Endocrine Abstracts

Hypopituitarism secondary to pituitary apoplexy is a rare but recognised complication following cardiac surgery but not cardiac arrest.We present a case report of acute pituitary apoplexy following a cardiac arrest on a background of sepsis. A 65-year-old gentleman presented with 3-day history of abdominal pain and vomiting. Of note, he underwent an appendicectomy 2 months earlier. He was septic and investigations revealed bowel perforation with faecal p...

We report an 84-year-old lady with stage A chronic lymphatic leukaemia which has been stable since 2002. She presented to our A&E in January 2013 with 3 days history of worsening frontal headache. She did not report visual disturbance or weakness. Examination revealed right sided homonymous hemianopia with no other neurological deficit.White cell count and lymphocytes were 53.9×109/l and 42.0×109/l respectively. CT hea...

A 74-year-old male presented with acute onset retro-orbital pain and nausea. He also complained of blurred vision and inability to open his left eye. There was no family history and the only past medical history was hypercholesterolemia treated with simvastatin. Clinical examination revealed a complete left ptosis, the left pupil was dilated with sluggish reaction to light and there was impaired adduction of the left eye. Visual fields and visual acuity were normal. Examinatio...

Introduction: The N-formyl peptide receptor (FPR) family of G-protein-coupled receptors, originally identified to recognise N-formylated bacterial peptides, has in more recent times been shown to bind annexin-1 (ANXA1). ANXA1 is a signalling molecule well demonstrated to mediate two key glucocorticoid effects in the anterior pituitary: inhibition of ACTH release from corticotrophs and regulation of cell proliferation. Whilst previous RT-PCR studies have detec...

Vasopressin (VP) and oxytocin (OT), the antidiuretic and natriuretic hormone, respectively, maintain the osmotic homeostasis. These molecules are synthesized in the magnocellular neurons (MCNs) of the supraoptic nuclei (SON) in the hypothalamus, transported via the axons toward the neural lobe of hypophysis (NLH) and released into the blood stream.Dp71 is the major form of dystrophins in the SON and NLH, where it was located in the glial-end-feet and end...

Introduction: It is well-known that prolactinomas sometimes resolve following pregnancy. We wanted to see how often this happens and pregnancy outcome.Patients and methods: From mid 2008 to mid 2013, 66 patients with hyperprolactinemia were studied. 39 had definite microprolactinomas, four probable microprolactinomas, three macroprolactinomas, eight nontumoral hyperprolactinemia and 12 patients were diagnosed elsewhere so no scan results were available. ...

A 26-year-old man presented with a 3-month history of polydipsia, polyuria and nocturia. Physical examination was unremarkable. Random blood glucose was 5.1 mmol/l, sodium 147 mmol/l, serum osmolality 297 mOsm/kg, urine osmolality 81 mOsm/kg. A water deprivation test confirmed cranial diabetes insipidus. Magnetic resonance imaging (MRI) of his pituitary gland revealed nodular thickening of the pituitary stalk suggestive of inflammatory or neoplastic aetiology. He also complain...

Gonadotrophs in rats, mice and humans, express an intact natriuretic peptide system, in which C-type natriuretic peptide (CNP) is the predominant member. Despite showing an interaction between CNP and GnRH at the level of cGMP and Ca2+ signalling, the role of CNP in gonadotroph biology is poorly understood. In this study, we utilise a novel multiplex qRT-PCR assay, examining simultaneous expression of natriuretic peptide genes along with genes for gonadotroph transc...

Management of newly-diagnosed non-functioning pituitary adenomas (NFPAs) has evolved over the last decade. Whilst surgical debulking remains the mainstay of treatment for patients presenting with compressive disease, the use of pituitary irradiation has declined, with greater emphasis on observation or further surgical debulking. We aimed to compare outcomes of treatment for NFPAs at our institution since 2004 with older management strategies.We reviewed...

BackgroundPancytopenia due to hypopituitarism has been reported previously in the literature. Most of these case reports relate to hypopituitarism secondary to Sheehan’s syndrome. We report a case of isolated ACTH deficiency causing pancytopenia which was successfully treated with hydrocortisone replacement.Case history: A 71-year-old lady with a known history of treated hypothyroidism and learning disabilities was referred to...

Introduction: Pituitary apoplexy (PA) remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of evidence in the management of this condition. We present our experience of 23 current cases.In classical acute PA, headache is the commonest presenting symptom. We found that a significant proportion (36%) of patients presented with subacute pituitary tumour apoplexy (SPA) – a term used to describe intra-adenomatous pituitary ha...

Objective: We studied the prevalence of endocrine dysfunction in subjects with idiopathic Parkinson’s disease (IPD) on newer dopaminergic agents (DA). DA are used in endocrine hypersecretory states in small doses and we hypothesized that endocrine dysfunction was likely in IPD where DA was used in comparatively much higher dosage.Patients and methods: 25 subjects with IPD on DA for were recruited to this cross-sectional study. We measured IGF1, prol...

Introduction: The HPA axis is essential for mammalian life. Glucocorticoids are commonly administered and long-term HPA axis suppression is a major clinical problem. Previous experiments in our lab have shown that long-term treatment with glucocorticoids cause silencing of tpit, a pituitary-specific master regulator of the key player in HPA axis regulation – propiomelanocortin (pomc). Even after withdrawal of treatment tpit expression is silence...

A 41-year-old woman was referred with 9 months history of secondary amenorrhoea and galactorrhoea. She was otherwise well and not taking any medications. Biochemical evaluation showed prolactin 2000 mU/l but otherwise unremarkable. Pituitary MRI revealed a 30 mm pituitary lesion with right cavernous sinus invasion, presumed to be a craniopharyngioma due to the presence of calcification. Surgical intervention was recommended, but the patient declined. She was commenced on caber...

A 68-year-old patient was noted to have prognathism, broad fingers and toes and coarse facial features during her admission for a hip replacement 2 years ago. Her family noted change to her facial features and she admitted to increase in her shoe size over 10 years. Her past medical history included treated hypertension only. Her oral glucose tolerance test (OGTT) confirmed paradoxical rise of GH with peak 6.23 μg/l. Her initial IGF1 was raised at 131 nmol/l (6–30 nm...

A 33-year-old woman was referred to our service for investigation of secondary amenorrhea. She is from India and moved to the UK 8 years ago. She has two children aged 7 and 4 years. She has a history of TB adenitis treated in 2007 with quadruple anti TB medication for 6 months. She was told she had no pulmonary involvement and was clear after treatment. She is currently on no medication. During 2012 she noticed her menstrual cycles were lengthening with amenorrhoea since Janu...

Aim: The insulin tolerance test (ITT) is considered the gold standard test in assessing the integrity of the hypothalamic–pituitary–adrenal (HPA) axis. The aim of this study is to evaluate if the 0900 h cortisol levels can be predictive of the patient’s response to hypoglycaemia, minimizing the use of the ITT as it is labour, intensive and unpleasant for the patient.Methods: This is a retrospective study of 110 ITTs performed at the Endocr...

Langerhan cell histiocytosis (LCH) is a rare; incidence 1.8/100 000. It affects bone, skin, and pituitary but can involve any organ. Diabetes insipidus (DI) is reported in 15–50% of patients, and anterior pituitary dysfunction in 5–20%. We describe a patient whose diagnosis was delayed because of the challenge in making a tissue diagnosis.A 42-year-old female presented in 2010 with sudden onset deafness and vertigo then 1 year later developed D...

A 60-year-old female was referred to the department in October 2010 after a CT thorax revealed an incidental finding of a right adrenal nodule. On questioning, the patient reported some sweats but otherwise no other symptoms of hormonal excess. Adrenal functional studies were normal and it was therefore decided that the patient should have a repeat CT scan in 6 months. Repeat CT adrenal glands in April 2011 did not show any changes to the size of the nodule but gave indetermin...

A 53-year-old retired military soldier had a 9 months history of recurrent blackouts predominately associated with blurred vision, feeling shaky, sweaty and they were mainly before meal. His past medical history included asthma, multiple shrapnel injuries, hearing impairment secondary to blast injury. He was on atorvastatin, ompeprazole and inhalers.He was admitted acutely to his local hospital and blood glucose 0.6 mmol/l was found. Prolonged 72 h fast ...

Tuberculosis affecting the pituitary gland is a rare phenomenon and is usually the result of haematological spread from another site. Only 0.9% of cases of TB in the UK, in 2012, showed any CNS involvement, excluding meningitis1. The clinical presentation of pituitary TB, range of hormonal dysfunction and radiological features can vary, making it hard to identify the condition. We report two clinical cases seen in our department.Case 1: A 48-y...

PANCH tumour (pituitary adenoma with neuronal choristoma), is a very rare form of pituitary pathology composed of a mixed pituitary adenoma/gangliocytoma. We describe a patient with acromegaly who had evidence of GH synthesis in the neuronal component of a PANCH tumour. A 55-year-old woman was found to have facial features of acromegaly, confirmed biochemically: basal GH 13.56 ng/ml, GTT nadir 8.87 ng/ml, and IGF1 raised at 97.2 nmol/l (ref 9–40). Pituitary function was o...

Introduction: Sheehan’s syndrome is hypopituitarism occurring due to pituitary infarction secondary to severe post-partum haemorrhage. Here, we are presenting an interesting case history of Sheehan’s syndrome diagnosed 15–20 years after its onset.Case history: A 47-year-old lady attended emergency room (ER) with recurrent episodes of nausea, vomiting and dizziness on standing. Initial evaluation revealed hypotension and the random...

Diabetes insipidus is characterised clinically by the inappropriate production of large volumes of dilute urine, even in the presence of clinical dehydration or depravation of water. DI occurs either due to deficiency or insufficiency of arginine vasopressin (AVP) hormone production. The gold standard test remains the water deprivation test. Hereditary DI accounts for <10% of all cases.We present a family with a known heterozygous missense mutation, ...

Somatotroph adenomas (SA) causing acromegaly are histologically classified into densely (DG) and sparsely granulated (SG) subtypes. We1 and others have shown that these histological subtypes may be clinically relevant. In short, SGSAs are generally found in younger, mainly female patients. They are larger at presentation, more invasive and show higher proliferation indices compared with DGSAs. Fibrous bodies (FBs) are the histological hallmark of SGSAs; they consist...

Sleep disordered breathing (SDB), including obstructive sleep apnoea (OSA), is associated with excessive daytime somnolence, and impacts significantly on quality of life in affected individuals. It also predisposes to premature cardiovascular (hypertension, congestive cardiac failure, myocardial infarction, sudden death, and stroke) and metabolic (diabetes mellitus and dyslipidaemia) dysfunction.SDB is a well-recognised complication of acromegaly. In mos...

Background: The peptide hormone kisspeptin is essential for human reproduction, acting on the hypothalamus to stimulate GnRH secretion. Kisspeptin is emerging as a possible novel therapeutic for women with infertility. However animal studies suggest that kisspeptin may also stimulate pituitary secretion of GH, prolactin, and TSH, which has important implications for its safety. There has been no previous study investigating kisspeptin effects on non-reproductive hormones in hu...

Introduction: Severe brain injury is usually sustained as a result of road traffic accident or high impact fall. Initial presentation of patients depends upon the severity of brain injury. Survivors of severe brain injury carry significant morbidity and often need prolonged period of rehabilitation. About one third of these patients are suspected to have partial or complete pituitary dysfunction which can manifest insidiously many months after the initial insult. Recognition a...

Background: SAH is a significant cause of morbidity and mortality. Survivors report long term psychological distress, sleep disturbance, libido changes and fatigue. Previous studies describe an increased incidence of hypopituitarism.Hypothesis: Evaluation of psychological symptoms and clinical and radiological features of SAH could predict the incidence of hypopituitarism.Patients and Methods: 102 post-interventional SAH survivors ...

Acromegaly causes impaired insulin sensitivity and reduced fat mass. Using acipimox to block lipolysis, the impact of free fatty acids (FFA) on insulin sensitivity in active acromegaly was investigated. 1H MRS was used to quantify triglyceride (TG) content of liver and muscle.Methods: 6 patients with active acromegaly (AA) (5M, age 59 (34–70), IGF-I (ng/ml) (median (range)) (452 (342–1002)) were studied on 2 visits; (i) baseline (BL)...

A 55-year-old male was referred to the endocrine clinic in October 2006 with a 6 month history of reduced libido, lethargy and right sided retro-orbital headaches. He was otherwise well and not on any medications. Examination revealed gynaecomastia, but no other cutaneous stigmata of endocrinopathies and visual fields were full to confrontational testing.Prolactin was elevated to 4791 mU/l, and a subsequent MRI confirmed a macroadenoma measuring 8×1...

Background: Thyrotropin secreting adenomas (TSHoma) are considered to be rare pituitary tumours. However, improvements in imaging techniques and greater use of more sensitive thyrotropin (TSH) assays has led to a recent increase in the detection rate of TSHomas and, specifically, the identification of more microadenomas. Surgery is considered the mainstay of treatment, however, primary medical therapy with somatostatin analogues is an emerging alternative therapeutic option.</...

Anterior pituitary hyperplasia is known to occur with primary hypothyroidism mimicing a pituitary tumour. Massive ovarian enlargement is sometimes associated with juvenile primary hypothyroidism but rarely reported in adults. We report a case of a 23-year-old female who presented with features of a pituitary macroadenoma and bilateral ovarian enlargement which regressed completely with thyroxine therapy.A 23-year-old woman presented with nipple discharge...

Background: It is estimated that 1-6% of patients with a pituitary adenoma develop ocular nerve palsies. These are primarily due to tumour extension into the cavernous sinus and most commonly affect the 3rd cranial nerve. Because of its sheltered position within the sinus, the 6th cranial nerve is rarely affected. When this does occur, it most commonly results from ischemic neuropathy secondary to diabetes, hypertension or mononeuritis multiplex.<p cl...

Background: We report a case of a 35-year-old male presenting with pituitary dysfunction secondary to an optochiasmal cavernoma.The gentleman was initially referred with gynaecomastia and biochemical tests consistent with secondary hypogonadism. On further questioning he also reported extremely lethargy, difficulties with weight loss and poor libido. Examination was consistent with features of hypogonadism with reduced body hair, bilateral gynaecomastia ...

Background: Germline mutations of the AIP tumour suppressor gene are associated with familial and sporadic pituitary adenomas, yet the tumorigenic mechanisms remain unclear. In addition, AIP protein expression in somatotroph adenomas from patients without AIP mutations correlates with clinical behaviour and somatostatin analogues responsiveness. Understanding the regulation of AIP gene expression will help uncover its pituitary tumour-suppressor role.Aim...