, a 14-18 kDa product of incomplete proteolytic cleavage of IGF-II pro-hormone, usually secreted by large mesenchymal tumours. The excess of pro-IGF-II in NICTH leads to a reduction in circulating insulin, GH, IGF-I, IGFBP-3 and acid-labile subunit (ALS) levels and to an increase in IGF binding protein-2 (IGFBP-2). IGFs and IGFBP-3 are found primarily in binary complexes of ap...

Introduction: Growth hormone (GH) replacement is widely used in the management of patients with adult-onset (AO) GH deficiency (GHD). In most cases, AO-GHD arises as a result of pituitary/peri-pituitary tumours and/or their treatment. The aim of this study was to examine the effect of GH replacement on growth/recurrence of non-anterior pituitary parasellar tumours.Methods: Fifty consecutive patients (21 males; mean age 45.9) with severe AO-GHD (peak seru...

Carpal tunnel syndrome (CTS) in acromegaly is caused, in part, by median nerve (MN) swelling. Pegvisomant (Peg), a growth hormone receptor (GHR) antagonist, lowers serum insulin-like growth factor-I (IGF-I) concentrations in patients with acromegaly, but serum GH levels rise and Peg is detected by most GH assays. Demonstrating that normalisation of serum IGF-I by Peg is associated with improvement/reversal of the consequences of GH excess is desirable. We documented changes in...

NICTH is a well-recognised syndrome associated with overproduction of pro-IGF-II, usually secreted by large mesenchymal tumours. The determination of pro-IGF-II is currently laborious and cumbersome. The aim of the present study was to therefore establish a quick method for determining serum pro-IGF-II. Serum samples from 13 patients with NICTH were obtained after informed consent and these samples were studied and compared to sex- and age-matched controls. Serum concentration...

Pegvisomant is a novel medical therapy for acromegaly that functions as a GH receptor antagonist. Insulin resistance is an important factor in the increased cardiovascular morbidity and mortality associated with acromegaly. The aim of this study was to compare insulin sensitivity (IS) in a group of 7 patients with acromegaly (3 male, mean age 59+/-13 years, SD), treated first with a stable dose of depot octreotide (OT) (median dose 20mg four weekly, range 10-20) for at least t...

Background: Acromegalics are at increased risk of developing colorectal neoplasia with an increase of right-sided disease. Several genes are implicated in colorectal neoplasia including components of the GH/IGF-1 axis. It is unclear whether regional variations in neoplasia are explained by variations in local expression of these genes. Aims: To compare the expression of the components of the GH/IGF-1 axis and other putative genes between the left and right colon of patients wi...

Background: Patients with acromegaly have an increased risk of colorectal neoplasia. In non-acromegalic subjects, carcinomas develop from dysplastic tubular adenomas and colonoscopic removal of these reduces the subsequent incidence of carcinoma. The frequency of such screening in acromegaly is controversial and it is uncertain which patients should be considered to be at particular increased risk. Methods: We reviewed the incidence of new colonic lesions amongst our large coh...

Patients with acromegaly treated with medical therapy intermittently discontinue therapy to allow assessment of underlying disease activity. This is particularly so in patients treated with pituitary irradiation. Typical 'washout' times include 5 weeks for bromocriptine and 2 weeks for short-acting sc octreotide; longer periods are required for cabergoline and slow-release somatostatin analogues. Pegvisomant is a novel medical therapy for acromegaly that functions as a GH rece...