Endocrine Abstracts

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 indeterminate washout characteristics. It also flagged up an incidental finding of bilateral renal cysts and recommended imaging with ultrasound. This revealed simple renal cysts but an incidental finding of a renal stone in the lower pole of the left kidney. Patient was referred to the urology team who then made a note of an incidentally raised serum calcium level. Patient was therefore re-referred back to endocrine clinic where her biochemistry was consistent with primary hyperparathyroidism. Localisation studies did not show concordance and therefore patient was offered bilateral neck operation which she refused. Coincidentally, baseline pituitary function tests were carried out although the indication for this was unclear. Surprisingly, this revealed a raised IGF1 value 57.2 nmol/l (9.8–27.6 nmol/l). Patient then proceeded to have an oral glucose tolerence test which revealed a GH nadir of 1.6 μg/l. She was otherwise eupituitary. MR scan of the pituitary revealed a small 7 mm right sided microadenoma. Patient proceeded to have endoscopic transphenoidal surgery. Post-operative testing revealed biochemical cure with a GH nadir of 0.1 μg/l on oral glucose tolerance test and a normalized IGF1 value 155 ng/ml (41–168). MEN genetic screening was negative and screening fasting gut peptides were also negative.