Endocrine Abstracts

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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). ...

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...

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...

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...

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...

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:...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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....

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...

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...

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...

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...

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...

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...

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 ...

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....

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 ...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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%...

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...

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...

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–...

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...

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...

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...

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...

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), ...

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...

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...