Endocrine Abstracts

Sunitinib, a tyrosine kinase inhibitor, inhibits VEGF-mediated tumour angiogenesis. Following NICE approval, it is increasingly used in the treatment of metastatic renal cell carcinoma.Hypothyroidism in sunitinib-treated individuals was first described in 2005. The aetiology remains uncertain and possibly reflects a destructive thyroiditis. Incidence rates of hypothyroidism from case series vary between 36 and 85%. We report a retrospective analysis of t...

Background: Auto-immune Addison’s disease (AAD) is the most prevalent cause of primary adrenal insufficiency in the UK. Co-morbidities are commonly associated with AAD and can manifest years after the initial diagnosis. There is no clear consensus on the optimal surveillance and management of this condition.Objectives: To establish the prevalence of co-morbidities, assess bone health and review clinical surveillance practice of patients attending an...

Introduction: Graves’ disease is a common cause of hyperthyroidism in pregnant woman, but usually improves during pregnancy.Case: A 23-year-old Pakistani woman in her first pregnancy had no personal or family history of thyroid disease. At 30 weeks gestation she developed a swollen, red left eye, which progressed to involve the right eye. Orbital MRI demonstrated left-sided proptosis, bulky superior and inferior rectus muscles, but no extra-orbital ...

Estrogen Receptor (ER) regulation of target gene transcription is a significant factor in tumor development and progression. Previous work on ER-mediated transcription focused primarily on promoter regions of target genes, although recent work from our lab combining ER Chromatin Immunoprecipitation (ChIP) with tiled microarrays covering chromosomes 21 and 22, showed that distal enhancers appear to be the primary ER binding sites, and that these sites require the Forkhead prote...

Introduction: Endocrine deficiency as a result of glandular infiltration by metastatic cancer is considered rare. Metastases to the adrenal cortex are relatively common and we present the clinical presentation and radiological appearances of cases involving pituitary and adrenal metastases.Case histories: Case 1: An 84 year old male with bronchogenic carcinoma presented with lethargy, polyuria and dehydration. The serum Na+ was 156 mmol...

Controversy exists as to the role of adrenal venous sampling in the assessment of primary aldosteronism (PA). There is no consensus as to how best to define successful outcome post resection of aldosterone producing adenoma (APA). We performed a retrospective analysis of the outcome of patients following unilateral adrenalectomy without pre-operative venous sampling. The study included 14 patients (9 males; mean age 47 yrs (r: 38–59 yrs) with PA and CT identified u...

No guidelines exist for the management of Congenital Adrenal Hyperplasia (CAH) in adults. With no ideal glucocorticoid regimen to replicate normal physiology, best practice remains unclear. Concerns have been raised regarding overtreatment, particularly with longer acting steroids, and potential adverse effects on body composition and bone mineral density (BMD).We examined the case records of all 35 patients currently under review in our unit. Mean±...

A 44-year-old woman presented to an emergency department with ear pain and worsening of longstanding headache. There was no history of menstrual disturbance, galactorrhoea, tiredness or weight gain and physical examination demonstrated only a left homonymous hemianopia. CT head scan revealed a brightly enhancing, enormous, lobulated mass arising from the pituitary fossa and causing obstructive hydrocephalus through compression of the fourth ventricle. Following collection of b...

Objective: To determine whether transdermal oestrogen (E2) preparations alter total cortisol and cortisol binding globulin (CBG) concentration similarly to oral E2 treatment.Methods: This cross-sectional, observational study compared levels of total serum cortisol, CBG, the free cortisol index (FCI) and salivary cortisol levels (as a measure of free cortisol) in oestrogen naïve women (n=15), women taking oral oestrogen (...

A 32 year old man with a history of epilepsy since childhood presented in 1992 with a grand mal seizure and clinical features of tuberous sclerosis (TSC). One year later he was referred with classical Cushingoid features. His serum Na was 140 mmol/l, K 3.4 mmol/l, 9 AM cortisol 1018 nmol/l with lack of diurnal variation and ACTH 42-50 ng/l. Urinary cortisol: 797 nmol/24 h. After overnight, low and high dose dexamethasone suppression, cortisol was 1018, 1154, and 62 nmol/l resp...