Endocrine Abstracts

Surgical parathyroidectomy remains the most cost effective treatment for primary hyperparathyroidism but where surgery is inappropriate because of significant co-morbidity there is a place for medical therapy. Calcimimetics are type II agonists (requiring calcium for activity) of the calcium sensing receptor (CaSR). The first compound of this class is cinacalcet which reduces PTH by about 50% at 4 h with recovery to within 20% of baseline over the next 8 h. Despite these fluct...

Severe hypercalcaemia poses a real threat of end organ damage mainly to the kidney and the skeleton. While an accurate diagnosis of the cause of the severe hypercalcaemia is important for effective management, initial treatment often has to be instituted before all tests are completed. The kidney is pivotal in this respect since it is the only way in which the body can excrete an unwanted calcium load. Hypercalcaemia impairs renal function by reducing GFR and also by causing n...

The sustained over-secretion of PTH is a common clinical problem with particular consequences for the skeleton. Hyperparathyroidism (HPT) increases the bone surface undergoing remodelling, amplifies the negative balance at the bone multicellular unit and increases activation frequency, eroded surface and formation, without increased trabecular perforation. Cortical bone is particularly susceptible to the effects of hyperparathyroidism and bone mineral density (BMD) measurement...

Dr David Unwin MbChB FRCGP Our GP practice of 9500 people has suffered an eight-fold increase in the number of patients with T2D since 1986. In addition, those affected now develop this condition decades earlier than was the norm back in 1986. A situation replicated all over the developed world. Nationally there are 122,780 children and young adults under the age of 40 years with type 2 diabetes, 1,560 (around 1.3 per cent) are under the age of 19 years. In 2013 our practice d...

The PTEN gene is a tumour suppressor gene with high risk of breast, thyroid, endometrial, colorectal, kidney tumours and melanoma, mucocutaneous lesions, macular pigmentation, and macrocephaly. Germ line heterozygous pathogenic variants in this gene leads to a spectrum of disease now called PTEN hamartoma tumour syndrome (PHTS). Cowden syndrome (the predominant phenotype of PHTS) is estimated to affect 1:200,000 individuals - however it may be under-diagnosed. Guidelines for s...

Professor David RayDavid Ray graduated in Medicine from University of Manchester in 1987. He trained in medicine and endocrinology in the North West, before doing a PhD with Anne White and Julian Davis, again in Manchester. Towards the end of his PhD he was offered a post with Shlomo Melmed at UCLA, and, attracted by the lab, and the adjacent coast, headed west. This research post stimulated an ...

30 M referred to the Surgical Same Day Emergency Care (SDEC) clinic with 2-month history of abdominal pain to left loin and RUQ and worsening back pain for 1-week. Abdomen was soft with tenderness to the RIF, LIF and bilateral loin area. Bloods demonstrated a CRP of 210, sodium 145, potassium 3.2, creatinine 63, ALP 572, ALT 73, bilirubin 12 with normal WCC and neutrophils. A CT abdomen pelvis demonstrated a large left adrenal 10 cm × 11 cm × 13 cm solid mass with so...

Over the last decades, studies using pharmacological approaches and transgenic mouse models have defined the major roles of bile acids as signaling molecules. Bile acids control many physiological functions such as lipid homeostasis, glucose, and energy metabolisms. In the last years, bile acids have been demonstrated to control male reproductive function. Here, we will highlight the impacts of bile acids on testicular physiology fo...

Introduction: The Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) is a collaboration across 32 sites in Canada, Australia and the United Kingdom exploring the early detection and prevention of complications in adolescents with type 1 diabetes.Methods: Over 4,000 young people aged 10–16 years were screened to identify 450 high risk (based on urinary albumin excretion) for a randomised controlled trial (RCT) of statins and ACE inhib...

Adipose inflammation is increasingly percieved to be a major factor in the pathogenesis of obesity associated insulin resistance. However, human evidence supporting this hypothesis remains largely unconvincing. An alternative model is suggested by observations made in patients with rare forms of lipodystrophy; namely that a relative inability to cope with sustained surplus energy intake underpins insulin resistaance. Recent data suggesting that subtle forms of lipodystrophy ar...