Endocrine Abstracts

Glioblastoma (GBM) is a highly aggressive form of brain cancer with a median survival time of 12–15 months from diagnosis. Standard therapies utilise a combination of radiotherapy, chemotherapy, and surgery. Patients also receive high doses of the potent anti-inflammatory glucocorticoid (Gc), Dexamethasone (Dex).Recent studies show that patients receiving the highest dose of Dex also have reduced survival time. Defining pathways under Gc control relevant to GBM is necessa...

Cushing’s syndrome (CS) and subclinical Cushing’s syndrome (SCS) show poor prognosis due to hypercortisolemia, which causes metabolic disorders, such as diabetes mellitus, hypertension, dyslipidemia, and osteoporosis. Aiming to improve prognosis and develop a novel treatment for these refractory diseases, we have been constructing a patient registry of CS and SCS founded on a multicenter database at Kyushu University hospital and related facilities since 2001. CS inc...

Background: Androgen excess in childhood is a common clinical presentation with potentially serious underlying pathology.Objectives and Design: We have examined the diagnostic utility of simultaneous measurement of serum dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4), and testosterone (T) to delineate the biochemical signatures of conditions underlying paediatric hyperandrogenism in a large tertiary care referral centre (2013–2017). Se...

Objective: To investigate a selection of novel bone or immunomarkers which may act as indicators for steroid replacement in Adrenal Insufficiency (AI).Introduction: AI is a condition where individuals are not able to produce sufficient steroids for their body’s requirement. Although mortality rates have improved since the introduction of exogenous steroid replacement, this condition is still associated with increased mortality and morbidity. This co...

Background: Hypopituitarism can occur post trans-sphenoidal adenomectomy(TSA). Accurate prediction of HPA axis recovery would inform hydrocortisone replacement strategies but there are limited studies on this. In our centre, HPA axis is assessed with pre-operative short synacthen test (SST), day-8 post TSA 9am cortisol and 6-week post-TSA SST. Patients are commenced on hydrocortisone post TSA until 6 weeks review.Methods: We performed a single-centre, lo...

Background: Both excess and insufficient glucocorticoid exposure in utero is associated with adverse fetal outcomes. Characterising the maternal hypothalamic-pituitary-adrenal (HPA) axis is challenging with large intra-individual variations in plasma and saliva. We hypothesised that 24-hour total urinary glucocorticoid (TUG) is a marker of maternal HPA axis during pregnancy. We tested associations of TUG with maternal BMI and birthweight.Methods: TUG was...

The Endocrine Society guidelines recommend initial testing for Cushing’s syndrome (CS) can be based on non-invasive late-night salivary cortisol measurement (NSC). In the BHSCT NSC (11pm), measured using the IBL ELISA kit has been found to be highly discriminative in identifying patients with CS. However it is a labour intensive test and the need for analysing samples in batches delays turnaround time, limiting its use in the routine work-up for CS. Roche provide an autom...

Introduction: UK guidelines state that all patients undergoing adrenalectomy for phaeochromocytoma must be admitted to intensive care post-operatively due to the risk of haemodynamic instability (HDI). Intensive care beds are a scarce resource and it is important to regularly evaluate the need for admission, preventing unnecessary admission.Methods: The study population included all patients who underwent adrenalectomy for phaeochromocytoma at a UK terti...

Background: Subtyping of primary aldosteronism (PA) using imaging and adrenal vein sampling (AVS) can yield discordant results. Varying interpretation criteria in determining AVS lateralization may affect discordance rates.Methods: We identified 337 consecutive patients with PA who underwent AVS at a quaternary care centre between August 2006 and February 2018. Patient demographics, laboratory results, diagnostic imaging, AVS results, and pathology were ...

The importance of measuring renin or plasma renin activity (PRA) and aldosterone in establishing mineralocorticoid deficiency is not in doubt. Once mineralocorticoid replacement therapy is initiated, guidance suggests that optimization of mineralocorticoid dose should be based upon measurements of blood pressure, renin (or PRA), and electrolytes. The aim of this study was to explore the relationship between renin and clinically important variables to determine whether measurem...

Background: Androgen deprivation therapy (ADT) for prostate cancer (PCa) leads to a global loss of lean mass. ADT leads to sexual dysfunction and a selective loss of leg muscle function, however individual muscle volumes have never been evaluated. We aimed to assess in men undergoing ADT, the muscle volumes of levator ani, which in mice is androgen-responsive, and of lower-limb muscles.Methods: We conducted a prospective case-control study involving 34 m...

Steroid-dependence is a life-long condition with a risk of premature mortality from undertreated adrenal crisis or omission of steroids. Previous studies identified rates of adrenal crisis around 8.3/100 patient years (Hahner 2015). We invited members of Addison’s Disease Self-Help Group to complete an online questionnaire about any experiences of adrenal crisis. Respondents(N=628) were asked to provide demographic information and details of their most recent adr...

Objective: Incidentally discovered adrenal masses (‘incidentalomas’) are found in 2% of the population. Adrenalectomy is necessary only in a small proportion of such subjects as outlined by the relevant ESE/ENSAT guideline1. However, uncertainty exists over the need for removal of lesions between 4 and 6 cm and those with low lipid content on CT scanning (found in 20% of benign adenomas). Our centre tends to offer surgery for all adenomas >4 cm.<p ...

Background: Negative imaging in the work-up for unilateral (surgical) primary aldosteronism (PA) presents a diagnostic dilemma. Clinicians may assume bilateral disease and treat medically or may proceed to adrenal vein sampling (AVS) to try to localize a unilateral source of aldosterone secretion. However, AVS is not without cost, risk, and limited access. We describe AVS results among imaging-negative PA patients.Methods: We identified 96 patients with ...

Background: Adrenal incidentalomas are mostly non-functioning adrenal tumours (NFAT) or adenomas with mild autonomous cortisol excess (MACE), of which the natural history is unclear. We conducted a systematic review and meta-analysis focussing on NFAT and MACE to determine the: (i) proportion and degree of tumour growth, (ii) incident change in hormone function, and (iii) proportion of malignant transformation.Methods: We searched MEDLINE In-Process &#38...

Aim: If ‘0’minute salivary cortisol (SALCORT_0) or cortisone (SALCONE_0) can predict normal post-synacthen cortisol response.Method: Baseline salivary sample was collected for 110 patients who had short synacthen test (SST) between 09:00 and 10:00 after hydrocortisone withdrawal for at least 24-hour. SST was labelled ‘pass’ if 30-minute serum cortisol was >450 nmol/l. Serum cortisol was measured by immunoassay whereas salivary cor...

Introduction: Adrenal incidentalomas (AIs) are found in ~3% abdominal scans, rising to 10% in the elderly. In 2016, the European Society of Endocrinology (ESE) published new guidance on their management.Aims & objectives: To (1) compare how AIs have been managed at the University Hospital of Wales (UHW) against ESE guidelines, and (2) provide an early evaluation of the impact of service changes implemented based on initial findings.<p class="abst...

First line screening for pheochromocytoma, as recommend by Endocrine Society guidelines, is to determine plasma free or urinary fractionated metanephrines. We routinely offer the latter. Although negative results rule out pheochromocytoma, it is not uncommon to see borderline results which require further investigation. In this situation we have historically relied on the measurement of plasma catecholamines in the clonidine suppression test (CST). Plasma metanephrines, howeve...

Adrenal vein sampling (AVS) is the gold standard for detecting aldosterone production in bilateral adrenal hyperplasia and for distinguishing the lateralization of aldosterone secretion. Successful AVS is determined by calculating the selectivity index (SI). The cut off value for the SI is ≥2.0 under un-stimulated conditions. The aldosterone level (AL) is corrected for cortisol level (CL) and adjusted values are then compared to determine the lateralizing index (LI). Mos...

Patients with Addison’s or adrenal insufficiency require regular steroid replacement usually in the form of oral hydrocortisone. Standard advice is given on how to deal with intercurrent illness and special situations such as surgery. Organisations such as the Addison’s disease self-help group provide authoritative guidelines for patients. Several of our patients with adrenal insufficiency have asked how their steroid replacement treatment should be adjusted for expe...

Aim: The short Synacthen test (SST) is an established test used to assess the hypothalamic-pituitary-adrenal axis. There remains debate whether a 30 minute or 60 minute cortisol sample has diagnostic superiority. Currently at the Queen Elizabeth University Hospital, Glasgow all tests arranged by endocrinology are performed by endocrine nurse specialists who utilise a 0 and 30 minute cortisol protocol. Performing a further 60 minute sample requires more nursing time and space r...

Background/aims: The short synacthen test (SST) is a dynamic function test used to assess the hypothalamic pituitary adrenal axis. Interpretation requires consideration of sample timing and cortisol method. Currently the 30 minutes post-synacthen cortisol (CORT30) at NHS Greater Glasgow and Clyde (NHS GGC) is >450 nmol/l measured on the Abbott Architect. A large reference range study published a cut-off of >430 nmol/l for this method. This audit aims to document clinic...

Introduction: Adrenal incidentalomas are masses discovered incidentally on imaging studies performed for possible pathologies other than suspected adrenal disease.Aim: To characterise a cohort of adrenal incidentalomas found on CT.Methods: This was a retrospective analysis, taking into account all the adrenal incidentalomas discovered on CT between July and December 2014 at the main hospital in Malta. The adrenal lesions were then ...

Background: Adrenal incidentalomas (AI) are asymptomatic adrenal lesions found on imaging not primarily performed to detect adrenal disease. We conducted a retrospective audit of management of AI following European Society of Endocrinology recommendation (2016).Methods: This was a retrospective review of incidentaloma referrals over 9 months (June 2017–March 2018). Cases were identified using criterion search of the referral console. Additional data...

Introduction: Endogenous Cushing’s syndrome (CS) is a rare disease associated with severe morbidity and increased mortality if untreated. Glucose metabolism is significantly altered in hypercortisolism.Objective: To retrospectively analyse the clinical presentation of a cohort of patients with endogenous CS and study the frequency of glucose metabolism abnormalities as opposed to other clinical signs and symptoms.Material and ...

Background: Adrenal incidentalomas (AI) are being seen frequently in endocrine clinics due to increased cross-sectional imaging with a prevalence of 4% (7% in patients >70 years) of abdominal CT scans. The majority of these tumours are benign and non-functional, but identifying malignancy and functionality is important. Excess cortisol production is the commonest endocrinopathy associated with AI, with a reported prevalence of ~10%. The overnight 1 mg dexamethasone suppres...

Introduction: After the introduction of the Endocrine Society Guideline 2008, the disease recognition rate in Southern Thailand becomes dramatically noticeable. However, the prevalence rate of primary aldosteronism (PA) in this region is still unknown and aldosterone-renin ratio screening (ARR) is not widely available.Objective: i) to identify the prevalence rate of PA among patients who had ARR screening, ii) to identify predictive factors for the PA di...

Introduction: Cushing’s syndrome (CS) is a rare disease that can be difficult to diagnose. 24 hour urinary free cortisol (UFC) is one of the reliable screening tests to diagnose CS. The Endocrine Society recommends against widespread screening for CS. It advises to screen those patients presenting with multiple and progressive features (easy bruising, facial plethora, proximal myopathy and striae) of CS, in addition to patients who experience unusual features for their ag...

Introduction: Pheochromocytomas (adrenal and extra- adrenal/Paragangliomas) are rare catecholamine producing tumors and required complex dedicated MDTintervention. We preliminarily reported our service in a tertiary referral centre over 10 years (2008–2018).Method: A retrospectively review of confirmed phaeochromocytoma were carried out by reviewing clinical correspondences and ICE investigation-result system (laboratory, radiology and histology.)</...

Objective: Based on recommendations from the Clinical Practice Guidelines committee group on management of adrenal incidentalomas our project aims to review whether patients found to have adrenal incidentalomas were managed as per recommendations of the committee as follows: If they had a 1 mg overnight dexamethasone suppression test,were they tested for phaeochromocytoma, whether the investigations were used judiciously keeping in view patients co-morbid state, were any of th...

Back ground: Our Cortisol assay was changed from older generation assay to new second-generation Roche cortisol assay for the Short synacthen tests. There is ~ 20–25% difference in cortisol values between these assays. There are debates about the cut off values for normal response (cortisol of 420 or 440 nmols), compared to 550 nmols/l with older assay. And to assess the use of 30 and 60 min cortisol response.Methods: Short synacthen tests data were...

In chronic inflammatory disease, an increased proportion of M1 polarised macrophages have been shown to contribute to inflammation and tissue damage through the production of pro-inflammatory cytokines such as TNFα. Previously, we have identified expression of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which converts inactive glucocorticoids (GCs) to their active counterparts, in M1 polarised macrophages in vivo. We hypothesised that 11β...

Pharmacological treatment with synthetic glucocorticoids, which are widely prescribed for the treatment of numerous inflammatory and autoimmune diseases, can also affect the way the adrenal gland produces cortisol. Indeed, patients undergoing synthetic glucocorticoid treatment can develop adrenal insufficiency. This condition is characterised by reduced responsiveness of the adrenal to ACTH stimulation, and adrenal crisis/shock can occur in response to acute physiological stre...

Introduction: The highly active human fetal adrenal gland plays a critical role in long term health. Maternal cigarette smoking alters post-natal health of the fetus and the mechanisms involved may include the fetal adrenal. However, understanding of human fetal adrenal development is limited.Aim: To examine the effects of nicotine, its metabolite cotinine, and cigarette smoke extract on H295R adrenocortical cell line steroidogenic capacity.<p class=...

Retinoic-acid-inducible gene I (RIG-I) is a cytosolic receptor that sense RNA viruses, such as influenza, producing proinflammatory cytokines and type 1 interferons. In severe influenza infection, inappropriate immune response can allow influenza virus to proliferate, triggering hypercytokinemia that leads to tissue damage and potentially death of the host. Glucocorticoid hormones (GC) are clinically used to suppress hypercytokinemia. However, the use of GC is controversial du...

Background: Glucocorticoids are prescribed for >3 months to 1% of the UK population, principally to control inflammation. In 10–30% of patients, chronic glucocorticoid treatment suppresses HPA axis activity, causing atrophy of the adrenals and a failure to mount an adequate response during stress (potentially fatal) and following treatment withdrawal. Understanding the mechanisms resulting in HPA axis failure may allow us to predict those at risk, inform treatment str...

Excess action of glucocorticoid hormones is implicated in metabolic disease and cognitive decline, 11β-hydroxysteroid dehydrogenase 1 (11βHSD1) catalysing generation of active glucocorticoid hormones in tissues. The penetration rates and tissue-specific contribution of 11βHSD1 to glucocorticoid turnover were assessed using tracer kinetics. 9,11,12,12-d4-Cortisol (d4F) was infused (1.75 mg/day, 7 days) into C57Bl6/J male mice and mice lacking 11βHSD1 (n<...

Endocrine disruptors are chemicals which in low concentrations can disturb gene expression in a range of endocrine glands and organs including the fetal and adult adrenal glands, potentially resulting in altered steroidogenic flux. With exposure to endocrine disruptors affecting both animals and humans, it is important to assess both the mechanisms and consequences of disruption in steroidogenic pathways, particularly as foetal development may be especially sensitive to endocr...