Endocrine Abstracts

During the warmest days reported in Wales and the United Kingdom recently, we have seen severe hyponatraemia phenomena in this part of the world. Water intoxication causes acute hyponatraemia when the sodium concentration of the blood falls too low due to prolonged sweating combined with excessive fluid consumption. Although primary polydipsia is found in a broad range of individuals including those with mental disorders, and healthy persons, as well as athletes who run marath...

Case Summary: A 72 year-old man presented with a one month history of anorexia, weight loss, lethargy, constipation, increased thirst and generalised aches and pains. He had a background of hypertension, ischaemic heart disease, aortic stenosis, and a renal transplant 23 years ago with declining renal function. No significant abnormalities were noted on physical examination. Investigations confirmed hypercalcaemia, with serum calcium rising from 2.8–3.05 mmol/l. This was ...

Hypoglycemia is an uncommon clinical problem in patients without diabetes mellitus. Potential aetiologies include drugs, critical illness, hormone deficiencies, and non islet cell tumors. In the absence of these causes, the possibility of accidental, surreptitious, or even malicious hypoglycemia should be considered. We present three cases of severe, prolonged hypoglycemia occurring spontaneously in healthy young men without a history of diabetes mellitus or chronic illness. A...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Introduction: Thyroid quality indicators were removed from the Quality Outcome Framework (QOF) targets in 2014, resulting in discontinuation of statutory system alerts to remind GPs to check annual thyroid function in patients with primary hypothyroidism treated with levothyroxine.Aim: To investigate the impact of the discontinuation and reinstitution of the QOF thyroid e-alerts on the management of hypothyroidism in primary care.<p cla...

Objective: Thyroid hormones are essential for maintaining metabolic balance and particularly influence lipid synthesis and degradation. Metabolomics and in-depth lipid profiling may enable us to assess for differential effects of thyroid hormones and provide insight into tissue thyroid status, that cannot be captured by levels of serum free thyroid hormones alone.Methods: 4,347 children from the Avon Longitudinal Study of Parents and Children who had thy...

Introduction: Around 15% of people diagnosed with primary hypothyroidism remain significantly symptomatic despite TSH normalisation with levothyroxine (LT4). The Thr92Ala substitution (rs225014) in a key deiodinase that activates T4 to T3, DIO2 may influence tissue levels of T3 but previous studies have been inconsistent regarding symptoms on LT4 and the presence of this polymorphism.Methods: We assessed HADS anxiety and depression scores in the HUNT2 st...

Introduction: Thyroid hormone replacement is frequently suboptimal but interventions that are proven to optimise therapy are lacking. In 2017, we developed in EMIS an electronic Protocol for Monitoring Patients on Thyroxine in General Practice (‘e-Prompt GP’), to offer automated alerts to prompt GP's to test and address out of range thyroid function tests in patients with hypothyroidism.Aim: To investigate the long-term impact of an electronic ...

Introduction: Following the introduction of the Quality Outcome Framework (QOF), 98–100% patients with hypothyroidism received annual TSH checks during the period 2009–2014. However, there was no evidence this resulted in improved care. We have developed an electronic protocol in EMIS web to both emulate the former QOF thyroid e-alerts in prompting GP’s to check annual thyroid function in patients with treated primary hypothyroidism, and also to alert if TSH is ...

Background: The short Synacthen test (SST) is frequently used to diagnose adrenal insufficiency; however the role of baseline cortisol. With the recent European shortage of synacthen, there was a pressing need to identify the best possible way to use the resource and rationalize the test. Our aim is to identify whether baseline cortisol can be safely used to rule out adrenal insufficiency in clinical practice.Methods: All SSTs performed at the OPD, Royal...