Endocrine Abstracts

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...

Significant delays in follow up and institution of thyroxine replacement for patients developing post-radioiodine (RAI) hypothyroidism were revealed by a three year retrospective audit. To reduce the incidence of undiagnosed early hypothyroidism and lengthy waits between outpatient visits, a telephone clinic was introduced in August 2000. Thyroid function tests are checked at 3, 6, 9 and 12 weeks post-treatment. Results are checked weekly by a Specialist Registrar. Patients wh...

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...

A 24-year old male who, was normal at birth, became listless and volume depleted at 3 weeks of age. Investigations yielded an Addisonian picture (serum Na+ 115 mmol/l; K+ 8.2 mmol/l; urea 15.8 mmol/l). Serum 17-hydroxyprogesterone (17-OHP) levels were measured and found to be high (2,564 nmol/l). Urinary 17-oxosteroids and 17-OHP were also elevated. The neonate was thought to have 21-hydroxylase-deficient congenital adrenal hyperplasia (CAH) and therapy with fludrocortisone an...

A thirty year old woman with complete 21-hydroxylase deficiency presented with a five centimetre adrenal mass necessitating operative removal to exclude malignant change. Her medical management had always been unsatisfactory, and she had been tried on both hydrocortisone and dexamethasone. When taking 1 milligram dexamethasone daily she had partially suppressed androgen levels, (evidenced by a fall in 17-hydroxy-progesterone levels to 29 nmol/l), at the expense of marked Cushi...

Following the establishment of a telephone clinic follow-up for patients receiving radioiodine for recurrent thyrotoxicosis, we wished to further improve our results in achieving hypo(eu)thyroidism while minimising the risk of transient hyperthyroidism and thyroid storm post-therapy. Although not widely used, lithium has been shown to increase the effectiveness of radioiodine therapy, leading to prompter control of hyperthyroidism. Since August 2001, patients undergoing radioi...

Annexin 1 (ANXA1), a Ca2+ and phospholipid binding protein, is an important mediator of glucocorticoid (GC) action in the host defence and neuroendocrine systems (1). It is not however known whether the dysregulation of the inflammatory response sometimes observed in patients with disturbances in GC secretion is associated with alterations in PBL ANXA1 expression/activity. To address this question we have (a) examined ANXA1 expression (flow cytometry and western blot analysis)...

BackgroundTSHomas are a rare cause of hyperthyroidism, and account for 0.5 to 3% of pituitary tumours. Incidence=0.15 per million per year. Prevalence=1 per million. Our limited experience of this condition can result in diagnostic and treatment challenges. Here we describe a case treated surgically lead to successful outcomesCase35 years old female referred to our service with secondary amenorrhea for the la...