Endocrine Abstracts

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...

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...

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...

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...

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...

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...

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="...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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...

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 ...

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...

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 ...

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...

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...

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...

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...

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 ...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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 ...

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) ...

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 ...

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...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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...

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. ...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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 ...

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...

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...

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...

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...

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 ...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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 ...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...