Searchable abstracts of presentations at key conferences in endocrinology
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17th European Congress of Endocrinology

Eposter Presentations

Adrenal cortex

ea0037ep1 | Adrenal cortex | ECE2015

Evaluation of cases by short synacthen test (dose: 250 μg i.v.) suspected as secondary adrenal insufficiency of prolonged steroid abuse

Ashrafuzzaman S M , Islam Jubaidul , Latif Zafar A

Introduction: Adrenal insufficiency is a common problem in our country due to steroid abuse in various forms. In many occasions the patients even do not know about its side effects and consequences of non-prescribed usage. Many of them presents with sudden withdrawal and adrenal crisis. Many of them admits in Gastroenterology unit due to vomiting, some of them in Medical unit with unexplained fever, weakness, anaemia, etc. Many of them having subtle features of Iatrogenic Cush...

ea0037ep2 | Adrenal cortex | ECE2015

Management of urgent surgical intervention due to coexistence of phaeochromocytoma and hydrocephalus in a patient presenting with Von Hippel Lindau syndrome

Yalin Gulsah , Barbur Mehmet , Yegen Gulcin , Tanrikulu Seher , Uzum Ayse Kubat , Aral Ferihan , Tanakol Refik

A 41-year-old woman was admitted with headache and hypertension. She described worsening of headaches in the last 2 months. On physical examination blood pressure was 150/90 mmHg, and grade 1 hypertensive retinopathy was present. Her sister died at the age of 24 due to pancreas neuroendocrine tumour and her mother was followed up with multiple pancreatic cysts. Abdomen MRI revealed a 6 cm phaeochromocytoma lesion on the right surrenal and multiple cysts in the pancreas, kidney...

ea0037ep3 | Adrenal cortex | ECE2015

A case of polyglandular autoimmune syndrome type 1 with hypercalcaemia and hypotension

Kutbay Nilufer Ozdemir , Yurekli Banu Sarer , Yaman Miray , Erdogan Mehmet , Cetinkalp Sevki , Saygili Fusun , Darcan Sukran , Ozgen Gokhan

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is also known as autoimmune polyendocrine syndrome type 1 (APS-1). We present a case of autoimmune polyendocrine syndrome type 1 with hypercalcaemia of adrenal insufficiency during the calcium treatment because of hypoparathyroidism.Case: A 20-year-old female patient was diagnosed with APS-1 in 2004. She applied to ER with the complaints of nausea and vomiting. Her laboratory finding...

ea0037ep4 | Adrenal cortex | ECE2015

The value of high effective liquid chromatography in the diagnosis of primary aldosteronism

Rebrova Dina , Vorokhobina Natalya , Velikanova Ludmila , Shafigullina Zulfiya

Objectives: Primary aldosteronism (PA) is considered to be the most common cause of secondary hypertension. Therefore, a relevance of early diagnosis of PA is obvious.Methods: We evaluated 98 patients with hypertension in age 47.8±1.4 years. We measured serum potassium by indirect porentiometry, serum aldosterone and plasma rennin activity (PRA) by RIA, serum corticosterone (B), 18-hydroxycorticosterone (18-OH-B), 11-deoxycorticosterone (DOC), 11-de...

ea0037ep5 | Adrenal cortex | ECE2015

Influence of glucocorticoids on markers of inflammation in community-acquired pneumonia

Blum Claudine A , Nigro Nicole , Schuetz Philipp , Winzeler Bettina , Arici Birsen , Refardt Julie , Urwyler Sandrine A , Briel Matthias , Mueller Beat , Christ-Crain Mirjam

Background: Glucocorticoids are frequently prescribed in inflammatory diseases. We investigated the influence of prednisone on classical and novel inflammatory markers in community-acquired pneumonia (CAP).Methods: We evaluated levels of C-reactive protein (CRP), procalcitonin, leukocyte and neutrophil count in a prospective randomized, double-blind, placebo-controlled multicenter trial which compared prednisone 50 mg for 7 days to placebo in patients ho...

ea0037ep6 | Adrenal cortex | ECE2015

Clinical and pathological characteristics of hypertensive and normotensive adrenal phaeochromocytomas

Yan Bi , Dalong Zhu , Yao Lu

Context: Distinct differences of clinical manifestations exist in hypertensive pheochromocytomas (HPs) and normotensive phaeochromocytomas (NPs), however the comparative analysis is lacking.Objective: The objective of the study was to assess the clinical symptoms, haemodynamics, metabolism, radiological and histological features of patients with HPs and NPs.Research design and methods: This retrospective study included 104 patients...

ea0037ep7 | Adrenal cortex | ECE2015

New onset sarcoidosis after remission of Cushing's syndrome

Canturk Zeynep , Selek Alev , Baris Serap , Cetinarslan Berrin , Tarkun Ilhan , Akyay Zeynep

Introduction: Glucocorticoids, even endogenous or exogenous, suppress the inflammatory response therefore they are the most preferred treatment options in inflammatory diseases. Persistent hypercortisolism induces lymphopenia and lymphoid tissue atrophy. Excessive endogenous hypercortisolism might mask the active inflammatory disease. Rebound immune modulation may occur after Cushing’s syndrome (CS) remission, leading to the new onset of autoimmune diseases.<p class="...

ea0037ep8 | Adrenal cortex | ECE2015

Extra-adrenal myelolipomas in association with cortisol hypersecretion

Cavusoglu Betul , Cakir Evrim , Ahbab Suleyman , Ataoglu Esra , Yenigun Mustafa

Extraadrenal perirenal myelolipom has been reported since 1980. In recent years, it has been reported at an increasing rate in different sites of the body ranging from the nasal cavity, mediastinum to presacral, paravesical region. However, it was the first reported case that perirenal multiple myelolipomas, each myelolipomas was about 5 cm in diameter, in associated with cortisol hypersecretion. A patient was an emigrant. She was followed in her country and was prescribed ket...

ea0037ep9 | Adrenal cortex | ECE2015

Salivary cortisol after overnight dexamethasone suppression test in different patient groups

Mert Meral , Tanakol Refik , Karpuzoglu Hande , Abbasoglu Semra Dogru , Soyluk Ozlem , Yarman Sema , Alagol Faruk

Introduction: The aim of this study was to evaluate the worth of the salivary cortisol after overnight 1 mg dexamethasone suppression test (DST) in different patients.Materials and methods: The patient groups of the study consisted of 18 Cushing’s syndrome patients, 12 patients with non-functional adrenal incidentaloma, 37 patients with obesity, 16 patients with hirsutism and 26 healthy control patients. Salivary cortisol (SC) and plasma cortisol af...

ea0037ep10 | Adrenal cortex | ECE2015

Overview of phaeochromocytomas at Vilnius University Hospital Santariskiu clinics (VUHSC): 5 year results

Girdziute Milda , Visockiene Zydrune

The aim of our study was to estimate the prevalence and describe diagnosis, treatment and follow up strategy of phaeochromocytomas at VUHSC.Results: There were 702 patients diagnosed with adrenal masses from 2010 to 2014. Only half of patients were screened for phaeochromocytoma which included 24 (the incidence is 3.4%). Phaeochromocytoma was diagnosed in 5 (20.8%) males and 19 (79.2%) females, average age 55±11.5 years. After surgery 2 (8.3%) were ...

ea0037ep11 | Adrenal cortex | ECE2015

Aldosterone- and cortisol-co-secreting adrenal adenoma in an adolescent girl: a case report

Sahin Serap Baydur , Aktan Ahmet Hamdi , Sahin Osman Zikrullah , Yucel Ahmet Fikret , Algun Ekrem

Introduction: Primary aldosteronism (PA) is the most common reason for secondary hypertension. Among adrenal disorders, rarely aldosterone- and cortisol-co-secreting adenomas (A/CPA) can lead to PA. 35 patients with A/CPA were reported to date and their mean age was 52 (range 34–80) years. We report an A/CPA in an adolescent girl presenting with hypertension combined with hypokalemia and signs of hypercortisolism.Case report: A 18-year-old girl admi...

ea0037ep12 | Adrenal cortex | ECE2015

Comparison of a RIA assay and a CLIA assay for aldosterone determination

Belaidi Nassima , Brossaud Julie , Georges Agnes , Corcuff Jean-Benoit

Objective: To extend knowledge about the clinical performances of a new chemiluminescent immunoassay (CLIA) for aldosterone set up in available analysers.Design and patient: We compared the results of a RIA assay to those of a CLIA assay in 198 serum and 80 urine samples from patients in endocrine and hypertension departments. Furthermore, for serum samples the concordance of results for postural tests was analysed.Results: RIA and...

ea0037ep13 | Adrenal cortex | ECE2015

Does IGF-1 have a role in ethiopathogenesis of adrenal incidentaloma?

Bahadir Cigdem Tura , Atmaca Hulusi

Objectıve: Due to increased usage of imaging modalities today, incidence of adrenal incidentaloma (AI) has increased. Insulin resistance is considered as the etiopathogenic mechanism. Since both insulin and IGF-1 are capable of interacting with same receptors, we aimed to investigate whether IGF-1 has a role in development of adrenal incidentaloma.Materıals and method: 50 female patients with nonfunctional adrenal incidentaloma and 55 acromegal...

ea0037ep14 | Adrenal cortex | ECE2015

Effects of megestrol acetate on adrenal function and survival in cancer patients

Yaylali Guzin Fidan , Dogu Gamze Gokoz , Demiray Atike Gokcen , Ergin Ahmet , Yaren Arzu , Akin Fulya

Introduction: Megestrol acetate (MA) has been used in various cancers as a palliative agent to treat cancer cachexia. It has glucocorticoid activity and can induce significant secondary adrenal suppression. We designed this study to determine the extent of adrenal insufficiency in cancer patients receiving MA and find out whether ther was any predictive factor for this.Methods: Thirty-one patients (11 females and 20 males, aged 48–83 years) who were...

ea0037ep15 | Adrenal cortex | ECE2015

The effect of retinoic acid on human adrenal corticosteroid secretion in vitro

Sesta Antonella , Tapella Laura , Cassarino Maria Francesca , Castelli Luigi , Cavagnini Francesco , Giraldi Francesca Pecori

Retinoic acid, a derivative of vitamin A, has recently yielded promising results in the treatment of Cushing’s disease (Pecori Giraldi et al. JCEM 2012). Its main site of action appears to be the tumoural corticotrope as retinoic acid inhibits POMC transcription and corticotrope proliferation (Paez-Pereda et al. JCI 2001). Studies on tumoural adrenal cell lines have revealed an additional inhibitory effect on cell proliferation and stimulated co...

ea0037ep16 | Adrenal cortex | ECE2015

Adrenal malignant melanoma masquerading as a phaeochromocytoma

Barmpari Maria , Savvidis Christos , Dede Anastasia , Markogiannakis Haridimos , Giannopoulos Dimitrios , Dikoglou Christina , Malaktari-Skarantavou Sofia

Introduction: Adrenal masses usually represent benign and nonfunctional adrenal adenomas however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. Primary adrenal melanoma is an extremely rare entity, while metastases of cutaneous melanoma to the adrenals occur much more often. We present a rare case of a possibly primary adrenal malignant melanoma with imagi...

ea0037ep17 | Adrenal cortex | ECE2015

Cushing's disease: experience in a third level hospital from Zaragoza (Spain)

Callau Francisco Losfablos , Hernandez Paloma de Castro , Aznar Pablo Trincado , Villanueva Marta Monreal , Perez Javier Acha

Objective: Cushing’s disease (CD) is caused by pituitary corticotrophin (ACTH)-secreting tumours. Our aim is to show our experience in a third level hospital attending a 500 000 based population area from 1990 to now.Methods: We review retrospectively the medical reports of all patients diagnosed as CD from 1990 by a data collection protocol. We reject the reports without enough or inadequate information. We present results by using descriptive stat...

ea0037ep18 | Adrenal cortex | ECE2015

Subclinical Cushing's syndrome and clinical implications in bilateral compared to unilateral adrenal incidentalomas: a meta-analysis

Paschou Stavroula A , Kandaraki Eleni , Dimitropoulou Fotini , Goulis Dimitrios G , Vryonidou Andromachi

Introduction: The aim of this study was to systematically review the literature for studies that have investigated possible differences in prevalence of subclinical Cushing’s syndrome (SCS) and related clinical implications between patients with unilateral (UAI) and bilateral adrenal incidentalomas (BAI) and to meta-analyze the best evidence available.Methods: Electronic databases PubMed, MEDLINE and EMBASE were systematically searched. Main study o...

ea0037ep19 | Adrenal cortex | ECE2015

Association of psoriasis with Cushing's syndrome

Bahadir Cigdem Tura , Gokosmanoglu Feyzi , Kan Elif Kilic , Ecemis Gulcin Cengiz , Atmaca Aysegul , Atmaca Hulusi , Colak Ramis

Introduction: Psoriasis is a chronic, inflammatory and T-cell mediated autoimmune disease of skin. Its prevalence is 2–3%. It may improve due to immunesupressive effects of hypercortisolaemia during the active phase of Cushing’s syndrome (CS) and may exacerbate after treatment. The aim of this study was to investigate association of psoriasis with CS.Methods: We prospectively followed 62 patients who had been diagnosed with CS between 2010 and ...

ea0037ep20 | Adrenal cortex | ECE2015

Should Cushing syndrome be only evaluated by endocrinologists and neurosurgeons?

Bahadir Cigdem Tura , Gokosmanoglu Feyzi , Kan Elif Kilic , Ecemis Gulcin Cengiz , Atmaca Aysegul , Atmaca Hulusi , Colak Ramis

Objective: Physical features such as central obesity, purple stria, thin skin, moon face and buffalo hump may be observed in Cushing’s syndrome (CS). Psychiatric and psychological disturbances may also be present in addition to the physical problems. The most common mental disturbance is major depression. Mania and anxiety disorders may also be seen. It may be detected both in active period or in remission of CS on account of persistent effect of previous period of hyperc...

ea0037ep21 | Adrenal cortex | ECE2015

Necessity of thrombophylaxis in Cushing's syndrome

Bahadir Cigdem Tura , Gokosmanoglu Feyzi , Kan Elif Kilic , Ecemis Gulcin Cengiz , Atmaca Aysegul , Atmaca Hulusi , Colak Ramis

Introduction: Cushing’s syndrome (CS) is accompanied by a ten times increased risk of venous thromboembolism and arterial thrombosis. In this study we aimed to analyze frequency of thromboembolism in CS.Methods: We prospectively followed 62 patients who had been diagnosed with CS between 2010 and 2014 in our clinic. Of the patients, 60% had Cushing’s disease (CD) (29 females and eight males) and 40% had ACTH-independent CS (20 females and five ...

ea0037ep22 | Adrenal cortex | ECE2015

Short Synacthen testing: are we referring appropriately and over diagnosing adrenal insufficiency?

Saeed Abu , Guthrie Sara , Pickles Oliver , De Parijat

Background: A previous short Synacthen test (SST) audit in our hospital (2012) showed 70% of initial SST tests were normal with 9% inappropriate requests. A new pro forma was devised whereby one of four criteria (specific symptoms, medications, previous diagnosis, and physical findings) had to be satisfied to be able to undergo a SST. Additionally, we noticed that a number of patients were probably being over-diagnosed wth adrenal insufficiency (AI) based on a single 30 min co...

ea0037ep23 | Adrenal cortex | ECE2015

Primary hyperaldosteronism: predictors of response to therapy in Singapore

Chow Minyang , Lum Grace , Dalan Rinkoo

Background: Primary hyperaldosteronism is a common cause of secondary hypertension, accounting for up to 5% of cases locally. It is treated medically with spironolactone and/or amiloride, or surgically with adrenalectomy. This study determines the prognostic factors for response to treatment, resulting in reduction of blood pressure to normotensive levels.Methods: We retrospectively reviewed records of 57 patients who were diagnosed with primary hyperald...

ea0037ep24 | Adrenal cortex | ECE2015

Reduced salivary cortisone, but similar cortisol day curves in Addison's disease in patients on hydrocortisone replacement

Ross Ian , Lacerda Miguel , Pillay Tahir , Blom Dirk , Johannsson Gudmundur , Dave Joel , Levitt Naomi , Haarburger David , van der Walt Jan-Stefan

Background: Salivary cortisol, as measured using electro-chemiluminescence has been used to monitor patients with Addison’s disease (AD) on hydrocortisone replacement. Salivary cortisone has been suggested as an alternative to salivary cortisol, as it may accurately reflect plasma free cortisol. We wished to examine the pharmacokinetics of these analytes in patients and controls.Methods: We measured salivary cortisol and salivary cortisone by liquid...

ea0037ep25 | Adrenal cortex | ECE2015

Problems in ACTH–ectopic syndrome diagnostics in clinical practice

Volkova Natalya , Davidenko Ilya , Porksheyan Maria

Introduction: Cushing’s syndrome describes symptoms associated with prolonged exposure to inappropriately high levels of cortisol. It may be increased as a result of high ACTH production in the pituitary gland or from tumours outside pituitary–adrenal system.Case report: Patient 34 years old was hospitalised with complaints of muscle weakness, shooting-pain in thoracic, lumbar spine, decreased height, amenorrhea, arterial hypertension and chang...

ea0037ep26 | Adrenal cortex | ECE2015

Primary adrenal lymphoma: case report

Marquez-Pardo Rosa , Baena-Nieto Maria-Gloria , Cayon-Blanco Manuel , Garcia-Garcia-Doncel Lourdes , Lopez-Velasco Rosario , Torres-Barea Isabel

Introduction: Malignancy is an uncommon cause of adrenal incidentaloma in patients without a known diagnosis of cancer. The actual frequency of primary adrenal carcinoma in patients with adrenal incidentaloma is ~2–5%; another 0.7–2.5% have nonadrenal metastases to the adrenal gland. The presence of a nonadrenal primary tumour is exceptional and has been scarcely reported in medical literature.Case report: We present a case of 71-year-old male ...

ea0037ep27 | Adrenal cortex | ECE2015

Cushing's syndrome and diabetes

Azzoug Said , Rabehi Leyla , Hannachi Sara , Medjdoubi Houda , Chentli Farida

Introduction: Cortisol has numerous actions on glucose metabolism and insulin action which explain the frequency of glucose abnormalities in Cushing’s syndrome (CS). The aim of our work was to assess the prevalence and characteristics of diabetes in CS.Material and methods: This is a retrospective study concerning 51 CS (44F/7M) in whom we looked for the presence of diabetes either by fasting glycaemia or 75 g oral glucose tolerance test. Thereafter...

ea0037ep28 | Adrenal cortex | ECE2015

Cushing's syndrome and dyslipidaemia

Azzoug Said , Rabehi Leyla , Hannachi Sara , Medjdoubi Houda , Chentli Farida

Introduction: Cortisol activates lipolysis in adipose tissue resulting in the release of free fatty acids into the circulation, it also activates cholesterol and triglycerides synthesis. The consequence is an increase in total circulating cholesterol and triglycerides with their inherent risks on the cardiovascular system. The aim of our work was to assess the prevalence and characteristics of dyslipidaemia in Cushing’s syndrome (CS).Material and me...

ea0037ep29 | Adrenal cortex | ECE2015

Cushing's syndrome and hypertension

Azzoug Said , Rabehi Leyla , Hannachi Sara , Medjdoubi Houda , Chentli Farida

Introduction: Patients with Cushing’s syndrome (CS) are prone to hypertension as cortisol stimulates renal reabsorption of sodium and enhances vascular sensitivity to catecholamine and angiotensin II. This explains the frequency of hypertension in patients with CS. The aim of our work was to assess the prevalence and characteristics of hypertension in CS.Material and methods: This is a retrospective study concerning 51 CS (44F/7M) in whom we looked ...

ea0037ep30 | Adrenal cortex | ECE2015

Asymmetric dimethylarginine level and markers of atherosclerosis in Cushing's syndrome

Ozsurekci Cemile , Akturk Mujde , Ozkan Cigdem , Gulbahar Ozlem , Altinova Alev , Yalcin Muhittin , Arslan Emre , Toruner Fusun

Objective: Cushing’s syndrome (CS) is related to diabetes mellitus, dyslipidaemia, hypertension, and obesity, which lead to cardiovascular disease (CVD). CVD is the major cause of mortality and morbidity in CS. The aim of our study was to investigate CVD risk markers, such as asymmetric dimethylarginine (ADMA), lipoprotein-associated phospholipase A2 (Lp-PLA2), highly sensitive C-reactive protein (hsCRP), homocysteine, lipid levels, ankle-brachial index (ABI), and carotid...

ea0037ep31 | Adrenal cortex | ECE2015

A case of aldosterone-secreting giant adrenal carcinoma: a case report

Evran Mehtap , Akkus Gamze , Sert Murat , Tetiker Tamer

Introduction: Primary aldosteronism is presented with signs of hypertension and hypokalaemia classically, however, primary adrenal carcinoma is very rare condition. We aimed to present a patient with a metastatic adrenal carcinoma after the primary diagnosis of hyperaldosteronism.Case report: A 46 years old male patient was referred to our hospital with weakness, dry mouth and weight loss. He had lost weight as 31 pounds during last 3 months. Physical ex...

ea0037ep32 | Adrenal cortex | ECE2015

The incidence and characteristics of adrenal insufficiency among patients with suspicious symptoms in general hospital in Korea

Kim Namkeong , Kim MiKyung , Cho Nanhee , Lee YeYeon , Kim Hyesoon

Objective: Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without mineralocorticoids deficiency and adrenal androgens. The mortality of untreated adrenal insufficiency reaches up to 80% in 2 years. Moreover, the symptom is non-specific like malaise, dizziness. Therefore, history taking, prompt diagnosis and management are more important. The diagnostic investigation, although well established, can be challengin...

ea0037ep33 | Adrenal cortex | ECE2015

A case of Addison's disease: high clinical suspicion should guide diagnosis and caution should be used when reviewing initial laboratory investigations

Sutton-Smith Mark , Ravelo Maria , Lipscomb David , Haya Naik

A 69-year-old lady with a history of autoimmune diabetes mellitus and primary autoimmune hypothyroidism presented to the Specialist Diabetes Clinic with a significant inexplicable variation in her capillary blood glucose. She had been undergoing investigations with the gastroenterologists for nausea, vomiting, and weight loss. Despite extensive investigations including: oesophageal–gastro-duodenoscopy, CT–thorax, abdomen, pelvis scanning, and gastric emptying studies...

ea0037ep34 | Adrenal cortex | ECE2015

Selective adrenal venous sampling is not always useful in primary aldosteronism

Paja Miguel , Pena Borja , Calles Laura A , Moreno Cristina

Adrenal venous sampling (AVS) is regarded as the gold-standard for the study of lateralisation of primary aldosteronism (PA) after its biochemical diagnosis. After catheterisation of both adrenal veins, confirmed by ratio of cortisol concentration in each adrenal vein and peripheral vein (selectivity index (SI)), lateralization is accepted if aldosterone/cortisol (A/C) ratio between both adrenal veins is over 3–4 (lateralization index (LI)), particularly if non-dominant v...

ea0037ep35 | Adrenal cortex | ECE2015

The safety of steroid replacement and patient's knowledge

Ahmed Ali , Mumdzic Enis , Wolfsan Paul , Atabani Suha , Malik Mohammed

Background: In steroid dependent patients the knowledge of steroid dose change during illness and stress is of paramount importance.Objectives: i) To assess patient’s knowledge of steroid management during acute illness and stressful condition. ii) To evaluate whether there is a relation between patient knowledge and admission with documented adrenal crisis. iii) To improve medical access to information about patients on steroid at Emergency Departm...

ea0037ep36 | Adrenal cortex | ECE2015

Pituitary macroadenoma with adrenocortical hypersecretion as the initial presentation of compensated adrenocortical failure

Lio Serafino , Albin Monica

Long-standing primary failure of pituitary-dependent endocrine glands may induce pituitary hyperplasia and adenoma both related to duration and severity of peripheral gland insufficiency, although the formation of an adenoma is rare. We report the case of an elderly man with pituitary macroadenoma but compensated adrenocortical failure. A 70-year-old man referred our centre in 2013 for headache and horizontal diplopia. MRI revealed pituitary macroadenoma (1.9×1.1×2.2...

ea0037ep37 | Adrenal cortex | ECE2015

Pregnancy-induced Cushing's syndrome

Andreescu Corina , Hofland Leo , Hofland Hans , Looijenga Leendert , de Herder Wouter , Feelders Richard

Cushing’s syndrome (CS) during pregnancy is a rare metabolic condition with only a few cases reported in the literature. Misdiagnosis of CS is common because of the overlapping features of fatigue, weight gain, striae, and emotional changes that occur during normal pregnancy. The clinical presentation together with laboratory and imaging findings help to make a diagnosis. However, changes in maternal hormones and their binding proteins complicate assessment of the normal ...

ea0037ep38 | Adrenal cortex | ECE2015

Cardiovascular system abnormalities in patients with Cushing's syndrome

Lebedeva Tatiana , Pronina Victoria , Fedorova Svetlana , Dreval Alexander , Komerdus Irina

Background: Patients with Cushing’s syndrome (CS) have a lot of complications due to chronic exposure of cortisol.Aim: To reveal specific changes of cardiovascular system in patients with CS.Material and methods: i) Six patients with CS (five females, one male, 47.1±1.5 years old), duration of CS 3.4±1.2 years, ii) 19 healthy patients (48.1±3.0 years old), and iii) ten patients with ischemic heart disease (IHD) ...

ea0037ep39 | Adrenal cortex | ECE2015

Clinical management of adrenal insufficiency shows significant heterogeneity: data from the EU-AIR study

Murray Robert D , Ekman Bertil , Jones Beverly A , Marelli Claudio , Quinkler Marcus , Zelissen Pierre

Introduction: No consensus guidelines currently exist as to the optimal glucocorticoid regimen in adrenal insufficiency (AI). In clinical practice physicians utilise a number of different glucocorticoids, usually administered in several doses throughout the day.Methods: The EU-AIR registry is a European multinational, multicentre, prospective, observational study sponsored by Shire inclusive of all patients with AI irrespective of aetiology. We analysed ...

ea0037ep40 | Adrenal cortex | ECE2015

Postural orthostatic tachycardia syndrome unmasked by successful treatment of primary aldosteronism

Lulsegged Abbi , Zuyeva Nataliya , Gall Nick

A 50-year-old woman was referred with a history of chronic, symptomatic hypokalaemia. She also had hypertension. There was no history of diarrhoea, increased bowel motions, vomiting, or laxatives/diuretic use. She was not diabetic and she did not have menopausal symptoms. Her mother had seven strokes and myocardial infarction. On examination weight is 69.9 kg, height 1.65 m, BP 163/99, pulse 70, heart sounds normal, and examination of the abdomen was unremarkable. ECG was norm...

ea0037ep41 | Adrenal cortex | ECE2015

Effect of stress-dosed hydrocortisone on physical capacity in patients with Addison's disease

Simunkova Katerina , Jovanovic Nevena , Oksnes Marianne , Lovas Kristian , Husebye Eystein Sverre

The current conventional glucocorticoid (GC) replacement therapy in primary adrenal insufficiency (Addison’s disease) and congenital adrenal hyperplasia (CAH) renders the cortisol levels unphysiological, resulting in very high levels alternating with almost undetectable levels of cortisol over the day. This reduces not merely the patient’s quality of life but increases the patient’s morbidity and mortality. The HPA axis is characterised by a dynamic circadian va...

ea0037ep42 | Adrenal cortex | ECE2015

Phenotypic characteristics of bilateral adrenal masses: about 34 cases

Fedala Nora Soumeya , Haddam Ali El Mahdi , Ali Leyla Ahmed , Benoumechiara Mounia , Chentli Farida , Meskine Djamila

Introduction: Bilateral adrenal tumours are rare and account for 10–15% of adrenal lesions. They can be infectious, inflammatory, tumour, hémmoragiques, and genetic. The clinical and imaging used to guide diagnosis.Aim: Assess clinical, etiologic, and therapeutic characteristics of bilateral adrenal masses.Population and methodology: This is a retrospective study of the records of patients with bilateral adrenal masses co...

ea0037ep43 | Adrenal cortex | ECE2015

Impact of congenital adrenal hyperplasia and glucocorticoid treatment on the final size and gonadal function

Fedala Nora Soumeya , Haddam Ali El Mahdi , Ali Leyla Ahmed , Benoumechiara Mounia , Chentli Farida , Meskine Djamila

Introduction: Congenital adrenal hyperplasia (CAH) are genetic diseases with a deficit of one of the enzymes of steroidogenesis (21 hydroxylase OH, 90%). The consequences of the adrenal hyperandrogenism that results are observed when the treatment is not undertaken precociously.Aim: To study the impact of CAH and or treatment by glucocorticoids on the final size and gonadal function in girls.Materials and methods: 25 patients with ...

ea0037ep44 | Adrenal cortex | ECE2015

Adrenal inclusions in congenital adrenal hyperplasia: clinical and progressive characteristics

Haddam Ali El Mahdi , Fedala Nora Soumeya , Ali Leyla Ahmed , Benoumechiara Mounia , Meskine Djamila , Chentli Farida

Introduction: Intra-testicular adrenal inclusions (ISIT) are benign tumors made of ectopic adrenal cortex tissue hyper stimulated by ACTH in excess. All pathologies causing a rise ACTH levels may be associated with adrenal inclusions. They are found mainly in patients with congenital adrenal hyperplasia (CAH) of untreated or poorly treated.Objective: Search the frequency of ISIT in CAH and clarify clinical and progressive characteristics.<p class="ab...

ea0037ep45 | Adrenal cortex | ECE2015

X-linked adrenal hypoplasia congenita with a novel DAX1 missense mutation

Tseng Fen-Yu , Tseng Yu-Ting , Shih Shyang-Ron , Chen Pei-Lung

Introduction: X-linked adrenal hypoplasia congenita (AHC) is a rare developmental disorder of the adrenal cortex. Adrenal insufficiency typically begins in infancy or in childhood. A few individuals present adrenal insufficiency in adulthood.Case report: A 21-year-old man visited our endocrine out-patient clinic due to underdeveloped secondary sexual characteristics, which was found at physical examination for military service. Physical examination revea...

ea0037ep46 | Adrenal cortex | ECE2015

Adrenal insufficiency during prednisolone treatment: need for cortisol replacement strategies in patients on long-term low-dose glucocorticoid treatment?

Borresen Stina Willemoes , Baslund Bo , Klose Marianne , Rasmussen AEse Krogh , Friis-Hansen Lennart , Hilsted Linda , Locht Henning , Hansen Annette , Hetland Merete Lund , Feldt-Rasmussen Ulla

Background: Patients on long-term glucocorticoid treatment are at risk of adrenal insufficiency during glucocorticoid treatment. The side effect can occur during glucocorticoid treatment if there is a mismatch between glucocorticoid requirements and production/intake. High-dose glucocorticoid treatment is often sufficient to overcome most stressful situations. A low-dose of 5 mg prednisolone/day is however, equivalent to 20 mg hydrocortisone, a dose often used as basal glucoco...

ea0037ep47 | Adrenal cortex | ECE2015

A challenging case of paraneoplastic Cushing's syndrome

Mazilu Adina , Gheorghiu Mona , Musat Madalina , Ranetti Aurelian-Emil , Mazilu Victor-Catalin , Tanase Narcis , Petrescu Razvan , Ciuche Adrian , Tudose Augustin , Vasilescu Florina , Ardeleanu Carmen

Introduction: Paraneoplastic Cushing’ syndrome (CS) represents 5–10% of all CS and has a severe prognosis due to severe metabolic imbalance, denutrition, associated infections, and progression of tumoural underlying pathology.A 67 years old woman presented with mental confusion, progressive weight loss, severe oedema and kypokalaemia, without typical features of Cushing or hyperpigmentation. Investigations revealed paraneoplastic Cushing’s...

ea0037ep48 | Adrenal cortex | ECE2015

The treatment with ‘dual release' hydrocortisone (DR-HC) in congenital adrenal hyperplasia: short-term (6 months) and long-term (12 months) follow-up after the switch from conventional glucocorticoids to DR-HC

Simeoli Chiara , De Martino Maria Cristina , Iacuaniello Davide , Mannarino Teresa , Cozzolino Alessia , De Leo Monica , Pivonello Claudia , Negri Mariarosaria , De Angelis Cristina , Colao Annamaria , Pivonello Rosario

In patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, life-long glucocorticoid (GC) treatment is often required to replace cortisol deficiency and to avoid the ACTH-dependent androgen levels increase. However, in these patients, the multiple daily doses required with conventional GCs can cause cortisol overexposure, leading to an increased risk of metabolic syndrome (MS), an impaired quality of life (QoL), and poor treatment compliance (TC). T...

ea0037ep49 | Adrenal cortex | ECE2015

The effect of oxidative stress to cardiovascular risk profile among non-functional adrenal incidentaloma patients

Bolat Hanife , Gul Kamile , Sokmen Gulizar , Sahin Murat , Kurutas Ergul , Oguz Ayten , Sokmen Abdullah , Tuzun Dilek , Taner Safiye Seyma , Akgul Omer Faruk

Aim: In this study our aim was to investigate the effects of non-functional adrenal incidentalomas to cardio-metabolic risk factors and endothelial function.Materials and methods: Our study involved 30 patients with non-functional adrenal incidentaloma (patient group), and two control groups without adrenal incidentaloma (control group 1 involved 26 patients have DM and/or HT and control group 2 involved 24 healthy control). Metabolic parameters (fasting...

ea0037ep50 | Adrenal cortex | ECE2015

Malignant phaeochromocytoma: about seven observations

Benoumechiara Mounia , Fedala Nora Soumeya , Haddam Ali El Mahdi , Ali Leyla Ahmed , Chentli Farida , Meskine Djamila

Introduction: Malignant phaeochromocytomas are rare tumours, developed at the medulla and paraganglia. Their diagnosis is established by the presence of metastases of organs devoid of chromaffin tissue or by the appearance of neoplastic recurrence. They are characterized by a morbidity and mortality due to the effects of uncontrolled and important hypersecretion cathécolaminergique and resistance to conventional cancer treatments.Aim: Report the obs...

ea0037ep51 | Adrenal cortex | ECE2015

Comparison of 17-OH progesterone response to various dose of tetracosactide

Kosak Mikulas , Duskova Michaela , Simunkova Katerina , Hana Vaclav , Krsek Michal , Jandikova Hana , Pospisilova Hana , Sramkova Monika , Velikova Marta , Starka Luboslav

ACTH test is widely accepted as diagnostic tool in suspicion on peripheral as well as on central hypocorticism. The optimal dose of tetracosactide for determination of hypocorticism is still matter of debate. The 250 μg as a standard dose of tetracosactide has been approved for diagnosis of congenital adrenal hyperplasia (CAH) many years ago. Moreover, current limited availability of tetracosactide and its increased financial cost on the market raised the question whether...

ea0037ep52 | Adrenal cortex | ECE2015

Functional oncocytic adrenocortical tumour: a case report

Sahin Murat , Tuzun Dilek , Oguz Ayten , Yuzbasioglu Mehmet Fatih , Sayar Hamide , Demir Hakan , Gul Kamile

Introduction: Adrenocortical oncocytomas are rare seen tumours. Most of these tumours are benign and non-functioning. We present here a case of oncocytic adrenocortical tumour, detected incidentally, presented with Cushing’s syndrome.Case: A 41-year-old male patient, while investigating for abdominal pain, bilateral adrenal masses were detected in abdominal ultrasonography and was admitted to Endocrinology Clinic. He had no history of hypertension. ...

ea0037ep53 | Adrenal cortex | ECE2015

Beneficial effects of replacement therapy with modified-release hydrocortisone in patients with adrenal insufficiency

Morelli Valentina , Messina Erika , Mendola Marco , Cairoli Elisa , Ambrosi Bruno , Cannavo Salvatore , Chiodini Iacopo , Spada Anna

Introduction: The classical replacement therapy for hypoadrenalism may expose patients to non-physiologic glucocorticoids levels with negative metabolic consequences. Up to now, one study demonstrated that, as compared to the classical treatment, a modified-release hydrocortisone (MRH), improves weight, blood pressure, glycaemic control and QoL in a 3-month follow-up period. Few data are available on the long-term persistence of these benefits.Design/met...

ea0037ep54 | Adrenal cortex | ECE2015

A phase 1, randomised, open-label, four-period crossover, single-dose study to evaluate the pharmacokinetics of hydrocortisone modified release tablets

Johannsson Gudmundur , Lennernas Hans , Marelli Claudio , Rockich Kevin , Skrtic Stanko

Novel biopharmaceutical techniques have allowed the development of a hydrocortisone modified release (MR) tablet (once-daily administration for replacement therapy in adrenal insufficiency) mimicking more closely the physiological serum cortisol profile. Robust bioavailability is needed to secure this new treatment safety.Aims: To compare single-dose pharmacokinetics (PK) of MR tablets manufactured at two different sites by assessing intra-subject variab...

ea0037ep55 | Adrenal cortex | ECE2015

Rare case of ectopic ACTH secreting tumour causing cyclical Cushing's syndrome

Acharya Jayashekara , Akavarapu Sriranganath , Abbara Ali , Parvathy Valsalakumari , Todd J F

We are reporting a rare case of ectopic ACTH secreting tumour causing cyclical Cushing’s syndrome. A 63-year-old lady presented in March 2013 with tiredness and bilateral leg swelling and weakness associated with easy bruising. She was admitted to local hospital in April 2013 with worsening proximal myopathy and peripheral oedema. Her midnight cortisol was elevated at 1710 nmol/l. ACTH 610 mU/l, prolactin 476 mU/l, GH 0.21 IU/l, TSH 0.73 mU/l, free T4 of 11.0 p...

ea0037ep56 | Adrenal cortex | ECE2015

Review of clinical presentation of primary hyperaldosteronism and identify unique features in our cohort

Lee Daphne , Shakoor Shaikh A K K Abdul , Pua Uei , Wong Daniel , Quek Lawrence

Aim: Review of clinical presentation of primary hyperaldosteronism (PHA) and identify unique features in our cohort.Method: Patients with PHA were identified from patients who underwent adrenal vein sampling (AVS) at our centre until October 2014.Results: 45 PHA patients (32 males, mean age of 50 years, 33 older than 45 years) were identified after confirmation with high aldosterone:renin ratio >15 and/or positive saline suppre...

ea0037ep57 | Adrenal cortex | ECE2015

To identify usefulness of adrenal vein sampling in clinical management of primary hyperaldosteronism

Lee Daphne , Shakoor Shaikh A K K Abdul , Pua Uei , Wong Daniel , Quek Lawrence

Aim: To identify usefulness of adrenal vein sampling (AVS) in clinical management of primary hyperaldosteronism (PHA).Method: Biochemical and radiological review (by two independent radiologists) of 48 AVS in 45 patients with PHA who underwent CT adrenals/AVS.Results: CT adrenal findings were: 31/45 (68.9%) unilateral nodule (one had two nodules unilaterally), 5/45 (11.1%) bilateral nodules, 7/45 no nodules, 1/45 bilateral bulky ad...

ea0037ep58 | Adrenal cortex | ECE2015

Diagnosis of Cushing's syndrome using scalp hair cortisol

Wester Vincent L , Koper Jan W , van den Akker Erica L T , de Rijke Yolanda B , Manenschijn Laura , Feelders Richard A , van Rossum Elisabeth F C

Background: Endogenous Cushing’s syndrome (CS) is caused by overproduction of cortisol. Current first-line screening tests for CS can produce false positive results due to medication use and stress, rely heavily on patient adherence to sampling instructions, and only measure short-term cortisol exposure which limits sensitivity. In general multiple tests are required to establish a diagnosis. Hair cortisol concentrations (HCC) offer a minimally invasive way to measure lon...

ea0037ep59 | Adrenal cortex | ECE2015

Role for 131I-6β-iodomethyl-norcholesterol scintigraphy in subclinical Cushing's syndrome with bilateral adrenal lesions

Guelho Daniela , Ferreira Rui , Paiva Isabel , Moreira Ana Paula , Moreno Carolina , Cardoso Luis , Vicente Nuno , Martins Diana , Oliveira Diana , Balsa Margarida , Costa Gracinda , Carrilho Francisco

Introduction: Subclinical Cushing’s syndrome (SCS) is the most frequent endocrine dysfunction found in adrenal incidentalomas. Although adrenalectomy constitutes a therapeutic option for selected cases, the presence of bilateral tumours can difficult the surgical decision.Objective: Evaluate the utility of 131I-6β-iodomethyl-19-norcholesterol scintigraphy in SCS with bilateral adrenal tumours.Methods: Retrospec...

ea0037ep60 | Adrenal cortex | ECE2015

Diagnostic pitfalls of Cushing's syndrome without specific clinical signs among patients with obesity

Volkova Nalalia , Porksheyan Maria , Ganenko Lilia

Introduction: Prevalence of CS without specific signs is thought to be high, which might be an indication for its general screening. However, conclusive data about its diagnostics is absent.Design: 189 overweight patients were studied. Nobody had clinical evidence of hypercortisolism. Diagnostic of CS was 1-mg overnight dexamethasone suppression test (1-mg DST; cut off 50 nmol/l) as a screening; midnight plasma cortisol (MPC) (<207 nmol/l) and 24-h u...

ea0037ep61 | Adrenal cortex | ECE2015

The utility of current guidelines in the assessment of adrenal incidentalomas

Austin Emily , Shepherd Lisa , Rahim Asad , Bates Andrew

Adrenal incidentaloma’s are a common clinical dilemma with increasing utilisation of cross-sectional imaging modalities. The aims of management include i) exclusion of possible malignancy and ii) identification of hormonally active lesions. Our unit has adopted AACE guidelines, including a screen for adrenal androgen hypersecretion. This audit aimed to review the utility of such an approach. We identified case notes of 100 consecutive adrenal incidentaloma’s referred...

ea0037ep62 | Adrenal cortex | ECE2015

Prospective evaluation of cardiovascular risk in subclinical Cushing's syndrome

Yener Serkan , Cekdemir Yasin , Baris Mustafa , Demirpence Mustafa , Demir Tevfik , Secil Mustafa

Introduction: Natural history of adrenal incidentalomas has not been totally understood. Current data from subjects with adrenal incidentalomas demonstrated an increased rate of metabolic disturbances and cardiovascular risk. It has been shown that subjects with subclinical cortisol excess were more susceptible to diabetes, hypertension, and obesity. However, there is no data regarding prospective cardiovascular risk evaluation in subjects with subclinical Cushing’s syndr...

ea0037ep63 | Adrenal cortex | ECE2015

Salivary cortisol values among nurses at Pathology and Emergency Department

Dyrmishi Blertina , Olldashi Taulant , Kolici Emirvina , Ylli Zamira , Ylli Agron

Aim: To see the difference between salivary cortisol values and correlation with the work stress.Methods: The salivary and serum cortisol values were analysed in two groups of nurses, six nurses in the Emergency Department and six nurses in the Pathology Department at our hospital, three females and three males for each group. The samples were taken before beginning the work and after finishing the work. The cases respected all the rules for salivary tes...

ea0037ep64 | Adrenal cortex | ECE2015

Serum brain-derived neurotrophic factor in Cushing's syndrome patients

Santos Alicia , Resmini Eugenia , Barahona Ma Jose , Crespo Iris , Valassi Elena , Martinez Ma Antonia , Marin Ana , Webb Susan M

Introduction: Brain-derived neurotrophic factor (BDNF) is a protein that has been linked to several cardiovascular risk factors and bone status. Stress and corticosteroid exposure can affect BDNF levels, although this has never been studied in Cushing’s syndrome (CS). The aims of this study were to establish if BDNF levels were reduced in CS and to check possible associations to cardiovascular risk factors and bone status.Methods: 52 patients (18 ac...

ea0037ep65 | Adrenal cortex | ECE2015

Urinary metanephrine levels can be spurious in the diagnosis of patients with phaeochromocytoma: preliminary results from a single centre

Topaloglu Oya , Baser Husniye , Aydin Cevdet , Dirikoc Ahmet , Ersoy Reyhan , Erel Ozcan , Cakir Bekir

Introduction: Phaeochromocytomas (PHEO) are diagnosed with classic findings and symptoms but biochemical confirmation must be made. Either urinary or plasma chatecholamines and metanephrines can be used for biochemical evaluation. Normal values rule out the diagnosis, whereas fourfold increase above the upper limit of normal confirm the diagnosis. But value of borderline or less than fourfold elevations in the diagnosis is not clear. We aimed to determine the urinary fractiona...

ea0037ep66 | Adrenal cortex | ECE2015

Clinical significance of contralateral adrenal suppression during adrenal vein sampling in primary aldosteronism

Monticone Silvia , Satoh Fumitoshi , Viola Andrea , Fischer Eveline , Vonend Oliver , Bernini Giampaolo , Quinkler Marcus , Giacchetti Gilberta , Morimoto Ryo , Willemberg Holger , Maccario Mauro , Veglio Franco , Ito Sadayoshi , Reincke Martin , Mulatero Paolo

Objective: Adrenal vein sampling (AVS) is recognised by Endocrine Society guidelines as the only reliable mean to distinguish between aldosterone producing adenomas and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). However, AVS protocols are not standardised and vary between centres. The objective of the present study was to assess whether the presence or absence of contralateral adrenal (CL) suppression has an impact on the postope...

ea0037ep67 | Adrenal cortex | ECE2015

Glucocorticoid receptor polymorphisms not affect the therapy efficiency in adult, Hungarian patients with 21-hydroxylase deficiency

Klara Koncz , Abigel Farkas , Marton Doleaschall , Nikolett Szucs , Miklos Toth , Peter Igaz , Karoly Racz , Attila Patocs

Background: Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder caused by 21-hydroxylase deficiency in 95% of all cases. Two main clinical subtypes: the classical (manifested after birth, or in early newborn period) and the late onset (LO) phenotype (manifested commonly during puberty). The lifelong glucocorticoid (GC) supplementation is essential in therapy of these patients. Response to GC therapy is individual and partly genetically determined....

ea0037ep68 | Adrenal cortex | ECE2015

The antidiabetic drug metformin affects H295R cells proliferation

Armignacco Roberta , Poli Giada , Cantini Giulia , Canu Letizia , Luconi Michaela , Mannelli Massimo

Adrenocortical carcinoma (ACC) is a rare, heterogeneous malignancy with a poor prognosis, particularly when metastatic at diagnosis. To date, radical surgery, possibly associated to mitotane adjuvant therapy, is the only available treatment. However, the mean 5-year survival rate drops under 10% in metastatic ACC and chemo-resistance often develops. Thus, more specific and effective drugs for ACC treatment are urgently required. The antidiabetic drug metformin, used in type 2 ...

ea0037ep69 | Adrenal cortex | ECE2015

Prevalence and natural history of adrenal incidentalomas: a prospective cohort study

Anagnostis Panagiotis , Siolos Athanasios , Zouli Chrisanthi , Adamidou Fotini , Efstathiadou Zoe , Panagiotou Athanasios , Mintziori Gesthimani , Kita Marina

Introduction: Adrenal incidentalomas (AIs) are frequently detected due to the increasing use of abdominal imaging for diagnostic purposes. However, few prospective studies exist with respect to their natural history, regarding their size and clinical course. The aim of this study was to report the prevalence and natural history of AIs.Methods/design: Interim analysis of a prospective cohort study. The following tests were performed: serum cortisol noctur...

ea0037ep70 | Adrenal cortex | ECE2015

Prevalence of hypercortisolism in type 2 diabetes patients: a meta-analysis

Steffensen Charlotte , Pereira Alberto , Dekkers Olaf M , Jorgensen Jens Otto

Background: Type 2 diabetes (T2D) and hypercortisolism associated with Cushing’s syndrome (CS) share clinical characteristics such as hypertension, dyslipidaemia, hyperglycaemia, and obesity. Several studies have recorded a relatively high prevalence of hypercortisolism in T2D, which may have therapeutic implications. The aim of this systematic review and meta-analysis was to assess the prevalence of hypercortisolism in T2D patients.Methods: Origina...

ea0037ep71 | Adrenal cortex | ECE2015

Fludrocortisone therapy in patients with primary adrenal insufficiency: relationships with different hydrocortisone doses

Ekman Bertil , Quinkler Marcus , Jones Beverly A , Marelli Claudio , Murray Robert , Zelissen Pierre , Wahlberg Jeanette

Introduction: During recent years many authors have advocated lower hydrocortisone doses in patients with primary adrenal insufficiency (PAI) mainly due to worries for non-physiological effects like increased cardiovascular risk and bone resorption, but very little attention has been drawn to fludrocortisone dosing. Our main hypothesis was that that the higher hydrocortisone dose, the lower the fludrocortisone dose and vice versa.Design: The Eur...

ea0037ep72 | Adrenal cortex | ECE2015

Prevalence of Cushing's syndrome at overweight and obese patients

Basaran Mehtap Navdar , Dogan Bercem Aycicek , Onal Eda Demir , Karakilic Ersen , Berker Dilek , Guler Serdar

Background: In the presence of specific symptoms and signs, Cushing’s syndrome (CS) may be easily recognised. On the other hand, in overweight and obese patients without typical features of CS, diagnosis may be omitted. Our aim was to evaluate the prevalence of CS among overweight and obese patients.Methods: We enrolled 264 overweight and obese patients who has not overt CS clinical features between January 2012 and December 2014 at Ankara Numune Ed...

ea0037ep73 | Adrenal cortex | ECE2015

The clinical course of patients with adrenal incidentaloma: is it time to reconsider the current recommendations?

Kastelan Darko , Kraljevic Ivana , Dusek Tina , Knezevic Nikola , Solak Mirsala , Gardijan Bojana , Kralik Marko , Poljicanin Tamara , Polovina Tanja Skoric , Kastelan Zaljko

Context: The current guidelines for the management of adrenal incidentaloma advise hormonal and radiological follow-up of the patients for 2–5 years after the initial diagnosis. However, a vast majority of adrenal incidentaloma are non-functional, benign cortical adenomas that require no treatment, so the routine application of the current strategies often results in a number of unnecessary biochemical and radiological investigations.Objective: The ...

ea0037ep74 | Adrenal cortex | ECE2015

An audit of the investigation and follow up of adrenal incidentalomas

McElwaine Fred , Ellis Peter , McCance David , Bell Patrick , Hunter Steven , Courtney Hamish , Mullan Karen

An adrenal incidentaloma is defined as an adrenal mass >1 cm diameter, discovered serendipitously on radiological imaging done for another reason. They are important because a percentage will turn out to be malignant or secrete excess hormones. The aim of the current study was to ascertain if these lesions were being investigated and followed appropriately compared to American Association of Clinical Endocrinologists guidelines. All imaging reports for the calendar year 20...

ea0037ep75 | Adrenal cortex | ECE2015

Biochemical control and clinical improvement is induced by long-term pasireotide administration in the majority of patients with Cushing's disease persistent after pituitary surgery

Messina Erika , Albani Adriana , Ferrau Francesco , Trimarchi Francesco , Cannavo Salvatore

Pasireotide (SOM230) is a multireceptor ligand somatostatin analogue with high binding affinity to somatostatin receptor subtype 5, which is predominantly expressed in ACTH-secreting pituitary adenomas. It is indicated for the treatment of adult patients with Cushing’s disease (CD) for whom pituitary surgery is not an option or has not been curative. Our study evaluated the effects of pasireotide, administered for 12 months at a dose of 600–900 μg/daily, in five...

ea0037ep76 | Adrenal cortex | ECE2015

Ectopic thyroid tissue in the adrenal gland: report of a case

Bozkirli Emre , Bakiner Okan , Belli Sedat , Kocer Emrah , Ulusan Serife , Reyhan Mehmet

Background: Ectopic thyroid tissue (ETT) can be explained as the localisation of thyroid parenchyma outside the orthotopic position of the thyroid gland. It can be more easily found in the tongue, neck, mediastinum, great vessels, heart and anywhere along Wölfler area, but presentation in the adrenal glands is absolutely very rare.Case: A 39-year-old woman was referred to our Endocrinology outpatient clinic with an incidental adrenal mass which was ...

ea0037ep77 | Adrenal cortex | ECE2015

Prevalence of neoplasms in patients with primary aldosteronism

Lang Katharina , Weber Katrin , Quinkler Marcus , Dietz Anna , Wallaschofski Henri , Hannemann Anke , Vonend Oliver , Willenberg Holger , Reincke Martin , Allolio Bruno , Hahner Stefanie

Context: Primary aldosteronism (PA) is the most common cause of secondary hypertension. Aldosterone excess can cause oxidative stress and respectively DNA damage in vitro and in vivo and increased levels of oxidative stress have been demonstrated in PA patients. Single case reports describe a coincidence of PA with renal cell carcinoma (RCC) and other tumours. However, so far no data on the prevalence of benign and malignant neoplasms in patients with PA exis...

ea0037ep78 | Adrenal cortex | ECE2015

Outcomes of short synacthen test in a university teaching hospital: are baseline and time 30 min sufficient?

Ahmed Mohamed , A Gunness , A Rakovac-Tisdall , E Cullen , N Barnwell , C Neary , G Boran , J Gibney , M Sherlock

Introduction: Short synacthen test (SST) has become the standard method of assessing the hypothalamic–pituitary–adrenal (HPA) axis. However, there are still variances in practice with regards to performing and interpreting this test in particular the need for measuring cortisol level at both time 30 and 60 min.Methods: A retrospective review of 500 consecutive SST performed at a University teaching Hospital in Dublin between 2005 and 2012. Seru...

ea0037ep79 | Adrenal cortex | ECE2015

Functional muscle capacity and daily physical activity deficits in patients with endogenous Cushing's syndrome

Assimakopoulou A , Louvaris Z , Balomenaki M , Chynkiamis N , Tzanela M , Vogiatzis I , Tsagarakis S

Cushing’s syndrome (CS) is a disease entity that through hypercortisolism affects all body’s tissues leading to increased morbidity, decreased quality of life and mortality. Muscles are among the tissues primarily affected. However, data on the impact of endogenous hypercortisolism on functional muscle capacity and daily physical activity levels are scarce. We studied 23 subjects with endogenous CS (mean age: 40.73±2.17 years) and 22 healthy aged and sex matched...

ea0037ep80 | Adrenal cortex | ECE2015

Metabolic abnormalities in patients with nonfunctional adrenal incidentaloma: random or causal?

Belceanu Alina Daniela , Armasu Ioana , Cirdei Oana , Crumpei Felicia , Preda Cristina , Leustean Letitia , Ungureanu Didona , Mogos Voichita , Vulpoi Carmen

Introduction: With a prevalence of 0.5–2% in computed tomography series, incidentally diagnosed nonfunctional adrenal tumours (NAI) become more and more common in clinical practice. It is not clear if the higher frequency of NAI in patients with metabolic syndrome is causal or random.Patients and methods: We retrospectively analysed patients diagnosed with adrenal tumors on computed tomography in 1 year interval (January–December 2014). Includi...

ea0037ep81 | Adrenal cortex | ECE2015

Acute adrenal insufficiency as a first sign of metastatic pulmonary carcinoma

Manolachie Adina , Volovat Constantin , Grigorescu Cristina , Botnariu Gina Eosefina , Gafton Bogdan , Armasu Ioana , Leustean Letitia , Vulpoi Carmen

Introduction: Adrenal glands are common sites for secondary lesions derived from malignant tumours (lymphoma, melanoma, renal, breast, colon, and bronchopulmonary cancer). Patients with adrenal secondary lesions are typically asymptomatic but 1% may present with adrenal insufficiency as a first manifestation. We report the cases of two males with lung adenocarcinoma, first presented with acute adrenal insufficiency.Cases presentation: Case 1: LC, 65 year...

ea0037ep82 | Adrenal cortex | ECE2015

Marked hypercholesterolaemia caused by mitotane adjuvant chemotherapy for adrenocortical carcinoma

Yurekli Banu Sarer , Kutbay Nilufer Ozdemir , Altun Ilker , Ozgen Gokhan

Aim: Mitotane (o,p′-DDD) has been used to treat adrenocortical carcinoma (ACC) for several decades. Mitotane is often given in adjuvant setting after surgical resection of ACC and treatment usually lasts 2–3 years to reduce ACC recurrence. The use of mitotane is associated with multiple adverse effects. We herein report a case of marked hypercholesterolemia in a man receiving mitotane as adjuvant chemotherapy for ACC.Case: A 64-year-old man wa...

ea0037ep83 | Adrenal cortex | ECE2015

Fasting during Ramadan in patients with adrenal insufficiency

Chihaoui Melika , Grira Wafa , Chaker Fatma , Yazidi Meriem , Slimane Hedia

Long fasting in patients with adrenal insufficiency could cause hypotension, dehydration or hypoglycaemia. No studies evaluated these risks and there is no recommendations about fasting for these patients. The aim of our study was to evaluate the potential risks of fasting during the month of Ramadan in patients with adrenal insufficiency.Subjects and methods: It is a cross sectional study that concerned 125 subjects (97 women and 28 men, mean age=47.8 y...

ea0037ep84 | Adrenal cortex | ECE2015

Awareness of adrenal crisis prevention in long-term steroid users

Salehmohamed Muhammad Ridhwaan , Griffin Mark , Branigan Tom , Cuesta Martin , Thompson Chris

Background: Patients taking corticosteroids for immune suppression are vulnerable to adrenal crisis during intercurrent illness or if steroids are stopped abruptly. Although patients on glucocorticoids for adrenal failure are routinely provided with sick day rules, we wished to ascertain whether patients on immunosuppressive steroids are appropriately counselled.Aim: This study sets out to compare patient awareness of steroid sick day rules in endocrine ...

ea0037ep85 | Adrenal cortex | ECE2015

Subclinical Cushing's syndrome: report of 17 cases

Kacem Faten Haj , Cheikhrouhou Nesrine , Charfi Nadia , Lassoued Najwa , Mnif Fatma , Mnif Mouna , Rkik Nabila , Abid Mohamed

Introduction: Subclinical Cushing’s syndrome refers to autonomous cortisol secretion in patients who do not have the typical signs and symptoms of hypercortisolism. This study was undertaken to describe clinical, biological and radiological features of this disease and to evaluate the clinical outcome after surgical and medical treatment.Methods: Retrospective study conducted over a period of 12 years and including 17 patients hospitalised in our de...

ea0037ep86 | Adrenal cortex | ECE2015

Challenges in a the management of adrenal Cushing's syndrome associated with bilateral adrenal tumours and uterine leiomyoma

Poiana Catalina , Carsote Mara , Gruia Adriana , Peretianu Dan , Gheorghiu Ermina , Petris Rodica , Paun Sorin , Dumitrascu Anda , Hortopan Dan

Introduction: The Cushing’s syndrome associated bilateral adrenal tumours comprise a wide area of diagnosis; the therapeutic approach is challenging since unilateral intervention might involve persistent hypercotisolemia, and bilateral adrenalectomy induces chronic adrenal insufficiency. The adrenal vein catheterism is not available in many countries.Case report: 50-year old non-smoker female has the following medical history: 2 years ago she presen...

ea0037ep87 | Adrenal cortex | ECE2015

Spectrum of presentation and aetiology of adrenal haemorrhage: a case series

McCabe John Joseph , Eochagain Colm Mac , O'Connor Donal , Gibney James , Conlon Kevin , Sherlock Mark

Introduction: Adrenal haemorrhage is rare. There is a broad spectrum of clinical presentation and aetiology of the condition making it challenging to diagnose. Endocrine dysfunction frequently complicates cases of adrenal haemorrhage. Failure to recognise the condition or its complications can lead to devastating consequences for the patient.Methods: All patients referred to our centre with adrenal haemorrhage between 2004 and 2014 were included in this ...

ea0037ep88 | Adrenal cortex | ECE2015

A single-centre 10-years experience with pasireotide in Cushing's disease: patients characteristics and outcome

Trementino Laura , Michetti Grazia , Angeletti Alessia , Marcelli Giorgia , Concettoni Carolina , Cardinaletti Marina , Polenta Barbara , Boscaro Marco , Arnaldi Giorgio

Introduction: Pasireotide is the first pituitary-directed drug approved for Cushing’s disease (CD). We report our 10-years experience with pasireotide in CD reviewing and analysing data about all the patients treated with pasireotide at our referral centre both in randomised trials and in clinical practice.Patients and methods: Twenty active CD patients were treated. Fourteen patients were treated with pasireotide in randomised trials and six patien...

ea0037ep89 | Adrenal cortex | ECE2015

Low DHEAS: a sensitive and specific screening test for the detection of subclinical hypercortisolism in adrenal incidentalomas

Dennedy Michael Conall , Anamalai Anand K , Smith Olivia Prankerd , Powlson Andrew S , Graggaber Johann , Shaw Ashley , Halsall David J , Gurnell Mark

Subclinical hypercortisolism (SH) occurs in 5–30% of incidentally-detected adrenal adenomas (AIs). Common screening tests for ACTH-independent hypercortisolism have significant false positive rates, mandating further investigations that are both time and resource intensive. We investigated whether a low basal DHEAS level is a sensitive and specific screening test for the detection/exclusion of SH in patients with newly-diagnosed AI. We recruited 185 consecutive patients w...

ea0037ep90 | Adrenal cortex | ECE2015

Ultrasound importance in adrenal incidentalomas diagnostication and management

Themeli Yllka , Barbullushi Myftar , Gjokutaj Aqif , Dilo Gjergji , Hoxha Lindita

Background: Adrenal incidentalomas are detected in about 0.1% of general health screening with ultrasound, in 0.4–1.9% among patients evaluated for nonendocrinologic complaints, in ~4.4% among patients who have a previous cancer diagnosis. Majority are benign, but careful evaluation is warranted to rule out carcinoma and functional adenomas.Aim: The purpose of presenting these cases is to highlight the importance of ultrasound examination in diagnos...

ea0037ep91 | Adrenal cortex | ECE2015

RNALDO: the effects of blocker withdrawal on renin and angiotensin

Griffin Tomas , Browne Gerard A , O'Shea Paula M , Dennedy Michael Conall

Primary hyperaldosteronism (PHA) prevails in up to 20% of individuals with essential hypertension, but often presents a diagnostic challenge due to difficulty in interpreting the aldosterone renin ratio (ARR) largely due to anti-hypertensive medication interference. Interpretation of the ARR in the context of beta blockers presents a particular challenge and may produce false positive results due to renin suppression. We investigated the effects of beta blocker withdrawal on A...

ea0037ep92 | Adrenal cortex | ECE2015

Long-term outcome from unilateral adrenalectomy in patients with primary aldosteronism

Hannon Mark J , Sze Candy , Carpenter Robert , Parvanta Laila , Matson Matthew , Sahdeve Anju , Druce Maralyn R , Waterhouse Mona , Akker Scott A , Drake William M

Primary aldosteronism (PA) is an important cause of hypertension which confers significant cardiometabolic risk. In approximately half of cases, the cause is a surgically resectable unilateral aldosterone-producing adrenal adenoma, making PA the most common potentially curable form of hypertension. Despite this, long-term data on surgical outcomes that could be used to guide discussions with patients are sparse. Here, we report on clinical outcomes several years post-adrenalec...

ea0037ep93 | Adrenal cortex | ECE2015

Phaeochromocytoma-the Mater hospital experience over the past two decades

Monaghan Bernadette , Egan Sinead , McEntee Gerry , Byrne Maria

Phaeochromocytoma is a rare neuroendocrine tumour. Incidence has been quoted at two to eight cases per million people. This study reviews all cases of surgically resected phaeochromocytoma in a large tertiary referral centre since 1996 with particular focus on preoperative care. 22 patients were diagnosed with Phaeochromocytoma with average age at diagnosis of 47 years. 13.6% (n=3) of patients had malignant phaeochromocytoma. Two patients had confirmed neurofibromatos...

ea0037ep94 | Adrenal cortex | ECE2015

Combined effects of sirolimus and mitotane in the inhibition of growth in human adrenocortical carcinoma cells

De Martino Maria Cristina , van Koetsveld Peter M , Feeldes Richard A , Lamberts Steven W J , de Herder Wouter W , Colao Annamaria , Pivonello Rosario , Hofland Leo J

Adrenocortical cancer (ACC) is a rare cancer with poor prognosis and scant treatment options. Mitotane alone, or in combination with cytotoxic chemotherapy, represents the referral current treatment for patients with unresectable ACC. Recent studies have shown that mTOR inhibitors suppress growth of ACC cells. This study aimed at evaluating the effects of mitotane in combination with mTOR inhibitors. In H295 and SW13 cells we tested the effects of a 6 day treatment with increa...