Endocrine Abstracts

Background: Ghrelin stimulates cell proliferation in a number of tissues including pituitary. AMPK, a heterotrimer kinase enzyme, is an important sensor and regulator of cellular energy balance. We have shown that ghrelin can change AMPK activity in various tissues and this mechanism could play a role in its metabolic effects. AMPK has recently been established to strongly inhibit cell proliferation and tumorigenesis. We therefore hypothesised that ghrelin stimulates cell prol...

Objective: To audit the benefits of MIBG and familial screening in patients with a phaeochromocytoma or paraganglionoma.Results: 77 patients (male:female 34:43) have been seen within our hospitals since 1985. Further information has been located on 75. Patients had a median age of 44.3 years (range 19.4–81.2) and a median follow up of 12.0 months postoperatively (range 0–12 yrs). The adenoma was unilateral in 65 cases (86%, left 25, right 40) a...

Background: Growth hormone (GH) excess is associated with increased insulin resistance (IR). Lanreotide autogel (Autogel) reduces GH-levels effectively in patients with active acromegaly. However, the effect of somatatostatin analogues on IR and (-cell function (HOMA %B) is complex and unpredictable. Our study prospectively monitored IR and related metabolic parameters in acromegalics treated with Autogel.Methods: Nine patients (P) with active acromegaly...

Background: Chromogranin A and B (CgA, CgB) are widely used as markers of neuroendocrine tumour (NET) disease. However, the sensitivity of the test is variable and the value of CgB measurement is unclear. We thus sought to review 3 years of CgA and CgB requests made in our hospital.Methods: CgA and CgB were measured at the Hammersmith Hospital. Case notes were reviewed in each of these patients.Results: There were 520 tests perform...

Insulinoma is a tumour of the endocrine pancreas, usually benign, with an annual incidence of 1–2 new cases per million population. We describe a case of Insulinoma complicated by the simultaneous development of diabetes.A 72year old lady had episodes of funny turns and confusion following her meal. She had lost a stone in weight over 6–8 months. There was no history of sulphonylurea ingestion. Examination revealed low BMI and no evidence of ra...

Controversy exists as to the role of adrenal venous sampling in the assessment of primary aldosteronism (PA). There is no consensus as to how best to define successful outcome post resection of aldosterone producing adenoma (APA). We performed a retrospective analysis of the outcome of patients following unilateral adrenalectomy without pre-operative venous sampling. The study included 14 patients (9 males; mean age 47 yrs (r: 38–59 yrs) with PA and CT identified u...

Background: Pregnancy after complete loss of hypophyseal function is rare. Complete lack of ovarian stimulation by FSH and LH results in anovulation and atrophy of the ovaries. We report a patient with panhypopituitirism who achieved pregnancy and delivery through in vitro fertilization (IVF) and embryo transfer (ET).Case: A 35 year-old lady had undergone four trans-sphenoidal hypophesectomy operations, at 12, 13, 23 and 26 years of age, for recur...

Introduction: Echocardiographic studies in patients with primary hyperparathyroidism (PHPT) suggest that up to half of patients have left ventricular dysfunction and an increased risk of congestive heart failure that improve after parathyroidectomy. The cardiac hormone B-type natriuretic peptide (BNP) is an independent risk marker for heart failure.Methods: Prospective cohort study of consecutive unselected patients with biochemical diagnosis of PHPT. Pl...

The sodium iodide symporter (NIS) mediates the uptake of iodide into thyroid follicular cells. The pituitary tumor transforming gene (PTTG) is a multifunctional oncogene which stimulates expression of fibroblast growth factor-2 (FGF-2) via PTTG binding factor (PBF). PTTG and FGF-2 inhibit iodide uptake in rat thyroid FRTL5 cells and PTTG and PBF repress NIS mRNA expression and iodide uptake in primary human thyroid cultures. To determine whether this regulation is a direct tra...

Insulinomas, although rare, cause significant morbidity. They are frequently small at diagnosis. Whilst this means they are frequently curable by surgery, it makes localisation of the tumour difficult. However the importance of accurate pre-operative localisation is essential especially since laparoscopic surgery has been developed, which allows a minimally invasive approach to be used, but makes it vital that multiple tumours are identified pre-operatively.<p class="abste...

A 30-year-old woman, presented 3 weeks postpartum, with episodes of sweating, dizziness and confusion, which occurred a few hours after eating and also on waking. At consultation she became vacant and lost consciousness. Her capillary blood glucose was found to be 1.2 mmol/l and she promptly responded to intravenous glucose administration. There was a history of several similar, but less severe episodes which required frequent feeding to avoid them. Her liver function and pitu...

Acromegaly is associated with increased morbidity and mortality. Surgical excision of the adenoma remains the best option to attain a cure. The results of surgery in the region were unsatisfactory compared to other European centres as was amply borne out in a 1998 review. As the lack of a dedicated pituitary surgical team was considered contributory, one was developed offering Endoscopic, transsphenoidal, pituitary surgery and their results audited.Sixte...

Surgery is the treatment of choice for GH secreting tumours. Recent papers suggest, early re-exploration of persistently active tumours may be beneficial. Endocrine assessment, to confirm cure, in the immediate post-operative period is difficult. We aimed to ascertain which test of GH excess performed post-operatively is a reliable predictor of longer term cureMethods: 16 consecutive patients (8 males and 8 females: mean age 46.8±13 years) with acti...

We had a 29 year old lady with 11 years history of hirsutism and amenorrhoea. She was diagnosed as polycystic ovarian syndrome in a different hospital few years ago and commenced on metformin and spironolactone. She noticed worsening of hirsuitism over last year, needing to shave daily, along with loss scalp hair, deepening of voice and clitoromegaly. On examination, she was obese without any overt signs of Cushing’s syndrome. She had severe hirsuitism affecting face, arm...

We describe two unrelated men with a previously unreported combination of tumours. The first patient developed a right-sided testicular teratoma at the age of 25 years treated with orchidectomy. He went on to develop a left-sided seminoma at the age of 35 years, treated with orchidectomy followed by prophylactic para-aortic radiotherapy (30 Gy in 15 fractions). At the age of 48 years he developed a nodule in the left lobe of thyroid (AC4/Thy4 on FNA) treated with hemithyroidec...

A 44-year-old man referred with erectile dysfunction was found to have hypogonadotrophic hypogonadism (HH), but otherwise apparently normal anterior pituitary function (LH 1.6 & FSH 2.7 IU/l; T 3.4 & cortisol 516 nmol/l; PRL 103, GH 5.5 & TSH 2.8 mU/l; f-T4 13, f-T3 4.8 & f-T 128 pmol/l; ferritin 103 ug/l). He appeared normally virilised, with central obesity (BMI 36 kg.m−2, collar size 46 cm) and symptomatic sleep apnoea (SA). MRI showed a rig...

Mutation in the genes encoding subunits of the succinate dehydrogenase enzyme complex, SDHB, SDHC and SDHD are associated with an increased risk of developing adrenal or extra-adrenal phaeochromocytoma and cervical paraganglioma. However, the penetrance in large kindreds has seldom been reported and the optimal screening for asymptomatic carriers has not been determined.The index case had a previous history of carotid body tumour and later died with meta...

Introduction: 131I-Metaiodobenzylguanidine (131I-MIBG) is used as palliative therapy in patients with metastatic neuroendocrine tumours (NET), but can cause bone marrow suppression, hypothyroidism and renal impairment.Methods: Retrospective case note analysis identified 58 patients treated with between May 1996 and May 2006. We assessed the efficacy and toxicity of 131I-MIBG therapy in 49 of these patients (12men; mean age at diagnosis: 57.4 years; range...

A 44 yr old IT systems analyst, presented in 2003 with a six month history of weight gain, diabetes and hypertension. On examination he was floridly Cushingoid. Investigations showed raised 9AM cortisol (1887 nmol/l) with failure to suppress following low and high dose dexamethasone, together with elevated 24 h urinary free cortisol (3300 nmol) and circulating ACTH (130 ng/l) levels. CT scan demonstrated a complex 11.5×9 cm lesion in the left lobe of liver and biopsy indi...

Background: Serum thyroglobulin (Tg) is a useful marker of recurrent or persistent disease in the follow-up of patients with differentiated thyroid carcinoma (DTC); the presence of interfering Tg antibodies (TgAb), even in low concentrations, can lead to a distorted evaluation of this marker. However, TgAb by itself has been shown to be a marker of disease following surgery. TgAb recognition of Tg epitopes differs in pathological and non-pathological states and may thus have p...

Background: Nadir GH<2 mU/l in OGTT, normal IGF-I and mean GH<5 mU/l in the growth hormone day curve (GHDC) are considered the therapeutic endpoints in patients with acromegaly. However, discrepancies between these parameters have been reported.Aim: To compare the utility of the above tests in assessing the acromegaly status following surgical treatment.Patients and methods: Twenty-six consecutive patients (16 females) diag...