Endocrine Abstracts

Pituitary macroadenomas often extend to the suprasellar region, however rarely they can extend inferiorly and include erosion into the sphenoid bone, presenting unique challenges. We present a 74-year-old female who received pituitary radiotherapy in 1995 for a pituitary macroadenoma with sphenoid extension. She initially presented in 1994 with secondary amenorrhoea and hyperprolactinaemia (30,000 mu/l). She could not tolerate MRI and subsequent CT showed a pituitary macroaden...

Ovarian neuroendocrine tumours are rare (< 2% gynaecological tumours) and first described in 1939 by Stewart et al. The occurrence of carcinoid heart disease alongside this is anecdotal. We present a previously fit 66 year old female, with a 6 month history of shortness of breath and ankle oedema. Echocardiogram revealed severe fixed tricuspid regurgitation, pulmonary valve disease, dilated right heart chambers and preserved left ventricular function. Carcinoid heart disea...

Background: Pituitary haemorrhage or infarction into a pituitary tumour is well reported unlike isolated Pituitary haemorrhage due to traumatic injury of a normal gland.Case report: A previously healthy 44-year-old man presented following two episodes of seizures following a closed head injury. He reported transient extreme thirst, polyuria and headache at the outset, which had resolved by the time of admission. His Glasgow Coma scale was 14/15 and his c...

We present a case of 71-year-old gentleman who presented with bitemporal hemianopia in 2008 with pituitary apoplexy compressing the optic chiasm. Prolactin was 55287MU/l, with deficiency of all other anterior pituitary hormones. He underwent transphenoidal adenectomy (TSA). Prolactin was 35633MU/l post-operatively and cabergoline was commenced. Histology was consistent with a lactotroph adenoma with MiB-1 index of 3–5%. Visual fields recovered and prolactin was normal unt...

Case: 60 year old transfemale had normal delivery, milestones and puberty. She developed gynaecomastia aged 14, associated obesity which resolved. As an adult she had reduced facial and body hair and reduced sexual function prior to hormone therapy but normal self-reported genitalia. She has female role from age of 24. She never had any children and was commenced female hormones 36 years ago. These were Premarin and Cyproterone Acetate which were continued post genital reconst...

Introduction: Limbic encephalitis is characterised by seizures, changes in personality and memory impairment. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with autoimmune limbic encephalitis is rare. We present an interesting case.Case: A 57-year-old gentleman presented with seizures and a cardiac arrest. He had a past history of excess alcohol intake and had been taking excess alcohol prior to this event. Physical examinat...

We present a case of a 48 year old male who presented originally with a 8mm prolactinoma. He presented with a reduced libido for 6 months, and lethargy and retro-orbital headaches for the previous 18–24 months. He had no visual disturbance. Initial investigations revealed hyperprolactinaemia with a level of over 4000 iu/L and a normal IGF1 of 184 iu/L in the presence of a pituitary macroadenoma (8 x 11mm). He responded well to Cabergoline with a noticeable improvement in ...

Germline aryl hydrocarbon receptor-interacting protein (AIP) mutations are responsible for 30% of pituitary gigantism cases. However, pathological accelerated growth and/or tall stature can be unrelated to the growth hormone (GH) axis, and may occur in isolation or as part of a syndrome, such as in Klinefelter, Marfan or Sotos syndromes. We report a five-generation kindred with two brothers with pituitary gigantism due to AIP mutation-positive GH-secreting pi...

Introduction: Pituitary apoplexy is both an endocrine and a neurosurgical emergency, and can typically present with sudden onset of headaches, impaired level of consciousness, fever, visual disturbances, nausea or vomiting. Apoplexy ensues when pre-existing pituitary tumour presumably outgrows its blood supply leading to ischaemia, necrosis and haemorrhage or infarction.Case: A 31-year-old man presented to the hospital with 3 months’ history of grad...

A 26 year old man of Angolan descent presented to the endocrine clinic with poorly controlled hypertension (systolic blood pressure >200 mmHg). He had been treated with Amlodipine for almost six years, and more recently the addition of Irbesatan and Indapamide had not led to adequate blood pressure control. His hypertension was diagnosed at age 19 and progressive features of Cushing’s disease had remained unnoticed, with truncal striae, easy bruising, myopathy, puffin...

Dopamine agonists (DA) are first line therapy for Prolactinoma which normalises prolactin(PRL) level in 80% of cases at a median weekly dose of 1 mg. An accepted criterion of pharmacological resistance to DA is failure to normalize PRL levels. We report a case of aggressive macroprolactinoma that required 7 mg of Cabergoline to reduce prolactin despite radiological evidence of tumour shrinkage. A 42 year old male presented with a bitemporal field defect. Imaging confirmed an i...

Adeno-gangliocytomas are rare tumours of the pituitary gland with less than 40 cases described worldwide. Due to the rarity of these tumours, treatment modalities largely follow that of conventional therapies for common pituitary lesions. Case reports on these tumours offer insight into their presentation and the effectiveness of treatment which helps guide future management. A 64-year-old man was admitted for stone fragmentation and ureteric stent insertion. During anaestheti...

A 36-year-old, previously healthy, man presented with several weeks’ history of gradually worsening headache. He attended A&E after he was woken by sudden worsening of the headache, associated with vomiting and pre-syncopal symptoms. Investigations revealed severe hyponatraemia - serum Na 109 mmol/L. He was also severely hypocortisolaemic – serum cortisol (random) 16 nmol/L, ACTH 19 ng/L. Cranial imaging revealed a 17 mm suprasellar, complex cystic pituitary lesi...

Introduction: We present the case of a clinically functioning gonadotroph adenoma in a pre-menopausal woman with abdominal pain, bilateral multi-cystic ovaries and fibromatosis. To our knowledge, this is the first case of fibromatosis associated with a functioning gonadotroph adenoma.Case: A 36 year old female presented on three occasions with acute abdominal pain. She was previously well and had two normal pregnancies. On the first admission, she underw...

Introduction: Hypoglycaemia is an endocrine and medical emergency. It is usually due to the excessive dose of insulin or oral anti-diabetic agents. Although rare, hypoglycaemia can be a tumour–induced. Some of the other causes include renal and liver failure, hormonal deficiency, antibodies to insulin, infection, starvation, spontaneous hypoglycaemia and reactive hypoglycaemia.Case report: A 70-year-old man presented with 6 months’ history of r...

Background: The blood supply of the pituitary gland comes via a portal circulation from the hypothalamus. During pregnancy, the anterior pituitary gland enlarges but the blood supply cannot increase, as it is derived from a capillary plexus. The pituitary is thus vulnerable to arterial pressure changes and infarction secondary to hypotension. We describe a case of a male patient with large pituitary adenoma who developed Sheehan’s like syndrome due to adenoma infarction s...

Background: The effect of weight loss on hypothalamic function is complex and not fully understood. There is interplay between neuropeptides (leptin, ghrelin) and hypothalamus with the postulated aim of energy conservation and prevention of pregnancy during unfavourable conditions. We present a memorable case.Case: A 35-yr-old lady presented with secondary amenorrhoea of 17 years duration. She attained menarche at age 13. At age 16 her periods became sca...