Endocrine Abstracts

Aims/hypothesis: Adrenal incidentaloma (AI) are very common, but optimal management of patients with AI and low-grade excess cortisol secretion is not established. Uncontrolled studies reporting outcomes of adrenalectomy suggest improvements in cardiovascular risk, but all are subject to selection bias, and it is unclear if benefits are due to removal of excess cortisol. We reasoned that short-term use of mifepristone, a rapidly-acting glucocorticoid receptor (GR) antagonist, ...

A central tenet in medicine is that disruption of homeostatic mechanisms leads to disease and effective therapy must re-establish normal physiology. The sun imposes a 24-hour periodicity to life and circadian rhythms have evolved to maintain homeostasis through the 24-hour day/night cycle. In humans, there is a central clock that controls the sleep/wake cycle which metabolically is a fast/feed cycle. The clock maintains homeostasis by synchronising metabolism to the time of fe...

CAH is the commonest inborn endocrine disorder and associated with significant morbidity. The health status of CAH adult patients has recently been reported by the UK Congenital adrenal Hyperplasia Adult Study Executive, CaHASE (Arlt et al. JCEM 2010 95 5110–5121). Compared to the health survey for England, metabolic abnormalities were common in adult patients with CAH: obesity (41%), hypercholesterolemia (46%), insulin resistance (29%),...

Cortisol is an essential stress hormone and replacement with oral hydrocortisone is lifesaving in patients with adrenal insufficiency. Cortisol has a diurnal rhythm regulated by the central body clock and this rhythm is a metabolic signal for peripheral tissue clocks. Loss of cortisol rhythmicity is associated with fatigue, depression and insulin resistance. A general principle in endocrinology is to replace hormones to replicate physiological concentrations; however the pharm...

Growth hormone (GH) is a potent anabolic hormone; deficiency results in extreme short stature and excess in gigantism and acromegaly. It is just over 50 years since Raben first demonstrated the dramatic impact of GH replacement on linear growth in a young boy with pituitary infantilism. Since then milestones in GH research have included identification of the GH binding protein (1986), the crystal structure of GH (1987), cloning of the GH receptor (1987) and the discovery of a ...

One in eight hundred young adults is now a survivor of childhood cancer as a result of tremendous advances in cancer therapy. However, this success now brings with it the challenge that both the cancer and its therapy may have late effects. In a recent review of 10 397 young adult survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with...

Replication of physiology is a basic tenet of endocrinology but this is rarely achieved. We developed a modified-release hydrocortisone to provide circadian cortisol. The adrenal glucocorticoid, cortisol, is an essential stress hormone and its secretion follows a distinct rhythm regulated by the central circadian oscillator in the suprachiasmatic nucleus. Circulating cortisol levels are low at sleep onset, rise between 0200 and 0400 h, peak within an hour of waking and then de...

GH acts through a cell surface receptor, GHR, which is a member of the type 1 cytokine receptor family. Cytokine receptors have a single trans-membrane domain and dimerisation is required to activate intra-cellular signalling pathways. In common with other cytokine receptors the extra-cellular domain of the GHR is proteolitically cleaved and circulates as a binding protein. Under physiological conditions GH is in part bound in the circulation and the complex with the binding p...

Knowledge transfer has now entered common parlance to describe the interaction between industry and universities. Knowledge transfer frequently involves exchange of money. It consists of many different activities which include teaching, consultancy, licensing patents, and spinning out companies. Many academics provide consultancy to industry and this has the attractive benefits of bringing money to the individual and bringing industry to the university. Consultancy is usually ...

Background: Congenital adrenal hyperplasia (CAH) and long-term glucocorticoid treatment may be associated with an increased risk of developing cardiometabolic sequelae such as abnormal glucose homeostasis, hyperlipidaemia, hypertension, cardiovascular (CV) disease, obesity and osteoporosis.Objectives: To study the current practice amongst expert centres for assessing cardiometabolic outcomes in adult patients with 21-hydroxylase CAH and to assess the pre...