Endocrine Abstracts

Background: Hyperprolactinaemia accounts for 1 in 7 patients presenting with amenorrhoea. Recent data suggests that prolactin acts at the hypothalamus to reduce GnRH-pulsatility. Conditions in which GnRH-pulsatility is reduced, such as hypothalamic amenorrhoea, favour FSH over LH secretion from the pituitary gland. We examined gonadotrophin secretion in hyperprolactinaemic patients as a surrogate marker of GnRH-pulsatility.Methods: A retrospective analys...

Introduction: Graves’ disease is the commonest cause of hyperthyroidism accounting for 80% of all cases. The first line treatment for Graves’ disease in the UK is medical therapy, most frequently using a ‘dose-titration’ regimen. Currently, there is a lack of guidance to aid clinicians in carrying out optimal dose-titration of carbimazole, resulting in a risk of under- or over-treatment. Thus, we aimed to develop a carbimazole dosing-algorithm for the medic...

Mrs. M is a 66-year-old female who has had secondary adrenal insufficiency for many years following the withdrawal of prednisolone therapy for pulmonary eosinophilia. Synacthen tests revealed complete adrenal suppression when the dose of prednisolone was weaned to 5 mg in previous years. The dose was further reduced by switching to hydrocortisone three times daily, following a 10 mg-5 mg-5 mg regimen. Occasionally, a flare of eosinophilia required restarting high-dose predniso...

Endogenous Cushing’s syndrome poses considerable diagnostic challenges. It is recommended to use two screening tests to confirm hypercortisolaemia. While late-night salivary cortisol assessment (LNSC) is reported to have good specificity and sensitivity and deemed to be cost-effective, it is the least widely biochemical tool used both nationally and in Europe. We aim to compare the specificity and sensitivity of LNSC against and in combination with other diagnostic tests,...

A 61 year-old woman presented with a two year history of facial hirsutism and frontal balding. She did not report voice change or acne. Menarche was at age 14 with regular menses until a hysterectomy (with ovarian preservation) for menorrhagia aged 29. She had a past medical history of T2DM and gastric bypass surgery. She was not on androgenic medication. Examination revealed clinical hyperandrogenism with androgenic alopecia and hirsutism (FG score 20) but no cliteromegaly. T...

Introduction: Diaphoresis, or excessive sweating, is well recognised as a presenting complaint for endocrine disorders such as hyperthyroidism, acromegaly, and phaeochromocytoma. However, diaphoresis is an unusual presenting complaint for Cushing’s syndrome.Case: We present the case of a 35-year-old lady who first presented to health services for symptoms of excessive sweating, and feeling hot most of the time. Whilst initial investigations such as ...

Introduction: Graves’ disease is an autoimmune disorder which may lead to thyroid overactivity and eye disease. Oestrogen and progesterone are thought to be immunomodulatory and have been postulated to play an important role in the difference in prevalence of autoimmune disorders between men and women. Autoimmune disorders, including autoimmune thyroid disease, are often quiescent during pregnancy with an increased prevalence postpartum. The increase in immune mediated th...

Phaeochromocytomas (PCC) and paragangliomas (PGL) are rare tumours derived from the sympathetic or parasympathetic paraganglia. They characteristically secrete catecholamines (noradrenaline/adrenaline/dopamine), which are metabolised to the metanephrines (normetadrenaline/metadrenaline/3-MT respectively). These tumour markers can be detected in acidified 24-h urine collections as first-line investigative tests. Plasma 3-MT has been characterised as a biomarker of metastatic PG...

Pituitary apoplexy caused by pure infarction is rare. Here we present three cases of pituitary macroadenoma infarction following hypotension.1. An 84 year old gentleman had a 2 × 2 cm pituitary macroadenoma causing chiasmal compression and a bitemporal hemianopia. He had panhypopituitarism and was on prednisolone, thyroxine and testosterone replacement. Before surgical intervention of the macroadenoma, he fell and broke his humerus, which requi...

Cabergoline has long been used to treat prolactinomas for symptomatic, radiological and biochemical resolution of pituitary tumours. As clinicians we are well-versed at screening for physical side effects, but are we holistic enough? We present two cases illustrating the damaging social consequences of cabergoline treatment for prolactinomas.Case 1A 49-year-old married father of two presented with a seizure in April 2018. MRI showe...