Endocrine Abstracts

Since July 2005 our centre has offered an e-mail enquiry service to General Practitioners. This service was established for two reasons, firstly to create a more efficient way of dealing with clinical enquiries from primary care and secondly with a long term objective to reduce GP referral rates. The service is manned by Endocrine/Diabetes Specialist Registrars and is part of their training commitment. Compared to telephone calls it gives the registrar more chance to think thr...

A 62-year-old lady was referred to our Department with a nine-month history of facial swelling, easy bruising, and centripetal weight gain. She had a longstanding history of depression, hypertension, and osteoarthritis. She was taking citalopram, buspirone, atenolol and bendrofluazide. A few months earlier she had received bilateral intra-articular knee injections at her local hospital for arthritic pain. On examination she had thin skin with multiple bruises, facial puffiness...

Introduction: Metyrapone is used as holding treatment in patients with Cushing’s syndrome awaiting definitive treatment or as adjunctive treatment following pituitary irradiation. The metyrapone day curve is used to assess the adequacy of suppression of cortisol synthesis, and in our institution involves taking four blood cortisol samples at 9 am, 12 pm, 3 pm and 6 pm respectively. A mean result between 200 and 300 nmol/l is deemed satisfactory.Aims...

Background: Insulin-induced hypoglycaemia (ITT) is considered the gold standard method for the evaluation of the hypothalamo-pituitary-adrenal axis. The standard short Synacthen test (SST) has been proposed as an alternative, but it may be associated with falsely reassuring results and potentially serious sequelae.Aim: To compare the serum cortisol response achieved in the SST with the one obtained during the ITT in patients with hypothalamo-pituitary di...

We present a rare case of acute falciparum malaria complicated by hypocalcaemia while having normal renal function.Case: A 64 year old African lady presented with a 2 week history of lethargy, weakness and oliguria. She had returned from Malawi a fortnight previously and had not taken antimalarial prophylaxis. Her malaria screen was positive for Plasmodium falciparum and she was commenced on quinine. On day 5 of her admission she developed perioral pares...

The value of the somatostatin analogues in the treatment of acromegaly is well established. The experience on their efficacy in gigantism is limited involving the administration of octreotide. To our knowledge, no such cases treated by lanreotide have been reported.An 18-year old student presented to the A&E with a month history of blurred vision and headaches. CT showed a suprasellar pituitary tumour with obstructive hydrocephalus. Emergency inserti...

Ectopic ACTH syndrome (EAS) is characteristically associated with neuroendocrine tumours and small cell carcinomas (SCC) typically of the bronchus. We report a rare case of EAS secondary to gastric adenocarcinoma.A 52-year old man presented to our department with a few week history of proximal myopathy, easy bruising, anxiety and weight loss. He was tanned and hypertensive. Laboratory investigations revealed hypokalaemia (2.3 mmol/l), hyperglycaemia and ...

Objective: To audit the benefits of MIBG and familial screening in patients with a phaeochromocytoma or paraganglionoma.Results: 77 patients (male:female 34:43) have been seen within our hospitals since 1985. Further information has been located on 75. Patients had a median age of 44.3 years (range 19.4–81.2) and a median follow up of 12.0 months postoperatively (range 0–12 yrs). The adenoma was unilateral in 65 cases (86%, left 25, right 40) a...

Background: A variety of preparations for testosterone replacement therapy are currently available. Testogel, a transdermal gel, is widely used and considered one of the most convenient. Measurement of serum testosterone level at various times after application of the gel is regarded as one of the ways of monitoring response to treatment.Aim: To investigate the variability of testosterone absorption and whether testosterone levels prior to application of...

Co-existence of a brain tumour (not associated with previous irradiation) and a pituitary adenoma has been rarely described. Astrocytomas have an incidence of <5/100,000 and somototroph adenomas of <4/1,000,000. In astrocytomas, a positive correlation between IGF-I immunoreactivity and histopathological grade/cell proliferation rates have been proposed. Here, we report a case of acromegaly detected incidentally shortly after the diagnosis of an anaplastic astrocytoma.<...