Endocrine Abstracts

Loperamide is a poorly absorbed opioid μ-receptor agonist that is the most commonly used anti-diarrhoeal medication in the UK. Prescription cost analysis from the Department of Health and Social Care Information Centre reported that 1.79 million prescriptions of the drug were issued in 2014 and it is also freely available ‘over the counter’. It is widely believed to be very safe, with constipation as the main side-effect.A 45-year-old man ...

Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessment. Biochemical evidence of endogenous steroid excess is demonstrated through overnight dexamethasone suppression test (ODST), low dose dexamethasone suppression test and/or 24-hour urinary free cortisol estimation (UFC). Once endogenous steroid excess is confirmed, random serum ACTH measurement is key in determining the suspected source of steroid excess: ACTH-inde...

Background: Diagnostic work-up for Cushing Syndrome (CS) can be challenging and is based on clinical and biochemical assessments. Biochemical evidence of endogenous steroid excess is demonstrated through overnight dexamethasone suppression test (ODST), low dose dexamethasone suppression test and/or 24-hour urinary free cortisol estimation (UFC). Once endogenous steroid excess is confirmed, random serum ACTH measurement is key in determining the suspected source of steroid exce...

Introduction: Hypercalcaemia diagnosed in hospital setting is most commonly PTH-independent and malignancy related, whilst hypercalcaemia discovered in community setting is commonly secondary to Primary Hyperparathyroidism (PHPT). Other rare causes include granulomatous diseases such as sarcoidosis and familial hypocalciuric hypercalcaemia (FHH).Case Summary: A 73-year-old male with a background of hypertension and chronic kidney disease stage 3 was foun...

A 33-year-old woman with type 1 diabetes and autoimmune Addison’s disease conceived in September 2021 following careful preconception counselling. The patient had a history of recurrent, severe hypoglycaemia requiring intensive care admission and had previously received two allogenic islet cell transplants (January 2020 and November 2020). The patient had no severe hypoglycaemia following transplantation, although she continued to experience overnight hypoglycaemia, while...

Background: Prevalence of Addison’s disease (AD) among patients with Type 1 diabetes mellitus (T1DM) is estimated at 0.2%, whilst prevalence of T1DM among patients with AD can be up to 14%. Residual adrenal function in patients with established AD may be present in up to 30% of cases but its clinical significance is not fully clear.Aims: To evaluate the prevalence of AD with preserved glucocorticoid function in patients with T1DM at Newcastle Diabet...

Background: Autoimmune Addison disease (AAD) is a rare but highly heritable endocrinopathy. The BACH2 protein plays a crucial role in T lymphocyte maturation, and in particular in regulatory T cell formation, and allelic variation in its gene has been associated with autoimmune conditions such as type 1 diabetes, autoimmune thyroid disease and vitiligo. Its role in susceptibility to autoimmune Addison’s disease (AAD) has not been investigated.Aim: T...

ACTH is a 39 amino acids polypeptide which stimulates adrenocortical steroid production. The N-terminal segment of ACTH(1–24) is biologically active and the C-terminal is considered to have greater antigenicity. In one previous (‘RoSA’) and one current (‘RADS2’) clinical trial synthetic ACTH (zinc tetracosactide; depot synacthen) was administered to autoimmune Addison’s disease (AAD) patients to stimulate adrenocortical regeneration. 4/13 RoSA pat...

Background: Unilateral adrenal haemorrhage is usually asymptomatic and picked up incidentally on CT imaging. However, adrenal haemorrhage can cause flank pain and when bilateral, adrenal insufficiency or adrenal crisis. Biochemical changes include electrolyte imbalances, low platelet count and anaemia. We report a case of unilateral adrenal haemorrhage with devastating outcome.Case: A 45-year-old male smoker was incident...

Background: The pathogenesis of autoimmune Addison’s disease (AAD) remains incompletely understood, but it is thought to be due to interplay between genetic, immune and environmental factors. A month of birth effect, with increased risk amongst those born in autumn and winter months, have been described in autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease.Aim: To investigate month of birth effect in two independent cohorts...