Marie Freel

Endocrine aspects of pre-eclampsia

Pre-eclampsia, defined as hypertension with proteinuria occurring after 20 weeks’ gestation, complicates up to 8% of pregnancies and is a major contributor to perinatal morbidity and mortality worldwide. It is now widely accepted that pre-eclampsia is also associated with the risk of maternal cardiovascular disease in later life. Although the pathogenesis of this complex condition remains incompletely understood, impaired placentation and subsequent endothelial dysfunction and inflammation are among the proposed hypotheses. In recent years, there has been a resurgence of interest in the pivotal role of aldosterone and volume status in pre-eclamptic pregnancy. This review will focus on the endocrine mechanisms believed to underpin development of pre-eclampsia and its early and late complications.

Recurrent bronchial carcinoid tumour presenting as a thyroid nodule

References 1. Skuladottir H, et al: Pulmonary neuroendocrine tumors: incidence and prognosis of histological subtypes. A population-based study in Denmark. Lung Cancer. 37(2), 127 (2002). 2. Gustafsson BI, et al: Bronchopulmonary neuroendocrine tumors. Cancer. 113(1), 5 (2008). 3. Ferguson MK, et al: Long-term outcome after resection for bronchial carcinoid tumors. Eur J Cardiothorac Surg. 18(2),156 (2000). 4. Fink G, et al: Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 119(6):1647 (2001). 5. De Dosso S, et al: Pulmonary carcinoid tumours: indolent but not benign. Oncology. 73(3-4), 162-8 (2007). 6. Capel I, et al: Cervical paraganglioma mimicking a thyroid nodule with recurrent nerve involvement. Endocrinol. Nutr. 59(4), 274-5 (2012). 7. Phitayakorn R, et al: Thyroid-associated paragangliomas. Thyroid. 21(7), 725-33 (2011). 8. Sivrikoz E, et al: Neuroendocrine tumors presenting with thyroid gland metastasis: a case series. J Med Case Rep. 6, 73 (2012). 9. Maly A, et al: Isolated carcinoid tumor metastatic to the thyroid gland: report of a case initially diagnosed by fine needle aspiration cytology. Acta Cytol. 50(1), 84-7 (2006). 10. Phan AT, et al: NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors. Pancreas. 39(6),784-98 (2010). Mananagement •Right lower and middle lobectomy Nov 2003 •Histology confirmed typical carcinoid tumour with complete resection margin •Well and back to work by Feb 2004. Discharged from respiratory follow-up L Hall 1, D Carty 1, C Smith 1, M Freel 1, N Reed 2, C Perry 1

Mineralocorticoids and Mineralocorticoid Excess Syndromes

Adrenal steroids can be subdivided according to their chemical structures and physiological properties into glucocorticoids, mineralocorticoids, and androgens. The principal human mineralocorticoid in humans is aldosterone, which is produced in small amounts (100–150 μg daily) by the outermost region of the adrenal gland, the zona glomerulosa. The precursor compounds, deoxycorticosterone and corticosterone, also have weak mineralocorticoid activity. Mineralocorticoid production by the adrenal cortex is substantially less than glucocorticoid synthesis. Cortisol (principal human glucocorticoid) production in the zona fasciculata is of the order of 10 to 20 mg daily.