Endocrine Abstracts

Initial clinical trials with pegvisomant at doses of up to 80 mg once weekly led to a 30% fall in IGF-I. Subsequently, daily administration of up to 40 mg/day (280 mg/week) achieved an IGF-I within reference range in 97% of patients. Pegvisomant’s half-life is >70 h suggesting weekly dosing may be possible using higher doses than in the original trials.We performed a two-centre, open-label prospective study in seven patients (4M, 3F, mean age 57...

The GH receptor antagonist pegvisomant entered clinical trials in 1997 and was (UK) marketed in 2005. There is little long-term experience with this novel drug. We report the experience from two centres that used common protocols to manage 58 patients (36 male, median age 53, range 27 78) since 1997. Before commencing pegvisomant, patients had IGF-I above the upper limit of normal (ULN) of age-related reference ranges (median 1.8 xULN, range 1.2–4.1 xULN) and were uncontr...

Background: Hyponatraemia (most commonly secondary to SIADH) is very common in cancer patients; it is associated with delays to oncology treatment and mortality.Aim: To evaluate the number of patients with hyponatraemia at a tertiary referral cancer centre and assess adherence to national recommendations for investigations and treatment.Methods: All biochemistry results (in-patient and outpatient) analys...

Background: Hyponatraemia (most commonly secondary to SIADH) is very common in cancer patients; it is associated with delays to oncology treatment and mortality.Aim: To evaluate the number of patients with hyponatraemia at a tertiary referral cancer centre and assess adherence to national recommendations for investigations and treatment.Methods: All biochemistry results (in-patient and outpatient) analys...

Case history: A 53-year-old male with melanoma who had a previous surgical excision of his skin lesion in December 2018 was being treated with adjuvant pembrolizumab. In June 2019 his treatment changed to combination immune checkpoint inhibitor therapy (ICPi) with ipilimumab and nivolumab due to radiological recurrence.Investigations: There were no pre-ICPi endocrine investigations available. In July 2019, thyroid function tests (TFTs) showed thyroid-sti...

Introduction: Late-night salivary cortisol assessment is an important element when investigating suspected Cushing’s syndrome (CS). The goal of medical therapy is achieving a mean (of 5 samples during a single day) serum cortisol (serumF) of 150–300 nmol/l (Cushing Day Curve [CDC]). Metyrapone is an 11β-hydroxylase inhibitor elevating levels of 11-deoxycortisol causing conventional immunoassay (IA) to overestimate SerumF; a problem obviated by LC–MS/MS. We ...

Introduction: Hypoparathyroidism is most commonly observed following neck surgery and is characterized biochemically by deficient parathyroid hormone (PTH) and hypocalcaemia alongside hyperphosphataemia and reduced 1,25-dihydroxyvitamin D. Standard treatment with oral calcium and vitamin D aims to maintain serum calcium within the low-normal range whilst avoiding hypercalciuria due to over replacement. However, concerns remain over the presence of hypercalciuria and the associ...

Background: The use of salivary cortisol is well validated in the diagnosis of Cushing’s syndrome but routine use of salivary measurements during dynamic tests of HPA axis sufficiency is uncommon and reference ranges are not established. Salivary cortisol (SalF) and cortisone (SalE) measurements by LC–MS have several advantages including ease of collection and more accurate reflection of unbound serum cortisol levels in conditions of altered CBG levels (e.g. oestroge...

Acromegaly causes impaired insulin sensitivity and reduced fat mass. Using acipimox to block lipolysis, the impact of free fatty acids (FFA) on insulin sensitivity in active acromegaly was investigated. 1H MRS was used to quantify triglyceride (TG) content of liver and muscle.Methods: 6 patients with active acromegaly (AA) (5M, age 59 (34–70), IGF-I (ng/ml) (median (range)) (452 (342–1002)) were studied on 2 visits; (i) baseline (BL)...

Background: CAYA cancer survivors who received cranial radiotherapy have an increased risk of stroke. Traditional cardiovascular disease (CVD) risk factors likely contribute, but there are no guidelines for management of stroke risk in this population. It is unclear how general CVD risk calculators (QRISK3, Framingham Risk Score) compare to specific cancer survivors scores such as the Childhood Cancer Survivors Study Stroke Risk Calculator (CCSS).<p class=...