Endocrine Abstracts

Hyponatraemia is commonly encountered in neurosurgical units. Salt wasting syndrome is rare, and thought to occur due to ANP- and BNP-mediated natriuresis, leading to hypovolemic hyponatraemia. A 31 year old male was transferred to the National Neurosurgical Unit with a 12 hour history of back pain, progressive lower limb weakness and sensory loss. MRI demonstrated an epidural haematoma, extending from C7 to T3, and he underwent emergency decompressive laminectomy. Vasopressin...

Transsphenoidal surgery (TSS) to resect a corticotroph adenoma is the first-line treatment for Cushing’s disease (CD); remission rates of up to 80% have been reported in cases of microadenomas. Endocrine Society guidelines define post-operative biochemical remission as morning serum cortisol <138 nmol/L within seven days of surgery. Our practice is to use a cut-off of <50 nmol/L at day 3 post-op to indicate biochemical remission. If serum cortisol on day 3 is 50&#...

A 24 year old man presented with gait instability, myalgia, and cognitive decline, after a holiday in Crete; his alcohol intake exceeded 200 units/week. He had marked facial dysmorphism, with frontal bossing, and global muscle weakness. He had hypernatraemic dehydration (plasma sodium 175 mmol/l urea 16.9 mmol/l), but denied thirst. Urine concentration was 894 mOsm/kg, excluding diabetes insipidus. CK was elevated at 15,540 U/l. CT brain shown marked hydrocephalus. Rhabdomyoly...

Introduction: Excess mortality due to hyponatraemia is well documented but it is not clear whether the mortality associated with SIADH is different to that associated with non-SIADH hyponatraemia (NSH).Methods/design: Prospective evaluation of all patients admitted with or developing hyponatraemia in a tertiary hospital (pNa <130 mmol/l) in January 2015. Diagnosis of SIADH was based on standard clinical and biochemical criteria (pNa, spot urine sodiu...

Patients with craniopharyngioma have increased mortality attributed to cardiorespiratory disease, when compared to other hypopituitary populations. There is little data on the cause for excess of fatal respiratory disease in this condition. Clinical observation had identified sleep apnoea in some craniopharyngioma patients in our cohort. Sleep apnoea increases cerebrovascular and cardiovascular morbidity and mortality. Our hypothesis was that sleep apnoea could be a contributo...

Context: The syndrome of inappropriate antidiuresis(SIAD) is the commonest cause of hyponatraemia. Data on the aetiology of SIAD is mainly derived from retrospective studies, often with poor ascertainment of minimum criteria for correct diagnosis. Although central adrenal insufficiency(CAI) is known to cause euvolaemic hyponatraemia, the incidence of undiagnosed CAI in SIAD is unknown.Objective: To establish the incidence of CAI in SIAD.<p class="abs...

Leptin is an adipocytokine with a role in appetite, energy expenditure and reproductive regulation. In normal, non-obese individuals, leptin levels are higher in females, independent of differences in body fat between the genders. High levels of leptin that were disproportionate to body mass index (BMI) have been reported in craniopharyngioma patients, thus we hypothesised that surgical resection and hypothalamic damage conferred leptin resistance on craniopharyngioma patients...

Introduction: The management of diabetic gastroparesis resistant to medical therapy is very difficult – the most severely affected patients often spend many days as hospital inpatients with intractable nausea and vomiting and consequent dehydration, leading to a marked reduction in quality of life. Recently, gastric pacing (also known as gastric electrical stimulation (GES)) has been tried in these patients as a means of correcting the physiological deficit. It has shown ...

Introduction: Patients who are severely affected with diabetic gastroparesis tend to spend many days as hospital inpatients with intractable nausea and vomiting and consequent dehydration. In patients who do not respond to promotility agents, gastric electrical stimulation (GES) is an option. This is a relatively new therapeutic modality which has shown promise in international trials. It has seen use in a very limited number of patients in Ireland. Here we outline our experie...

Context: Fluid restriction (FR) is recommended as first line therapy for SIAD by both the European1 and the American guidelines2 for management of SIAD. Not all patients respond to FR however, and the American guidelines have identified clinical predictors of failure to respond to FR. These include 1.Urine osmolality (UOsm) >500 mOsm/Kg 2. Furst formula (ratio UNa+UK/pNa) > 1, and 3. 24 hour-urine volume<1500 mlObjective...