Endocrine Abstracts

A 73 year old male presented to his optician with reduced vision in his right eye. He was found to have a right sided visual field defect and referred to Opthalmology. An MRI scan was arranged which showed a 29 x 22 x 17mm pituitary fossa mass, elevating and flattening the optic chiasm. He was therefore referred urgently to Endocrinology. He denied any symptoms other than some lethargy, a mild headache and erectile dysfunction. His anterior pituitary function tests are display...

35-year-old lady, has a background of Hypertension, oophorectomies for ovarian cancer and previous 2 IVF attempts, referred to endocrinology with three-week history of blurred vision, bitemporal hemianopia and large pituitary mass on MRI Upon assessment, she reported visual disturbance and intermittent headache. She has no periods which is expected with the history of oophorectomy, but she denied galactorrhoea or any symptoms suggestive of pituitary hormone excess or deficienc...

45/M presented to hospital with h/o assault on head (hit by meat cleaver). Background history of drug abuse and previous drug induced psychosis. Trauma CT head revealed mass in the enlarged pituitary fossa. MRI head revealed 5 x 4 cm mass in the sella turcica encasing the internal carotid vessels but sparing optic chiasma. Visual field examination was normal and no other clinical symptoms were present. Serum prolactin was 67922. Tumor was not for resection so medical treatment...

A 51F domestic worker presented with classic clinical and biochemical features of acromegaly. This included a long history of arthralgia, increase in hand and foot size, paraesthesia requiring bilateral carpal tunnel release and coarsening of facial features. She was also newly diagnosed with hypertension and diabetes. On examination she demonstrated central adiposity, a prominent supra orbital ridge and nasal bridge, prognathism, interdental spacing, skin tags, and broad hand...

42-year-old male with past medical history of intermittent migraines, only 1 episode this year and no known family history was referred by ophthalmology with history of sudden onset of visual loss for 4 weeks. He described having woken up with visual blurring 4 weeks ago and same degree of blurriness has remained since with no improvement or progression. He denies any headaches, nausea, vomiting or limb weakness. He suffered from covid 19 infection 1 week before presentation. ...

A 47 year old lady referred to the endocrine clinic following raised prolactin levels picked up on investigation for infertility in 2013. She had irregular periods with cycle length up to 50 days. Peak prolactin following diagnosis was 1309mIU/l. She had no headaches, visual problems or galactorrhoea. An MRI head had picked up a 6.3 x 6.9 x 8.3mm right sided pituitary mass in 2013. She was commenced on Bromocriptine. Her periods normalised on treatment to 24 to 25 day cycles. ...

A 41 year-old gentleman, known case of type 2 diabetes, presented to the emergency department after a witnessed episode of jaw clenching followed by unresponsiveness. The patient was amnesic to the event. He was noted to have a lateral tongue bite. He also reported a similar episode 8 months previously. Initial blood investigations including a random blood glucose were normal. A sulphonylurea induced hypoglycaemia was excluded. Brain imaging by means of a Computed Tomography (...

A 52 year old gentleman was referred for an inpatient Endocrinology review. He was admitted after incidental finding of severe hyponatremia of 119. He felt unwell after having an episode of vomiting at home a few days ago and then had his bloods done at primary care. He denied any headache, dizziness, or visual disturbance. Further investigations were requested which revealed plasma osm 247, urine osm 350, and urine sodium 132. A diagnosis of SIADH was established and he was p...

Pituitary apoplexy is a rare but potentially life-threatening condition that occurs due to sudden hemorrhage or infarction in a pre-existing pituitary adenoma. Here, we present a case study of a 20-year-old girl who presented to the emergency department (ED) with severe headache due to pituitary apoplexy. The patient had a history of one-year intermittent headache, which was diagnosed as migraine/cluster headache in previous ED visits. She was on Mirena coil and had amenorrhea...

Introduction: Prolactinoma are the commonest functioning pituitary tumors. Pressure symptoms such as headache and visual field defect are common in patients with macroprolactinoma. Early investigation and intervention can deter permanent visual impairment, pituitary apoplexy and panhypopituitarism.Case vignette: 27-year-old lady presented to ophthalmologist with two months history of headache with visual impairment on the right side. She was found to hav...

A 44 year old man was referred in 2012 to his local endocrine service for headaches and visual deterioration with bi-temporal hemianopia. His prolactin was found at 107,240 mU/l(85-325) and pituitary MRI demonstrated a 3.1x1.5x3.3 cm adenoma, compressing the optic chiasm. He was commenced on cabergoline 0.5 mg twice per week and hydrocortisone 20 mg and 10 mg empirically and was referred to us. On review in our Pituitary clinic, he reported considerable improvement in his head...

A 29yrs lady presented to endocrinology clinic with 2-3 stone weight gain over a 3 year period which was central in nature, associated with rounding of her face, muscle weakness, fatigue and ease of bruising. She was plethoric and had a number of violaceous striae since age 22yrs suggesting her Cushing’s syndrome was long-standing. Her past history included renal calculi, liver focal nodular hyperplasia and hidradenitis suppurativa. Initial investigations showed LH 5.5iu/...

The goals of treatment for a prolactinoma are to normalise serum prolactin and decrease the size of the tumour. Dopamine agonists (cabergoline is first-line) represent primary therapy for almost all prolactinomas. Some prolactinomas exhibit resistance to dopamine agonist treatment and require higher doses. Our patient was a 35-year-old male who presented to Ophthalmology in March 2021 with visual disturbance, confirmed to be secondary to a bitemporal hemianopia. OCT showed bil...

A 19-year-old man attended his optician with an 18-month history of decreased visual acuity. Formal visual field testing revealed significant bitemporal hemianopia. On further questioning in hospital, his voice had deepened only 6 months previously. He had no facial hair. He had no difficulty with erections or libido. He had felt fatigued for months, but had no headaches, weight loss or postural dizziness. There was no history of galactorrhoea, gynaecomastia, nocturia, or exce...

A 19 year old male was referred urgently due to a significantly raised Prolactin. He had seen his GP due to a cough, who then noted the patient had not progressed through puberty and organized further testing. On examination he had a BMI of 47. His height was 178 cm with a target of 184.5 cm (range 176-193). He had bilateral gynaecomastia with micropenis and pre-pubertal testes. He had never shaved and his voice was high-pitched. He did not report anosmia. Visual fields were n...

Introduction: Pituitary apoplexy is an endocrinological emergency that can be life-threatening if treatment is delayed. Apoplexy occurs either due to haemorrhage or infarction of a pituitary tumour.Case History: A 19-year-old male, presented with a sudden severe headache and visual disturbances. The examination was normal with stable haemodynamic parameters and tanner staging 5. An urgent MRI pituitary revealed a haemorrhagic pituitary macroadenoma compr...