Endocrine Abstracts

Vitamin D is a pleotropic hormone with important actions in a wide variety of cell types. Whilst its role in the endocrine control of calcium metabolism via the active circulating metabolite 1,25- dihydroxy cholecalciferol is widely appreciated, other actions in a range of cells and tissues depend on activation of circulating 25-hydroxy vitamin D by intracrine mechanisms and paracrine actions which may be locally controlled. Of particular interest are the roles of vitamin D pe...

We report the case of a 63-year-old lady with refractory hypocalcaemia due to surgical hypoparathyroidism, decompensated by malabsorption following gastric bypass, successfully treated with recombinant human parathyroid hormone 1-84 (rhPTH), Natpar. She initially presented with medullary thyroid cancer aged 33 and was found to have MEN2A. She underwent thyroidectomy and developed post-surgical hypoparathyroidism. She was managed for over 20 years with alfacalcidol and oral cal...

Background: Chemerin is a multifunctional adipokine involved in pathogenesis of metabolic disease by regulating inflammation, adipocyte plasticity and glucose metabolism. It is known to be influenced by age, adiposity and triglycerides, and supports important roles in systemic lipid and glucose metabolism.However, the direct acute effects of circulating chemerin on varying metabolic disease states given a high–saturated fat meal has not been addressed.<p clas...

Background: Primary hyperaldosteronism (PHA) typically manifests as resistant hypertension, hypokalaemia and metabolic alkalosis. We present a case of PHA who subsequently exposed type 4 renal tubular acidosis (RTA) after surgical intervention.Case history: A 62 year old man underwent investigation for chronic resistant hypertension, which had failed to respond to titration of three antihypertensive agents including Perindopril, Amlodipine and Doxazosin....

Background: Insulin tolerance test (ITT) is the gold-standard investigation in children with suspected growth hormone deficiency (GHD). Despite their benefits, ITTs are resource intensive, potentially dangerous and can result in unnecessary treatment due to false positive results in children that are at low risk for GHD.Methods: Retrospective analysis of all paediatric patients undergoing an ITT in two tertiary hospitals in the UK (centre A between 2017-...

Background: Reports from several countries have suggested an increased incidence of diabetic ketoacidosis (DKA) at presentation of type 1 diabetes mellitus (T1DM) during the COVID-19 pandemic. Published data on this from the United Kingdom is sparse. We examined the frequency and severity of DKA at diagnosis of T1DM in children presenting to a university hospital during the first year of the pandemic in comparison to preceding years.Methods: In England, ...

Background: Current guidance recommends screening for coeliac disease (CD) at diagnosis of type 1 diabetes mellitus (T1DM) using measurement of serum anti tissue transglutaminase immunoglobulin A (tTG-IgA). It is recognized that tTG-IgA levels can fluctuate and there are reports of transient rises in tTG-IgA levels in response to acute stress, such as infection and acute coronary syndrome. The effect of diabetic ketoacidosis (DKA) on tTG-IgA has not been reported. We investiga...

Background: Growth hormone (GH) stimulation testing is necessary for the diagnosis of growth hormone deficiency (GHD). Insulin tolerance test (ITT) has been considered the gold standard for evaluating GHD in adults. However, it carries a risk of rare but severe adverse effects secondary to hypoglycaemia and is therefore avoided in many centres. There is no consensus for the first test in children.Aim: Audit to compare ITT to Arginine test as a first line...

Background: Overnight dexamethasone suppression tests (ONDST) are conducted to investigate patients with symptoms suggestive of cortisol hypersecretion or if an adrenal incidentaloma is identified. Cortisol levels of 50 nmol/l and above following ONDST may be related to autonomous cortisol secretion (ACS) and require further investigation. Determining likely presence of ACS is essential given reported associations with type 2 diabetes mellitus (T2DM), obesity, cardiovascular d...

Obesity in pregnancy is associated with an increased risk of complications for mother and child. Epigenetic modifications have been proposed as an important underlying mechanism. As the placenta plays a key role in fetal nutrition and metabolism we hypothesized there would be placental DNA methylation differences between lean and obese placenta. DNA methylation array (Human Methylation 450K) was performed on placentas from n=31 obese (BMI&...