Searchable abstracts of presentations at key conferences in endocrinology
Previous issue | Volume 32 | ECE2013 | Next issue

15th European Congress of Endocrinology

Poster Presentations

Adrenal cortex

ea0032p1 | Adrenal cortex | ECE2013

Chronocort®, a multiparticulate modified release hydrocortisone formulation, shows dose linearity and twice daily dosing provides physiological cortisol exposure

Ross Richard , Whitaker Martin , Debono Miguel , Huatan Hiep , Arlt Wiebke , Merke Deborah

Cortisol has a distinct circadian rhythm; levels rise from 0300 h to peak within an hour of waking and gradually decline until 1800 h before a quiescent period lasting from 1800 to 0300 h. Current hydrocortisone replacement regimens are unable to replicate this rhythm and we have been investigating modified release technology. Our initial formulation, using tableting technology, demonstrated it was possible to replicate the overnight rise in cortisol but the tablet had reduced...

ea0032p2 | Adrenal cortex | ECE2013

Impaired quality of life in CAH adults is associated with adiposity and insulin resistance

Han TS , Krone N , Willis DS , Conway GS , Rees DA , Stimson RH , Walker BR , Arlt W , Ross RJ

Background: Quality of life (QoL) has been variously reported as normal or impaired in congenital adrenal hyperplasia (CAH) adults. We found impaired QoL in UK CAH adults (Arlt et al. Journal of Clinical Endocrinology and Metabolism 2010 95 5110–5121) and now report the relationship between QoL (SF-36) and health outcomes in these patients.Methods: Cross-sectional analysis of 151 CAH adults with 21-hydroxylase defi...

ea0032p3 | Adrenal cortex | ECE2013

Correlation between cell cycle, steroidogenesis and PKA RIA and RIIB subunits in adrenocortical tumors cells

Basso Francesco , Rezaei Neda , Ragazzon Bruno , Bertherat Jerome , Rizk-Rabin Marthe

The cyclic AMP (cAMP) signalling cascade is one of the main pathways involved in the pathogenesis of adrenocortical tumors (ACT). PRKARIA or PRKARIIb are involved in the proliferation/apoptosis in a subset of tumors.Majors alterations of genes involved in both cell proliferation and the cell cycle have been described by transcriptome and miRNome analysis in various types of adrenocortical tumors (ACC, ACA, AIMAH, and PPNAD). In addition...

ea0032p4 | Adrenal cortex | ECE2013

Long-term follow-up in adrenal incidentalomas: an Italian Multicentre Study

Morelli Valentina , Reimondo Giuseppe , Giordano Roberta , Casa Silvia Della , Muscogiuri Giovanna , Policola Caterina , Salcuni Antonio Stefano , Dolci Alessia , Beltrami Giulia , Palmieri Serena , Scillitani Alfredo , Arosio Maura , Ambrosi Bruno , Ghigo Ezio , Beck-Peccoz Paolo , Chiodini Iacopo , Terzolo Massimo

Introduction: The need of a long-term follow-up in adrenal incidentalomas (AI) is debated and data on cardiovascular events (CVE) are lacking.Methods: In this retrospective study all patients referred to seven Italian Endocrine Centers for AI, without signs of hypercortisolism at baseline and with a ≥5 years follow-up (80.7±30 months, range 60–286), were enrolled. From 171 patients (121 F) aged 59.5±10.2 years (range 25–79) the ...

ea0032p5 | Adrenal cortex | ECE2013

The gene expression profile of cortisol secretion in adrenocortical adenomas

Roussel Hortense Wilmot , Vezzosi Delphine , Rizk-Rabin Marthe , Barreau Olivia , Ragazzon Bruno , Rene-Corail Fernande , de Reynies Aurelien , Bertherat Jerome , Assie Guillaume

The cortisol secretion level of adrenocortical adenomas range from hormonally silent to overt hypercortisolism. The mechanisms leading to the autonomous hypersecretion of cortisol are unknown. The aim was to identify the gene expression alterations associated with the autonomous and excessive cortisol secretion of adrenocortical adenomas.Methods: The transcriptome of 22 unilateral adrenocortical adenomas (5 non-secreting, 6 subclinical cortisol-producing...

ea0032p6 | Adrenal cortex | ECE2013

Activation of EGFR promotes ACC cell proliferation by inducing VEGF autocrine secretion

Gagliano Teresa , Mole Daniela , Gentilin Erica , Bellio Mariaenrica , degli Uberti Ettore , Zatelli Maria Chiara

Adrenocortical cancer (ACC) is a rare and aggressive malignancy. Currently the main therapeutic option is surgery, but due to difficult and delayed diagnosis and to the onset of metastases, medical therapy is often tried. ACC treatment is mainly represented by Mitotane alone or in association with chemotherapy, with variable results. Understanding the molecular mechanisms that regulate ACC proliferation could be useful to identify new therapeutic options. Aim of our study is t...

ea0032p7 | Adrenal cortex | ECE2013

Human leukocyte antigen (DQ2/DQ8) and 21-hydroxylase antibodies determine the thyroid peroxidase antibody status of patients in autoimmune Addison's disease

Penna-Martinez Marissa , Schwartz Julia M. , Shoghi Faroquhi , Meyer Gesine , Wolff Anette B. , Hahner Stephanie , Willenberg Holger , Reisch Nicole , Quinkler Marcus , Seidl Christian , Husebye Eystein , Badenhoop Klaus

Autoimmune Addison’s disease (AAD) results from the immune mediated selective destruction of adrenal steroid hormone-secreting cells. Autoantibodies (Abs) against 21-hydroxylase (21OH) are diagnostic present in 85–90% newly diagnosed patients. Its genetic susceptibility is conferred by human leukocyte antigen (HLA) DQ2 and DQ8. In many patients autoimmunity extends forming the autoimmune polyglandular syndrome type 2 (APS-2). The aim of this study was to test, whethe...

ea0032p8 | Adrenal cortex | ECE2013

Plasma metanephrine for assessing the selectivity of adrenal venous sampling

Dekkers Tanja , Deinum Jaap , Kool Leo Schultze , Blondin Dirk , Vonend Oliver , Hermus Ad , Peitzsch Mirko , Rump Lars , Antoch Gerald , Sweep Fred , Lenders Jacques , Bornstein Stefan , Willenberg Holger , Eisenhofer Graeme

Context: More reliable parameters than cortisol are needed for assessing correct catheter positioning during adrenal vein sampling (AVS). Plasma metanephrine represents one such alternative.Objective: To determine the utility of adrenal venous (AV) plasma concentrations of metanephrine to establish correct catheter positioning during AVS.Design and methods: We included 86 AVS procedures: 52 ACTH-stimulated and 34 non-stimulated seq...

ea0032p9 | Adrenal cortex | ECE2013

Insulin sensitivity in patients with Addison's disease: a randomised cross-over trial comparing conventional glucocorticoid replacement therapy with continuous subcutaneous hydrocortisone infusion therapy.

Bjornsdottir Sigridur , Nystrom Thomas , Isaksson Magnus , Oksnes Marianne , Husebye Eystein , Lovas Kristian , Kampe Olle , Hulting Anna Lena , Bensing Sophie

Background: Conventional glucocorticoid replacement therapies result in unphysiological variation in plasma cortisol levels; concern has been raised regarding long-term metabolic consequences. Glucocorticoid replacement is technically feasible by continuous subcutaneous hydrocortisone infusion (CSHI), which can mimic the normal diurnal cortisol rhythm. The aim of this study was to compare insulin sensitivity in patients with Addison’s disease (AD) on CSHI vs three daily d...

ea0032p10 | Adrenal cortex | ECE2013

First phase insulin secretion is impaired by aldosterone excess in primary aldosteronism

Fischer Evelyn , Adolf Christian , Pallauf Anna , Then Cornelia , Bidlingmaier Martin , Beuschlein Felix , Seissler Jochen , Reincke Martin

Context: Primary aldosteronism (PA) represents the most frequent cause of a curable secondary arterial hypertension. Conflicting data have been published regarding the effect of aldosterone excess on glucose and lipid metabolism.Objective: Our aim was to analyze insulin sensitivity and beta cell function in a cohort of PA patients. Prospective follow-up investigations were performed in a subgroup of patients before and after adrenalectomy to assess the m...

ea0032p11 | Adrenal cortex | ECE2013

Molecular screening for personalized treatment approach in advanced adrenocortical cancer

De Martino Maria Cristina , Al Ghuzlan Abir , Do Cao Christine , Assie Guillaume , Scoazec Jean-Yves , Leboulleux Sophie , Aubert Sebastien , Libe Rossella , Nozieres Cecile , Pattou Francois , Borson-Chazot Francoise , Pivonello Rosario , Mazoyer Clement , Bertherat Jerome , Schlumberger Martin , Lacroix Ludovic , Baudin Eric

Propose: To screen for the presence of putative targets for new treatments in a large cohort of advanced adrenocortical cancer (ACC)Experimental design: In 40 adult stage III-IV ACC primary samples, we used comparative genomic hybridization (CGH) and hotspot gene sequencing (with Ion Torrent) to describe the presence of copy number abnormalities and mutations in more than 40 genes involved in cancer development and putative drug sensitivity (HER2; EGFR; ...

ea0032p12 | Adrenal cortex | ECE2013

Abstract withdrawn....

ea0032p13 | Adrenal cortex | ECE2013

Detection of circulating tumor cells in adrenocortical carcinoma: a monocentric preliminary study

Poli Giada , Pinzani Pamela , Scatena Cristian , Salvianti Francesca , Corsini Elisa , Canu Letizia , Piccini Valentina , Nesi Gabriella , Mannelli Massimo , Luconi Michaela

Objective: Adrenocortical carcinoma (ACC) is a rare malignancy, whose prognosis is mainly dependent on the stage at diagnosis. The identification of disease-associated markers representing solid biomarkers for early diagnosis and drug monitoring is mandatory to improve survival rate and life quality of patients. CTC are tumor cells originating from primary tumor or metastases. The tumor-induced angiogenesis and invasion allow aggressive tumors to release CTC into blood stream ...

ea0032p14 | Adrenal cortex | ECE2013

New diagnostic methods for primary aldosteronism with specific antibodies

Volpe Cristina , Hoog Anders , Ogishima Tadashi , Mukai Kuniaki , Hamberger Beril , Thoren Marja

Background: Among patients diagnosed with primary aldosteronism (PA) due to an aldosterone producing adenoma (APA), about 10% fail to normalize aldosterone hypersecretion after unilateral adrenalectomy, and may instead have bilateral aldosterone producing hyperplasia. With routine histopathology it may be difficult to distinguish between APA and hyperplasia. We have recently reported the use of specific antibodies to identify the source of aldosterone excess in the removed adr...

ea0032p15 | Adrenal cortex | ECE2013

In vivo and in vitro evidence supporting SSTR/mTOR pathway targeting in adrenocortical cancer

Germano Antonina , Rapa Ida , Duregon Eleonora , Votta Arianna , Ardito Arianna , Volante Marco , Papotti Mauro , Terzolo Massimo

Objective: In vitro data suggest that somatostatin receptors (SSTR) and mTOR pathways might represent reasonable targets for novel therapies, since are involved in growth of adrenocortical carcinoma (ACC). However, in vitro analysis of combination treatments, targeting both mTOR and SSTR as compared to mitotane, and detailed tissue typing mTOR/SSTR pathway are poorly explored in ACC.Methods: This study was designed to characterize the t...

ea0032p16 | Adrenal cortex | ECE2013

Mortality in long-term follow-up patients with progressively increased patterns of subclinical cortisol hypersecretion

Di Dalmazi Guido , Vicennati Valentina , Paccapelo Alexandro , Pagotto Uberto , Pasquali Renato

Background: Subclinical Cushing’s syndrome (SCS) is defined as alterations in hypothalamic–pituitary–adrenal axis without classic signs or symptoms of glucocorticoid excess. This condition has been associated to increased risk of adverse metabolic and cardiovascular outcomes, independently of other potential risk factors. However, is still not known if this condition could lead to a higher mortality respect to non-secreting adrenal masses (NSA).<p class="abs...

ea0032p17 | Adrenal cortex | ECE2013

Role of adrenal vein sampling in primary aldosteronism: impact of different diagnostic criteria on subtype diagnosis

Cicala Maria-Verena , Salva Monica , Miotto Diego , Rubin Beatrice , Pezzani Raffaele , Patalano Anna , Iacobone Maurizio , Mariniello Barbara , Mantero Franco

In patients with primary aldosteronism (PA), adrenal vein sampling (AVS) is considered the gold standard to distinguish between unilateral and bilateral autonomous production of aldosterone, while diagnostic imaging tests by CT scan or MRI are often inconclusive for the diagnosis. To date agreement is lacking on the best criteria indicating successful cannulation and lateralization.The aim of the study was to evaluate the impact of different diagnostic c...

ea0032p18 | Adrenal cortex | ECE2013

The diagnosis of nonclassical congenital adrenal hyperplasia due to 21 hydroxylase deficiency in woman can be established by genetic testing or urine steroid profile analysis but not by ACTH stimulation test

Ambroziak Urszula , Kepczynska-Nyk Anna , Nowak Karolina , Malunowicz Ewa Maria , Morawska Emilia , Kunicki Michal , Bednarczuk Tomasz

Backgroud: ACTH stimulation test is considered the basic diagnostic tool in the diagnosis of nonclassical congenital adrenal hyperplasia due to 21 hydroxylase deficiency (CAH). The cut off of 17OHP stimulation recommended for diagnosis is 10 ng/ml.Aim: To assess whether the recommended threshold of 17OHP after ACTH stimulation confirms nonclassical CAH among woman with hyperandrogenism and elevated basal 17OHP level.Material and Me...

ea0032p19 | Adrenal cortex | ECE2013

Genetic analysis does not confirm NCCAH in almost half of the women who had received this diagnosis: preliminary results of an audit

Alcantara Valeria , Tundidor Diana , Webb Susan , Carreras Gemma , Espinos Juan Jose , Chico Ana Isabel , Martinez Silvia , Blanco Francisco , Corcoy Rosa

Introduction: Non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase deficiency is one of the most frequent autosomal recessive diseases. Genetic analysis performed for genetic counselling revealed a miscorrelation with the clinical diagnosis in several patients at our centre.Aim: Confirm the genetic diagnosis of NCCAH in women attended for this condition.Materials and methods: Consecutive patients attended at o...

ea0032p20 | Adrenal cortex | ECE2013

Investigation of β-catenin, N-cadherin, and E-cadherin expression in adrenocortical tumors

Rubin Beatrice , Pezzani Raffaele , Cicala Maria Verena , Iacobone Maurizio , Olivotto Andrea , Fassina Ambrogio , Manteri Franco

Background: Adrenocortical tumors (ACT) are classified as adenomas (ACA) or carcinomas (ACC). β-Catenin constitutive activation is a frequent alteration in benign and malignant ACT. E-cadherin was discovered as a protein associated with β-catenin which plays a crucial role in cadherin-mediated cell adhesion. N-cadherin seems to be involved in the development of malignant ACT, but information regarding expression of N-cadherin or E-cadherin in ACT is very limited....

ea0032p21 | Adrenal cortex | ECE2013

Bilateral inferior petrosal sinus sampling in cushing's syndrome: comparison between an old and a new technique in naples experience

De Leo Monica , Tortora Fabio , Cozzolino Alessia , Simeoli Chiara , Iacuaniello Davide , Albano Aurora , Briganti Francesco , Cirillo Sossio , Colao Annamaria , Pivonello Rosario

Introduction: Bilateral inferior petrosal sinus sampling (BIPSS) is the test that offers the highest diagnostic accuracy in the differential diagnosis between pituitary and ectopic Cushng’s syndrome (CS). The aim of this study was to compare the diagnostic accuracy of BIPSS performed in the last six years, after the change in the technical procedure with that performed in the past period in Naples centre.Patients and methods: Seventeen patients with...

ea0032p22 | Adrenal cortex | ECE2013

21-hydroxylase and interferon omega autoantibodies in Turner syndrome

Cleemann Line , Oftedal Bergithe , Trolle Christian , Holm Kirsten , Husebye Eystein , Gravholt Claus

Introduction: An increased frequency of autoimmune diseases and an elevated incidence of autoantibodies have been observed in Turner syndrome (TS), but indirect immunofluorescence (IIF) has not been able to demonstrate autoantibodies against the adrenal cortex. We asked if the more sensitive radioimmunosorbant assay employing recombinant human 21-hydroxylase was able to identify autoantibodies against 21-hydroxylase, (21OH-Ab) in TS patients; 21-hydroxylase is the major adrena...

ea0032p23 | Adrenal cortex | ECE2013

Immunohistochemical markers of adrenal cortical tumors

Altieri Barbara , Fadda Guido , Capozzi Anna , Pontecorvi Alfredo , Casa Silvia Della

Introduction: Adrenocortical tumors (ACTs) are usually divided in adenoma (ACA) or carcinoma (ACC) according to histopathologic methods. Some lesions are occasionally difficult to classify according to these criteria. We studied the use of some immunohistochemical markers to recognise the difference between malignant and benign tumors.Materials and methods: We studied 12 patients affected by ACC and 10 by ACA. Clinical evaluation and hormone analysis wer...

ea0032p24 | Adrenal cortex | ECE2013

Management of Addison's disease patients using dual release hydrocortisone during periods of intercurrent illness

Simonsson Ulrika SH , Skrtic Stanko , Lennernas Hans , Marelli Claudio , Johannsson Gudmundur

Introduction: Current management of intercurrent illness (ICI) in adrenal insufficiency (AI) is inadequate. We attempted to optimise ICI regimens with pharmacokinetic simulations of a dual-release (DR) hydrocortisone (HC) and tested them in a formal clinical trial.Methods: This work consisted of: i) dosing recommendations in episodes of mild ICI with DR-HC using simulations with a population pharmacokinetic model, ii) collection of ICI episodes with incr...

ea0032p25 | Adrenal cortex | ECE2013

Abstract withdrawn....

ea0032p26 | Adrenal cortex | ECE2013

Longitudinal assessment of adrenocortical responses to low-dose ACTH in critically ill septic patients

Vassiliadi Dimitra A , Dimopoulou Ioanna , Zervou Maria , Tzanela Marinella , Tsagaris Hercules , Augustatou Callirrhoe , Douka Evangelia , Livaditi Olga , Orfanos Stylianos , Kotanidou Anastasia , Armaganidis Apostolos , Tsagarakis Stylianos

Introduction: The hypothalamo-pituitary adrenal axis has been extensively investigated in sepsis. Most studies concentrated in the acute phase and in most the high-dose ACTH stimulation test has been applied. Studies extending in the post-acute phase by using the more physiological low-dose ACTH stimulation are scarce.We aimed to investigate the time course of cortisol levels before and after stimulation with 1μg Synacthen in mechanically ventilated...

ea0032p27 | Adrenal cortex | ECE2013

Increasing prevalence of Addison’s disease in Germany: health insurance data 2007–2011

Meyer Gesine , Neumann Kathrin , Badenhoop Klaus , Linder Roland

There are no epidemiological data of Addison’s disease in Germany. Since there is no national registry for this rare disease alternative data sources need to be retrieved. The Technikerkrankenkasse (TK) is one of the large German health care insurance providers covering nearly 10% of the population. Documentation of diagnoses by all members with a doctor contact is evaluated by a scientific institute (WINEG). Screening of the database for Addison’s disease was design...

ea0032p28 | Adrenal cortex | ECE2013

The role of late-night salivary cortisol measurement in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentalomas

Perogamvros I , Tzanela M , Koletti A , Tsirona S , Memi E , Tsagarakis S

The diagnosis of subclinical hypercortisolism (SH) is a challenging issue, especially as the high prevalence of adrenal incidentalomas (AI) is increasingly recognized. The diagnosis of subclinical hypercortisolism relies on a combination of tests that include overnight (ODST) or low dose dexamethasone suppression (LDDST), plasma ACTH, and 24-h urinary free cortisol (UFC). Late night salivary cortisol (LNSC) has been successfully used in the diagnosis of Cushing’s syndrome...

ea0032p29 | Adrenal cortex | ECE2013

Aldosterone measurement: performances of a new fully automated chemilunescence-based immunoassay

Gruson Damien , Lepoutre Thibault

Introduction: Measurement of aldosterone, the major mineralocorticoid secreted by adrenal cortex, is important for the screening of primary aldosteronism and for the clinical assessment of hypertensive patients. RIA remain widely used for the measurement of aldosterone but some automated immunoassays are emerging. The aim of our study was to evaluate the performances of a new automated aldosterone immunoassay.Methods: Method imprecision of the Liaison&#1...

ea0032p30 | Adrenal cortex | ECE2013

Patients with Addison’s disease have increased frequency of the metabolic syndrome: a case–control study

Bergthorsdottir Ragnhildur , Ragnarsson Oskar , Johannsson Gudmundur

Background: Patient’s with Addison’s disease (AD) have increased morbidity and mortality. Cardiovascular disease is considered the leading cause of death. The aim was to study cardiovascular risk factors in patients with AD.Methods: In a single-centre, case–ontrol study 78 patients (52 women) with AD were compared to 78 controls, matched for gender, age, BMI, and smoking habits. Serum was collected in a fasting state for measurement of lip...

ea0032p31 | Adrenal cortex | ECE2013

Reliability of serum versus salivary cortisol in ACTH test

Kosak Mikulas , Hana Vaclav , Hill Martin , Simunkova Katerina , Lacinova Zdena , Krsek Michal , Marek Josef

Introduction: Salivary cortisol measurement, representing free cortisol, seems to be a promissing alternative method to serum cortisol. Besides its use in the diagnostics of hypercortisolism, it could be of help in evaluation of adrenocortical reserve. It might be useful especially in patients on estrogen replacement, which modulates transcortin and hence total cortisol levels.Aims: Compare the reliability of salivary vs. serum cortisol assessment during...

ea0032p32 | Adrenal cortex | ECE2013

Diagnostic performance of first line biochemical tests to differentiate ACTH-ectopic syndrome among ACTH dependent Cushing’s syndrome

Belaya Zhanna , Rozhinskaya Liudmila , Dragunova Natalia , Dzeranova Larisa , Arapova Svetlana , Marova Evgenia , Kolesnikova Galina , Melnichenko Galina

Introduction: This study evaluates the diagnostic accuracy of clinical features and first line routine screening tests to differentiate ACTH-ectopic syndrome from Cushing’s disease (CD).Materials and methods: The retrospective clinical and biochemical presentations of 180 patients with histologically proven ACTH-dependent Cushing’s syndrome (CS) (159 CD, 21 ACTH-ectopic syndrome) were compared according to the cause of hypercortisolism. ROC-ana...

ea0032p33 | Adrenal cortex | ECE2013

Salivary cortisol is a useful tool to assess the immediate response to pasireotide in patients with Cushing’s disease

Cardinaletti Marina , Trementino Laura , Concettoni Carolina , Marcelli Giorgia , Polenta Barbara , Spinello Maurizio , Boscaro Marco , Arnaldi Giorgio

Introduction: Pasireotide is a promising treatment option for patients with Cushing’s disease (CD). The measurement of salivary cortisol is useful for diagnosing hypercortisolism and monitoring patients with CD following pituitary surgery. It may also be a better index of cortisol secretion than serum cortisol or urinary free cortisol (UFC). We investigated the value of salivary cortisol in monitoring short-term efficacy of pasireotide in patients with CD.<p class="ab...

ea0032p34 | Adrenal cortex | ECE2013

Male hypogonadism in Addison's disease - an under-recognized problem

Ross Ian , Blom Dirk , Haarburger David

Introduction: Male hypogonadism may complicate Addison’s disease (AD), but the prevalence of testosterone deficiency in adult males with primary hypoadrenalism is unknown.Methods: Male patients older than 18 years of age enrolled in the South African AD national registry were screened for biochemical testosterone deficiency (early morning basal testosterone <9.9 nmol/l). Testing was also performed to see if these subjects were more susceptible t...

ea0032p35 | Adrenal cortex | ECE2013

A national survey on the prevalence and treatment outcome of active Cushing’s disease in Belgium

Bex Marie , Nauwelaerts Heidi , T'Sjoen Guy , Velkeniers Brigitte , Corvilain Bernard , Abrams Pascale , Beckers Albert , De Block Christophe , Maiter Dominique

To estimate the point prevalence of active Cushing’s disease (CD) in Belgium, all endocrinologists were invited to perform a retrospective chart review of the CD patients they had been treating between 1-1-2009 and 31-12-2010.Only patients requiring cortisol lowering therapy because of cortisol excess could be included, such as de novo patients (n=53), previously diagnosed patients with persisting/recurrent disease after pituitary surgery a...

ea0032p36 | Adrenal cortex | ECE2013

More than two successive measurements of late-night salivary cortisol are needed to accurately diagnose early-stage post-surgical recurrence of Cushing’s disease

Danet Marie , Asselineau Julien , Perez Paul , Vivot Alexandre , Laure Nunes Marie , Corcuff Jean-Benoit , Tabarin Antoine

The performance of late-night salivary cortisol (LNSC) and optimal number of samples to accurately diagnose post-operative recurrence of Cushing’s disease (CD) at an early-stage are unknown. We performed a retrospective analysis in a single tertiary-care center to compare the accuracy of multiple salivary sampling strategies to diagnose early-stage recurrences of CD. 36 patients in remission of CD after surgery were followed up for 69.2±10.6 mo with multiple successi...

ea0032p37 | Adrenal cortex | ECE2013

Adrenal venous sampling is mandatory and CT scan is unreliable for diagnosing unilateral primary hyperaldosteronism

Jonsdottir Guobjorg , Guomundsson Jon , Birgisson Gudjon , Agusta Sigurjonsdottir Helga

Introduction: There is ongoing debate about how to diagnose and treat unilateral primary hyperaldosteronism (PA). The use of CT scans and adrenal venous sampling (AVS) for the diagnosis of unilateral PA leading to unilateral adrenalectomy is still a matter of discussion. Moreover, some have suggested subtotal adrenalectomy when a detectable nodule is found on imaging studies while others prefer total adrenalectomy. We gathered information on imaging, diagnosis and treatment in...

ea0032p38 | Adrenal cortex | ECE2013

Endosonography-guided fine-needle aspiration biopsy in differential diagnosis of adrenal gland tumours – pilot study

Krcma Michal , Hejda Vaclav , Dvorakova Eva

Introduction: Adrenal incidentaloma is a problem with increasing importance. There are CT-density and washout criteria for distinction between adrenal adenoma and other tumours, there are well established protocol of screening for malignancy and/or hormonal dysfunction. But there remains small portion of atypical adenoma where detailed diagnostic is needed. One relatively new option is endosonography-guided fine-needle aspiration biopsy.Aim: To assess va...

ea0032p39 | Adrenal cortex | ECE2013

The Urinary Aldosterone in the Diagnosis of Primary Aldosteronism

Solar Miroslav , Malirova Eva , Ballon Marek , Ceral Jiri

Introduction: The estimation of urinary aldosterone is one of the recommended confirmatory tests when diagnosing primary aldosteronism (PA). The study assessed the interpretation of the urinary aldosterone secretion (UA).Subjects and methods:: The study enrolled both healthy volunteers and patients with suspected PA. Estimation of UA in 24-hour urine specimen was performed in enrolled individuals. Increased oral salt intake was recommended before and dur...

ea0032p40 | Adrenal cortex | ECE2013

Autoimmune polyglandular syndrome on a cohort of patients with primary adrenocortical insufficiency

Gouveia Sofia , Ribeiro Cristina , Alves Marcia , Saraiva Joana , Moreno Carolina , Guelho Daniela , Carrilho Francisco

Introduction: On average, 40 to 50% of the patients with autoimmune adrenocortical insufficiency will eventually develop an autoimmune polyglandular syndrome (APS). Our aim was to characterize a population with primary adrenocortical insufficiency (AI) and determine the prevalence of other autoimmune disorders that might establish the diagnosis of APS.Materials and methods: We included patients with primary AI under surveillance at our Department. Those ...

ea0032p41 | Adrenal cortex | ECE2013

Non-classic adrenal hyperplasia (NCAH) in patients with bilateral adrenal incidentally discovered tumors

Przybylik-Mazurek Elwira , Tracz-Bujnowicz Marta , Kuzniarz-Rymarz Sylwia , Hubalewska-Dydejczyk Alicja

The prevalence of adrenal incidentalomas in computed tomography (CT) studies ranges from 0.6–1.9%. Adrenal masses are detected bilaterally in 10–15% of the cases.Non-classic adrenal hyperplasia (NCAH), also termed as late onset of CAH, is a very mild form of 21-hydroxylase deficiency. The incidence of disease is estimated at 0.1% of population. Reported prevalence in women with androgen excess range from 0.6 to 9%.Some pa...

ea0032p42 | Adrenal cortex | ECE2013

Effect of glucocorticoids treatment on anthropometric parameters and sexual maturation rating in salt wasting and simple virilizing forms of congenital adrenal hyperplasia in Pakistani boys

Akram Maleeha , Shahbaz Madiha , Riaz Misbah , Aslam Shaista , Shahid Gulben , Qayyum Mazhar , Naseem Afzaal Ahmed , Tahir Fahim , Rizvi S S R

Congenital adrenal hyperplasia (CAH), caused by lack of 21-hydroxylase, impairs cortisol secretion, which increases ACTH release that results in hyperplasia of adrenal glands and increased secretion of adrenal androgens. Elevated androgen concentration leads to increased skeletal maturation, early pubertal development and diminished pubertal growth. Treatment with glucocorticoids averts early puberty but may abruptly slow down growth. The effect of exogenous glucocorticoids on...

ea0032p43 | Adrenal cortex | ECE2013

Overt and ubclinical hypercortisolism in patients with diabetes mellitus and obesity

Dreval Alexander , Komerdus Irina , Murzina Anastasiya , Nechaeva Olga , Tishenina Raisa , Borodina Elena , Anaskina Galina

Background: It has been hypothesized that patients with type 2 diabetes mellitus (DP) are very suspicious to have hypercortisolism, especially those which a high HbA1c level. The prevalence of hypercortisolism also could be high in obese patients (OP).Methods: To 111 DP (male:female, 1:3; 58 (50; 64) years old; HbA1c, 9.5±2.2%), and 39 OP (male:female 2:1, 22 (20; 28) years old) 1 mg dexamethasone suppression test (DST-1) have been done. If post-DST...

ea0032p44 | Adrenal cortex | ECE2013

Association of a variant of V281L of 21-hydroxylase gene CYP21A2 with simple virilizing and salt wasting types of CAH in Pakistani population

Shahbaz Madiha , Mansoor Qaiser , Akram Maleeha , Riaz Misbah , Beg Azhar , Aslam Shaista , Shahid Gulben , Qayyum Mazhar , Ahmed Naseem Afzaal , Rizvi S.S.R. , Ismail Muhammad

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by deficiency of 21-hydroxylase (CYP21), which inhibits adrenal synthesis of cortisol and aldosterone. The reduced cortisol synthesis leads to increased ACTH secretion, which results in adrenal gland hyperplasia, accumulation of steroid precursors and excessive adrenal androgen production, causing pseudoprecocious puberty. The study aimed at determining variance in two SNPs, I172N and V281L, of CYP2...

ea0032p45 | Adrenal cortex | ECE2013

Long-term efficacy of pasireotide in a patient with Cushing's disease and diabetes: results in the short term are not always predictive of long-term response

Trementino Laura , Cardinaletti Marina , Concettoni Carolina , Marcelli Giorgia , Boscaro Marco , Arnaldi Giorgio

The management of Cushing’s disease (CD) can be problematic, particularly when the disease persists following pituitary surgery. Here we report the case of a 55-year old woman with CD that persisted after repeat transsphenoidal surgery. The patient had an overt phenotype with facial rubeosis, central obesity with supraclavicular fat accumulation, cervical fat pad and proximal muscle weakness. She had received anti-hypertensive drugs and insulin for diabetes mellitus. Horm...

ea0032p46 | Adrenal cortex | ECE2013

Autonomous aldosterone secretion as a significant cause of arterial hypertension: the effectiveness of targeted therapy

Papanastasiou Labrini , Pappa Theodora , Fountoulakis Stelios , Tsounas Panagiotis , Markou Athina , Tsiavos Vaios , Anastasakou Marina , Marakaki Chrisanthi , Malliopoulos Dimosthenis , Kounadi Theodora , Piaditis George

Introduction: The prevalence of autonomous aldosterone secretion (AAS) in hypertensive subjects varies due to the use of various suppression tests and cut-off values. Our aim was to evaluate the prevalence of AAS in hypertensive subjects and test the anti-hypertensive effect of targeted treatment of the renin angiotensin II aldosterone system (RAAS) in AAS subjects.Description of methods/design: We investigated 336 hypertensive subjects with and without ...

ea0032p47 | Adrenal cortex | ECE2013

Cushing’S syndome: source of ectopic secretion of acth found after 20 years of follow-up

Bajuk Studen Katica , Pfeifer Marija

A 59-year-old lady presented with Cushing’s syndrome in 1991. Hormone testing revealed that it was due to ectopic secretion of ACTH. However, even after a comprehensive diagnostic workup, the source of ACTH secretion was not found. Since the symptoms (arterial hypertension and diabetes) were not successfully controlled with drugs, bilateral adrenalectomy was performed and the patient was put on hydrocortisone and fludrocortisone. The patient was then followed annually in ...

ea0032p48 | Adrenal cortex | ECE2013

Glucose tolerance in Cushing’s disease

Rachdi Imene , Haouat Emna , Ben Salem Leila , Kamoun Ines , Turki Zinet , Ben Slama Claude

Cushing disease (CD) is a rare affection due to an ACTH secreting pituitary adenoma with a hypercorticism as main consequence.The aim of this study was to assess glucose tolerance anomalies in CD.Patients: Twenty-one patients with a diagnosed CD were included; The majority of them (77.3%; n=17) were female. Mean age was 34.2 (19–54 years) and mean BMI 31.9 kg/m2 (25.9–43.7). Mean progression period of ...

ea0032p49 | Adrenal cortex | ECE2013

European Adrenal Insufficiency Registry: a comparative observational study of glucocorticoid replacement therapy

Eckman Bertil , Fitts David , Marelli Claudio , Murray Robert , Quinkler Marcus , Zelissen Pierre

Introduction: A once-daily modified-release formulation of hydrocortisone (Plenadren®) has been developed to better mimic physiological cortisol secretion in the treatment of patients with adrenal insufficiency (AI). Here, we describe EU-AIR, an ongoing post-authorization observational study (registry) designed to collect information on AI management and to assess the long-term safety of Plenadren® compared with traditional glucocorticoid replac...

ea0032p50 | Adrenal cortex | ECE2013

Oncocytic adrenal carcinoma with production of testosterone and cortisol: case report

Krcma Michal , Dvorakova Eva

We describe case of 29-year woman with no concomitant illneses in her history and with negative family history in sense of adrenal or cancer disease.She came first in February 2012 for secondary hypomenorrhea lasting for 3 months, hirsutism and worsening of acne. Laboratory examination reveals markedly elevated free testosterone (9.6 nmol/l) and slightly elevated morning cortisol (687.4 nmol/l) with almost no suppresion in low dose dexamethasone suppresi...

ea0032p51 | Adrenal cortex | ECE2013

Prevalence of primary aldosteronism among hypertensive population in Trabzon City, Turkey

Algun Ekrem , Incecayir Omer , Anaforoglu Inan , Ersoy Kerem , Ayhan Semiha

Introduction: There have been no studies on the prevalence of primary aldosteronism (PA) in Turkey. In this study, the prevalence of PA among the hypertensive population was investigated.Methods/Design: The study was conducted among hypertensive patients, aged 16–88 years, who visited the out-patient clinic of Endocrinology from January 10th, 2011 to September 30th, 2011. 768 of the 774 consecutive hypertensive patients volunteered to participate. T...

ea0032p52 | Adrenal cortex | ECE2013

Adrenal metastases: aetiolgies and outcome

Boutekedjiret Faiza , Bendali Mohammed , Chentli Farida

Introduction: Adrenal metastases used to be rare in endocrinology compared to others adrenal tumours, and deemed to have a dire prognosis. Our aim is to analyze 13 cases in order to study their morphological aspects, their causes, and their outcome.Subjects and method: Thirteen cases were studied over a long period of time (2000–2012). All of them had biological, hormonal, and radiological assessments.Results: We had ten men a...

ea0032p53 | Adrenal cortex | ECE2013

Adrenal inclusion in testicular: about six cases

Haddam Ali El Mehdi , Soumeya Fedala Nora , Meskine Djamila , Chentli Farida

The adrenal enzyme deficiency leads pseudopuberty in later diagnosis or in the absence of treatment. The existence of testicular enlargement in boys can be related to adrenal inclusion. We report six observations about this pathology: Two brothers of 2 and 12 years old with 11β-hydroxylase and four patients of three, five, height and ten years old with 21-hydroxylase deficiency. The reson of consultation was the development of the penis and pubic hair with a testiculary e...

ea0032p54 | Adrenal cortex | ECE2013

Hyperaldosteronism in patients with hyperparathyroidism: three cases

Gracia Teresa Ruiz , Capel Francisco Fernandez , Zamorano Nuria Fuertes , Hoyos Emilia Gomez , Hernandez Martin Cuesta , Pascual Alfonso Calle , De La Vega Isabelle Runkle

Introduction: Hyperaldosteronism can induce elevated parathyroid hormone (PTH) levels, presumably by increasing calciuria. Furthermore, PTH stimulates aldosterone secretion in vitro, and increases angiotensin–II-stimulated aldosterone release. In a patient with hyperaldosteronism and hyperparathyroidism, PTH receptors were detected in aldosteronoma tissue. We present three patients sent to an endocrinologist for treatment/follow-up of primary hyperparathyroidism,...

ea0032p55 | Adrenal cortex | ECE2013

Analyses of data of the patients with Cushing's disease with use of Moscow Region's database

Komerdus Irina , Dreval Alexander , Murzina Anastasia , Bogatyrev Oleg , Britvin Timur , Demidov Ivan , Nechaeva Olga

Introduction: To analyze clinical, laboratory and anamnestic data of the patients with Cushing’s disease (CD) we conducted a CD database.Methods: One hundred and eighty patients with CD were investigated in MRRCI from 1975 year. To all of them in 2011 the invitation letter was sent. In only 22 patients we could confirm diagnosis of CD according to their medical documentation. Three patients died to 2011. From 2009 to 2012 in 16 patients CD were newl...

ea0032p56 | Adrenal cortex | ECE2013

Evaluation of monitoring protocol for adrenal incidentalomas in our area

Mateo-Gavira Isabel , Vilchez-Lopez Francisco Javier , Larran-Escandon Laura , Roldan-Caballero Pilar , Gavilan-Villarejo Inmaculada , Lopez-Tinoco Cristina , Coserria-Sanchez Cristina , Aguilar-Diosdado Manuel

Introduction: According to the latest recommendations, monitoring protocol for adrenal incidentalomas includes: hormonal determinations annually for 4 years and imaging at 6, 12 and 24 months. The objectives of this study are: i) to define the clinical features, natural history and clinical management of adrenal incidentaloma in our area, ii) to evaluate the performance of the current monitoring protocol.Methods: Retrospective study including patients di...

ea0032p57 | Adrenal cortex | ECE2013

Impact of antihypertensive drugs, sodium intake and potassium plasma concentrations on plasma aldosterone and plasma renin aktivity

Lalic Tijana , Zarkovic Milos , Ciric Jasmina , Beleslin Biljana , Stojkovic Mirjana , Stojanovic Milos , Nisic Tanja , Savic Slavica , Trbojevic Bozo

Introduction: Primary aldosteronism (PA) is a group of disorders which are characterized by inadequate and non-suppressible production of aldosterone. The prevalence of PA is increasing in hypertensive population. The golden standard of screening for primary aldosteronism, determination of aldosterone/plasma renin activity (ARR), is influenced by numerous exogenous and endogenous factors. Testing cannot always be conducted under optimal conditions.Object...

ea0032p58 | Adrenal cortex | ECE2013

A case of Addison's disease caused by systemic disseminated tuberculosis: mimicking lymphoma on F-18 FDG PET-CT

Moon Junsung , Park Byungsam , Yoon Jisung , Lee Hyoungwoo , Won Kyuchang

Addison’s disease is most commonly caused by autoimmune adrenalitis. But, adrenal tuberculosis is still major cause in developing countries, that usually caused by hematogenous spread of pulmonary tuberculosis. Systemic tuberculosis causing Addison’s disease has been rarely reported. We present a case of Addison’s disease caused by systemic disseminated tuberculosis which was mimicked as lymphoma on F-18 FDG PET-CT (PET-CT).Sixty eight-yea...

ea0032p59 | Adrenal cortex | ECE2013

Cardiovascular risk in Cushing's syndrome

Ouldkablia Samia , Aribi Yamina , Bensalah Meriem , Kemali Zahra

Introduction: Cushing’s syndrome is rare but severe because of his association with multiple complications and particularly increased cardiovascular factors. This complications determine a mortality rate four times higher than in general population.Objects: The aim of our study was to evalated the prevalence of cardiovascular factors in Cushing’ syndrome.Subjects and methods: Twenty-five patients with Cushing’ syndro...

ea0032p60 | Adrenal cortex | ECE2013

Management of adrenal carcinoma in a tertiary center of Endocrinology in Romania

Jercalau Simona , Stanescu Bogdan , Tomulescu Victor , Caragheorgheopol Andra , Badiu Corin

Adrenal cortical carcinoma is a rare disease with an incidence of 1–2/million per year. Diagnosis is related to autonomy of adrenal steroid synthesis, tumour size above 6 cm, local invasion and tendency to recurrence. Treatment consists in adrenal surgery, non-specific chemotherapy and radiotherapy, and, more specific-Mitotane (Lysodren).Pathology diagnosis is based on capsular and vascular invasion, histological changes suggestive for malignancy an...

ea0032p61 | Adrenal cortex | ECE2013

Severe hyperglycemia due to cortisol producing adrenal carcinoma

Harbeck Birgit , Berndt Matthias , Sufke Sven , Schutt Morten , Lehnert Hendrik

Introduction: Adrenal carcinomas are rare aggressive endocrine tumours with an incidence of 1–1.7 per 1 000 000. Sixty percent of patients present with symptoms of excess hormone secretion, most commonly as hypercortisolism, with or without virilisation due to accompanying androgen secretion. Tumours without clinical hormonal excess most often present with symptoms such as abdominal discomfort or back pain due to tumour growth.Case report: A 72-year...

ea0032p62 | Adrenal cortex | ECE2013

Metastatic adrenocortical carcinoma presenting with concomitant secretion of glucocorticoid, mineralocorticoid, androgen, and catecholamines: a case report

Akin Safak , Dagdelen Selcuk , Yuksel Elif , Altindag Kadri , Sayek Iskender , Baydar Dilek Ertoy , Erbas Tomris

Introduction: We report the first case of metastatic adrenocortical carcinoma (ACC) concomitantly secreting cortisol, aldosterone, catecholamines and androgens with the extensive distant metastasis at the time of diagnosis.Case report: A 57-year-old woman referred for left adrenal mass (5.5×4.0 cm) two years after the diagnosis of breast cancer. The patient’s medical history revealed hypertension and diabetes mellitus. She has cushingoid and hy...

ea0032p63 | Adrenal cortex | ECE2013

Adrenal lymphoma: about two cases

Haddad Meriem , Fedala Nora Soumeya , Chentli Farida , Akkache Lyna

Lymphoma adrenal is a rare cause of adrenal tumor (0.5%). Bilateral primary lymphoma adrenal phenotype T is exceptional. We report two observations. MO 56 years old was hospitalized FOR exploration and therapeutic management of two large adrenal masses discovered on CT imaging after back pain, and weight loss. Physical examination revealed a patient asthenic, with no signs of hypersecretion. The rest of the examination was unremarkable and research call signs primary neoplasm ...

ea0032p64 | Adrenal cortex | ECE2013

Hypercortisolism endogenous and pregnancy: a report of three cases

Chabour Asma , Fedala Nora Soumeya , Chentli Farida , Chabour Asma , Bala Imene

The occurrence of Cushing’ syndrome in pregnancy is a rare entity due to hypogonadism. Its diagnosis and treatment are very difficult because pregnancy causes hormonal and physical changes which can lead to confusion. In addition, the therapeutic opties are limited because of reduced fetal risk. We rereport the observations of three patients who presented severe Cushing’ syndrome appeared in the first part of pregnancy. This is unkown despite a very evocative paintin...