Endocrine Abstracts

Background and aims: Electrolyte imbalance is common among hospital inpatients, reflecting severity of underlying illness, but also independently contributing to excess morbidity and mortality. However, studies have largely been retrospective, with incomplete data capture. We prospectively evaluated the prevalence of major Na and Ca disorders among inpatients at the Newcastle-upon-Tyne Hospitals.Method: With approval of the Information Guardian, we used ...

Aim: To assess whether using urine catecholamines as a second line investigation has affected clinical decision making in patients with suspected pheochromocytoma and paraganglioma.The need for the audit: New society of endocrine guidelines in June 14, have recommended using urine metanephrines as the initial screening test for PPGL. Current practise at University Hospital Wales is to offer urine catecholamines as the second line test to patients with a ...

Objective: Hyponatraemia is the most common electrolyte disturbance encountered in patients – yet its management remains challenging and variable. We audit the management of hyponatraemia in a busy district general hospital, focusing on length of stay (LOS), readmissions and mortality.Methodology: A retrospective analysis was carried out of 30 consecutive inpatients alerted by the hospital biochemistry department with a sodium concentration of &#880...

Prednisolone has been reported to have greater deleterious effects on bone turnover than other glucocorticoids, although the evidence for this is confounded by the effects of higher dose prednisolone, as used in conditions such as asthma. We hypothesise that a physiological replacement dose of prednisolone will have a less dramatic effect on bone than has previously been suggested, and might be safer than hydrocortisone for replacement in adrenal insufficiency. We investigated...

Background: Phaeochromocytoma and paraganglioma (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla and paraganglia. Biochemical assessment relies on demonstrating elevated concentrations of catecholamines and their metabolites. Analytical methods for catecholamine and metanephrine measurement vary in sensitivity and specificity. We reviewed our biochemical work-up in order to optimise patient diagnosis.Methods: This retrospective au...

Vitamin D exists as two forms; D3 (UV) and D2 (plant derived). Measuring the metabolite 25-hydroxyvitamin D (25OHD) is routinely applied in research and clinical laboratories to assess vitamin D status. The Institute of Medicine and Society for Endocrinology have previously set recommended vitamin D guidelines based on combined 25OHD3 and 25OHD2 serum concentrations. In order to achieve accurate quantitation of these metabolites, the respective C3 epimers must be separately qu...

Introduction: Hyponatraemia is the commonest inpatient electrolyte abnormality and its severity correlates with inpatient mortality, length of stay and use of hospital resources. Frequently, hyponatraemia is not sufficiently acknowledged in the acute medical setting. The aim of this audit was to evaluate the investigation and management of hyponatraemia in a district general hospital.Methods: Seventy-seven hyponatraemic patients (Na<...

Background: Endocrine emergencies such as hyponatraemia and hypercalcaemia commonly present during unselected medical on-call. However, in our hospital a questionnaire survey of trainees revealed lack of confidence and preparedness in managing endocrine emergencies. 18 trainees responded (12 Foundation Year 1 (FY1), 1 Foundation Year 2 (FY2), 5 Core Medical trainees (CT1) reporting lack of confidence and preparedness in managing endocrine emergencies. 76.92% of FY1 doctors fel...

This study aimed to establish the optimal cut-off decision point for Folate and B12 levels. Retrospective review of serum, RBC folate as well as B12 test results performed at our hospital for the period April 2012 up to May 2016 were analysed for concordance.With data analysis of around serum folate and B12 20,000 results, the new cut-offs for low values are tentatively set to be 5.5 ng/ml and 178 pg/ml. The percentages of deficiencies in our patient pop...

Introduction: ‘Primary Aldosteronism Detection, Diagnosis and Treatment Guidelines’ from the Endocrine Society (2008) recommend the use of the aldosterone- renin ratio (ARR) to detect primary aldosteronism (PA) in patient groups with high prevalence of PA. The guidelines suggest cut-offs specific to assay type and measurement units. The department of Clinical Chemistry and Metabolic Medicine at RLBUHT recently moved to a direct renin method (iSYS, Immunodiagnostics) ...

Background: 25-hydroxyvitamin D (25(OH)D) is metabolised into two forms of metabolites: 1,25-dihydroxyvitamin D (1,25(OH)2D) by the actions of 1α hydroxylase, and 24,25-dihydroxyvitamin D (24,25(OH)2D) by 24-hydroxylase. Studies suggest the production of 1,25(OH)2D is 24,25(OH)2D dependent. Genetic mutations of CYP24A1 gene resulting in reduced or total loss of 24-hydroxylase function are associated with hypercalcaemic condition...

Background: Hyponatraemia is the most common electrolyte abnormality in hospitalised patients. It is an independent risk factor for mortality and is associated with increased length of hospital stay.Method: The objective of audit was to review practice of investigations and management of hyponatraemia in adults at Bedford hospital in line with evidence based guidelines including European Society of Endocrinology 2014 clinical practice guidance. An observ...

Background: Work in a hot environment can cause elevated core body temperature (Tc), circulatory insufficiency and death from Exertional Heat Illness (EHI). Failure to undergo successful heat acclimatisation (HA) is seen in ~5% of otherwise healthy volunteers and may lead to significant EHI, but pathways to severe illness remain poorly understood. Copeptin, a glycopeptide co-secreted with the pituitary hormone arginine vasopressin, reflects osmotic and cardiovascular stress an...

As the SGLT-2i class gains popularity for management of type 2 diabetes (T2DM), the risk of diabetic ketoacidosis (DKA) has been recognised as a potential adverse event. However, all the reported cases of DKA associated with SGLT-2 inhibitors seem to have some additional predisposition to this condition and been exposed to alternative precipitants. We report a root-cause analysis of five locally presenting cases of DKA associated with dapagliflozin followed by a literature rev...

Introduction: According to NICE: adults receiving growth hormone (GH) treatment, IGF1 levels should reach therapeutic range by 9 months. Patients are reviewed at 1, 3, 6, 9, 12 months and 6 months thereafter in our clinics. GH dose is titrated by 0.1 mg each visit. This work aims to compare the time it takes to get the IGF1 in range, between adults and adolescent patients attending our specialist regional clinics.Method: We performed a retrospective audi...

Thyroid dysfunction is associated with well-recognised maternal and fetal complications. There is an increase in thyroxine requirement during pregnancy by 25–50% hence close monitoring of thyroid function and dose augmentation is vital in attaining euthyroid status. In our combined antenatal-endocrine clinic we aim to test thyroid function tests (TFTs) at booking, in the second and third trimesters. In order to reduce the need for patients to re-attend the clinic purely f...

Introduction and aim: Pancreatic neuroendocrine tumours (PNETs) may occur sporadically (sPNETs) or as part of the multiple endocrine neoplasia type 1(MEN1) syndrome, which is characterised by occurrence of PNETs, parathyroid and anterior pituitary tumours. Our aim was to review the management of these patients in relation to the clinical practice MEN1 guidelines, and the ENETS and UKINETS guidelines for PNETs.Patients and methods: Patients attending with...

Background: Metyrapone is commonly used in medical management of Cushing’s syndrome. It inhibits 11-β hydroxylase, which catalyses the conversion of 11-deoxycortisol to cortisol. The adequacy of metyrapone blockade can be assessed either clinically or biochemically using a target mean serum cortisol 150–300 nmol/l. Cortisol is normally measured by immunoassay.Case report: A 21-year-old female presented with clinical and biochemical feature...

Background: Metyrapone inhibits 11-β hydroxylase and causes a subsequent rise in the cortisol precursor, 11-deoxycortisol. Cortisol measurements by immunoassays are susceptible to interference and reagent antibody cross-reactivity with cortisol precursors when used in patients receiving metyrapone treatment. Clinicians rely on clinical and biochemical features of cortisol excess for dose titration of this medical blockade. The extent of this interference remains unclear. ...

Introduction: Male hypogonadism is a clinical syndrome comprising symptoms, signs and biochemical evidence of testosterone deficiency due to primary testicular failure or secondary pituitary/hypothalamic disease. Management may vary. This audit aimed to assess adherence to Endocrine Society Clinical Practice guidelines in investigation and management of male hypogonadism.Methods: Electronic patient records for 25 men with hypogonadism attending endocrino...

Background: In 2014, Thy002 (the proportion of patients with hypothyroidism on the practice register with thyroid function tests recorded in the preceding 12 months) was removed as a Quality Outcome Framework (QOF) target.Aim: To audit the current management of hypothyroidism in primary care two years following the QOF changes.Method: Four local practices (total patient population: 37 200 (range 7300–1300 per Practice)) partic...

Background: Isolated pituitary stalk (PS) lesions/thickening detected on imaging pose challenging dilemmas.Aim: Audit the diagnostic approach and management of patients with isolated PS lesions/thickening reported on MRI in a tertiary hospital.Methods: Reports of pituitary/brain MRIs performed in our Radiology Department between 1/2013 and 12/2015 were searched for the terms ‘stalk’, ‘infundibular’, ‘infund...

Introduction: The assessment of a new patient in the medical outpatients relies on thorough history taking as well as clinical examination. In particular, biochemical tests are pivotal in the diagnosis of endocrine conditions. Historically, our unit only mostly performed biochemical tests after new patients attended clinic. We proposed that diagnosis and management would be more efficient if this system was reverted, with the aim of minimising the number of clinic appointments...

Background: Endocrinology is well-established as an outpatient specialty. However, virtually no data exist on the volume, nature, management and disposal of inpatient referrals to inform the design and delivery of a quality-assured service.Methods: We undertook an audit of all activity of the Inpatient Endocrine Service at University Hospitals Birmingham NHSFT (IES@UHB) between January 2010 and December 2015. Referrals received electronically via the Pat...

Introduction: Type 2 diabetes mellitus (T2DM) is associated with urological and endocrine complications, including erectile dysfunction (ED) and hypogonadism.Aim: REVITALISE was conducted to assess men with/without T2DM at risk of ED and/or hypogonadism, and highlight gaps in current clinical management.Methods: Data were collected from 13 UK primary care practices on incidence of ED, hypogonadism (defined as serum total testostero...

Introduction: BTA guidelines-2014 outlined the need for key features to be included in thyroid ultrasound scan (USS) reporting including risk stratification. The aim of this audit was to evaluate the quality of thyroid-USS reporting at Northumbria Healthcare NHS Foundation Trust (NHCT); using BTA guidelines as the gold standard.Methods: All thyroid/neck-USS between 1st November to 31st December 2015 were retrieved from radiology records at NHCT. Scans ev...

Mrs SP was a 50-year old patient who presented with typical features of Cushing’s syndrome in 2003 and proceeded to pituitary surgery. Following this she was not cured, and elected to have a bilateral adrenalectomy. Following this, she was initially commenced on hydrocortisone 30 mg daily taken as 15 mg in the morning, 10 mg at noon and 5 mg at 1600 h, and fludrocortisone 100 μg daily. She continued on this for 10 years, but switched her glucocorticoid replacement to...

We here report the cases of two patients receiving glucocorticoid replacement, whose treatment has been guided by serum prednisolone measurements and whose day curves are presented below. Ms B was a 33-year-old patient who presented 3 years ago with panhypopituitarism following transsphenoidal surgery in 2012, for a sellar mass in a foreign country. She had already commenced 5mg prednisolone daily in addition to DDAVP, levothyroxine and the COCP. Having noticed mild weight gai...