Endocrine Abstracts

The rising prevalence of obesity and type II diabetes makes the diagnosis of Cushing’s syndrome increasingly difficult. The dexamethasone-suppressed corticotrophin-releasing hormone (CRH) test, which involves CRH administration immediately following a standard low dose dexamethasone suppression test (LDDST), has been reported to diagnose Cushing’s syndrome with 100% sensitivity and specificity. We adapted our LDDST protocol to include CRH administration post-dexameth...

Pre-operative localisation of insulinomas is essential prior to resection. Many imaging modalities have been used. Angiography is well described for localising neuroendocrine tumours and the use of selective intrarterial calcium injection to stimulate insulin release with simultaneous sampling of insulin levels in the hepatic vein has been shown to allow localisation of the tumour to particular vascular territories, even when other modalities have not been helpful.<p class...

A 55 year old lady presented to our hospital in 1991 with a year's history of diarrhoea, weight loss and abdominal pain. On examination, she had 5cm hepatomegaly. Serum gastrin was elevated (148 pmol per litre NR < 40), as was GAWK (276 pmol per litre NR < 150). Basal gastric acid secretion was increased (39 mmol per hour NR < 5). CT abdomen showed multiple hepatic metastases, confirmed to be neuroendocrine in origin on biopsy. There were no clinical or biochemical fe...

A 19 year old university student who participated in athletics presented with secondary amenorrhoea. Examination revealed no features of endocrine disease. A pituitary profile showed normal serum thyroid function and prolactin, but undetectable LH, FSH, and oestradiol. Random serum GH level was detectable (9 milli units per litre), but IGF1 level was low, 72 (190-530 micrograms per litre). An OGTT demonstrated a paradoxical rise in her GH levels (3.5, 2.2, 38, 33, 20; mean GH ...

Eliciting an accurate diagnosis of Cushing's disease before transphenoidal hypophysectomy is essential to avoid unnecessary surgery. Localisation of the tumour increases the chance of operative success.In the right hands, Inferior Petrosal Sinus Sampling (IPSS) can provide invaluable information in distinguishing ectopic ACTH from pituitary Cushing's and localising the tumour in patients who are known to have Cushing's syndrome. Due to the invasive natur...

WF a 52 year old female was referred to the Hammersmith Hospital in August 2001 for further investigation of her persistently elevated fasted gut hormones (GIH) [all previously assayed at the Hammersmith Hospital]. WF was initially diagnosed with irritable bowel syndrome 16 years ago. Following an exacerbation of her condition 9 years ago, fasting gut hormones were performed, which showed gross elevation of all peptides measured.The possibility of a neuroendocrine tumour was p...

A 47 year-old woman was referred with hypercalcaemia. She was receiving lithium, haloperidol and olanzapine for a schizo-affective disorder. Five years previously she had been diagnosed with liver metastases and a biopsy confirmed a neuroendocrine tumour. She had been told that her life-expectancy was limited, and she was discharged. Her calcium was 2.7mmol/l three years ago. At presentation to her local hospital, her calcium was >6.0mmol/l. She was treated aggressively wi...

A 29 year old woman was admitted to her local hospital with haematemesis, and found to be hypercalcaemic. A peptic ulcer was confirmed and she was commenced on omeprazole. There was biochemical evidence of primary hyperparathyroidism and a single-gland parathyroidectomy was performed. During her admission, a diagnosis of gastrinoma was suspected, but an attempt at measuring fasting gut hormone concentrations off omeprazole therapy resulted in gastro-intestinal perforation. She...

In August 1999, to reduce pressure on an overcrowded outpatient department and the incidence of undetected early hypothyroidism, we implemented a new protocol for the follow-up of patients undergoing radioiodine treatment for recurrent thyrotoxicosis. Suitable patients are invited to participate in follow-up by telephone. Thyroid function tests are checked at 3, 6, 9 and 12 weeks post-treatment. Patients who become hypothyroid post-treatment (fT4 <14 picomoles per litre) a...

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...