Endocrine Abstracts

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of poli...

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...

Background: SIADH is the most frequent underlying cause of hyponatraemia but is frequently ignored and suboptimally treated.Aim: To identify the treatment applied in clinical practice for hyponatraemia due to SIADH and to evaluate the effect of fluid deprivation.Method: A prospective, non-intervention observational study of a sequentially evaluated cohort of hyponatraemic patients during first 48 h after hospitalization from Januar...

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...

The diagnosis of Cushing’s Syndrome (CS) requires demonstration of excess circulating cortisol. Measurement of late night salivary cortisol (LNSF) has been advocated as a simple, non-invasive and reliable outpatient diagnostic tool for patients with suspected CS but the usefulness of its metabolite cortisone (LNSE) remains unclear. LNSE levels are approximately six times higher than LNSF in saliva due to the rapid action of 11β-hydroxysteroid dehydrogenase type 2 (11...

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...

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...

Context: The economic and logistic burden of screening for hypopituitarism following moderate/severe traumatic brain injury (TBI) is considerable. Published guidelines suggest prioritisation for screening of patients with symptoms of pituitary dysfunction.Objective: To evaluate the implementation of targeted symptom-based screening for hypopituitarism after moderate/severe TBI, compared with routine consecutive screening.Design: Gr...

Fluid restriction (FR) is the recommended first-line treatment for chronic hyponatraemia due to syndrome of inappropriate antidiuresis (SIAD) in expert guidelines, despite the lack of prospective data to support its efficacy. We aimed to test the hypothesis that FR was more effective than no treatment. 46 patients with chronic SIAD were randomised to either fluid restriction (1 litre/day, FR) or no specific hyponatraemia treatment (NoTx) for one month. Inclusion criteria were ...

Introduction: Alterations in the hypothalamic–pituitary–thyroid axis have been reported following GH replacement, with a decline in circulating T4 concentration the most consistent finding. However, the clinical significance of GH-induced alterations in circulating levels of thyroid hormone is unclear.Aim: To examine the relationship between changes in serum concentration of thyroid hormones and known biological markers of thyroid ho...