Endocrine Abstracts

Background and aims: We have previously reported an increased prevalence of gallbladder polyps in treatment-naive acromegaly when compared with the general population (29 vs 4.6%), with potential implications for future malignant transformation and screening. However, little is known about biochemical markers of liver function in active acromegaly, or in response to treatment. Furthermore, somatostatin analogue (SSA) therapy is associated with the development of gallstones. He...

Introduction: Familial dysalbuminemic hyperthyroxinemia (FDH) is characterized by artefactual hyperthyroxinemia caused by enhanced binding affinity of thyroxine to the mutant albumin. However little is known about how FDH affects the measurement of thyroid hormones, especially FT3, across many assay platforms.Methods: Forty-eight genetically confirmed FDH patients (R218H mutation) had FT4 and FT3 measured with 1-step (ADVIA CENTAUR®, Siem...

Background: Although, the diagnostic accuracy of magnetic resonance imaging (MRI) has increased in recent years, it may fail to detect secretory adenoma in a few patients with GH excess. Managing such patients with acromegaly can be challenging. We present a case where 11C-methionine PET/CT co-registered with SPGR/volume MRI proved to be helpful in identifying GH secreting pituitary adenoma.Case history: A 42-year-old male was referred by surg...

Background: Accurate assessment of GH & IGF1 status in acromegaly is crucial for informing management to minimise excess morbidity/mortality. Expert panels have differed with respect to recommended testing modalities and thresholds – the most recent being the Endocrine Society 2014 guidelines. We evaluated their simplified algorithm, which minimises the need for day-case testing, against other more resource-intensive measures.Methods: A retrospe...

Case history: A 38-year-old man was referred with a 12-month history of recurrent bouts of transient hyponatraemia (serum sodium ranging from 115 to 125 mmol/l). Citalopram, which he was taking for depression, was discontinued, but the episodes continued.Initial investigations: Whilst symptomatic, and clinically euvolaemic, his biochemical profile was consistent with a syndrome of inappropriate antidiuresis (SIAD): sodium 124 mmol/l, potassium 4.5 mmol/l...

Background: Thyrotropinomas (TSHomas) are traditionally considered a rare albeit important cause of thyrotoxicosis, accounting for ∼1% of all pituitary adenomas. Although early case series reported a preponderance of macroadenomas, emerging evidence suggests microadenomas are being increasingly diagnosed. In addition, the clinical/biochemical phenotype appears to be more variable than previously suspected. We therefore examined the clinical, metabolic, biochemical and ra...

Corepressors and coactivators mediate thyroid hormone receptor-dependent repression and transactivation of positively-regulated target genes respectively, but their role in negative regulation is not understood.A 4 years old boy was born at 31 weeks. He was jittery at birth, with neonatal respiratory distress. Childhood features included poor weight gain, heat intolerance, tachycardia and hyperactivity. Ongoing problems are low frequency hearing loss, po...

Corepressors and coactivators of thyroid hormone receptor-mediated function facilitate repression and transactivation of positively-regulated target genes respectively, but their role in negative regulation is not understood. A 13 yr old boy, born at 31 weeks gestation, was jittery at birth, with neonatal respiratory distress. Childhood features included poor weight gain, heat intolerance, tachycardia and hyperactivity. Ongoing problems are low frequency hearing loss, poor sig...

Background: The recently published ‘Consensus on Criteria for Cure of Acromegaly’ (Giustina et al. JCEM, 2010) highlighted concerns regarding the quality of currently available insulin-like growth factor 1 (IGF1) immunoassays which may contribute, at least in part, to the discordance between GH and IGF1 that is observed in up to 30% of patients with acromegaly after treatment. The development of mass spectroscopy (MS)-based technology has been proposed ...

Metyrapone (MT) is used in the medical management of Cushing’s syndrome as it decreases serum cortisol (CT) levels by inhibiting adrenal β-hydroxylation of 11-deoxycortisol, the final step in CT synthesis. CT precursors, in particular 11-deoxycortisol (DOC), increase following MT therapy. Monitoring glucocorticoid replacement in patients taking MT could therefore be confounded as DOC cross-reacts in commonly used immunoassays (IA) for serum CT. Serum CT results from ...