Ben C Whitelaw

Ben C Whitelaw
National Health Service | NHS · Department of Endocrinology

MBBS MA MSc

About

64
Publications
11,641
Reads
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757
Citations
Citations since 2017
23 Research Items
616 Citations
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2017201820192020202120222023020406080100120
2017201820192020202120222023020406080100120
Introduction
Ben Whitelaw currently works at the Department of Endocrinology, King's College Hospital NHS Foundation Trust. Ben does research on aggressive pituitary tumours and adrenal tumours. He also has a ongoing project on 'Unprofessional Communication.'

Publications

Publications (64)
Article
Full-text available
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinica...
Article
Full-text available
Temozolomide is an oral chemotherapy used to treat aggressive pituitary tumours since 2006. It is inexpensive and well tolerated, the main side effects are fatigue, nausea and cytopenia. Overall the studies demonstrate approximately 70% response rate for temozolomide, if response is defined radiologically as complete, partial response or stable dis...
Article
Case history: A 39 year old female had a first admission to her local hospital with cough and haemoptysis. She reported palpitations for the previous 6 months and had been previously investigated with an echocardiogram which showed a normal LV function. There was no other past medical history. During this first admission CT Pulmonary Angiogram (CTP...
Article
Myocarditis is inflammation of the cardiac muscle. The symptoms, signs and basic investigation findings can mimic that of myocardial infarction. The most common cause is infection (most commonly viral). Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive diagnostic test for potential acute myocarditis as it allows assessment o...
Article
Hypophysitis is a rare condition characterised by inflammation of the pituitary gland, usually resulting in hypopituitarism and pituitary enlargement. Pituitary inflammation can occur as a primary hypophysitis (most commonly lymphocytic, granulomatous or xanthomatous disease) or as secondary hypophysitis (as a result of systemic diseases, immunothe...
Article
Full-text available
Background: Adrenal venous sampling (AVS) is considered the gold standard for lateralisation of aldosterone production in patients with primary aldosteronism (PA). However, in some patients AVS is not technically successful and management may depend on radiological findings. Aim: To determine 1) the success rate of AVS and 2) the outcomes after su...
Article
Full-text available
Introduction: Multi-modal therapy for adrenocortical carcinoma (ACC) includes surgery, therapy with the adrenolytic agent mitotane and systemic chemotherapy. Achievement of therapeutic mitotane concentrations (≥14 mg/l) has been related to improved outcomes. Aim: To evaluate the effectiveness of a defined* high dose protocol mitotane therapy in pa...
Article
Full-text available
We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DO...
Article
Full-text available
Background: Adrenocortical carcinoma (ACC) is a rare malignancy, with an annual incidence of 1 or 2 cases per million. Biochemical diagnosis is challenging because up to two-thirds of the carcinomas are biochemically silent, resulting from de facto enzyme deficiencies in steroid hormone biosynthesis. Urine steroid profiling by GC-MS is an effectiv...
Conference Paper
Full-text available
We present 51 yr. A female Caucasian patient who, in 8/14 while on vacation became aware that her clothes became tight. She was well, had consulted a Cardiologist 12 months previously with an episode of palpitations (assumed SVT), which did not recur with reduced caffeine. She had no signs of cortisol or androgen excess. Abdominal examination, Ima...
Article
Full-text available
Temozolomide (TMZ) has been shown as an effective treatment option in aggressive pituitary adenomas and carcinomas. This review analyses the published case series and demonstrates 42 % of patents show a radiological response and 27 % experience stable disease following TMZ. Prolactinomas and corticotroph tumours respond best to TMZ, showing approxi...
Article
Full-text available
The REarranged during Transfection (RET) proto-oncogene is a receptor tyrosine kinase involved in growth and differentiation during embryogenesis and maintenance of the urogenital and nervous systems in mammals. Distinct mutations across hotspot RET exons can cause Multiple Endocrine Neoplasia Type 2A (MEN2A) characterised by development of medulla...
Poster
Full-text available
This poster describes an interesting case of pheochromocytoma in which constipation was the presenting symptom.
Conference Paper
Introduction: Primary aldosteronism (PA) is the most common endocrine cause of hypertension affecting up-to 10% of hypertensives. Saline suppression, a confirmatory test for PA helps avoiding patients undergoing invasive lateralisation procedures due to a false positive aldosterone-to-renin ratio (ARR). The proposed cut-off to exclude PA is post-sa...
Conference Paper
Background: Phaeochromocytoma and paraganglioma (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla and paraganglia. Biochemical assessment relies on demonstrating elevated concentrations of catecholamines and their metabolites. Analytical methods for catecholamine and metanephrine measurement vary in sensitivity and specificit...
Conference Paper
Background: Understanding hypoadrenal patients’ perceptions of adrenal crisis is vital in the prevention of this endocrine emergency. This study explored the experiences, knowledge and attitudes of hypoadrenal patients to adrenal crises and their prevention. Method: A cross-sectional qualitative study using structured interviews with patients with...
Conference Paper
Background: Metyrapone inhibits 11-β hydroxylase and causes a subsequent rise in the cortisol precursor, 11-deoxycortisol. Cortisol measurements by immunoassays are susceptible to interference and reagent antibody cross-reactivity with cortisol precursors when used in patients receiving metyrapone treatment. Clinicians rely on clinical and biochemi...
Conference Paper
Background: Metyrapone is commonly used in medical management of Cushing’s syndrome. It inhibits 11-β hydroxylase, which catalyses the conversion of 11-deoxycortisol to cortisol. The adequacy of metyrapone blockade can be assessed either clinically or biochemically using a target mean serum cortisol 150–300 nmol/l. Cortisol is normally measured by...
Conference Paper
Introduction: Pituitary and adrenal Cushing’s may be managed by pharmacological-inhibition of adrenal steroidogenesis, using metyrapone and/or ketoconazole. Assessment of biochemical control is challenging owing to cross-reactivity in immunoassays (e.g. cortisol and 11-deoxycortisol) leading to over/under-treatment. Off-target effects can also resu...
Article
Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed...
Article
Immune checkpoint inhibitors are a new and effective class of cancer therapy, with ipilimumab being the most established drug in this category. The drugs' mechanism of action includes promoting the effector T cell response to tumours and therefore increased autoimmunity is a predictable side effect. The endocrine effects of these drugs include hypo...
Article
Full-text available
Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between do...
Conference Paper
Full-text available
Adrenocortical carcinoma (ACC) is a rare malignancy, accounting for up to 11% of adrenal masses investigated in referral centres. Diagnosis remains a challenge. Up to two-thirds are biochemically inactive, resulting from de facto enzyme deficiencies in the steroid hormone biosynthetic pathways, as shown by urine steroid profiling by gas chromatogra...
Article
Full-text available
Making a telephone referral to another clinician for an opinion or consultation is a common clinical activity vital for safe and efficient patient care. However, these referral skills are rarely taught. A programme was developed to address this need.
Article
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Referrals are an important and frequent part of a junior doctor's work. Difficulty with making successful referrals is also very common. Despite this, training in referral skills is not routinely carried out in medical schools. We designed and delivered a 1-h interactive lecture to final year medical students to teach referral skills. The lecture w...
Article
Full-text available
The definitive treatment for Cushing’s disease is curative surgery. Patients with severe disease burden will likely require pre-operative medical blockade to reduce the risk of peri- and post-operative complications. The threshold for deciding when to medically block excess cortisol is currently based on clinical judgment. Expert centres may use a...
Article
Full-text available
Unlabelled: Therapeutic shrinkage of prolactinomas with dopamine agonists achieves clinical benefit but can expose fistulae that have arisen as a result of bony erosion of the sella floor and anterior skull base by the invasive tumour, resulting in the potential development of cerebrospinal fluid (CSF) rhinorrhoea, meningitis, and rarely pneumocep...
Conference Paper
Full-text available
Phaeochromocytomas (PCC) and paraganglioma (PGL) are neural crest tumours arising from the chromaffin producing cells of the adrenal medulla or sympathetic/parasympathetic system respectively. Recently, in part due to advances in high throughput sequencing, our understanding of the genetic predisposition to these tumours has greatly increased. To d...
Article
Hyponatraemia is associated with adverse outcomes including increased mortality and risk of falls. It is not previously known whether hyponatraemia, on discharge from hospital, is associated with an increased risk of readmission. We conducted a retrospective cohort study identifying all patients admitted to a UK teaching hospital as emergency gener...
Article
A 34-year-old African woman presented with a 4-month history of profound lethargy, weight loss and a 3-day history of vomiting, fever, confusion, and drowsiness. She had given birth to her third child 6 months previously. Her pregnancy and delivery were uncomplicated and she had breastfed for 5 months prior to discontinuing due to exhaustion. Inves...
Article
Full-text available
Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous...
Article
Pheochromocytoma crisis is an endocrine emergency associated with significant mortality. There is little published guidance on the management of pheochromocytoma crisis. This clinical practice update summarises the relevant published literature, including a detailed review of cases published in the past five years, and a proposed classification sys...
Article
Background: Mitotane is an adrenolytic chemotherapy, currently accepted as first line adjuvant therapy in adrenocortical carcinoma. Mitotane has a narrow therapeutic window. Serum levels of >14 mg/l are required to achieve a cytotoxic effect and levels of >20 mg/l are potentially toxic. There are two strategies for mitotane initiation: a low-dose r...
Article
Background: Adrenocortical tumours (adenoma or carcinoma) present in well-recognised ways: hormones excess (Cushing’s, Conn’s, virilisation) or hormonally silent with symptoms of mass effect, or found incidentally on imaging. We present 3 cases of adrenal tumours, referred to our regional adrenal multidisciplinary meeting with unusual presenting fe...
Article
Background: Pituitary metastases are a rare complication of systemic malignancy. The most common presentations of pituitary masses include visual field defects, headaches, and hypopituitarism, but cranial nerve palsies and diabetes insipidus are also recognised although unusual. We aimed to determine if these were more frequently associated with pi...
Article
Background: The initial management of hypercalcaemia is well described: aggressive intravenous rehydration and subsequent intravenous bisphosphonates if required. Isolated case reports document the use of haemo/peritoneal dialysis and haemofiltration in the management of severe hypercalcaemia. We report three cases that required renal replacement t...
Article
Full-text available
Context: Glucagon-like peptide-1 (GLP-1) is a gut peptide that promotes insulin release from pancreatic β-cells and stimulates β-cell hyperplasia. GLP-1 secretion causing hypoglycemia has been described once from an ovarian neuroendocrine tumor (NET) but has not been reported from a pancreatic NET (pNET). Objective: A 56-yr-old male with a previ...
Article
The majority of prolactinomas respond to dopamine agonist therapy, but a proportion are resistant, requiring other treatments including surgery and/or radiotherapy. Temozolomide is an oral chemotherapy agent, which has been used as a salvage therapy to treat aggressive pituitary adenomas and carcinomas, including prolactinomas, unresponsive to all...
Article
This article has been retracted by the journal. The retraction was made before the article reached its final form in the publication process. However, the authors' accepted manuscript, prior to copy editing, page layout and proofing, was made available online as a European Journal of Endocrinology Accepted Preprint on 17 February 2012.The article h...
Conference Paper
Full-text available
At King’s, increasing referrals of adult patients with endocrine neoplasms – effective team approach Heeded call at 2011 BES meeting to share findings. Here we compare findings on ACC v. ACA in King’s patients Methods: - Urinary steroid profiling (USP) by GC up to 2005 and by GC-MS (with cyclic scanning) thereafter. Values for 19 steroids in standa...
Article
Gestational diabetes mellitus (GDM) is defined as glucose intolerance which first occurs or is first detected during pregnancy. It is a common condition with an incidence of 3–14% depending on the population studied. In the UK, World Health Organisation (WHO) criteria for diagnosis are normally used, but internationally there are no agreed criteria...
Article
Full-text available
A 64-year-old Caucasian woman presented with left eye pain and a transient left oculomotor nerve palsy. Subsequent imaging revealed a mass involving the sphenoid sinus and sella with suprasellar extension. A trans-sphenoidal hypophysectomy was performed. Histopathology showed a fungal infection consistent with phaeohyphomycosis. Development of this...

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