Endocrine Abstracts

A 59-year-old lady presented with significant weight gain, and a history of hypertension for investigation of possible Cushing’s syndrome. Her BMI was 29, with mainly central obesity. Initial tests revealed elevated untimed cortisol on two separate occasions, at 905 nmol/l and 893 respectively with detectable midnight cortisol, at 548 and 481. Of 24-hour urinary free cortisol (UFC) was also elevated on two separate occasions, at 931 nmol/24 h and 827 respectively. ACTH wa...

Antipsychotic induced hyperprolactinaemia, mediated by blockade of dopamine D2 receptors, is much more common than prolactinoma in patients receiving antipsychotic medication. We present two cases of the latter.Case 1: A 47-year-old gentleman with depression treated with amitriptyline, fluoxetine and risperidone presented with headaches and a left sided visual field defect. Pituitary MRI showed a 2 cm macroadenoma abutting the optic chiasm. Prolactin was...

Background: Secondary adrenal insufficiency is a common complication of transsphenoidal hypophysectomy (TSS) for pituitary adenoma. It is therefore imperative to rapidly and accurately identify patients requiring glucocorticoid replacement, thus minimising risks of adrenal insufficiency or unnecessary glucocorticoid exposure. The gold-standard test of HPA axis reserve, the insulin tolerance test (ITT), cannot be performed safely until after post-operative recovery. Nine am cor...

A 30-year-old lady was transferred to our hospital at 37 weeks of pregnancy. Hypertension was noted at 24 weeks of gestation and managed with methyldopa and labetalol. Despite treatment, BP was labile with a systolic of 90–220 and diastolic of 50–129 mmHg. She reported occasional palpitations but not chest pain or shortness of breath. The patient had a history of migrainous headaches but not hypertension prior to pregnancy. Her brother had previously had an operation...

Primary hyperparathyroidism (HPT) in pregnancy is an uncommon phenomenon, mostly occurring in the 2nd or 3rd trimester. HPT in pregnancy may cause complications affecting both the mother (renal stones, pancreatitis) and fetus (neonatal tetany, seizures, intra-uterine growth retardation and preterm labour). We report two recent cases that highlight the potential risks.Results: The patients, 37 and 35 years old at presentation respectively, both presented ...

Hypophysitis describes inflammatory pituitary lesions which can be classified into lymphocytic (autoimmune), granulomatous or xanthomatous. Rathke’s cleft cysts (RCC) are usually assymptomatic, benign tumours derived from remnants of Rathke’s pouch. We present a case of lymphocytic hypophysitis secondary to a ruptured RCC and the first reported case of post-surgical recurrence.A 34-year-old female presented with secondary amenorrhoea and fatigu...

Aim: Population studies have shown that basal calcitonin concentrations are below 10 ng/l in the normal population. Ten nanograms per liter is used as a diagnostic cut-off by most laboratories and patients with levels higher than this are offered a pentagastrin stimulation test to exclude medullary thyroid carcinoma. However, these guidelines were adopted from studies that used the Cisbio Immunoradiometric assay for measuring calcitonin. Most laboratories have now moved to che...

A 36-year-old man was referred to the neurologists for leg weakness and pain, fatigue and lethargy for 2 years. Sarcoidosis was diagnosed 6 years previously, on the basis of uveitis, lower motor neurone facial palsy, hilar lymphadenopathy and transbronchial biopsy. Prednisolone had been discontinued 3 years prior to his current presentation.His blood pressure was 99/71. Examination was otherwise unremarkable. His ACE was 109 U/l (10–70). His TSH was...

We describe a case of pituitary apoplexy in a patient with a known non- functioning macroadenoma. A 57 year old female was incidentally found to have a 20 x 16 mm solid and cystic pituitary mass abutting the optic chiasm on MRI scanning. She had gonadotrophin deficiency on endocrine testing and normal visual fields. Although repeat perimetry 12 months later revealed a mild superior bi-temporal hemianopia, the patient elected not to have surgery.Several m...

The definition of early cure post transphenoidal surgery (TSS) for Cushing’s disease continues to be debated. The low dose dexamethasone suppression test with corticotrophin releasing hormone (LDDST-CRH) is a test for diagnosis of Cushing’s; however it has not been validated in early post TSS to determine remission. The aim of this study was to determine whether the combined LDDST-CRH test could be used in post TSS patients.The combined LDDST-C...