Anne Marie Hannon

The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study

The syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatraemia. Data on SIAD are mainly derived from retrospective studies, often with poor ascertainment of the minimum criteria for the correct diagnosis. Reliable data on the incidence of adrenal failure in SIAD are therefore unavailable. The aim of the study was to describe the aetiology of SIAD and in particular to define the prevalence of undiagnosed adrenal insufficiency.

Diabetes in Patients With Acromegaly

Purpose of ReviewAcromegaly is a clinical syndrome which results from growth hormone excess. Uncontrolled acromegaly is associated with cardiovascular mortality, due to an excess of risk factors including diabetes mellitus, hypertension and cardiomegaly. Diabetes mellitus is a frequent complication of acromegaly with a prevalence of 12–37%. This review will provide an overview of a number of aspects of diabetes mellitus and glucose intolerance in acromegaly including the following:1.Epidemiology and pathophysiology of abnormalities of glucose homeostasis2.The impact of different management options for acromegaly on glucose homeostasis3.The management options for diabetes mellitus in patients with acromegalyRecent FindingsGrowth hormone and IGF-1 have complex effects on glucose metabolism. Insulin resistance, hyperinsulinaemia and increased gluconeogenesis combine to produce a metabolic milieu which leads to the development of diabetes in acromegaly. Treatment of acromegaly should ameliorate abnormalities of glucose metabolism, due to reversal of insulin resistance and a reduction in gluconeogenesis. Recent advances in medical therapy of acromegaly have varying impacts on glucose homeostasis. These adverse effects influence management choices in patients with acromegaly who also have diabetes mellitus or glucose intolerance.SummaryThe underlying mechanisms of disorders of glucose metabolism in patients with acromegaly are complex. The aim of treatment of acromegaly is normalisation of GH/IGF-1 with reduction of co-morbidities. The choice of therapy for acromegaly should consider the impact of therapy on several factors including glucose metabolism.

IgG4 hypophysitis – a rare and underdiagnosed cause of pituitary gland and stalk mass-like thickening

Abstract Our aim is to present a typical case of IgG4-related hypophysitis, which will offer insight into the aetiology and pathogenesis of this relatively newly described disease. IgG4 Related Disease is a protean systemic condition that mimics inflammatory, infectious, and malignant processes. Biopsy of affected organs will show a typical histopathological pattern.

Mortality rates are lower in SIAD, than in hypervolaemic or hypovolaemic hyponatraemia: Results of a prospective observational study

Hyponatraemia is associated with increased mortality, but the mortality associated specifically with SIAD is not known. We hypothesized that mortality in SIAD was elevated, but that it was less than in hypervolaemic (HEN) or hypovolaemic (HON) hyponatraemia.

Secondary resistance to tolvaptan in two patients with SIAD due to small cell lung cancer

Sir, Syndrome of inappropriate antidiuresis (SIAD) is characterized by euvolaemic hyponatraemia due to the antidiuretic effects of inappropriate elevation of plasma vasopressin (pAVP, also referred to as antidiuretic hormone (ADH)). Randomized controlled trials report a good response to tolvaptan-induced vasopressin receptor blockade, with reversal of hyponatremia in SIAD [1], including those with lung cancer [2]. Prolonged treatment is effective for up to four years [3]. We report two patients with small cell lung cancer (SCLC) who showed an initial good response to tolvaptan, but who subsequently displayed resistance to the aquaretic effects of the drug.

Clinical features and autoimmune associations in patients presenting with Idiopathic Isolated ACTH deficiency

Idiopathic Isolated ATCH deficiency (IIAD) is a rare cause of secondary adrenal insufficiency. As the condition is rare, and the diagnostic criteria ill‐defined, there are few good clinical descriptions in the literature. We have described presenting features, autoimmune associations, natural history and responses to CRF, in a large case series of patients presenting with IIAD.

VARIABLE THYROID-STIMULATING HORMONE DYNAMICS IN 'SILENT' THYROTROPH ADENOMAS

ABSTRACT Objective: Pituitary adenomas that produce thyroid-stimulating hormone (TSH) are typically accompanied by hyperthyroxinemia and a non-suppressed or elevated TSH at diagnosis. Occasionally, patients with this type of tumor have normal thyroid function test results, a condition termed ‘silent’ thyrotroph adenomas. This report characterizes TSH dynamics in this rare pituitary tumor subtype. Methods: We report 2 cases of pituitary macroadenoma associated with visual failure and hypopituitarism. The patients had normal thyroid function test results but the adenoma was intensely immunopositive for β-TSH expression. The results of TSH dynamics are reported for both cases. Results: Preoperative assessment did not reveal any clinical or biochemical evidence of pituitary hormone excess save mild, asymptomatic hyperprolactinemia consistent with pituitary stalk compression. In particular, thyroid function test results were within normal ranges. In both cases, each patients vision recovered following transsp...