Endocrine Abstracts

During pregnancy there are a number of physiological changes in the regulation of the hypothalamo-pituitary-adrenal (HPA axis). These changes make the diagnosis of adrenal insufficiency and management of patients with known adrenal insufficiency challenging in pregnancy. The management of patients with known adrenal insufficiency needs to be altered during pregnancy and the management of labour and delivery needs MDT input. This session will review the physiological changes th...

Approximately 1% of the population are on some form of long-term glucocorticoid therapy, either as an immunosuppressant or as replacement therapy for adrenal suppression. In recent years, it has become increasingly evident that many of these patients (even those on inhaled steroids) develop adverse consequences of this therapy with the development of iatrogenic Cushing’s syndrome (and its adverse metabolic profile) and associated tertiary adrenal insufficiency due to hypo...

Disorders of salt and water homeostasis are common following traumatic brain injury. Diabetes insipidus is a well-recognized complication of TBI. Polyuria occurs immediately after significant brain injury in up to 22% of cases, nearly always occurring within the first 2–3 days. The great majority of cases resolve spontaneously, and cross-sectional studies of long-term survivors of TBI report low rates of chronic diabetes insipidus. It is likely that in the absence of form...

Acute adrenal insufficiency, also termed adrenal crisis, is a life-threatening endocrine emergency due to a lack of production of the adrenal hormone cortisol (and also aldosterone in primary adrenal insufficiency). Patients with both primary (PAI) and secondary adrenal insufficiency (SAI) are at risk of adrenal crisis. PAI is caused by loss of function of the adrenal gland itself resulting in both glucocorticoid and mineralocorticoid deficiency. SAI is caused by alterations i...

Pituitary adenomas/ tumours remain the commonest cause of growth hormone deficiency (GHD; indeed recent studies from the UK and Belgium have reported higher than previously estimated prevalence of clinically significant pituitary adenomas). However, the aetiological spectrum of pituitary dysfunction has changed in recent years with endocrinologists increasingly reviewing patients with pituitary dysfunction secondary to radiation injury, traumatic brain injury and subarachnoid ...

A 53-year-old caucasian female presented with tremor, palpitations, sweating, breathlessness and chest discomfort. Examination revealed a non-tender, large diffuse goitre and TFT showed an elevated T4 and undetectable TSH. Thyroid antibodies were elevated; 115 IU/ml (NR <35) and thyroid ultrasound confirmed diffuse vascular goitre. Patient was diagnosed with thyrotoxicosis with a likely aetiology of Grave’s disease.Carbimazole was com...

Anterior pituitary dysfunction is a well-recognized complication of traumatic brain injury (TBI) but recovery is an exceptional event, with only three previously published case reports.We report a case of a 25 year old man who suffered severe TBI in a road traffic accident in 1997. His neurological recovery was slow and incomplete with significant cognitive deficit and recurrent seizures. He developed polyphagia and his weight increased by 20 Kilograms i...

Adrenocortical carcinoma (ACC) is a rare malignant tumour arising from the adrenal cortex, with an estimated annual incidence of one to two patients per million. Ectopic ACCs are extremely rare. They are believed to arise from cortical fragments arrested during embryologic migration and have been found close to the adrenal gland or along the path of gonadal descent. The majority of ACCs are sporadic, however, ACC has been linked with genetic disease processes, including multip...

A 34 year old male diagnosed with congenital adrenal hyperplasia (21 hydroxylase deficiency, salt wasting variety) shortly after birth. Initial presentation was poor feeding with hypoglycemia, pigmented scrotum with elevated 17-OH progesterone. He had a right orchidopexy at age 9 for undescended testis. He was admitted multiple times with adrenal crises during his childhood. He went through puberty and achieved height of 177 cm which is 75th centile. His sister also has CAH. H...

A 56-year-old male presented in 2017 with acute symptomatic hyponatraemia. He was admitted with a seizure and a plasma sodium of 112 mmol/l. His past medical history was notable for alcohol excess and smoking. The acute presentation was managed with 3% hypertonic saline infusion in ITU. Plasma osmolality was 240 mOsm/Kg, urine osmolality 327 mOsm/kg and sport urine sodium 28 mmol/l. CT TAP showed some oesophageal thickening only; endoscopy was normal. He made a good recovery f...