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Endocrine Abstracts December 2008 Volume 18 ISSN 1470-3947 (Print) ISSN 1479-6848 (Online) 3rd Hammersmith Multidisciplinary Endocrine Symposium 2008 12 December 2008, London, UK Endocrine Abstracts December 2008 Volume 18 ISSN 1470-3947 (print) ISSN 1479-6848 (online) 3rd Hammersmith Multidisciplinary Endocrine Symposium 2008 12 December 2008, London, UK Online version available at 1470-3947(200812)18;1-K www.endocrine-abstracts.org EEJEA_18_cover.inddJEA_18_cover.indd 1 111/28/081/28/08 77:59:44:59:44 PPMM Endocrine Abstracts (www.endocrine-abstracts.org) Endocrine Abstracts (ISSN 1470-3947) is published by Copyright © 2008 by BioScientifica Ltd. This publication BioScientifica, Euro House, 22 Apex Court, Woodlands, is copyright under the Berne Convention and the Bradley Stoke, Bristol BS32 4JT, UK. Universal Copyright convention. All rights reserved. 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EEJEA_18_cover.inddJEA_18_cover.indd 2 111/28/081/28/08 77:59:48:59:48 PPMM Volume 18 Endocrine Abstracts December 2008 3rdHammersmith Multidisciplinary Endocrine Symposium 2008 12 December 2008, London, UK Abstract Book EDITORS Theabstracts were marked by theAbstractMarking Panellistedbelow Abstract Marking Panel SR Bloom London WDhillo London KMeeran London FPalazzo London 3rd Hammersmith Multidisciplinary EndocrineSymposium 2008 AbstractManagement BioScientifica Ltd Euro House Contact: Kate Openshaw 22 Apex CourtTel: +44 (0)1454642214 Woodlands Fax: +44 (0)1454642222 Bradley StokeE-mail: info@bioscientifica.com Bristol BS32 4JT,UKWeb site:http://www.bioscientifica.com Endocrine Abstracts (2008) Vol 18 3rd Hammersmith Multidisciplinary Endocrine Symposium 2008 CONTENTS 3rd Hammersmith MultidisciplinaryEndocrine Symposium 2008 ORAL COMMUNICATIONS ..............................................OC1–OC7 POSTER PRESENTATIONS ................................................P1–P41 INDEX OF AUTHORS Endocrine Abstracts (2008) Vol 18 3rd Hammersmith Multidisciplinary Endocrine Symposium 2008 Oral Communications Endocrine Abstracts (2008) Vol 18 3rd Hammersmith Multidisciplinary Endocrine Symposium 2008 OC1 not be solely reserved for recurrent disease. The rarity of adrenocortical Bilateral adrenalectomy in apatient with congenital adrenal carcinoma makes the undertaking of adequately poweredrandomised trials hyperplasia difficult. Owais Chaudhri1 ,Emma Hatfield1 ,Katie Wynne2 ,Fausto Palazzo1 , Sanjeev Mehta1 ,Humera Shaikh1 ,Tricia Tan1 ,Niamh Martin1 & Karim Meeran1 1 Endocrine Unit, Department of Investigative Medicine, Imperial College Healthcare NHS Trust, London, UK; 2 Department of Endocrine Surgery, Imperial College Healthcare NHS Trust, London, UK. OC3 An unusual case of hypertension We present the case of a33-year-old woman diagnosed with congenital adrenal Binu Krishnan &Emma Bingham hyperplasia (CAH)due to classical 21-hydroxylase deficiencyfollowing asalt- Frimley Park Hospital, Frimley, Surrey, UK. losing crisis as anewborn. She had previously been controlled on dexamethasone 0.25 mg bd and fludrocortisone 100 mcg od, as evidenced by high-normal 17-hydroxyprogesterone (17-OHP) and low-normal testosterone levels (8.5 and A21-year-old femalepatient was referred from the eye clinic after she was noted 0.4 nmol/l respectively). to have bilateral papilloedema during aroutine eye examination. She gave a3 However, she had experienced significant symptoms of Cushing’s syndrome on months history of intermittent headaches and fleeting episodes of profuse this replacement regimen (body mass index 34.6 kg/m2 ,striae). Areductioninthe sweating and rash, unrelated to the headaches. She had been investigated by the dose of dexamethasone resulted in secondary amenorrhoea and distressing GP with routine blood tests which were found to be normal. hirsutism refractory to treatment by conservative measures. Efforts to identify a On examination, shewas notedtobetachycardic at 100beats/min and steroid replacement dose that adequately suppressed adrenal androgen production hypertensive at 189/130 mmHg. She had erythematous maculopapular rashes without causing further progression of her iatrogenic Cushing’s syndrome were over the lower forearm and hand bilaterally. Examination of the fundus confirmed unsuccessful. bilateral papilloedema. ECG showed evidence of left axis deviation and left The patient underwent along synacthen test to characterise the level of residual ventricular hypertrophy. CXR showed normal sized heart and clearlung fields. adrenal cortisol synthesis. Cortisol levels were undetectable throughout, in the She was commenced on Nifedipine MR 20 mg bd. Ultrasound of the abdomen presence of asignificant rise in 17-OHPlevels (peak levels54.6 nmol/l), revealed a4cm right adrenal mass. MRI of the brain was reported as normal.An confirming complete blockade of the21-hydroxylase enzyme.Bilateral MRI of the adrenals and MIBG scan were arranged. adrenalectomy was therefore considered as atreatment option to permit the use Nifedipine was stopped and she was commenced on Phenoxybenzamine 10 mg of lower doses of exogenous steroid and removing the source of excess androgens. bd. As the patient remained well with improved control of her blood pressure, she She underwentanuncomplicated bilateral laparoscopic adrenalectomy in October was commenced on Propranolol 40 mg bd after 3days. 2007. One year later, she is maintained on hydrocortisone replacement (10 mg The patient unfortunately had acardiac arrest and died despiteprolonged am, 5mglunchtime) and has gradually lost weight. Symptomatically, she has resuscitation. The coroner reported cause of death as acute pulmonary oedema improved significantly. secondary to malignant hypertension due to aright adrenal phaeochromocytoma. Discussion will revolve around the use of adrenalectomy to overcome the difficult Results of 3 ! 24 hurinecatecholamines obtained thereafter showed nor- need to balanceadequate suppressionofadrenal androgen production vs weight adrenalinelevelsalmost100 times more than thenormal levels at gain in women with CAH. 11 800/24 700/19 100 m g/24 h(normal range ! 100) and normetanephrine levels at 100/47/30 m g/24 h(normal range ! 3.3). This case highlights the difficulty in treating these extremely rare tumours and the potentially fatal complications due to an adrenergic crises in these patients. OC2 Adrenocortical carcinoma presenting as Cushing’s syndrome: 2case
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