Endocrine Abstracts

Graves’ disease is characterised by an autoimmune response to the TSH receptor leading to circulating stimulatory TSH receptor antibodies (TRAbs) which directly cause hyperthyroidism and goitre. Patients with thyroid eye disease, children and teenagers, and those with large goitre, severe hyperthyroidism or high TRAb titres have unmet clinical needs and frequently have unsatisfactory outcomes with current therapies. In common with all other antibodies, TRAbs are secreted ...

It is obvious that adrenal cortex is plastic, with adrenal atrophy and functional hypoadrenalism during exogenous glucocorticoid therapy; yet adrenal hyperplasia and hyperfunction during stimulation from ACTH during Cushing’s disease. This is owing to subcapsular adrenocortical stem cells that regenerate the zones of adult adrenal cortex throughout life.We have performed a series of experimental medicine trials in order to explore the idea that auto...

Addison’s disease is a good therapeutic target for regenerative medicine, as adrenal cell mass and steroidogenesis have clear intrinsic plasticity, as determined by circulating ACTH concentrations. With the advent of the biological agents as disease-modifying therapy for inflammatory arthritis and their experimental use in several other autoimmune conditions including type 1 diabetes, we undertook a pilot study of immunomodulatory therapy in patients with autoimmune Addis...

Endocrine management of the patient with coeliac disease (CD) can be divided between management of the long-term consequences of malabsorption and timely identification and treatment of associated autoimmune disorders. CD patients have chronic calcium and vitamin D malabsorption at diagnosis, leading to secondary hyperparathyroidism, which is frequently associated with hypocalcaemia, low BMD and osteopenia. In many cases these will improve following institution of a gluten-fre...

Autoimmune Addison’s disease (AAD) can be divided into two distinct genetic aetiologies. The childhood onset type 1 polyendocrinopathy (aka APECED) syndrome is a monogenic autosomal recessive trait. Whereas the common-or-garden AAD that may be found as an isolated endocrinopathy, or in association with thyroid disease or type 1 diabetes as part of the autoimmune polyendocrinopathy type 2 syndrome (APS2). Isolated AAD (IAD) and APS2 can be considered as very similar from t...

Subclinical thyroid diseases are common, affecting around 5% of the general population, and rising in prevalence with advancing age. While some people have a congenital abnormality of the hypothalamic–pituitary–thyroid axis set point, for instance due to germline mutations that cause loss of TSH-receptor function, this does not appear to account for the majority of cases of subclinical thyroid disease. There is a change in the reference range for TSH (which is the de...

Subclinical thyrotoxicosis, due to endogenous hyperthyroidism, affects about 1% of the older population and is predominantly caused by indolent progression to a state of autonomous thyroid function in people with nodular thyroid disease. For more than a decade, it has been known that subclinical hyperthyroidism is associated with a three-fold increased risk of atrial fibrillation (Sawin et al.) over 10 years of follow-up. More recently, three separate...

Introduction: Causes of hypophosphataemia include reduced intestinal absorption, inadequate intake, transcellular shifts (refeeding syndrome, glucose/insulin infusion), renal loss which is either FGF23 mediated (inherited forms or tumour induced osteomalacia) or non-FGF23 mediated (hyperparathyroidism, drugs)Case report: We present a case of 51 years old female referred to us with multiple fractures during her half marathon. She suffered from bilateral m...

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 ...

Monitoring patients with thyroid cancer for recurrent disease relies heavily on measuring serum thyroglobulin (Tg). Tg cannot be assessed reliably in the presence of anti-thyroglobulin antibodies for analytical reasons, this being the case in about a third of patients. There has been recent interest in microRNA profiling of fine needle aspiration biopsies of thyroid nodules, with encouraging results. The objective of this pilot was to explore microRNAs in peripheral blood of p...