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19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

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20-23 May 2017, Lisbon, Portugal Further information

Eposter Presentations: Adrenal and Neuroendocrine Tumours

Adrenal cortex (to include Cushing's)

ea0049ep1 | Adrenal cortex (to include Cushing's) | ECE2017

Confirmatory tests for diagnosis of primary aldosteronism among Chinese hypertensives

Jiang Minchun , Ma Dujuan , Lin Hailun , Lin Ying , Deng Yajuan , Tang Juying , Zhang Shaoling , Guo Ying

Objective: Primary aldosteronism (PA) has emerged as the most frequent form of secondary hypertension. For the diagnosis of PA, confirmatory testing is indispensable and different tests are recommended by guidelines, including captopril challenge test (CCT) and saline infusion test (SIT). However, there are sparse studies evaluating and comparing CCT and SIT in Chinese population. Hence, we investigate the diagnostic efficiency of CCT and SIT for PA in Chinese hypertensives in...

ea0049ep2 | Adrenal cortex (to include Cushing's) | ECE2017

The correlation of salivary cortisol values with serum cortisol values

Dyrmishi Blertina , Olldashi Taulant , Lumi Ema , Puca Entela , Kolici Emirvina , Ylli Dorina , Fureraj Thanas

Aim: The aim of the study was to evaluate the correlation between salivary and serum cortisol values to the healthy people and patients with Cushing’s syndrome.Methods: 33 cases: 21 healthy people aged 22 to 53 years old; 12 patients with Cushing’s syndrome values were included to our study. All the participiants of control group were healthy without known disease. Two samples of salivary and serum cortisol was taken to all the participiants of...

ea0049ep3 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenocortical virilizing tumor in an adult woman in remission after surgical therapy performed more than 12 years ago

Larumbe Terroba , Soto Crespo , Pascual Citores , Fernandez Benito , Aguilar Calero , Goyogana Anacabe , De Linares Urbon Lopez , Vina Ventosa , Olmedo Cuellar , Mures Palacio

Introduction: Adrenocortical carcinomas (ACCs) are rare, frequently aggressive tumors. Pure virilizing carcinomas are infrequent, constituting 5 to 10% in most series.Clinical case: A 36-year-old female consults for 5 years evolution of amenorrhea associated with hirsutism attributed to polycistic ovary syndrome (PCOS) and treated with oral contraceptives during the previous 2 years. There was no other data on virilization, changes in body weight, hypert...

ea0049ep4 | Adrenal cortex (to include Cushing's) | ECE2017

Investigation of atrophic adrenal glands in Cushing’s syndrome model rats induced by the administration of dexamethasone

Seki Toshiro , Yasuda Atsushi , Kitajima Natsumi , Seki Masami , Oki Masayuki , Takagi Atsushi , Fukagawa Masafumi

Cushing’s syndrome is a disease caused by excessive glucocorticoids from adrenocortical tumors. In most cases, impaired adrenocortical function is likely caused by atrophy of the normal adrenal tissue as a result of chronic suppression by the low ACTH levels in the hypercortisolism state. Secondary adrenal insufficiency causes with surgical resection of cortisol-secreting tumors. Therefore, we thought that it was necessary to prepare Cushing’s syndrome model rats for...

ea0049ep5 | Adrenal cortex (to include Cushing's) | ECE2017

Long-term assessment of AddiQoL and patient diaries may identify Addison patients at high risk for adrenal crises

Koch Maike , Badenhoop Klaus , Herrmann Eva , Meyer Gesine

Introduction: Several studies have shown a reduced quality of life (QoL) in patients with Addison’s disease (AD). However, by now there are no data investigating the changes of QoL over a long-term course. Adrenal crises (AC) are frequent and potentially life-threatening complications in patients with AD. Since no reliable laboratory indicator can predict impending crises it is difficult to detect patients at increased risk. The purpose of this study was to test whether t...

ea0049ep6 | Adrenal cortex (to include Cushing's) | ECE2017

Impact of Cortrosyn treatment on weight and adrenal structure in the wistar rat

Akdader-Oudahmane Samira , Hamouli-Said Zohra , Hadj-Bekkouche Fatma

The corticotropic hormone (ACTH) mainly secreted by the anterior lobe of the pituitary gland which, following a physiological or psychological stress situation, stimulates the adrenal gland and induces the release of glucocorticoids. Many studies have shown their effects on several physiological functions such as immunity, inflammation as well as the cardiovascular system whose action is controlled by ACTH. For this purpose, the study carried out in the wistar rat revealed the...

ea0049ep7 | Adrenal cortex (to include Cushing's) | ECE2017

Molecular variability determines subtle adrenal biosynthetic defect in non-classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Mermejo Livia , Coeli-Lacchini Fernanda , Turatti Wendy , Elamid Marcia , Parente Renata , Martinelli Carlos , Antonini Sonir , Castro Margaret , Moreira Ayrton

There is a clinical spectrum of non-classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NC-CAH). In addition, CYP21A2 gene mutations analysis present in homozygosis or as compound heterozygosis.Objectives: To evaluate the relationship between the genotype and biochemical profiles and also compare with clinical severity in NC-CAH.Patients and methods: Clinical, hormonal and molecular data of 57 patien...

ea0049ep8 | Adrenal cortex (to include Cushing's) | ECE2017

Corticoids-therapy related complications in patients with primary adrenal insufficiency

Rodriguez Juan Carlos Romero , Gutierrez Maria Calatayud , Reyes Laura Mola , Vaca Carlos Silva , Iglesias Sonsoles Guadalix , Diaz-Guerra Guillermo Martinez

Introduction: Patients with primary adrenal insufficiency (PAI) require lifelong corticoids replacement and they are at risk of therapy-related osteoporosis and cardiovascular complications.Objectives: Determine the prevalence of cardiovascular risk factors, osteoporosis, and other toxicities related with corticoids treatment.Material and methods: Retrospective, descriptive study in patients with PAI follow up in our service during...

ea0049ep9 | Adrenal cortex (to include Cushing's) | ECE2017

Severe hypertriglyceridemia in relation to toxic levels of mitotane in a patient with stage IV adrenocortical carcinoma (ACC)

Larumbe Terroba , Soto Crespo , Goyogana Anacabe , De Linares Urbon Lopez , Sesmero Amon , Vina Ventosa , Olmedo Cuellar , Garcia Marcos , Roussel Otero , Munoz Almendros

Introduction: The use of mitotane as ACC therapy is associated with multiple adverse effects including hypercholesterolemia due to increased levels of LDL cholesterol. There are no reported cases of severe hypertriglyceridemia (HTG).Clinical case: A 59-year-old male with a personal history of dyslipidemia phenotype IV and pulmonary emphysema, former smoker and drinker was diagnosed with non-functioning left-sided ACC. Left adrenalectomy + left nephrectom...

ea0049ep10 | Adrenal cortex (to include Cushing's) | ECE2017

Addison’s disease presenting as severe hypoglycaemia and cachexia

Martins Ana Claudia , Bogalho Paula , Agapito Ana

Addison’s disease (AD), also known as primary adrenal insufficiency, is caused by destruction or dysfunction of the adrenal cortex, resulting in hypocortisolism. The usual clinical features of chronic AD are non-specific and include fatigue, nausea, vomiting and hyperpigmentation. We describe the case of a 58-year-old African black male with AD presenting with recurring severe hypoglycaemia. The patient was admitted several times to the emergency department with hypoglyca...

ea0049ep11 | Adrenal cortex (to include Cushing's) | ECE2017

Posterior reversible encephalopathy syndrome (PRES) in a patient with primary aldosteronism

Silva-Fernandez Julia , Val-Zaballos Florentino Del , Gomez-Alfonso Francisco Javier , Gonzalez-Lazaro Paloma , Torres-Arroyo Belvis , Garcia-Ruiz Rafael , de Agredos Alvaro Garcia-Manzanares Vazquez , Lopez-Iglesias Maria , Gomez-Garcia Ines

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by varied neurological symptoms. There are two leading theories regarding the pathophysiology: hypertension crisis and endothelial dysfunction.Case reportWe report the case of a 42-year-old patient with history of hypertension. She presented to the emergency department with headache and bilateral loss of vision. She described one previous e...

ea0049ep12 | Adrenal cortex (to include Cushing's) | ECE2017

Evaluation of cardiovascular risk in patients with adrenal incidentaloma

Yorulmaz Goknur , Akalin Aysen , Yagiz Burcu

Introduction: Recent studies indicate that patients diagnosed with adrenal incidentaloma may present with cardiovascular disease. The aim of this study was to investigate markers of subclinical cardiovascular disease in patients with adrenal incidentaloma and healthy control group.Methods: This study included 50 patients with non-functional adrenal adenoma and 30 healthy controls. BMI and waist circumference of the patients were measured. The lipid param...

ea0049ep13 | Adrenal cortex (to include Cushing's) | ECE2017

Hair cortisol in patients with primary aldosteronism

Hodes Aaron , Lodish Maya , Tirosh Amit , Meyer Jerrold , Belyavskaya Elena , Lyssikatos Charalampos , Rosenberg Kendra , Demidowich Andrew , Swan Jeremy , Jonas Nichole , Stratakis Constantine , Zilbermint Mihail

Context: Primary aldosteronism (PA) is a common cause of secondary hypertension, and some PA adrenal tumors co-secrete glucocorticoids, causing subclinical or overt Cushing syndrome (CS). We recently reported correlations between hair cortisol concentration (HCC) and serum and urinary levels of cortisol in patients with CS.Objective: To determine correlations of segmental hair cortisol and biochemical markers of a referred cohort of patients for the eval...

ea0049ep14 | Adrenal cortex (to include Cushing's) | ECE2017

Salivary steroid levels during diagnostic tests for adrenal insufficiency

Duškova Michaela , Šimůnkova Kateřina , Vitků Jana , Kolatorova Lucie , Jandikova Hana , Pospišilova Hana , Šramkova Monika , Kosak Mikulaš , Starka Luboslav

Diagnostic tests of the hypothalamic–pituitary–adrenal axis (HPA axis), measuring of free cortisol and use of other adrenal steroids are the subject of debate.We investigated 15 healthy men with mean/median age 27.4/26 (±4.8) years, and mean/median BMI 25.38/24.82 (±3.2) kg/m2. All subjects underwent four dynamic tests of the HPA axis, specifically 1, 10, and 250 μg synacthen tests and an insulin tolerance test (ITT). ...

ea0049ep15 | Adrenal cortex (to include Cushing's) | ECE2017

Assessment of quality of life of patients with Cushing’s syndrome depending on the disease course

Narimova Gulchekhra , Yusupovna Zamira , Fayzullaev Ravshan , Arifjanov Iskandar

Aim of the study: To evaluate effectiveness of pituitary transsphenoidal surgery (TSS) in patients with ACTH-dependent Cushing’s syndrome (ACTH-DCS) in Republic of Uzbekistan (RUZ).Materials and methods: Patients who included in CS register monitored in 2015. All data from 2000 to 2015 analyzed including outpatient, inpatient examines, tests and treatment. To present, 158 patients with ACTH-DCS registered and monitored. Of these 158 patients, 41 mal...

ea0049ep16 | Adrenal cortex (to include Cushing's) | ECE2017

Paraneoplastic Cushing’s syndrome and nephrotic syndrome in a patient with bronchial carcinoid

Grigorie Daniel , Caragheorghopol Andra , Iordachescu Carmen , Hortopan Dan , Pascanu Ionela , Hara Livia , Brezean Iulian , Galie Nicolae , Vasilescu Florina , Mandache Eugen , Sucaliuc Alina

Introduction: We report a case of Cushing’s syndrome association with nephrotic syndrome in a patient with occult ectopic ACTH (EAS) secretion by a bronchial carcinoid and resolution of both disorders after bilateral adrenalectomy.Case report: A 42-year-old man was admitted to our department with the suspicion of EAS. He was in a very good health until several months ago when he developed suddenly nephrotic syndrome, severe hypertension, severe hypo...

ea0049ep17 | Adrenal cortex (to include Cushing's) | ECE2017

Frequancy of diabetes and prediabetes in patients with adrenal incidentaloma without hormonal activity

Bandurska-Stankiewicz Elzbieta , Myszka-Podgorska Katarzyna , Rutkowska Joanna , Matuszewski Wojciech

Aim of the study: Estimation of the frequancy of diabetes and prediabetes in patients with adrenal incidentaloma (AI) without hormonal activity.Material and methods: The study comprised patients with AI without hormonal activity, verified by CT. The hormonal function of adrenal glands was determined according to the circadian rhythm of cortisol and/or dexametasone suppression test, ACTH, aldosterone, plasma renin activity, DHEAS, androstenedione, 17hydro...

ea0049ep18 | Adrenal cortex (to include Cushing's) | ECE2017

To big to work! Lymphoma presenting with primary adrenal insufficiency

Capraro Joel , Giessen Hanna , Muller Beat

Background: Primary adrenal lymphoma (PAL) is a rare cause of primary adrenal insufficiency (PAI). Most often patients present with unspecific symptoms. Bilateral adrenal enlargement with signs and symptoms of PAI are clues, percutaneous biopsy after having excluded pheochromocytoma in a situation of high suspicion is diagnostic. Most of PAL are highly malignant B-cell lymphomas with a bad prognosis.Case: A 71-year-old patient was sent for endocrine work...

ea0049ep19 | Adrenal cortex (to include Cushing's) | ECE2017

Specificity of the posture test for subtyping of primary aldosteronism, a 10 year nationwide summary in Iceland

Gunnarsdottir Hrafnhildur , Jonsdottir Gudbjorg , Gudmundsson Jon , Birgisson Gudjon , Sigurjonsdottir Helga

Introduction: The posture test (PT), developed to distinguish idiopathic adrenal hyperplasia (IAH) from aldosterone producing adenoma (APA), has been postulated as inaccurate. In 2007, standardized diagnostic methods, including PT for subclassification, were introduced in Landspitali University Hospital (LUH), housing the only endocrine department in Iceland. The aim of this study is to review the results of PT performed in LUH in 2007–2016.Methods:...

ea0049ep20 | Adrenal cortex (to include Cushing's) | ECE2017

Cofilin is a cAMP effector in mediating actin cytoskeleton reorganization and steroidogenesis in mouse and human adrenocortical tumor cells

Catalano Rosa , Peverelli Erika , Giardino Elena , Treppiedi Donatella , Morelli Valentina , Chiodini Iacopo , Marcon Lorenzo , Ronchi Cristina L , Bertherat Jerome , Beuschlein Felix , Arosio Maura , Spada Anna , Mantovani. Giovanna

The cAMP signaling pathway plays a major role in the pathogenesis of cortisol-producing adrenocortical adenomas (CPA). In adrenocortical cells cAMP induces dramatic changes in cell morphology accompanied by actin cytoskeleton rearrangements that precede steroidogenesis, the causal relationship between these events being still undefined. In this study we investigated cAMP effects on cytoskeleton rearrangements and steroidogenic response in mouse (Y1) and human adrenocortical tu...

ea0049ep21 | Adrenal cortex (to include Cushing's) | ECE2017

Primary Aldosteronism in Iceland, nationwide results from 2012–2016

Gunnarsdottir Hrafnhildur , Gudmundsson Jon , Birgisson Gudjon , Sigurjonsdottir Helga

Introduction: Primary aldosteronism (PA) is an important, potentially curable cause of hypertension (HT) with higher risk of cardiovascular events than essential HT. In 2007, a standardized PA work-up protocol was introduced in Landspitali University Hospital (LUH), housing the only endocrine department in Iceland. The aim of this study is to review characteristics, test results and histopathology for patients diagnosed with PA in 2012-2016 in LUH.Method...

ea0049ep22 | Adrenal cortex (to include Cushing's) | ECE2017

Cardiovascular risk factors do not play a role in the risk factor profile of adrenal crisis

Quinkler Marcus , Murray Robert D. , Zhang Pinggao , Zelissen Pierre , Ekman Bertil

Introduction: Adrenal crises (ACs) are life-threatening events in patients with primary (PAI) or secondary (SAI) adrenal insufficiency, occurring ~4–10 times per 100 patient-years. Major causes of ACs are infections, especially gastroenteritis and tonsillitis/laryngitis. Risk factors for ACs remain ill defined, but could include concomitant endocrine diseases (diabetes mellitus, premature ovarian failure) in PAI, diabetes insipidus in SAI, and concomitant non-endocrine di...

ea0049ep23 | Adrenal cortex (to include Cushing's) | ECE2017

Bilateral adrenal incidentaloma: a diagnostical and therapeutical challenge

Bilic-Curcic Ines , Bacun Tatjana , Tripolski Marija , Zulj Biljana

Incidentally discovered adrenal masses (incidentalomas) present challenges both in diagnosis and management. The bilateral adrenal mass carries a risk of hormone hypersecretion, but it could also present a metastasis from another primary carcinoma or be a part of genetic syndrome.We report a 68 year old patient with bilateral adrenal incidentalomas (revealed accidentally on US, confirmed by abdominal CT in 2015.) left 29 mm, right 33 mm in diameter, radi...

ea0049ep24 | Adrenal cortex (to include Cushing's) | ECE2017

Are we missing patients with primary aldosteronism (PA) if we require both elevated aldosterone: renin ratio (ARR) and elevated aldosterone levels?

Puar Troy , Khoo Joan , Zhang Meifen

Introduction: Although the Endocrine Society guidelines recommend using aldosterone: renin ratio (ARR) to screen patients for primary aldosteronism (PA), whether to include a cut-off for aldosterone levels remains controversial. In Singapore, most centres require both an ARR >550 (ng/dl)/(ng/ml per h) and aldosterone ≥15 ng/dl. However, it has been shown that patients with PA may have aldosterone levels<15 ng/dl, and also respond well to mineralocorticoid antagon...

ea0049ep25 | Adrenal cortex (to include Cushing's) | ECE2017

Severe hypoglycaemic ketoacidosis in a patient with adrenal crisis

Mohammed Azmi , Tarigopula Giridhar , Peter Paul , Partha Praveen , Kamaruddin Shafie

We present a case of a 26 years old female who was rushed to hospital with 4 days history of abdominal pain, vomiting and dizziness. She also had one episode of diarrhoea. Further history revealed that she had lost 32 kilograms of weight over the last 18 months through diet and exercise. There were no signs suggestive of an eating disorder.On examination she was peripherally cold, tachycardic (117/min), hypotensive (86/50 mmHg) and sweaty. Her Glasgow Co...

ea0049ep26 | Adrenal cortex (to include Cushing's) | ECE2017

Assessment of the hypothalamic pituitary adrenal axis in patients receiving adjuvant mitotane treatment after radical resection of adrenocortical carcinoma

Reimondo Giuseppe , Puglisi Soraya , Zaggia Barbara , Basile Vittoria , Saba Laura , Perotti Paola , De Francia Silvia , Zatelli Maria Chiara , Cannavo Salvatore , Terzolo Massimo

Mitotane, used in the treatment of adrenocortical cancer (ACC), is able to inhibit multiple enzymatic steps of adrenocortical steroid biosynthesis, potentially causing adrenal insufficiency (AI). Recent studies in vitro have also documented a direct inhibitory effect of mitotane at the pituitary level.The aim of the study was to assess the hypothalamic pituitary adrenal (HPA) axis in patients receiving mitotane as adjuvant treatment after radica...

ea0049ep27 | Adrenal cortex (to include Cushing's) | ECE2017

Extra-gastrointestinal stromal tumor in the retroperitomeum which had difficulty in differential diagnosis with adrenal cancer

Kanamoto Naotetsu , Nagatsuji Makiko , Yamagami Keiko , Tokunaga Shinya , Hosoi Masayuki

Extra-gastrointestinal stromal tumors (EGISTs) in the retroperitomeum are extremely rare. A 44-year-old man was referred from a private clinic suspicious of an adrenal tumor that was incidentally detected by abdominal ultrasound. Computed tomography (CT) scan showed a retroperitoneal mass of 12 cm harboring a feeding artery from the left adrenal gland contiguous with the left adrenal gland, which enhanced heterogeneously on post-contrast imaging. By magnetic resonance imaging,...

ea0049ep28 | Adrenal cortex (to include Cushing's) | ECE2017

Perceptions of medical practitioners’ management of addison’s disease across Africa: an on-line survey

Ross Ian Louis , Mofokeng Thabiso RP , Mahomed Fazleh , Beshyah Salem

Objectives: Addison’s disease diagnostic and management challenges in Africa are not well documented. We aimed to identify the specific needs of patients with established Addison’s disease, across Africa.Methods: An online survey of a large pool of medical practitioners was undertaken. The questionnaire covered patient demographics, aetiology, therapy and limitations of diagnosis and treatment.Results: Of the 36,203 recip...

ea0049ep29 | Adrenal cortex (to include Cushing's) | ECE2017

Improved metabolic outcomes for patients with subclinical Cushing’s syndrome treated with surgery: Ten year experience in a tertiary centre

Loh Lih Ming , Swee Du Soon , Tay Wei Lin , Kek Peng Chin

Introduction: Subclinical Cushing’s syndrome (SCS) occurs in up to 12% of patients with incidentally found adrenal masses. Optimal management remains controversial. We report our experience of nine patients with SCS managed at our institution from 2007 to 2016.Methods: All patients were referred for adrenal incidentalomas (AI) and had no discriminatory clinical features of Cushing’s syndrome. SCS was defined using cortisol levels > 138 nmol...

ea0049ep30 | Adrenal cortex (to include Cushing's) | ECE2017

Severe hypoaldosteronism after unilateral adrenalectomy for primary hyperaldosteronism

Goncalves Joao Ananias , Barrros Rui , Ferreira Betania , Amaral Claudia

Introduction: Primary hyperaldosteronism is a known cause of arterial hypertension, classically with hypokalaemia. About 30–40% of the cases are caused by unilateral aldosterone-producing adenoma, and the recommended treatment is adrenalectomy. Hypoaldestoronism is an uncommon complication of unilateral adrenalectomy, but it can be life-threatening. We present a case of severe hypoaldosteronism after unilateral adrenalectomy for the treatment of primary aldosteronism....

ea0049ep31 | Adrenal cortex (to include Cushing's) | ECE2017

The role of CYP11B2 polymorphism in the pathogenesis of hypertension in patients with adrenal incidentaloma

Zukowski Lukasz , Wawrusiewicz-Kurylonek Natalia , Mysliwiec Janusz , Gorska Maria

Background: Significant prevalence of hypertension in the world’s population and its consequences tend to an intensive search for pathogenesis and etiology of this disease. Epidemic of hypertension is accompanied by an epidemic of adrenal incidentaloma and grows in direct proportion to patients age. Polymorphism of aldosterone synthase (CYP11B2) in -344th region of promoter seems to have much in common with hypertension and adrenal incidentaloma.Aim...

ea0049ep32 | Adrenal cortex (to include Cushing's) | ECE2017

Primary aldosteronism: more common than once thought: Two clinical cases

Monteiro Nadine , Comenda Eduarda , Costa Joana , Vitorino Helena , Santos Sofia , Moleiro Filipa , Jesus Claudia , Afonso Ana , Cantante Helena

Introduction: Estimated prevalence of hypertension (HT) in Portugal is 42%. It is a major risk factor for coronary heart disease and cerebrovascular disease, the leading mortality cause in Portugal. Primary aldosteronism (PA) was once recognized as rare cause of secondary hypertension and hypokalemia a condition present in all cases. Nowadays, prevalence of this condition is about 10% in HT patients, being the commonest form of secondary HT. Secondary forms of HT should be exc...

ea0049ep33 | Adrenal cortex (to include Cushing's) | ECE2017

Rapid reduction in left ventricular mass in primary aldosteronism after treatment; a prospective cardiac MRI study

Grytaas Marianne Aardal , Sellevag Kjersti , Thordarson Hrafnkell Baldur , Husebye Eystein Sverre , Lovas Kristian , Larsen Terje Hjalmar

Background: Primary aldosteronism (PA) patients have increased left ventricular mass (LVM) and increased cardiovascular morbidity compared with those with essential hypertension. Echocardiographic studies have demonstrated that adrenalectomy or spironolactone decreases LVM. The aim of the present study was to use MRI to assess both LVM and cardiac function before and during stress testing, at baseline and after treatment with adrenalectomy or spironolactone, compared with heal...

ea0049ep34 | Adrenal cortex (to include Cushing's) | ECE2017

The treatment with dual release hydrocortisone in patients with adrenal insufficiency: correlation between change of the evening cortisol exposure time profile and change in metabolic profile, depression status and quality of life

Simeoli Chiara , Ferrigno Rosario , Pivonello Claudia , Auriemma Renata Simona , Negri Mariarosaria , Di Gennaro Gilda , Iacuaniello Davide , De Martino Maria Cristina , Colao Annamaria , Pivonello Rosario

Conventional glucocorticoids (CGCs) are unable to mimic physiological cortisol rhythm in adrenal insufficiency (AI), resulting in increased metabolic morbidity and impaired quality of life (QoL). Non-physiological cortisol pattern and elevated evening cortisol levels may be responsible for the increased risk of metabolic disorders observed in AI patients under CGCs. Once daily dual-release-hydrocortisone (DR-HC), which better reproduces physiological daily cortisol profile, si...

ea0049ep35 | Adrenal cortex (to include Cushing's) | ECE2017

Treatment of adrenal insufficiency with hydrocortisone dual-release formulation: glycometabolic profile and health-related quality of life

Mongioi Laura Maria , Condorelli Rosita Angela , Cimino Laura , La Vignera Sandro , Calogero Aldo Eugenio

Introduction: Treatment of adrenal insufficiency (AI) in the last years has been object of important changes due to the development of a dual-release preparation of hydrocortisone (Plenadren®). Hydrocortisone dual-release therapy contemplates a once-daily tablet that allows more closely mimicking the physiological circadian rhythm cortisol, thus avoiding overexposure.Objective: The aim of the study was to value effects of Plenadren administration on...

ea0049ep36 | Adrenal cortex (to include Cushing's) | ECE2017

Transformation from Addison’s disease to adrenocortical carcinoma presented as Cushing’s syndrome with androgenisation

Rajic Antonela Sabati , Resman Kristina Groti , Kocjan Tomaž , Pfeifer Marija

We present a female patient 56 years old, who was treated at the endocrinology department from the year 2006. The diagnosis of Addison’s disease was established and she was properly treated. At the same time primary hypothyroidism was diagnosed, also started treating it properly. She was regularly controlled more often at the first time, than yearly at outpatient clinic. In September 2015 she was in menopause. A few months before she noticed oedematous legs and arms and d...

ea0049ep37 | Adrenal cortex (to include Cushing's) | ECE2017

Visinin-Like Protein-1 in the regulation of aldosterone biosynthesis

Gomez-Sanchez Celso , Kuppusamy Maniselvan , Ishimwe Jeanne , Williams Tracy , Mulatero Paolo , Gomez-Sanchez Elise

Visinin-Like Protein-1 (Vsnl1) is a member of the EF-hand calcium sensor protein family that is expressed in the zona glomerulosa of the rat and human adrenal and upregulated in aldosterone-producing adenomas.We studied the expression pattern of Vsnl1 and co-localization with the CYP11B2 enzyme and the zona glomerulosa (ZG) marker Dlk1 (ZOG) using double and triple immunofluorescence in the adrenal of rats on a normal, high and low sodium diets. We also ...

ea0049ep38 | Adrenal cortex (to include Cushing's) | ECE2017

Metabolic syndrome is common among patients with adrenal incidentalomas, but not associated with functional adrenal status

Tsentidis Charalampos , Bampilis Andreas , Ntova Vasiliki , Betsi Grigoria , Kassi Georgia

Background: Adrenal incidentalomas (AI) have an increasing prevalence during last decades, probably due to the extended use of new imaging techniques and longer life expectancy. Adrenal hormonal hypersecretion, even subclinical, is probably related to cardiovascular disease (CVD).Methods: We evaluated 100 patients with adrenal masses, incidentally discovered in imaging techniques performed for non adrenal disorders (67 Female, 33 Male, mean 58.1±12....

ea0049ep39 | Adrenal cortex (to include Cushing's) | ECE2017

The clinical course of patients with adrenal incidentaloma: Başkent University experience

Kirnap Nazli Gulsoy , Iyidir Ozlem Turhan , Bozkus Yusuf , Ramazanova Lala , Nar Asli , Kut Altug , Tutuncu Neslihan

The prevalance of incidentally discovered adrenal masses increased in last three decades. The major clinical concern is the risk of malignancy and hormone overproduction but most of them are non-fonctional and benign. Current practices in the management of adrenal incidentalomas reevaluated the follow-up suggestions considering low probability of the transformation of a benign and non-functional adrenal mass to a malignant or functional one. Therefore, in the present study we ...

ea0049ep40 | Adrenal cortex (to include Cushing's) | ECE2017

Predictive baseline morning P-cortisol levels for the response to a Synacthen test in prednisolone treated patients

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

Introduction: Evaluation of glucocorticoid production generally requires a dynamic test. Cut-off levels for baseline cortisol concentrations predicting the outcome of a Synacthen test have been proposed for different cortisol assays. With introduction of the new Roche Elecsys Cortisol II assay, P-cortisol concentrations are expected to decrease by 20%. We have investigated cut-off levels for baseline P-cortisol concentrations measured with the Roche Elecsys Cortisol II assay t...

ea0049ep41 | Adrenal cortex (to include Cushing's) | ECE2017

Silent pheochromocitoma – a rare case of adrenal incidentaloma

Martins Ana Filipa , Vale Sonia do , Martins Joao Martin

Introduction: Pheochromocytomas are rare tumors arising from adrenomedullary chromaffin cells. Pheochromocytomas are a serious clinical condition and undiagnosed cases are associated with increased unexpected cardiovascular mortality.Case report: A female Caucasian patient aged 52-year-old was referred to the endocrine department of a public central hospital because of an incidental right adrenal mass first found 3 years before during the work out of non...

ea0049ep42 | Adrenal cortex (to include Cushing's) | ECE2017

LH and adrenal tumor size correlate with insulin resistance in menopausal patients with adrenal incidentalomas and (possible) autonomous cortisol secretion

Marina Ljiljana , Ivovic Miomira , Tancic-Gajic Milina , Arizanovic Zorana , Rakovic Dragana , Milin-Lazovic Jelena , Kendereski Aleksandra , Micic Dragan , Pandurevic Srdjan , Vujovic Svetlana

High prevalence of insulin resistance (IR) has been shown in patients with adrenal incidentalomas (AI) and it has been demonstrated that an increase in IR is related to the adrenal tumor size (ATS). Also, responsive adrenal pathologies are well documented in patients with chronically elevated LH. The aim was to investigate the association between LH and IR and ATS and IR in AI patients. The case-control study was conducted in Clinic for endocrinology, diabetes and metabolic di...

ea0049ep43 | Adrenal cortex (to include Cushing's) | ECE2017

A case of recurrent Cushing’s disease after total bilateral adrenalectomy

Vicic Ivan , Kruljac Ivan , Cacic Miroslav , Peric Bozidar , Filipovic-Grcic Maja , Mirosevic Gorana , Cerina Vatroslav , Pazanin Leo , Vrkljan Milan

Bilateral adrenalectomy usually results in lifelong primary adrenal insufficiency. Evidence exists that up to 34% of patients with Cushing’s disease (CD) have some degree of endogenous cortisol secretion after bilateral adrenalectomy due to ACTH driven hyperplasia of residual cortical tissue. We present a case of a patient with atypical corticotropinoma/carcinoma and recurrence of CD after bilateral adrenalectomy.A 59-year-old man presented with Cus...

ea0049ep44 | Adrenal cortex (to include Cushing's) | ECE2017

Late-night salivary cortisol: cut-off definition and diagnostic value in Cushing’s syndrome

Lages Adriana , Frade Joao , Paiva Isabel , Oliveira Patricia , Oliveira Diana , Martins Diana , Ventura Mara , Cunha Nelson , Rebelo-Marques Alexandre , Antunes Susana , Leitao Fatima , Carrilho Francisco

Background: The diagnosis of Cushing’s syndrome (CS) remains a challenge in clinical endocrinology. Several screening tests have been proposed to establish hypercortisolism. Late-night salivary cortisol (LNSC) is used as screening tool, however, individualized cut-off levels for each population must be defined.Methods: Three group of subjects were studied: healthy volunteers, suspected CS and proven CS. All patients collected saliva at 23.00 h using...

ea0049ep45 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenal involvement in MEN1 families

Ventura Mara , Melo Miguel , Gomes Leonor , Saraiva Joana , Barros Luisa , Rodrigues Dircea , Oliveira Diana , Martins Diana , Lages Adriana , Cunha Nelson , Carrilho Francisco

Introduction: MEN1 is a rare autosomal dominant syndrome typically characterized by neoplastic lesions of parathyroid glands, anterior pituitary gland and endocrine pancreas. Several other tumours are associated with this syndrome, including adrenal lesions, but their prevalence and clinical characteristics (endocrine secretion and aggressiveness) are largely unknown.Objective: To determine the prevalence, clinical characteristics and the possible genoty...

ea0049ep46 | Adrenal cortex (to include Cushing's) | ECE2017

Differential effects of aldosterone excess on potassium homeostasis and blood pressure in Asian subjects

Swee Du Soon , Kek Peng Chin , Loh Lih Ming

Introduction: Hypokalemia is considered as a late manifestation of primary aldosteronism (PA), long preceded by hypertension. However, there have been reports of normotensive PA patients presenting with hypokalemia. This study aims to examine the relationship of hypokalemia and blood pressure in patients with hyperaldosteronism.Methods: A retrospective review of patients who underwent saline infusion test (SIT) from 2014 to 2016 was conducted. All patien...

ea0049ep47 | Adrenal cortex (to include Cushing's) | ECE2017

Effect of adrenal mass lateralization on diagnostic tests in patients with Cushing

Tarcin Ozlem Ustay , Pehlevan Emre , Imre Eren , Uygur Melin , Deyneli Oguzhan , Yavuz Dilek Gogas

The frequency of adrenal masses is increasing in parallel with the progress of the technology. Most of these masses, which are detected by chance, are not functional, and only a part of them are exposed to an excess of hormone. The most common dysfunction in masses with hormonal activity is hypercortisolism. However, the diagnosis of Cushing’s disease is based on more than one test. In this study, we intended to compare the values of screening tests to determine whether t...

ea0049ep48 | Adrenal cortex (to include Cushing's) | ECE2017

Late night salivary cortisol measurement may help in excluding Cushing’s syndrome in patients with chronic kidney disease

Ambroziak Urszula , Kondracka Agnieszka , Rojek-Trębicka Jadwiga , Gajkowski Paweł , Stańczyk Agnieszka , Stępor Malwina , Bednarczuk Tomasz

Objective: The diagnosis of Cushing’s syndrome may be challenging, especially in cases of patients with chronic kidney disease (CKD).Aim: The assessment of late night salivary cortisol concentration, serum and salivary concentration in overnight dexamethasone suppression test in patients with CKD stage III–V and a control group.Patients and methods: 37 patients mean age 66±12 (M=13) with CKD stage III–V...

ea0049ep49 | Adrenal cortex (to include Cushing's) | ECE2017

The short Synacthen test revisited – reevaluation of the normal reference range using LCMSMS

Ueland Grethe AEstrom , Methlie Paal , Oksnes Marianne , Lovas Kristian , Thordarson Hrafnkell , Husebye Eystein

Background: The Synachten test is used to diagnose for adrenal insufficiency (AI) and non-classical congenital adrenal hyperplasia (CAH). The cut-off levels for s-cortisol and s-17-hydroxyprogesterone are derived from immunoassays that were not well standardized and are no longer in use. Introduction of liquid chromatography tandem mass spectrometry (LCMSMS) could resolve the lack of standardization of steroid hormone assays and enable increased diagnostic accuracy.<p clas...

ea0049ep50 | Adrenal cortex (to include Cushing's) | ECE2017

Cushing’s syndrome in pregnant woman

Chekanova Anastasiia , Komerdus Irina , Shestakova Tatiana , Burumkulova Fatima , Britvin Timur , Dreval Alexander

Background: Pregnancy occurs rarely in Cushing’s syndrome (CS), slightly over 150 cases have been reported in the literature. The risk of maternal morbidity and a poor fetal outcome is significant when CS coexists with pregnancy. CS may be difficult to detect clinically and laboratory because of the hormonal changes and pathological comorbidities associated with normal pregnancy.Material and methods: A case of CS that was diagnosed and treated durin...

ea0049ep51 | Adrenal cortex (to include Cushing's) | ECE2017

Education sessions in patients with adrenal insufficiency

Tavora Aldora , Lemos Ema , Duarte Isaura , Sobral Joaquim , Machado Catarina , Tavares Patricia , Rocha Gustavo , Monteiro Sara , Sousa Ana , Rodrigues Pedro , Oliveira Maria Joao

Introduction: Adrenal insufficiency (AI) is a rare and potentially life-threatening disease. The most common causes are primary adrenal insufficiency (Addison’s Disease), due to an adrenocortical disease, and secondary insufficiency, due to disorders of the pituitary gland. Chronic glucocorticoid replacement is vital and patients should be educated about how to act in acute stress situations, in order to avoid adrenal crisis. Taking this into account, we organized educati...

ea0049ep52 | Adrenal cortex (to include Cushing's) | ECE2017

Characteristics of aldosterone-producing adenomas: a tissue microarray study

Rhayem Yara , Feuchtinger Annette , Woischke Christine , Ludwig Philippe , Kunzke Thomas , Schwarzmayr Thomas , Hahner Stefanie , Gomez-Sanchez Celso E. , Strom Tim M. , Kirchner Thomas , Reincke Martin , Walch Axel , Beuschlein Felix

Background: Sporadic aldosterone-producing adenomas (APA) are relevant cause of endocrine related hypertension in Primary Aldosteronism (PA). Next generation sequencing techniques have identified somatic mutations in APA harbored in KCNJ5, ATP1A1, ATP2B3, CACNA1D, CTNNB1 and PRKACA genes. Yet, a number of APA harbor no mutations in candidate genes (designated as wild type, WT) and little is known about genotype/phenotype correlation.Objectives: We invest...

ea0049ep53 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenal cushing’s syndrome surprisingly unveiling breast cancer

Neves Joao Sergio , Oliveira Ana Isabel , Souteiro Pedro , Oliveira Sofia Castro , Baldaia Helena , Melo Daniel , Neves Celestino , Freitas Paula , Carvalho Davide

Introduction: Cushing’s syndrome is an endocrinopathy characterized by glucocorticoids excess. Adrenalectomy is the recommend treatment for unilateral adrenal Cushing’s syndrome and is usually associated with resolution of the disease.Clinical Case: A 54-year old woman with central obesity (BMI 34.3 kg/m2), diabetes and hypertension had a left adrenal mass of 15 mm and characteristics suggestive of adenoma (Hounsfield unit of <10...

ea0049ep54 | Adrenal cortex (to include Cushing's) | ECE2017

Giant adrenal tumor in a patient admitted for fever

Neves Joao Sergio , Teles Luis , Souteiro Pedro , Oliveira Sofia Castro , Oliveira Ana Isabel , Fernandes Ana Catarina , Damasceno Margarida , Graca Luisa , Rodrigues Elisabete , Neves Celestino , Freitas Paula , Carvalho Davide

Introduction: Adrenal tumors are usually detected due to clinical manifestations of hormonal hypersecretion or incidental findings on imaging evaluation. Although most incidentalomas are non-functioning adenomas, it is important to appropriately evaluate such masses to exclude hormonal excess or malignancy.Case description: An 81-year old male was admitted to our hospital for fever with 15 days of evolution. The patient also presented chills and loss of ...

ea0049ep55 | Adrenal cortex (to include Cushing's) | ECE2017

The relative risk of developing Addison’s disease among patients with type 1 diabetes mellitus: a nationwide, matched, observational cohort study

Chantzichristos Dimitrios , Persson Anders , Eliasson Bjorn , Miftaraj Mervete , Franzen Stefan , Svensson Ann-Marie , Johannsson Gudmundur

Background: Both prevalence and incidence of type 1 diabetes (T1DM) is increasing. T1DM is associated with other autoimmune diseases, such as Addison’s disease (AD). This combination is rare, with estimated prevalence in Norway 20 per million. Having both DM & AD is associated with marked excess mortality.Objectives: To study prevalence and incidence of AD among patients with and without T1DM.Methods: Nationwide, observati...

ea0049ep56 | Adrenal cortex (to include Cushing's) | ECE2017

The frequency of incidental liver and renal masses in patients with adrenal incidentalomas

Nasiroglu Imga Narin , Tutuncu Yasemin , Unal Mustafa , Tuna Mazhar Muslum , Aycicek Bercem , Isik Serhat , Berker Dilek , Guler Serdar

Purpose: Adrenal incidentalomas (AIs) are adrenal masses, which are found on imaging studies not performed related to an adrenal problem. Hepatic incidental masses and renal incidental masses are usually seen in abdominal imaging methods. We aim to investigate the frequency and the kind of hepatic and renal incidental masses in patients with AIs.Methods: Retrospective evaluation of 381 (245 female and 136 male) AI patients and 285 (168 female and 117 mal...

ea0049ep57 | Adrenal cortex (to include Cushing's) | ECE2017

Primary adrenal insufficiency: a Portuguese multicentre study by the adrenal tumour study group

Ferreira Lia , Silva Joao , Martins Ana , Belo Carlos , Oliveira Diana , Simoes Helder , Paiva Isabel , Guimaraes Joana , Ferreira Marta , Silva Rita , Garrido Susana , Silva Tiago , Fernandes Vera , Pereira Maria Lopes

Introduction: Primary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. There are no studies characterizing portuguese patients with PAI.Aims: To characterize the clinical presentation, diagnostic workup, treatment and follow-up of patients with confirmed PAI.Methods: A multicentre retrospective study of PAI patients followed in 12 portuguese hospitals.Results: We in...

ea0049ep58 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenal incidentaloma: a challenging dilemma!

Bonner Caoimhe , Shah Usman , Hawkins Anna , Pittathankal Anthony , Syed Imran , Casey Edel , Nikookam Khash

The prevalence of adrenal incidentaloma on abdominal Computed Tomography (CT) is around 4.4%. This prevalence is increased in obese, diabetic, hypertensive patients, and could be as high as 10% in older patients. Unilateral adrenal masses larger than 4 cm should be considered for surgical removal to avoid missing adrenal carcinoma, particularly in younger patients.This is the case of a 67 year old gentleman with Type 2 diabetes mellitus, known to have hy...

ea0049ep59 | Adrenal cortex (to include Cushing's) | ECE2017

Assay of steroids with Liquid chromatography tandem mass spectrometry is superior to immunoassays in monitoring patients with 21-hydroxylase deficiency

Nermoen Ingrid , Dahl Sandra Rinne , Brondstad Ingeborg , Husebye Eystein S , Thorsby Per M , Lovas Kristian

Objective: Immunoassays of steroids are still used in the diagnosis and biochemical monitoring of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21 OHD). However, high levels of steroid intermediates can promote cross-reactivity between steroids giving rise to falsely elevated levels.Design: Fifty-nine patients with classic 21OHD (38 women) were studied. Blood samples were collected in the morning after overnight medicatio...

ea0049ep60 | Adrenal cortex (to include Cushing's) | ECE2017

Treatment of patients with primary and secondary adrenal insufficiency with hydrocortisone modified-release (Plenadren®)

Pilli Tania , Forleo Raffaella , Cardinale Sandro , Cenci Valeria , Pacini Furio

Introduction: Adrenal insufficiency is a life-threatening disease. Conventional treatment requires multiple daily doses of immediate-release hydrocortisone or cortisone acetate causing non-physiological peaks and nadir of cortisol and it has been also associated with premature mortality, high frequency of infections, reduced quality of life, altered metabolic profile and reduced bone mineral density. A modified-release hydrocortisone (Plenadren®, Shire) by combining a rap...

ea0049ep61 | Adrenal cortex (to include Cushing's) | ECE2017

Autoimmune Addison disease – data from long-term follow-up of patients from a tertiary hospital’s Endocrinology Department

Oliveira Diana , Paiva Isabel , Lages Adriana , Martins Diana , Ventura Mara , Cunha Nelson , Paiva Sandra , Carrilho Francisco

Introduction: Autoimmune Addison disease requires lifelong glucocorticoid and mineralocorticoid replacement. Optimal therapy is not standardized and must balance adequate hormone substitution with prevention of treatment-related complications.Objective: Assessment of patients followed at our department: epidemiology, associated conditions, treatment, cumulative hydrocortisone dose and comorbidities.Methods: Review of clinical recor...

ea0049ep62 | Adrenal cortex (to include Cushing's) | ECE2017

Effect of GH treatment on coagulation and fibrinolysis parameters in prepubertal children with growth hormone deficiency

Karachaliou Feneli , Kafetzi Maria , Drakopoulou Maria , Vlachopapadopoulou Elpis , Leka-Emiris Sofia , Fotinou Aspasia , Michalakos Stefanos

Background: Increased fibrinogen levels have been reported in prepubertal children and adolescents with growth hormone deficiency (GHD), which were reduced after rhGH treatment. rhGH treatment has also been shown to exert a beneficial effect on the amount of aPAI-1 in children with GHD.Aim: Of the study was to evaluate whether prepubertal GH deficient (GHD) children showed any impairment in coagulation- and fibrinolysis-related parameters and the effect ...

ea0049ep63 | Adrenal cortex (to include Cushing's) | ECE2017

Treatment with modified-release hydrocortisone for 6 months: A clinical audit in 15 patients with adrenal insufficiency

Steffensen Charlotte , Andersen Marianne , Feldt-Rasmussen Ulla , Kistorp Caroline , Jorgensen Jens Otto L

Background: Patients with adrenal insufficiency (AI) exhibit increased morbidity, mortality and impaired quality of life (QoL) and conventional hydrocortisone replacement does not mimic the endogenous circadian pattern and may compromise adherence. A modified – release hydrocortisone formulation (Plenadren) for once-daily use is licensed in order to meet these needs.Objective: To audit the effects of treatment change from HC to Plenadren in an out-p...

ea0049ep64 | Adrenal cortex (to include Cushing's) | ECE2017

Cushing’s Syndrome During Pregnancy mimicking preeclampsia – case report

Radojkovic Danijela , Radojkovic Milan , Pesic Milica , Antic Slobodan , Kostic Sonja , Curkovic Sanja , Ciric Vojislav , Ilic Ivan

Introduction: Physiological changes of pregnancy could be similar with classical presentation and biological confirmation of Cushing’s Syndrome (CS). To diagnose CS in pregnancy is very difficult especially in previously healthy women. Since the hypercortisolemia in the pregnancy increase maternal and foetal morbidity it is a concern for endocrinologists, gynaecologists, and paediatricians.Patient case report: Herein, we present young woman (23 year...

ea0049ep65 | Adrenal cortex (to include Cushing's) | ECE2017

Potentially aggressive adrenal oncocytoma during pregnancy: about one case

Mezoued Mouna , Smaili Maissa , Meskine Djamila

Oncocytary cells adrenal adenoma or adrenal oncocytoma is an extremely rare tumor, mainly composed by oncocytomes. The diagnosis is exclusively confirmed on histological findings. There are about 50 cases published in the scientific reviews, of which only one case described a pregnant woman.We report an observation about a 31 years old patient, with no personal antecedent, explored in our unit for an adrenal masse, measuring 71×58×46 mm discove...

ea0049ep66 | Adrenal cortex (to include Cushing's) | ECE2017

Primary hyperparathyroidism associated with Cushing syndrome and primary hyperaldosteronism

Mnif Fatma , Elfekih Hamza , Elleuch Mouna , Hadjkacem Faten , Ghorbel Dorra , Rekik Nabila , Ammar Mouna , Mnif Mouna , Abid Mohamed

Introduction: The simultaneous occurrence in the same patient of more than one endocrinological condition is rare and was described in the multiple endocrine neoplasia (MEN). Here, we report a patient with an unusual combination of primary-hyperparathyroidism, papillary thyroid microcarcinoma, primary-hyperaldosteronism and ACTH-independent Cushing’s syndrome.Case description: A 54-year-old women with a primary-hyperparathyroidism was admitted to ou...

ea0049ep67 | Adrenal cortex (to include Cushing's) | ECE2017

Comparison of biochemical and hormonal parameters in patients with primary adrenal insufficiency of autoimmune and no-autoimmune cause

Angelousi Anna , Karapanagioti Aggeliki , Nikolopoulos Giorgos , Moschouris Panagiotis , Tsoli Marina , Mavroeidi Vasiliki , Kokkinos Michalis , Assonitis Nikolaos , Petychaki Fotini , Kaltsas Gregory , Kassi Eva

Introduction: Primary adrenal insufficiency (PAI) can be of autoimmune origin (AI), non-autoimmune origin (bilateral adrenalectomy, acute hemorrhage, infection) (NAI) or pharmaceutical (mitotane) origin. Studies have shown that these patients develop long-term morbidities and increased mortality due to excessive glucocorticoid tissue exposure. Data about differences concerning hydrocortisone (HC) needs, cortisol hormonal levels and metabolic parameters in these patients are sc...

ea0049ep68 | Adrenal cortex (to include Cushing's) | ECE2017

The role of dehydroepiandrosterone sulphate (DHEAS) in the evaluation of autonomous cortisol secretion in adrenal incidentalomas

Adamidou Fotini , Georgiou Thomas , Mintziori Gesthimani , Tsirou Efrosini , Anagnostis Panagiotis , Panagiotou Athanasios , Kita Marina

Introduction: Subclinical hypercortisolism (SH) has been reported in 5–20% of patients with adrenal incidentalomas (AIs), with various cardiometabolic consequences. We intended to investigate the contribution of DHEAS to standard testing, as another indicator of autonomous cortisol secretion in AIs.Materials and methods: Ninety consecutive patients (n=90) with AIs were included in a prospective cohort study. SH was diagnosed if ≥2 cri...

ea0049ep69 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenocortical carcinoma in pregnancy

Yorulmaz Goknur , Kebapci Nur , Canaz Funda , Buyruk Betul Aydin , Alaguney Sevil , Badak Bartu , Kebapci Mahmut

Introduction: Adrenocortical carcinoma (ACC) is a very rare tumor. The mean age at onset is between 40 and 50 years. Patients with nonfunctioning ACC report symptoms of abdominal discomfort or back pain due to the large tumor size. Surgery for ACC should be performed by an expert surgeon.Case: A 29-year-old patient with 25 weeks of pregnancy admitted at our clinic with right side pain. 10×11 cm solid mass on right adrenal gland was detected by ultra...

ea0049ep70 | Adrenal cortex (to include Cushing's) | ECE2017

Abnormal aldosterone/renin ratio is common in patients of African compared to European origin, is associated with hypokalaemia, and left ventricular hypertrophy, but is rarely associated with abnormal adrenal imaging characteristics

Ahmed KS , Bogdanet D , Heshe S , Boran G , Behan LA , Sherlock M , Gibney J

Adrenal mineralocorticoid biochemistry differs between people of African and European ancestry. The aldosterone/renin ratio (ARR) is the initial screening test for primary hyperaldosteronism (PHA), but little data exists regarding ethnic variations in this.Following clinical observation of a high prevalence of abnormal ARR in patients of African origin, we retrospectively reviewed all ARR measurements in a single centre over 10 years. Rates of hypokalaem...

ea0049ep71 | Adrenal cortex (to include Cushing's) | ECE2017

Neutrophil-lymphocyte and platelet-lymphocyte ratios as biomarkers in distinguishing adrenocortical adenomas and carcinomas

Solak Mirsala , Kraljevic Ivana , Kastelan Marko , Kakarigi Luka , Dusek Tina , Polovina Tanja Skoric , Balasko Annemarie , Knezevic Nikola , Kastelan Darko

The role of systemic inflammation in promoting tumor progression has been a topic of increasing interest. Neutrophil-lymphocyte ratio (NLR) >5 and platelet-lymphocyte ratio (PLR) >190 used as indicators of inflammation have been reported to have prognostic value in numerous solid tumors. The aim of this retrospective study was to investigate NLR and PLR as biomarkers in distinguishing between adrenocortical adenomas and adrenocortical carcinomas (ACC). Nineteen patient...

ea0049ep72 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenal involvement of Non-Hodgkin’s lymphoma: a case report

Oz Gul Ozen , Cander Soner , Erturk Erdinc , Ersoy Canan

Introduction: The involvement of certain organs such as the adrenal gland is rare in non-Hodgkin’s lymphoma (NHL). Although lymphomas can involve virtually all extranodal organs, different organs show different frequency of involvement. Adrenal gland involvement is usually bilateral. We report that a rare case of unilateral adrenal involvement of diffuse large B-cell lymphoma presenting with abdominal pain.Case: A 64-year-old-man presented with abdo...

ea0049ep73 | Adrenal cortex (to include Cushing's) | ECE2017

Challenges in differential diagnosis of adrenal incidentaloma or clinical case of multiple myeloma

Volkova Natalia , Porksheyan Maria , Davidenko Ilya , Oleg Kit , Serguey Dimitriadi

Adrenal incidentaloma (AI) in patients with cancer poses diagnostic challenge for doctors. We present clinical case of generalised metastatic bone diseases and adrenal mass.Male 59 years old asked the second opinion about incidental adrenal mass, which was suspected for adrenal cancer by urologist. His medical anamnesis began in April of 2015 with severe generalised bone pain. The whole body MRI/CT detected multiple bone lesions, adrenal mass (57×45...

ea0049ep74 | Adrenal cortex (to include Cushing's) | ECE2017

Iatrogenic Cushing syndrome and suprarenal secondary insufficiency due to interaction between fluticasone and ritonavir

Lorena Suarez Gutierrez , Brenda Veiguela Blanco , Lorena Dieguez Felechosa , Laura Manjon Miguelez , Maria Riestra Gonzalez , Nuria Antuna Garcia , Jesus Diaz Fernandez Maria , Florentino Casal Alvarez

Introduction: The interaction between corticosteroids and protease inhibitors (PIs) is a clearly described drug interaction.Case report: A 44-year-old woman diagnosed with HIV category B3 diagnosed in 1989; severe lipodystrophy. In addition , HCV genotype IA. Bronchial asthma since 2000. Treatment with fluticasone 1 inh/24 h, salbutamol on demand, darunavir 800 mg/day and ritonavir 100 mg/day. He had known lipodystrophy since 2001 and the abdominal perim...

ea0049ep75 | Adrenal cortex (to include Cushing's) | ECE2017

Body composition in women with Cushing’s syndrome of different etiology

Ilic Dusan , Macut Djuro , Antic Ivana Bozic , Popovic Bojana , Bogavac Tamara , Isailovic Tatjana , Elezovic Valentina , Ognjanovic Sanja , Damjanovic Svetozar

Introduction: Cortisol has important roles in the regulation of body composition and hypercortisolaemia have major impact on body fat distribution. The aim of this study was to analyze differences in adipose tissue distribution in women with Cushing’s disease and Cushing’s syndrome due to adrenal adenoma.Method: We evaluated 12 women with Cushing’s syndrome, six with ACTH secreting pituitary adenomas (Group A) and six with adrenal adenomas...

ea0049ep76 | Adrenal cortex (to include Cushing's) | ECE2017

Clinical course of patients with adrenal incidentaloma: retrospective analysis of a single center

Serrano Ana Carolina Ruiz , Colet Ana Megia , Cortes Silvia Naf , Ortega Joan Vendrell , Muela Inmaculada Simon , Fraile Esther Solano , Alevras Theodora Michalopoulou

In the adrenal incidentaloma (AI) it is fundamental to determine functionality and benignity. The aim of this study was to evaluated the clinical, radiological and hormonal evolution of AI and compare the frequency of autonomous cortisol secretion (ACS) between American and European Guidelines.Methods: Retrospective evaluation of patients with AI referred to our service in the last 5 years.Results: 140 patients were included, 50.9%...

ea0049ep77 | Adrenal cortex (to include Cushing's) | ECE2017

Malignant androgen-secreting adrenocortical carcinoma with adrenal insufficiency: a case report

Mnif Fatma , Kalthoum Mehdi , Elleuch Mona , Wajdi Saafi , Charfi Nadia , Ammar Mouna , Feki Hamza , Mnif Mona , Abid Mohamed

Adrenocortical carcinoma (ACC) is a rare malignancy, accounting for 0.02% of all annual cancer. The majority of these tumors are benign, non-functioning adenomas that are incidentally discovered on abdominal image studies. Others are functional adenomas secreting cortisol, aldosterone, or less commonly androgens or estrogens. Pure androgen-secreting adrenal tumors are very rare.Case report: A 34-year-old female patient presented with pain in the left upp...

ea0049ep78 | Adrenal cortex (to include Cushing's) | ECE2017

Hyperaldosteronism screening in Hypertensiologists experience - epidemiological review of over 800 cases

Korzynska Weronika , Jodkowska Anna , Mazur Grzegorz

Primary aldosteronism (PHA) is one of the most common cause of secondary hypertension. It can possibly concern over 10% of hypertensive patients, but often is being under-recognised. The basic tool of case PHA detection is aldosterone to renin ratio (ARR). Appropriate cutoff value of ARR is still under discussion.We review occurrence of CT/MRI detectable adrenal gland laesions according to assigned ARR cutoff value. Retrospective data from 833 consecutiv...

ea0049ep79 | Adrenal cortex (to include Cushing's) | ECE2017

Clinical, laboratorial and densitometric evaluation of adult women with congenital adrenal hyperplasia

Vensao Leilane , Borba Victoria , Rodrigues Adriane

Introduction: There is paucity of data comparing bone densitometry and body composition in adult women with congenital adrenal hyperplasia (CAH) treated with glucocorticoids since childhood and the same parameters in healthy women of the same age and BMI.Methods: 20 women with classical CAH (35% simple virilizing, 65% salt losing), aged 16–45 years, had anthropometric, laboratorial and densitometry exam (DXA) for bone mineral density (BMD) (L1–...

ea0049ep80 | Adrenal cortex (to include Cushing's) | ECE2017

The effect of subclinical hypercortisolism on bone mineral density in female patients with adrenal incidentalomas

Ognjanovic Sanja , Macut Djuro , Petakov Milan , Elezovic Valentina Kovacevic , Isailovic Tatjana , Antic Ivana Bozic , Ilic Dusan , Popovic Bojana , Bogavac Tamara , Antic Jadranka , Damjanovic Svetozar

To investigate the prevalence of SH and osteoporosis in female patients with unilateral AIs (UAIs) and bilateral AIs (BAIs).We enrolled 106 female patients, 68 (64.2%) with UAIs and 47 (35.8%) with BAIs. SH was diagnosed in the presence of serum cortisol levels after 2-day low-dose dexamethasone suppression test (LDDST) >50 nmol/l with at least one of the following parameter (midnight serum cortisol >208 nmol/L, 24-h urinary free cortisol >24...

ea0049ep81 | Adrenal cortex (to include Cushing's) | ECE2017

Long term follow up of patients with adrenal incidentaloma and ‘autonomous cortisol secretion’

Kraljevic Ivana , Solak Mirsala , Dusek Tina , Polovina Tanja Skoric , Balasko Annemarie , Kastelan Darko

The aim of this study was to compare the long-term co-morbidities and biochemical data between patients with adrenal incidentaloma and ‘autonomous cortisol secretion’ who were treated surgically and conservatively.Methods: The research of the database of the patients with adrenal incidentaloma diagnosed between 2007 and 2014 was performed. Among them, 43 patients with ‘autonomous cortisol secretion’ were identified and invited for a f...

ea0049ep82 | Adrenal cortex (to include Cushing's) | ECE2017

Adrenocortical carcinoma - casuistic analysis

Ribeiro Catia , Lobo Joao , Mesquita Ana , Martins Pedro C , Peyroteo Mariana , Matos Maria Joao , Antunes Pedro , Sanches Cristina , Moreira Augusto , de Sousa Joaquim Abreu

Introduction: Adrenocortical carcinomas are rare neoplasms with an incidence of 0.7 to 1.5 per million/year. Diagnosis often requires a multidisciplinary approach. When the disease is confined to the adrenal gland, absolute criteria defining malignancy, do not exist, however a score of Weiss> or =a 3 is considered diagnosis. The prognosis is usually reserved and conventional chemotherapy is not curative.Material and Methods: Retrospective analysis of...

ea0049ep83 | Adrenal cortex (to include Cushing's) | ECE2017

A near miss on blaming the heart: a rare case of Adrenocortical carcinoma with thrombus extension into right atrium and Cushing syndrome

Morsi Hadeil , Eisa Mohamed , Goodwin Lynsey , Flegg Peter , Aye Myint

A 39 year old female patient presented with one week history of Shortness of breathing. Over the last four months she noted bilateral leg swelling, which failed to improve on diuretic. Examination revealed no other evidence of fluid overload or heart failure. An element of right heart strain rather than failure was raised on cardiologists review. Subsequently, an echo showed a friable mass extending form inferior vena cava to right atrium into proximal left ventricle. The natu...

ea0049ep84 | Adrenal cortex (to include Cushing's) | ECE2017

Congenital Adrenal Hyperplasia due to 11β-Hydroxilase Deficiency: clinical and molecular studies of two novel families with variable phenotypes

Pfeilsticker Alessandra , Valadares Luciana , Sousa Selma , Cardoso Sarah , Morais Olivia , Santarem Renata , Lofrano-Porto Adriana

11β-hydroxylase deficiency is the second most frequent cause of congenital adrenal hyperplasia (CAH), corresponding to approximately 5% of cases., and caused by inactivating mutations in the CYP11B1 gene. We aimed to describe four new cases from two different families with a clinical diagnosis of 11β-hydroxylase deficiency. Family 1: Two siblings born from consanguineous parents. A 31-year-old (yo) woman presented at 5 yo with genital ambiguity (Prader II), ...

ea0049ep85 | Adrenal cortex (to include Cushing's) | ECE2017

‘Record-breaking hyponatraemia’ with Addison’s disease

Khan Irfan , Cheyne Elizabeth

Addisons disease is a rare but potentially life threatening endocrine disorder. It is well-known for disguising as a variety of presentations before diagnosis. Here we present a case report of Addison’s disease presenting with very severe hyponatraemia. A 35 year old lady was admitted with lethargy, low mood, weight loss and feeling generally unwell for the last 3 months. Six weeks prior to her admission, her GP arranged some routine investigations including U&E which...

ea0049ep86 | Adrenal cortex (to include Cushing's) | ECE2017

24 hour ambulatory blood pressure levels according to adrenal adenoma size

Atasoy Alp , Cakir Evrim , Ahbab Suleyman , Kayas Derya , Ataoglu Esra , Yenigun Mustafa

Aim: The etiology and underlying pathology of non-functional adrenal adenoma has not been clearly defined, yet. Blood pressure levels according to adrenal adenoma size has not been evaluated, yet. Therefore, we evaluated 24 hour ambulatory blood pressure levels in patients with non functional adrenal adenoma.Materials & Methods: We studied thirty newly diagnosed adrenal adenoma patients in a tertiary health-care center. They grouped in two categories...