Endocrine Abstracts

A 52 year-old female, newly diagnosed with Type 2 Diabetes during pre-operative assessment for cholecystectomy, was referred to Diabetes clinic. An initial trial of metformin was discontinued in view of intolerable gastrointestinal side effects and the patient was started on low dose gliclazide. The patient’s main concern was her struggle to lose weight despite lifestyle measures, a seemingly common issue faced by patients with diabetes on sulphonylureas. On further examination the patient was noted to be plethoric, with a centripetal fat distribution and interscapular fat accumulation. Proximal myopathy was also noted. Hypertension was confirmed with a blood pressure of 180/90mmHg at clinic. Given the above investigations were consistent with Cushing’s syndrome, a non-contrast Computed Tomography (CT) Scan of the adrenal glands was done. This showed a 2.7 cm right adrenal nodule with an attenuation of 9 HU, compatible with an adenoma whereas the left adrenal gland was normal in size. The endocrine surgeons were subsequently involved and the patient underwent a laparoscopic right adrenalectomy three months later. In the interim she was optimsed with adequate glycaemic and blood pressure control. Throughout this period the patient complained of worsening proximal myopathy, and was thus given a trial of metyrapone. At induction of surgery the patient was given 100 mg of Hydrocortisone and subsequently kept on 50 mg Hydrocortisone 6 hourly while nil by mouth. At day 2 after surgery, 9am cortisol was repeated (having omitted last evening and first morning hydrocortisone doses) in order to ensure the adenoma had been excised. A cortisol level of 62 nmol/lmeant that altough an appreciable difference was notable the patient will need to be surveilled closely for recurrence. Histology later confirmed an adenoma with no suspicious features. Oral hydrocortisone at a dose of 20 mg-10 mg-10 mg was started once the patient was tolerating oral intake. This was tailed down gradually with decrements of 5 mg of hydrocortisone per month. The patient is currently off antihypertensive therapy and demonstrates improved glycaemic control with a single daily dose of gliclazide.