Endocrine Abstracts

Background: Bone turnover markers (BTM) are potential measures for understanding the effect of antiresorptive medications upon osteoclast activity. As a dynamic marker of therapy effect, they could complement or replace DXA-BMD. The translation of population data on BTM changes with therapy to the individual patient is less established. Post-hoc trial data suggests a reduction in BTM of 40% may represent a target for defining appropriate response to therapy.<p class="abste...

Case history: A 40-year-old woman presented with long-standing hypokalemia fluctuating between 2.3 and 2.5 mmol/l. She had episodes of right-sided weakness and was seen by Neurologists without a clear diagnosis. She had no other past medical history. Physical examination was unremarkable. Her blood pressure (BP) was 116/63.Investigations: Plasma aldosterone was 1363 pmol/l. Plasma renin activity was 0.18 ng/ml/h. Aldosterone-renin ratio (ARR) was 7570 (n...

Background: Growth hormone deficiency (GHD) is an increasingly recognized potential consequence following traumatic brain injury (TBI). Outside of a formal, blinded RCT to demonstrate treatment effects, long term adherence to hGH replacement in a full reimbursement setting may serve as a pragmatic indicator of patient-perceived therapy benefits. Our objective was to evaluate adherence to therapy at one year for patients with GHD secondary...

Background: Growth hormone deficiency (GHD) is an increasingly recognized potential consequence following traumatic brain injury (TBI). Outside of a formal, blinded RCT to demonstrate treatment effects, long term adherence to hGH replacement in a full reimbursement setting may serve as a pragmatic indicator of patient-perceived therapy benefits. Our objective was to evaluate adherence to therapy at one year for patients with GHD secondary...

Context: Recent guidelines recommend a diagnosis of adrenal insufficiency when stimulated peak cortisol level falls below 500 nmol/l. This may not be valid when using a highly specific cortisol immunoassay or cortisol measured by liquid chromatography-mass spectroscopy.Objective: Determine the diagnostic threshold for adrenal insufficiency using a highly specific cortisol assay.Design: For 4 months, all subjects having a dynamic te...

Severe hyperkalemia post adrenalectomy is documented in the literature but not actively sought after in high risk post-operative patients.Case: Fifty-one year old woman with a 12 year history of hypertension and hypokalemia. Her BP was controlled with amlodipine 10 mg OD. Serum aldosterone was 2832 pmol/l with undetectable renin activity leading to aldosterone to renin ratio (ARR) >28 000 pmol/l per ng/ml per h. Creatinine was 75 μmol/l with eGF...

Pheochromocytoma-Paraganglioma (PPGL) is a rare but important tumour with non-specific presentations that overlap with extremely common entities such as anxiety, hypertension, acute illness and episodic ‘spells.’ Assessment of urine normetanephrine or metanephrine(UNM-M) in real life practice, where PPGL is very rare and PPGL mimics are extremely common, may show overlap in results with loss of specificity depending on the reference range chosen. We performed a retro...

Background: Subtyping of primary aldosteronism (PA) using imaging and adrenal vein sampling (AVS) can yield discordant results. Varying interpretation criteria in determining AVS lateralization may affect discordance rates.Methods: We identified 337 consecutive patients with PA who underwent AVS at a quaternary care centre between August 2006 and February 2018. Patient demographics, laboratory results, diagnostic imaging, AVS results, and pathology were ...

Background: Negative imaging in the work-up for unilateral (surgical) primary aldosteronism (PA) presents a diagnostic dilemma. Clinicians may assume bilateral disease and treat medically or may proceed to adrenal vein sampling (AVS) to try to localize a unilateral source of aldosterone secretion. However, AVS is not without cost, risk, and limited access. We describe AVS results among imaging-negative PA patients.Methods: We identified 96 patients with ...

Unilateral forms of primary aldosteronism (PA) should, by inference, have a contralaterally normal and therefore suppressed adrenal zona glomerulosa. However, there is no agreed definition of expected adrenal suppression. We hypothesized two biochemical definitions of adrenal suppression based upon measurements done during adrenal vein sampling. These were then applied to a PA–AVS-outcomes database to determine whether either definition proved useful for interpretation of...