Endocrine Abstracts

Background: Both undernutrition and chronic inflammation impair linear growth through resistance to GH. Fibroblast growth factor 21 (FGF21) is known as an important regulator of the metabolic adaptation to fasting. Elevated expression of FGF21, secondary to prolonged undernutrition has been identified to develop GH resistance and subsequent attenuation of skeletal growth and growth plate chondrogenesis in both mice and human. However, the mechanism of FGF21’s actions rema...

Introduction: Previous audits demonstrated low bone mineral density (BMD) in adolescent patients with hormone deficiencies. We wanted to ascertain if gender had any relationship with the development of low BMD.Method: A retrospective analysis of 42 Transitional clinic patients who underwent DEXA scanning was made using case notes and hospital systems. Follow-up data was gathered as previous audit of 25 transitional patients had shown a significant number...

Autosomal dominant hypocalcaemia type 1 (ADH1) is a systemic disorder of calcium homeostasis caused by gain-of-function mutations of the calcium-sensing receptor (CaSR). ADH1 may lead to symptomatic hypocalcaemia, inappropriately low parathyroid hormone (PTH) concentrations and hypercalciuria. Active vitamin D metabolites are the mainstay of treatment for symptomatic ADH1 patients, however their use predisposes to nephrocalcinosis, nephrolithiasis and renal impairment. Calcily...

The active form of vitamin D, 1,25-dihydroxyvitamin D (1,25D), acting via the vitamin D receptor (VDR) is a potent regulator of gene expression, with effects on skeletal and extra-skeletal physiology. We have shown that actions of 1,25D on bone-forming osteoblasts also involve regulation of microRNAs (miRNAs) that play a key role in the functional development of these cells. In the current study, we have investigated miRNAs as mediators of innate and adaptive immune responses ...

Introduction: Evidence suggests that ionised calcium (iCa) and not total calcium is the physiologically relevant blood calcium component. Most blood gas (BG) analysers calculate iCa, but this is often ignored. We report our findings from a retrospective audit in medical in-patients and the potential benefit of this underused resource.Methods: A retrospective audit of admissions to two general medical/endocrine wards during January and February 2016. Data...

The CaSR, a G-protein-coupled receptor that regulates extracellular calcium (Ca2+o), predominantly signals via G-protein-αq/11 (Gαq/11), initiating IP3-mediated intracellular calcium (Ca2+i) accumulation, and mitogen-activated protein kinase (MAPK) signalling. CaSR also activates MAPK signalling via Gαi/o, or by associating with the scaffolding protein β-arrestin. CaSR g...

Background: Acute hypercalcaemia of biochemical and symptomatic nature is a relatively common emergency medical presentation. Its management has tended to vary significantly and this can affect patient’s outcomes and length of hospital stay.Aim: To assess the acute management of hypercalcaemia in relation to the new Society for Endocrinology guidance.Method: A retrospective audit of all cases of hypercalcaemia admitted to Oxfo...

Aims: To study changes in bone mineral density (BMD), bone mineral parameters, metabolic profile, body composition and quality of life at base line and 6 months following parathyroidectomy, in subjects with primary hyperparathyroidism (PHPT).Material and methods: This prospective study was conducted over 18 months with first 12 months of recruitment and next 6 months for follow-up. Sixty-eight patients with PHPT who underwent surgery were compared with 1...

Objective: To study the impact of HBV related chronic liver disease (CLD) and its treatment with Tenofovir on bone health in Indian subjects.Methods: This cross-sectional study included men between 18 and 60 years and comprised of three groups: Group 1 was treatment naïve HBV-related CLD (n=79), Group 2 – those with HBV-related CLD on tenofovir for at least 1 year duration (n=136), Group 3 – normal age, sex and BMI-matche...

Introduction: Primary Hypoparathyroidism is a rare endocrine disorder characterized by hypocalcaemia associated with an inappropriately low parathyroid hormone concentration. As currently there are no UK guidelines for the management of this condition, we performed an audit comparing our performance with published European guidelines (1). These state that• Patients should be educated both t...

A young female with autosomal dominant hypoparathyroidism type 1 who had inherited the gene defect from her mother was under the care of paediatric endocrinologist. Since childhood she was on a large dose of calcium (elemental calcium 5 g) along with Vitamin D, potassium and magnesium replacements. Despite careful monitoring there was significant fluctuations in serum calcium levels which led to recurrent hospital admissions with hypercalcaemia and acute kidney injury or sever...

Background: The principal cause for increased osteoporosis risk in young adults is the underlying endocrine condition that can severely compromise the prime bone building stage occurring during adolescence. As this could lead to a diminished quality of life from a relatively early stage, emphasis lies on correcting the endocrine condition with appropriately tailored management that can prevent its deterioration. Examples of treatments include replacing deficit hormones such as...

Retrospective audit of Patients had Parathyroidectomy over 2 years in East Sussex NHS trust; 73 patients had Parathyroid surgery for Primary hyperparathyroidism during this period. We have collected the data using case notes and hospital electronic records. Fifty-six patients were females and 17 were Males. Ninety-three per cent of patients were more than 50 years old. Common presenting symptoms were Lethargy (51%), bone pain (44%) and other symptoms were polyuria, polydipsia....

Background: Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80–85% of cases, but may also be due to multi-gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in th...

Background and aims: Vertebral fractures are the most common type of osteoporotic fracture but approximately three quarters remain undiagnosed. Densitometric VFA is a recognised imaging modality for vertebral fracture identification. The International Society for Clinical Densitometry (ISCD) has published separate criteria in 2007 and 2013 to identify patients suitable for VFA. The aim of this audit is to determine the potential impact on the service of introducing VFA with ea...

Background: A minimally invasive approach to primary hyperparathyroidism (PHPT) is equivalent to bilateral exploration when intraoperative parathyroid hormone (iPTH) monitoring is used. We have recently established an iPTH service jointly with Surgical and Clinical Chemistry teams and the aim of the study was to evaluate our initial results with its use.Patients and methods: We collected data from 18 operations for PHPT from October 2015, including one r...

Aim: Somatic growth results from the generation of new support and connective tissue. Since collagen is the major protein constituent of connective tissue, its synthesis must be a prerequisite for the normal growth. The aim of the study was to determine age-related reference intervals for P3NP, a collagen – formation marker in a group of normal height prepubertal children and to compare to IGF1 levels.Subjects: Forty-three prepubertal children, male...

Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder; its evaluation includes biochemical investigations and imaging studies prior to surgical intervention. Imaging is advised as an aide to surgery and not for diagnostic purposes. Coexistence of PHPT and vitamin D deficiency is common; however, the exact nature of the relationship (causal vs secondary) is not clear.Subject and methods: We conducted a retrospective ...

The SIGN guideline group recently suggested a fracture risk threshold of 10% as an indication for DXA. Patients who do not have a 10 year fracture probability of 10% or more would therefore not meet the criteria for direct access to DXA. In order to assess whether implementing these guidelines would impact overall management, we undertook a prospective audit of our direct access DXA and health promotion service. Charts from 61 consecutive patients were reviewed (54F/7M, Mean a...

Introduction: In CKD, net effects of declining kidney function and increasing FGF23 (and PTH) concentrations on vitamin D catabolism and iron metabolism are not clear.Objectives: Compare the Biomedica to the Immutopics’ immunoassay for measurement of cFGF23. Determine the relationship between iron status; vitamin D and intact FGF23 (iFGF23) and c-terminal (cFGF23) concentrations in blood.Method: Samples from routine care and a...