Endocrine Abstracts

Accelerated coronary and peripheral vascular atherosclerosis is one of the most common and chronic complications of diabetes mellitus. A relatively recently analysed aspect of coronary artery disease in this condition is its silent nature. We studied silent myocardial ischaemia (SMI) in unselected consecutive middle aged asymptomatic patients with type II diabetes by treadmill exercise test.Ninety four asymptomatic type II diabetics between the ages 36 a...

Objectives: The extent and mechanisms of the diurnal variation in insulin sensitivity are poorly described. This study set out to assess the relative contributions of diurnal rhythm and length of fast to insulin sensitivity in normal healthy human subjects.Methods: Nine healthy women (age 25.3±1.2 years, BMI 22.4±0.8 Kg/m2) ate a standardised meal before each of the four fasts, two ten-hour fasts ending at 0900 and 1700 and two thirteen-hou...

Objective: Vanadium salts have been suggested as a possible therapeutic agent for treating diabetes mellitus in the experimental models of the disease. This study was done to show the correlation between amelioration of diabetic signs and preservation of pancreatic islets in vanadyl sulphate treated streptozotocin - induced diabetic rats.Methods: Diabetes was induced in male Wistar rats by intravenous injection of 40 milligram per kilogram streptozotocin...

Reactive Hypoglycaemia (RH) is a controversial condition that has been popularised in the media and lay literature. A recent survey of randomly selected women in Nottinghamshire revealed that 37.8% experience symptoms that they attribute to a 'low blood sugar', with over 18% experiencing symptoms more than once a week (1). The aim of this study was to investigate whether a non-patient group who report symptoms synonymous with RH have concomitant hypoglycaemia.<p...

Objective: Despite being the most common endocrine malignancy, the management of thyroid cancer in the UK remains sub-optimal, with reduced survival rates compared with Western Europe. The British Thyroid association published national guidelines in March 2002 to help standardize and improve the management and survival of thyroid cancer in the UK. We have audited the management of thyroid cancer in a large district hospital comparing the results to the standards set by the Bri...

A 62 year old woman presented in May 2001 with a one year history of palpitations. A 24 hour tape showed a short run of supra ventricular tachycardia only.In December 2001 she was admitted with palpitations, presyncope and a labile blood pressure. Systolic pressures of 150-186mmHg and diastolic pressures of 95-112mmHg were recorded. 24 hour urine collection for catecholamines revealed normal adrenaline levels but elevated noradrenaline at 5265 nanomols p...

The anabolic role of androgens in growth and regeneration, has similar implications in periodontal tissues. Studies suggest that androgens and growth factors could affect activity of the enzyme alkaline phosphatase, being closely linked to anabolic effects on tissues matrices. Nicotine has detrimental effects on healing. One of the mechanisms involved is impairment of alkaline phosphatase activity. The aim of this investigation is to study the response of nicotine to platelet ...

Physiologically active androgens and growth factors contribute to healing responses by a variety of mechanisms, including stimulation of enzymes associated with matrix turnover. Some of these effects may be partially negated by nicotine. Both androgens and growth factors are able to compensate for oxidative effects induced by nicotine, being a significant deterrent to wound healing. The aim of this investigation is to establish the metabolic yields of androgen biomarkers in re...

Topiramate is an antiepileptic drug, with anoressant effect, known to positively modulate GABA receptors. There are some published data concerning the use of topiramate in mood disorders (expecially BED), while there are not know data on its use in obese patients without BED. This is a preliminary study to explane the effectiveness and tolerability of topiramate in non-Binge Eating Disorder (BED) obese patients with metabolic syndrome. We described the effects of topiramate, w...

Objectives: To define clinical and metabolic factors associated with severe hypoglycaemia (SH) in affected individuals with Type 1 diabetes (T1DM).Methods: Individuals with T1DM and SH (defined as hypoglycaemia requiring third party intervention within the preceding 12 months) were characterised to include screening for other underlying autoimmune disease (coeliac serology, short synacthen and thyroid function tests); a questionnaire to evaluate underlyi...

We conducted a prospective audit of triple therapy in type 2 patients (Dec01 to Dec02). 51 patients on maximal Metformin and sulphonylurea had a Glitazone added. 11 patients were lost to follow up. The remaining 40 patients, 23 Male, 17 Female, mean age 51years (35-66), diabetes mean duration 8.5 years (2-16) had a mean BMI of 33.8 (range 22-47). Mean baselineHbA1C was 9.6% (7.3-12.3%).Parameters measured were blood pressure, height, weight BMI, full blo...

A 44 year old woman presented in November 2000 with a two week history of headaches, vomiting and blurred vision. Past history consisted of type 2 diabetes and migraine. Initial investigation revealed hyponatraemia (sodium 114 mmol/l) and deranged liver biochemistry. ANA, anti dsDNA, cANCA, pANCA, anti Ro, La, RNP, Scl-70, Jo-1, smooth muscle and mitochondrial antibodies were negative. MRI revealed a 13x18x15mm pituitary mass elevating the optic chaism, without evidence of rec...

Type 1 diabetes mellitus is usually believed to present acutely and it is assumed that metabolic decompensation is sudden.We present 3 cases of asymptomatic type 1 diabetesCase1A 28 year old asymptomatic gentleman moved to a new surgery and glycosuria was noted as part of routine screening , no ketonuria., body mass index 21, no past medical illness or any family history of diabetes. His fasting blood glucose...

The role of vascular endothelial growth factor (VEGF) in the pathogenesis of numerous complications associated with diabetes is well established. However, little is known of VEGF's role in erectile dysfunction (ED), a condition commonly experienced by diabetic men. We hypothesized that expression of VEGF, its receptors and its signaling pathway, Akt, may be altered in diabetic penile tissues and, consequently, induce expression of molecules involved in the development of ED in...

Decondensation of chromatin and the pattern of its packaging in eukariotic nuclei underlie gene expression. It should be outlined that both features are determined not only by the main components of chromatin and nuclear matrix, but also by loosely bound molecules, such as phospholipids, which can interact with nucleoproteins and maintain the degree of chromatin condensation.The steroid hormone estradiol induced changes both of total phospholipid and ind...

Fine needle aspiration biopsy (FNAB) is the investigation of choice for patients with thyroid nodules in secondary care. Ideally the following standards should be met: assessment within 2 weeks of referral; FNAB performed in the first visit; consent obtained and documented; communication of the result in person.A cohort of 64consecutive patients (57 female) was identified. The median age was 49 (16-78). Thyroid function tests were normal in 89% of patien...

In humans, pregnancy is considered a diabetogenic event1. A similar situation occurs in sows1. The amount of fat in the sows' diet is inversely correlated to glucose clearance time, thus modifying glucose tolerance2. The aim was to investigate the influence of altered maternal diet during gestation (term = 115days) on the glucose tolerance of the sow. Thirty-four pregnant sows were randomly allocated to 4 isocaloric diets for either the first (G1) or second (G2) 60 days of ges...

Case: A GP with autoimmune hypothyroidism presented with a phaeochromocytoma during labour at the age of 36 y. A left adrenalectomy confirmed the diagnosis and a basal cell carcinoma was also removed. She had a history of Dupuytren's lesions of both soles and palms starting in her teenage years and multiple keratosis. There was no family history of any endocrine or skin disorder. At 41y, a benign breast lump was removed and also a gastrointestinal spindle cell stromal tumour (...

Objectives: To compare the cell dynamics of term placental tissue in pregnancies conceived by in-vitro fertilization (IVF) and embryo transfer with spontaneous pregnancies.Methods: Placental samples were obtained from singleton term IVF pregnancies (n=25) and singleton term spontaneous pregnancies (n=30). Ethical approval was obtained from the Faculty of Medicine, The University of Hong Kong. The incidence of apoptotic and proliferative cells was determi...

Symptomatic pituitary metastasis is an uncommon presentation of primary carcinoma. We report a case of a 65 years old lady who presented with a six week history of headache and diplopia and a five day history of diarrhoea and vomiting. She also suffered from osteoporosis. She had undergone a hysterectomy for a fibroid. Examination revealed diplopia in all directions of gaze, no papilloedema and an unremarkable systemic examination. Brain MRI showed a contrast enhancing pituita...

IntroductionRenal disease in type 2 diabetes can be prevented and limited with early detection and management of the condition. We studied the adherence of renal guidelines introduced by national institute of clinical excellence (NICE), in patients who attended the annual review in the last 12 months.MethodsAudit standards were based on guidelines for Prevention and Early Management of Renal disease in Type 2...

This 42-year-old male presented with a six-month history of general lethargy and mood changes. He had experienced weakness & difficulty climbing stairs; weight loss; ankle swelling and increased frequency of micturition. There was no significant past medical history.Initial investigations revealed Na+ 144mmol/L (135-145);K+ 2.3mmol/L(3.5-5.2); U 8.8mmol/L (2.6-6.7); Cr 75μmol/L (60-125); TCO2 41mmol/L (21-31); Fasting glucose 7.4mmol/L; TSH 0.21mU...

The continuous glucose monitoring system (CGMS) have recently been developed for use in diabetes to provide comprehensive blood glucose data around the clock during normal activities. We have demonstrated for the first time that CGMS can assist in the management of 2 patients with confirmed insulinomas. We present 2 female patients (aged 41 and 35 years) with symptoms suggestive of hypoglycaemia. Both had biochemical evidence of insulinoma with hypoglycaemia, hyperinsulinaemia...

Central cholinergic defects, as well as cognitive impairments, have been reported in humans with non-insulin-dependent diabetes mellitus (NIDDM). The levels of acetylcholine are partly controlled by the activity of acetylcholinesterase (AChE) which breaks it down. We have previously reported evidence for abnormal AChE activity in the skeletal muscles of the obese diabetic (ob/ob) mouse which provides a model for NIDDM. The aim of the present study was to investigate the levels...

We have previously shown that β-endorphin reduces muscle fatigue and increases glucose uptake in contracting and non-contracting skeletal muscles of the mouse. The aim of this study was to compare the effect of these peptides on glucose uptake and muscle fatigue in normal mice and obese-diabetic mice (which provide a model for non insulin-dependent diabetes mellitus, NIDDM). The uptake of glucose into contracting and non-contracting muscle was assessed using the non-metab...

PCOS is associated with increased biochemical risk markers for cardiovascular disease, particularly low HDL cholesterol and increased triglycerides. There is accelerated progression to type 2 diabetes and hypertension in middle age. These biochemical abnormalities associate with insulin resistance which is present to a greater extent than can be explained by obesity alone. Notwithstanding, hard endpoint data in terms of increased cardiovascular mortality remains elusive. Infla...

Aim: To assess usage of newly available rapid-acting insulin analogues in the antenatal diabetes clinic, and to determine whether introduction of these agents has influenced glycaemic control.Methods: We analysed our diabetes antenatal clinic attendances from April 2002 to June 2003 using the DIABETA 3 database. 290 pregnant women were seen over this period which was divided into three groups: Group I (April to September 2002), Group II (October 2002 to ...

Cardiovascular disease is the leading cause of morbidity and mortality in patients with diabetic renal disease. We did a retrospective study on our Joint Diabetic-Renal clinic, which has run for 12 years, to see if we could reproduce targets from clinical trials and local guidelines in routine practice for management of cardiovascular risk. We collected data using clinical notes and electronic records on 133 patients. Our cohort included 62% type 2 and 38% type 1 Diabetics. Me...

Embryonic stem cells (ES cells) represent a population of self renewing pluripotent cells, capable of differentiating into derivatives of the 3 embryonic germ layers and are therefore a promising source material for generation of replacement pancreatic beta cells for transplantation in type 1 diabetes. ES cells can be induced to undergo unregulated differentiation when cultured as floating clusters (embryoid bodies). Successful generation of pancreatic endocrine cells from ES ...

The clinical relevance of macroprolactin and its prevalence among those with 'hyperprolactinaemia' are unclear(1). Macroprolactinaemia has often been described as asymptomatic, benign and not related to pituitary disease(2,3,4). Recent reports, however, suggest that macroprolactinaemia is common among those with 'hyperprolactinaemia', can often be symptomatic and may be occasionally associated with pituitary adenoma(5,6). Pituitary imaging has been recommended in all symptomat...

IntroductionCardiovascular disease, which may be structural or ischaemic, is the major cause of morbidity and mortality for women with Turner Syndrome (TS). This study investigated arterial augmentation index (AI%) and pulse wave velocity (PWV) as measures of arterial stiffness in adults with TS. A more positive AI% and greater PWV indicate increased arterial stiffness.Method66 women with TS and 8 normal wome...

BackgroundIdiopathic Addisons disease is characterised by the presence of adrenal antibodies and a documented variable subclinical period. In previously well controlled Type 1 diabetes, it may present with recurrent hypoglycaemia, or worsening erratic glycaemic control.Case ReportA 24 year old with previously well controlled Type 1 diabetes since age 18 months presented with worsening glycaemic control, 2 sto...

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