Searchable abstracts of presentations at key conferences in endocrinology
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Society for Endocrinology BES 2019

Brighton, United Kingdom
11 Nov 2019 - 13 Nov 2019

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Come and exchange knowledge, share experiences and strengthen collaborations across our global community of endocrinologists!


Adrenal and Cardiovascular

ea0065p1 | Adrenal and Cardiovascular | SFEBES2019

Single cell RNA-seq reveals complex processing of glucocorticoid controlled transcriptional programmes

McGinnis Kathryn , Baker Syed Murtuza , Donaldson Ian , Berry Andrew , Rattray Magnus , Ray David , Stead Lucy , Cook Graham , Bond Jacquelyn , Matthews Laura

Synthetic glucocorticoids (Gc) are the most potent anti-inflammatory agents known and are widely used to treat a range of chronic inflammatory diseases including rheumatoid arthritis and asthma. However their therapeutic utility is limited by the development of Gc resistance over time – particularly at sites of inflammation. Understanding the underlying mechanisms that control Gc sensitivity is essential to overcome this. Previous studies have measured the average transcr...

ea0065p2 | Adrenal and Cardiovascular | SFEBES2019

11β-HSD1 mediates muscle atrophy induced by glucocorticoid therapy in chronic inflammatory disease

Webster Justine Michelle , Fenton Chloe , Lavery Gareth , Langen Ramon , Hardy Rowan

Objective: Therapeutic glucocorticoids (GCs) are used to treat chronic inflammatory disease, due to their anti-inflammatory effects. Despite their efficacy, chronic exposure to GCs elicits undesirable side effects, including muscle atrophy. 11 beta-hydroxysteroid dehydrogenase 1 (11β-HSD1) activates GCs within muscle, is induced by inflammation, and has previously shown to drive GC-induced muscle wasting. We examined the role of 11β-HSD1 in mediating muscle wasting i...

ea0065p3 | Adrenal and Cardiovascular | SFEBES2019

A role for salivary cortisol measurement in assessing heat tolerance during exercise

Stacey Mike , House Carol , Woods David , Allsopp Adrian , Brett Stephen , Sa Daniel Roiz de

Introduction: Exercise in the heat can impose significant physiological strain and may result in incapacity, illness and death from exertional heat stroke (EHS). The adrenocortical response to exercise is known to be amplified with concurrent heat stress, suggesting the potential utility of cortisol measurement in dynamic surveillance for heat intolerance. In laboratory conditions, a standard Heat Tolerance Assessment (HTA) may be used to determine thermal tolerance to exercis...

ea0065p4 | Adrenal and Cardiovascular | SFEBES2019

Serum estrogens and the sexual dimorphism in heritable and idiopathic pulmonary arterial hypertension (PAH)

Denver Nina , Homer Natalie ZM , Austin Eric D , Andrew Ruth , MacLean Margaret R

Serum was collected with ethical approval from Vanderbilt Medical Center, USA for blinded analysis between clinical phenotypes; heritable and idiopathic PAH patients (hPAH n=13, 14; iPAH n=7, 12) compared to non-PAH control (n =17, 17) (female, males, respectively). Quantification of circulating estrogens in human bio-fluids may reveal insights into disease aetiology but has been hampered through inadequate sensitivity and specificity of immunoassays...

ea0065p5 | Adrenal and Cardiovascular | SFEBES2019

Cardiovascular morbidity is increased in secondary but not primary adrenal failure

Ngaosuwan Kanchana , Godsland Ian , Cox Jeremy , Majeed Azeem , Quint Jennifer , Johnston Desmond , Robinson Stephen

Background: Increased cardiovascular mortality and evidence of atherosclerosis have been reported in patients with pituitary disorders, irrespective of type of pituitary hormone deficiency. However, there are few data on cardiovascular events in patients with secondary adrenal failure due to pituitary disease compared with those who have primary adrenal failure.Subjects: 2052 patients with primary adrenal failure were compared with 20 366 matched control...

ea0065p6 | Adrenal and Cardiovascular | SFEBES2019

Monitoring metyrapone therapy for Cushing’s syndrome using salivary glucocorticoid measurement by liquid chromatography tandem mass spectrometry (LC–MS/MS)

Manson Megan , Adam Safwaan , Higham Claire , Keevil Brian , Trainer Peter , Monaghan Phillip

Introduction: Late-night salivary cortisol assessment is an important element when investigating suspected Cushing’s syndrome (CS). The goal of medical therapy is achieving a mean (of 5 samples during a single day) serum cortisol (serumF) of 150–300 nmol/l (Cushing Day Curve [CDC]). Metyrapone is an 11β-hydroxylase inhibitor elevating levels of 11-deoxycortisol causing conventional immunoassay (IA) to overestimate SerumF; a problem obviated by LC–MS/MS. We ...

ea0065p7 | Adrenal and Cardiovascular | SFEBES2019

ULTRADIAN adrenal steroid metabolodynamics successfully discriminates pituitary Cushing’s disease from healthy normal variation

Upton Thomas , Zavala Eder , Fraser Diane , Methlie Paal , Russell Georgina , Tsagarakis Stelios , Kampe Olle , Lightman Stafford , Husebye Eystein

Background: Establishing endocrine diagnoses including pituitary Cushing’s remains challenging with delayed or misdiagnosis being very costly for both patient and the health care system. A key issue is that standard diagnostic tests are typically single time point, single analyte samples, which do not consider dynamic variation intrinsic to endocrine systems. Having previously demonstrated that free tissue hormones correlate strongly with plasma concentrations, we present...

ea0065p8 | Adrenal and Cardiovascular | SFEBES2019

Clinical outcomes in adrenocortical carcinoma: evaluation of single and combined prognostic markers in a UK single centre cohort

Elhassan Yasir , O'Reilly Michael , Asia Miriam , Chortis Vasilis , Sutcliffe Robert , Skordilis Kassiani , Arlt Wiebke , Ronchi Cristina

Background: Adrenocortical carcinoma (ACC) has an aggressive but variable behaviour. ENSAT tumour stage and Ki67 proliferation index are used to predict clinical outcome but they are limited in distinguishing patients with best outcome. We aimed to investigate the prognostic role of clinical/histopathological parameters alone or in combination according to previously proposed points-based score (mGRAS, Lippert JCEM 2018).Methods: We assessed 112 patients...

ea0065p9 | Adrenal and Cardiovascular | SFEBES2019

Exploring diagnostic thresholds for adrenal insufficiency with the new generation Roche cortisol assay

Daultrey Harriet , Chakera Ali , Crown Anna

Introduction: In 2017 the Roche cortisol assay underwent a generation update. The increased specificity of this assay was expected to lower cortisol results by approximately 30%. Based on a local consensus, the 30 min short Synacthen Test (SST) cortisol was lowered from 550 to 420 nmol/l. With the previous assay, a morning cortisol of ≥375 nmol/L gave a 99% PPV of an SST ‘pass’.Aims: • To compare the numbers of SSTs and the SST pass ...

ea0065p10 | Adrenal and Cardiovascular | SFEBES2019

Thyroid hormone receptors in the mouse kidney in health and chronic kidney disease

Tasinato Elena , Boelaert Kristien , Long David , Vasilopoulou Elisavet

Introduction: Chronic kidney disease (CKD) is a devastating condition characterised by progressive loss of renal function that leads to end-stage renal disease. In patients with CKD there is increased prevalence of subclinical hypothyroidism. The importance of thyroid hormone (TH) action on kidney development, growth and physiology has been established, however the role of TH on kidney disease progression is not well understood.Aim: To assess the express...

ea0065p11 | Adrenal and Cardiovascular | SFEBES2019

Cosyntropin stimulation test post unilateral adrenalectomy for non-steroid secreting lesions: not all who fail require steroids

Zaman Shamaila , Almazrouei Raya , DiMarco Aimee , Palazzo Fausto , Wernig Florian

Aim: Recent studies reported a wide range in baseline and peak cortisol responses to surgery. We report the results of cosyntropin stimulation testing following unilateral adrenalectomy for non-steroid secreting lesions.Methods: Data of 36 patients who underwent cosyntropin stimulation testing on the second day post unilateral adrenalectomy were collected retrospectively. None of the patients had clinical signs of hypercortisolism. No patient received pr...

ea0065p12 | Adrenal and Cardiovascular | SFEBES2019

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as an alternative to left sided adrenalectomy in the treatment of primary aldosteronism

Wu Xilin , Ney Alexander , Cheow Heok , Goodchild Emily , Argentesi Giulia , Chung Teng-Teng , Drake William , Pereira Stephen , Brown Morris

Primary aldosteronism (PA) is the cause of 5–10% of hypertension, surgically curable in patients with unilateral aldosterone-producing adenomas (APAs). However <1% of patients are currently diagnosed and cured. Newer and simpler modalities of diagnosis and treatment are required. The aim of FABULAS (a feasibility study of endoscopic ultrasound-guided ablation as a non-surgical, adrenal sparing treatment for aldosterone-producing adenomas) is to determine in 30 patient...

ea0065p13 | Adrenal and Cardiovascular | SFEBES2019

Seasonal vaccination and associated steroid management practice in adrenal insufficiency

O'Murchadha Liam , Dib Liana , Hannon Anne Marie , Dineen Rosemary , Garrahy Aoife , Thompson CJ , Fitzpatrick Fidelma , Sherlock Mark

Background: Adrenal insufficiency remains a potentially life-threatening condition, necessitating adequate glucocorticoid replacement and appropriate stress-related adjustment to avoid crisis. Flu-like illness is a key precipitant of adrenal crisis. While some authorities recommend annual influenza vaccination for such patients, uptake rates in this population are unknown. Additionally, while seasonal vaccines may lead to minor symptoms in the general population, there are no ...

ea0065p14 | Adrenal and Cardiovascular | SFEBES2019

Adrenal aldosterone and cortisol levels and their concordance with intervention in patients being investigated for primary hyperaldosteronism

Burningham Kevin , Park Harold , Ali Sadia , Hashim Ibrahim

Introduction: Adrenal venous sampling (AVS) is widely used when investigating primary hyperaldosteronism. In this study we reviewed adrenal aldosterone and cortisol values for measurement range and for biochemical concordance with intervention in patients being investigated for aldosterone producing adenoma (APA).Methods: Retrospective review of AVS procedures performed at our institution during three years (May 2016–May 2019) was conducted. Aldoste...

ea0065p15 | Adrenal and Cardiovascular | SFEBES2019

A rare case of cardiac phaeochromocytoma with germline mutation

Vanderpant Natalie , Mitchell Catherine , Bahrami Toufan , Wernig Florian

Cardiac phaeochromocytomas account for only 1% of all extra-adrenal phaeochromocytomas. We present a rare case, which through a multidisciplinary approach achieved an excellent outcome. A 49-year-old male presented with chest pain. Echocardiography revealed a pericardial mass behind the left atrium and subsequent cardiac angiography confirmed a highly vascular lesion, suspicious for a phaeochromocytoma. Urine and plasma metanephrines were elevated; urine normetadrenaline 10888...

ea0065p16 | Adrenal and Cardiovascular | SFEBES2019

Abstract withdrawn....

ea0065p17 | Adrenal and Cardiovascular | SFEBES2019

Very high rate of false positive biochemical results when screening for phaeochromocytoma in a large, undifferentiated population with variable indications for testing

Kline Gregory , Boyd Jessica , Leung Alexander , Tang Andrew , Sadrzadeh Hossein

Pheochromocytoma-Paraganglioma (PPGL) is a rare but important tumour with non-specific presentations that overlap with extremely common entities such as anxiety, hypertension, acute illness and episodic ‘spells.’ Assessment of urine normetanephrine or metanephrine(UNM-M) in real life practice, where PPGL is very rare and PPGL mimics are extremely common, may show overlap in results with loss of specificity depending on the reference range chosen. We performed a retro...

ea0065p18 | Adrenal and Cardiovascular | SFEBES2019

A rare presentation of Cushing’s syndrome

Zaman Shamaila , Mohsin Zaineb , Wernig Florian , Palazzo Fausto , Glynne Paul , Vanderpump Mark

Ectopic adrenocorticotropic hormone (ACTH) production is a rare cause of Cushing’s syndrome. It is usually seen with small cell lung cancer, bronchial carcinoid, or medullary thyroid cancer. Rarely, the source of ectopic ACTH production can be a phaeochromocytoma. A 55 year old gentleman presented to a general physician following an episode of presumed gastroenteritis with vomiting and general malaise. Further episodes of diarrhoea, joint pains and palpitations followed. ...

ea0065p19 | Adrenal and Cardiovascular | SFEBES2019

Support for adopting a pragmatic approach to adrenal incidentalomas

Lim Yen Theen , Sulkin Thomas , Browne Duncan

Background: Adrenal incidentalomas are discovered unexpectedly and with increasing frequency on cross-sectional imaging acquired for reasons unrelated to adrenal dysfunction. Whilst the majority are non-functioning, literature suggests there is an increased risk of malignancy for adrenal incidentalomas above 4 cm. American guidelines advising resection of all incidentalomas above 4 cm were established without strong evidence whilst European guidelines adopt a more pragmatic ap...

ea0065p20 | Adrenal and Cardiovascular | SFEBES2019

Can short Synacthen tests (SST) be rationalised by establishing a lower baseline cortisol level which will predict SST outcome?

Lange Maria , Rea Kathy , Geevarghese Cheriyan , Kotonya Christine

Aim: Shortage of tetracosactide in the UK has put pressure on clinicians to reduce the number of SST’s ordered. Our aim was to establish if a lower baseline cortisol level from the currently accepted cut-off could predict a positive SST outcome. This would aid our Endocrine Department in rationalising use of tetracosactide.Methods: A retrospective observational study of indications and results of SST’s performed in non-critically ill general me...

ea0065p21 | Adrenal and Cardiovascular | SFEBES2019

Dipeptidyl peptidase-4 inhibitor sitagliptin induces vasorelaxation via the activation of Kv channels and PKA

Park Won Sun , An Jin Ryeol , Jung Hee Seok , Seo Mi Seon

The present study investigated the vasorelaxant effects of sitagliptin, which is a dipeptidyl peptidase-4 (DPP-4) inhibitor in aortic rings pre-contracted with phenylephrine (Phe). Sitagliptin induced vasorelaxation in a concentration-dependent manner but the inhibition of voltage-dependent K+ (Kv) channels by pretreatment with 4-aminopyridine (4-AP) effectively reduced this effect. By contrast, the inhibition of inward rectifier K+ (Kir) channels by pret...

ea0065p22 | Adrenal and Cardiovascular | SFEBES2019

Linagliptin induces vasorelaxation via inhibition of Rho-associated protein kinase activity in aortic smooth muscle

Seo Mi Seon , An Jin Ryeol , Jung Hee Seok , Park Won Sun

In this study, we used the phenylephrine-precontracted aortic ring preparation to investigate the mechanisms underlying the vasorelaxant effect of linagliptin. We found that linagliptin induced vasorelaxation in a dose-dependent manner. The vasorelaxant effect of linagliptin was not changed by the removal of the endothelium, or by pre-treatment with a NO synthase inhibitor (L-NAME) or a small-conductance Ca2+-dependent K+ channel inhibitor (apamin). Moreo...

ea0065p23 | Adrenal and Cardiovascular | SFEBES2019

Non-adrenal tumours encountered during adrenal surgery

Mihai Radu

Background: Benign cortical and medullary tumours, adrenocortical cancers (ACC), bilateral adrenal hyperplasia, adrenomyelolipomas and metastases are commonly discussed in the differential diagnosis of a tumour in the adrenal bed. This study reports a series of non-adrenal tumours encountered during surgery for expected adrenal tumours.Method: Retrospective review of surgical practice in a tertiary referral centre.Results: Between ...

ea0065p24 | Adrenal and Cardiovascular | SFEBES2019

Short Synacthen test; are we getting it right?

Papanikolaou Nikoleta , Sommereux Lauren , Leonard Maureen , Leong King Sun

Background: The short Synacthen test (SST) is used primarily to diagnose adrenal insufficiency (AI), with hyponatraemia being among the commonest indications. Given the national shortage of tetracosactide and following cases of test mismanagement highlighted by our Biochemistry department, we investigated the indications, appropriate patient selection and performance of this test.Methods: A retrospective analysis of 117 cases identified to have a SST per...

ea0065p25 | Adrenal and Cardiovascular | SFEBES2019

A case of severe hypokalaemia and metabolic acidosis

Gaur Smriti , Gunda Rohini , Ahluwalia Rupa , Todd Matt

Introduction: Hypokalaemia is a common biochemical abnormality seen in inpatients; it is usually mild and iatrogenic. We report a rare case of muscle paralysis due to severe unprovoked hypokalaemia, presenting on acute medical take.Case: The patient presented with a two week history of epigastric pain, nausea, vomiting, muscle spasms and dizziness. Past medical history included asthma, vitiligo, pernicious anaemia as well as long standing history of unex...

ea0065p26 | Adrenal and Cardiovascular | SFEBES2019

A cross-sectional audit reviewing the management of adults with congenital adrenal hyperplasia in Leicester

Quinn Lauren , Baldwin Andrew , Levy Miles , Reddy Narendra , Bhake Ragini

Introduction: Following the recent publication of The Endocrine Society Clinical Practice guideline for Congenital Adrenal Hyperplasia (CAH), we performed an evaluation of the service provided for adults with CAH to assess how well we are meeting the guideline standard and to make recommendations for service improvement.Methods: We performed an audit of adults with CAH under the care of the University Hospitals of Leicester. We undertook a cross-sectiona...

ea0065p27 | Adrenal and Cardiovascular | SFEBES2019

Secondary hypertension service in a District General Hospital – the success story

Naziat Auditi , Banerjee Ritwik , Dhere Archana , Soo Shiu-Ching

A secondary hypertension service was set up by the Endocrinology team in 2016 aiming to capture young hypertensive (age <30 years), refractory hypertension and hypertensive emergency to provide holistic care. A pathway was developed streaming Hypertensive emergencies to the high dependency area for intravenous treatment and hypertensive urgencies to the Ambulatory care for oral medications. All patients were linked to a secondary hypertension clinic. Staring with one clini...

ea0065p28 | Adrenal and Cardiovascular | SFEBES2019

Recalibration of thinking about adrenocortical function assessment: How the random cortisol relates to the short Synacthen test ‘Verdict’

Michaelidou Maria , Yadegarfar Ghasem , Robinson Adam , Naseem Asma , Khan Inamullah , Kochhar Rupinder , Scargill Jonathan , Trainer Peter , Heald Adrian

Background: The short synacthen test (SST) is the most commonly performed investigation to assess for suspected adrenocortical dysfunction. We investigated how random cortisol levels may relate to pass/fail on the STT.Methods: We analysed the relation between random cortisol measurements taken between 04.40 and 20.52 in the day and results of SST baseline and 30/60 min cortisol performed over a 12 month period (338 SSTs) at Salford Royal Hospital. Serum ...

ea0065p29 | Adrenal and Cardiovascular | SFEBES2019

Immunoassay interferences and their impact on patient care

Marrington Rachel , MacKenzie Finlay

Hormones and other analytes that are requested in the investigation of endocrine abnormalities are routinely measured using automated immunoassays in clinical laboratories. Assay kit inserts usually detail interference in terms of % cross reactivity, but this information is not always communicated to the clinician. Another complicating factor is that different assay platforms show different degrees of interference, therefore clinicians need to be aware of the source of their p...

ea0065p30 | Adrenal and Cardiovascular | SFEBES2019

A UK national audit of the laboratory investigation of phaeochromocytoma and paraganglioma

Boot Christopher , Toole Barry , Harris Sharman , Tetlow Lisa

Background: A range of laboratory tests are available for investigation of phaeochromocytoma/paraganglioma (PPGL) and there is scope for significant variation in practice between centres. Endocrine Society Clinical Practice Guidelines make recommendations concerning the laboratory investigation of PPGL. We performed a national audit using these recommendations as audit standards.Methodology: A questionnaire was distributed to all clinical biochemistry de...

ea0065p31 | Adrenal and Cardiovascular | SFEBES2019

The PASS score is not a reliable measure of predicting aggressive potential in phaeochromocytoma – experience over 14 years at our University Teaching Hospital

Gohil Shailesh , Seehra Jaspreet , Chauhan Vishnusai , Richards Catherine , Lloyd David , Bhake Ragini , Bhardwaj Neil , Levy Miles

Background: The phaeochromocytoma of the adrenal gland scaled score (PASS) is used for histological reporting of phaeochromocytomas as a surrogate marker of malignant potential. A PASS score of ≥4 (of a maximum of 20) suggests an aggressive tumour and hence the importance of lifelong careful follow-up. However, the utility of the PASS score has been questioned recently due to the discordance between PASS score and clinical outcomes.Aim: To review t...

ea0065p32 | Adrenal and Cardiovascular | SFEBES2019

An unusual case of adrenal cortical carcinoma presenting with hypogonadotrophic hypogonadism

Sagar Rebecca , Gibbons Stephen , Abbas Afroze

We report the case of a 52 year old gentleman who presented to Primary Care with a short history of gynaecomastia, loss of libido and erectile dysfunction. He was normally fit and well, with no past medical history and no regular medications. Initial blood tests showed low testosterone (0.7 nmol/l (normal 11–28)) with inappropriately low gonadotrophins (LH 1.2iU/l (1.5–9.3), FSH <0.1 iU/l (1.4–18.1)). Other blood tests were unremarkable (TFTs, prolactin, FBC...

ea0065p33 | Adrenal and Cardiovascular | SFEBES2019

Aldosterone deficiency type 1 due to mutation of the CYP11B2

Ismail Rayan , Eid Hatem , Ye Jing , McEntagart M , Bano G

Isolated hyperreninemic hypoaldosteronism presents in infancy with failure to thrive, hyponatremia, hyperkalemia, markedly elevated plasma renin activity, and low or inappropriately normal aldosterone. It is usually caused by mutations in the CYP11B2 gene encoding aldosterone synthase. Patients have normal cortisol levels and no features of congenital adrenal hyperplasia. We report a patient who presented with hyperreninemic hypoaldosteronism in early infancy.<p class="abs...

ea0065p34 | Adrenal and Cardiovascular | SFEBES2019

Hepatocellular carcinoma masquerading as an adrenocortico-carcinoma

Gohil Shailesh , Iwuji Chinenye , Noble Sophie , Levy Miles

Case: A 62 year old man was admitted acutely with right sided abdominal pain. A CT scan with contrast showed an acute right-sided adrenal haemorrhage with adjacent necrotic lymphadenopathy and multiple pulmonary nodules. An MRI, requested to further define the lesion, reported a malignant looking 7.4 cm right adrenal mass with direct focal invasion into the liver and inferior vena cava however no further liver lesions were identified. The images were discussed at the multi-dis...

ea0065p35 | Adrenal and Cardiovascular | SFEBES2019

Mitiglinide induces vasodilatory through the activation of voltage-gated K+ channels and SERCA pump in aortic smooth muscle

Jung Hee Seok , Seo Mi Seon , An Jin Ryeol , Na Sung Hun , Park Won Sun

The vasodilatory effects of the meglitinide class of anti-diabetic drug, mitiglinide in phenylephrine (Phe)-pre-contracted aortic rings were investigated. Mitiglinide concentration-dependently induced vasodilation. Administration of the large-conductance Ca2+-dependent K+ (BKCa) channel inhibitor paxilline, inward rectifier K+ (Kir) channel inhibitor Ba2+, and ATP-dependent K+ (KATP) channel inhibitor...

ea0065p36 | Adrenal and Cardiovascular | SFEBES2019

Extensive resection of adrenal tumours requiring complex multidisciplinary approach

Mihai Radu

Aims: Given that the vast majority of surgeons who undertake adrenal surgery in UK have a median workload of 1 case/year there is increasing awareness that the care of such patients should be centralised. This case series illustrates the benefits of multidisciplinary input from surgeons with various expertise involved in the care of complex adrenal cases.Methods: Retrospective review of cases in which endocrine, hepatobiliary and cardiac surgeons collabo...

ea0065p37 | Adrenal and Cardiovascular | SFEBES2019

Group education clinics for patients with adrenal insufficiency; a DGH experience

Smurthwaite Hannah , Pierides Michael , Patel Kishor , Owen Lisa , Mani Hamidreza

Background: Adrenal crisis is a potentially life-threatening situation which can affect any patient with adrenal insufficiency (AI). Patients with AI and healthcare professionals looking after them should know the sick day rules and when and how to use parenteral hydrocortisone. Patient stories and feedback from patients with AI indicated low standards locally. We therefore aimed to empower patients through education and provide them with a hydrocortisone emergency kit.<p ...

ea0065p38 | Adrenal and Cardiovascular | SFEBES2019

Audit of adrenal crisis management at University Hospitals Leicester NHS Trust

Sim Sing Yee , Mavilakandy Akash , Kieffer Nikki , Bremner Emma , Robinson Carole , Bhake Ragini , Levy Miles , Reddy Narendra

Background: Adrenal crisis is a life threatening emergency with an incidence of 5–10 adrenal crises/100 patient-years with mortality around 0.5/100 patient-years.Objective: Audit of inpatient adrenal crisis management was undertaken in line with Society for Endocrinology (SFE) guidance 2016 (Trust audit No:9763).Methods: Retrospective evaluation of electronic and paper case records of 2 years (January 2017–December 2018)....

ea0065p39 | Adrenal and Cardiovascular | SFEBES2019

Retrospective analysis of the management of adrenal incidentalomas

Nair Devu Sasikumar , Ghaffar Muhammad Khairul Fadli Abd , Sadiqi Rana Muhammad , Cozma Lawrence , Chowdhury Sharmistha Roy , Boregowda Kusuma

Introduction: With the increased use of imaging modalities, detection of Adrenal Incidentaloma (AI) has become common.Aim: We evaluated management of patients with AI to improve service delivery.Method: Patients with AI referred to our endocrinology outpatient service (2006–2019). Data was collected from electronic case records and radiology reporting system. Demography, biochemical investigations, time interval between two sc...

ea0065p40 | Adrenal and Cardiovascular | SFEBES2019

The peri-operative management of diabetes in elective major vascular procedures: a completed cycle quality improvement project (QIP)

Abadi Porya Hassan , Edwards Allen

Aim: Diabetes is the most common metabolic disorder in the UK, affecting 20–30% of vascular inpatients. Diabetes is associated with increased mortality and adverse outcomes. Major vascular operations accompany an increased incidence of metabolic complications. There are trust guidelines outlining the optimal peri-operative management of diabetes. We audited compliance to this guideline in patients undergoing major vascular operations and measured patient outcomes.<p c...

ea0065p41 | Adrenal and Cardiovascular | SFEBES2019

Use of sub-cutaneous pump for continuous hydrocortisone administration in patient with bilateral adrenalectomy and small bowel injury complicated by enterocutaneous fistula

Britt Penelope , Murphy June , Newland-Jones Phil , Bujanova Jana

We present a case of 39y old male who underwent adrenalectomy and aortic lymph node dissection for neuroendocrine tumour in context of underlying VHL disease and previous adrenalectomy. Iatrogenic injury to his duodenum resulted in prolonged, multiple intraabdominal infections and development of enterocutaneous fistula. He had to remain NBM, relied on high dose iv hydrocortisone administration and TPN feed for several months. Conversion back to oral steroids was considered unr...

ea0065p42 | Adrenal and Cardiovascular | SFEBES2019

A rare presentation of an androgen-secreting tumour without hyperandrogenic symptoms

Haboosh Sara , Wijetilleka Sajini , Flora Rashpal S , Abbara Ali , Meeran Karim , Wernig Florian , Palazzo Fausto , Todd Jeannie F , Comninos Alexander N

A 33-year-old lady was referred to the endocrinology clinic with mild hyperprolactinaemia on the background of having missed a single period, with a raised testosterone of 4.1 nmol/l (0–2). She had no other medical problems. Her menstrual cycles normalised by the time she attended clinic. She had no galactorrhoea, visual disturbance or features of hyperandrogenism. Her BMI was normal and she was normotensive. Blood tests revealed mild hyperprolactinaemia of 709 nU/l (100&...

ea0065p43 | Adrenal and Cardiovascular | SFEBES2019

An unusual pathology presenting as adrenal incidentaloma

Vijay Arun , Moulik Probal , Singh Prashant , Rangan Srinivasa

Introduction: Adrenal Incidentalomas (AI) are frequently encountered in clinical practice with radiological studies suggesting a frequency of 3% at 50 years rising to 10% in elderly. Majority of AI are non functional adenomas with malignant lesions quoted as less than 20% at most. We report a case of AI, which was found to a Melanoma on biopsy with no other primary site.Case: An 84 year old gentleman was found to have a right suprarenal mass on ultrasoun...

ea0065p44 | Adrenal and Cardiovascular | SFEBES2019

A case of catecholamine induced cardiomyopathy

Ahmad Farooq , Morrison Amy , Mohamed Issam , Hughes David

Introduction: We describe the case of a patient referred to Cardiology with an abnormal ECG & hypertension. Investigation led to the diagnosis of catecholamine induced cardiomyopathy caused by a pheochromocytoma. The case is unique as the cardiomyopathy was reversed with alpha and beta blockade prior to surgery.Case: A 56 year old female with 20 pack year smoking history, no regular medications and evidence of hypertension underwent CT AP for abdomin...

ea0065p45 | Adrenal and Cardiovascular | SFEBES2019

An audit of the management of adults with Congenital Adrenal Hyperplasia in Newcastle upon Tyne – where are we now?

Devine Kerri , Pearce Simon , James Andy , Quinton Richard , Mitchell Anna

Background: Congenital adrenal hyperplasia (CAH) is the commonest genetic endocrine disorder, affecting 1 in 18 000 UK births. The 2010 CaHASE Study identified a myriad of health problems associated with CAH and its treatment, and a lack of consensus on treatment strategies in adults. Endocrine Society guidelines (2010, revised 2018) have since been published to support management. As one of the original CaHASE centres, we have audited our recent practice against these new sta...

ea0065p46 | Adrenal and Cardiovascular | SFEBES2019

Primary adrenal failure from bilateral adrenal infiltration by classical Hodgkin’s lymphoma

Bray Diane , Pilobello Nemia , Bujanova Jana

Lymphoma can cause adrenal glands infiltration, but only a handful of cases of adrenal involvement have been reported in classical Hodgkin’s lymphoma. We present a case of 24y male of Indian origin presenting with B symptoms, AKI, breathlessness, and diarrhoea. CT CAP showed lymphadenopathy, enlarged kidneys and adrenal glands bilaterally. 18F-FDG PET CT showed PET avid lymphadenopathy and non-avid bilateral adrenal masses. Histology of axillary lymph node conf...

ea0065p47 | Adrenal and Cardiovascular | SFEBES2019

Hypokalaemic cardiac arrest – a rare presentation of primary aldosteronism

Siddiqui Mohsin , Mohan Chithra , Scott Rebecca , Wernig Florian , Hatfield Emma

A 58 year old female, with a 15 year history of hypertension and recent poor control, was admitted to the emergency department after an out of hospital cardiac arrest due to ventricular fibrillation requiring DC cardioversion. Initial investigations showed a metabolic alkalosis with profound hypokalaemia at 1.7 mmol/l. In view of lateral ST depression on the ECG post-resuscitation, she underwent an urgent coronary angiogram which demonstrated unobstructed coronary arteries. Wh...

ea0065p48 | Adrenal and Cardiovascular | SFEBES2019

Twenty-five years of familial glucocorticoid deficiency: genotypic and phenotypic variability

Smith CJ , Maharaj AV , Prasad R , Hughes C , Qamar Y , Clark AJL , Chan LF , Metherell LA

Within the last 25 years more than 400 cases with suspected Familial Glucocorticoid Deficiency (FGD) have been referred to our centre for genetic testing. All cases had low or undetectable serum cortisol paired with an elevated plasma ACTH level. Our patient cohort comprises 352 families from 30 different nationalities and ranges from neonates to patients in their eighties. In 1993 the first gene defect, in MC2R, was discovered by candidate gene sequencing. Subsequent...

ea0065p49 | Adrenal and Cardiovascular | SFEBES2019

An interesting case of acute hypoadrenalism following an intervention to treat bleeding splenic artery pseudoaneurysm by thrombin injection

Balafshan Tala , Sharma Dushyant , Hegde Pallavi , Purewal Tejpal

Background: Evidence shows relative adrenal insufficiency is one of the complications known to be associated with major procedures such as cardiopulmonary bypass surgery or critical illness. This is the first case we are presenting someone with acute hypoadrenalism following post thrombin injection to treat pheudoaneurysms.Case: We present an interesting case of 55 years old man with known decompensated alcoholic liver disease with oesophageal varices, p...

ea0065p50 | Adrenal and Cardiovascular | SFEBES2019

Vildagliptin induces vasorelaxation by activation of SERCA pump and Kv channels in aortic smooth muscle

An Jin Ryeol , Seo Mi Seon , Jung Hee Seok , Na Sung Hun , Park Won Sun

In this study, we explored vildagliptin-induced vasorelaxation and its related signaling mechanisms using phenylephrine induced pre-contracted rabbit aortic rings. Vildagliptin induced vasorelaxation in a dose-dependent fashion. Pre-treatment with the large-conductance Ca2+-dependent K+ channel inhibitor paxilline, ATP-dependent K+ channel inhibitor glibenclamide and inward rectifier K+ channel inhibitor Ba2+ did not chang...

ea0065p51 | Adrenal and Cardiovascular | SFEBES2019

Heparin-induced hypo-aldosteronism and hyperkalemia

Alizadeh Katrin , Qureshi Sheharyar

We present an interesting case of Heparin inducedhypoaldosteronism associated hyperkalemia in a 69 year old man with a prosthetic heart valve requiring a right sided nephrectomy for a liposarcoma. His persistent hyperkalaemia failed to respond to conventional treatment initiallybut a switch to Warfarin and use of oral Fludrocortisone was effective in normalisation of observed high renin and low aldosterone levels. Early and timely recognition of Heparin induced hypoaldosteroni...

ea0065p52 | Adrenal and Cardiovascular | SFEBES2019

Inpatient pheo crisis in neurofibromatosis type1 (NF 1) ‘Triggers and management’

Eltayeb Randa , Khoo Bernard , Karra Efthimia , Bitat Syed , Ali Sarah

Pheochromocytoma crises are uncommon but have high mortality. We describe herein a case where multidisciplinary team management was crucial in safely carrying the patient through such a crisis. The patient was a 63 year old lady with a background of neurofibromatosis type 1 (NF-1), and previous renal artery stenosis bypass surgery. She was admitted via A&E with increasingly frequent episodes of sweating, headache, dyspnoea and palpitations. Her troponin was raised at admis...

ea0065p53 | Adrenal and Cardiovascular | SFEBES2019

Adrenal suppression following Herbal remedy for Nasal Polyps....not to be sniffed at

Kauser Samina , Shepherd Lisa , Dar Shujah , Lawson Alex , Shakher Jayadave

A 69-year-old South Asian male presented in A+E with hyponatremia. He had pervious history of Lyme Node TB (treated 2014), Asthma and Nasal Polyps. Medication history, patient was taking Fludrocortisone nasal spray for the 30–40 years and Seretide inhaler. Also, CT scans at admission did not identify relapse in Lyme Node TB. Upon investigation he was found to have undetectable morning cortisol (<28 mmols). He was started on Hydrocortisone 10 mg, 5 mg and 5 mg regime, ...

ea0065p54 | Adrenal and Cardiovascular | SFEBES2019

A case of adrenal insufficiency due to histoplasmosis

Yasin Zeeshan , Robinson Stephen

A 75 year old male presented in August 2017 with dizziness, nausea and weight loss. In ENT clinic he was found to have right vocal cord lesion. He had CT chest, abdomen and pelvis which showed mediastinal and hilar lymphadenopathy and bilateral adrenal lesions. A PET–CT scan showed intense metabolic uptake in the adrenals with low volume, but moderately active mediastinum and hilar lymphadenopathy. He was presumed to have adrenal and mediastinal Tuberculosis and was start...

ea0065p55 | Adrenal and Cardiovascular | SFEBES2019

Unexplained adrenal insufficiency after gastric bypass surgery

Baskaralingam Nishani , Hikmat Mondy , Joshi Hareesh , Rajkanna Jeyanthy , Oyibo Samson O , Sagi Satyanarayana V

Introduction: Gastric bypass surgery is performed for intractable severe reflux oesophagitis not amenable to vagotomy and pyloroplasty. Long-term complications include dumping syndrome, nutritional deficiencies, incisional hernia and weight loss. We report a case of unexplained adrenal insufficiency in a patient who had gastric bypass surgery.Case: A 77-year-old gentleman presented with a history of recurrent hypoglycaemic episodes. Hypoglycaemic symptom...

ea0065p56 | Adrenal and Cardiovascular | SFEBES2019

A case of anaphylaxis in phaeochromocytoma

Mohamed Issam , Morrison Amy , Ahmad Farooq , Brewer Alison , Ugur Antonia , Hughes David

Introduction: The physiological actions of catecholamines have led to the empirical use of adrenaline in the management of anaphylaxis, with alpha-adrenergic activation increasing peripheral vascular resistance and beta-adrenergic activation relaxing bronchial smooth muscle and inhibiting histamine release. Supraphysiological levels of catecholamines are released by phaeochromocytoma and hence blockade of these same receptors is required for symptom control, prevention of end ...

ea0065p57 | Adrenal and Cardiovascular | SFEBES2019

A case of familial hyperkalemia due to Gordon’s syndrome

Rathi Manjusha

Gordon’s syndrome is a rare, autosomal dominant disorder characterized by hyperkalaemia, hypertension, mild hyperchloraemic metabolic acidosis despite normal glomerular filtration rate, with low or low-normal plasma renin activity and aldosterone concentrations. Here we describe a case of Gordon’s syndrome presenting a diagnostic challenge. She first presented age 17 yrs with constipation and abdominal pain. No significant past medical or medication history to note. ...

ea0065p58 | Adrenal and Cardiovascular | SFEBES2019

Safe withdrawal of corticosteroids after prolonged use: a call for a national protocol

Nawaz Zahrah , Sorungbe Adebola O , Rajkanna Jeyanthy , Seechurn Shivshankar B , Sagi Satyanarayana V , Oyibo Samson O

Introduction: Prolonged therapy with high-dose corticosteroids (≥ 7.5 mg Prednisolone or 1–1.5 mg Dexamethasone daily) can result in adrenal atrophy and hypofunction. Abrupt withdrawal of corticosteroids after prolonged use can lead to adrenal insufficiency, corticosteroid withdrawal symptoms or a relapse of the initial disease. There are several in-house protocols for safe corticosteroid dose tapering but a national protocol is required.Our p...

ea0065p59 | Adrenal and Cardiovascular | SFEBES2019

Real life experience of 8 people with adrenal insufficiency using subcutaneous hydrocortisone infusion in continuous and pulsatile regimens recruited through hydrocortisone pump support group

Yeoh Phillip , Kenworthy Jenn

Subcutaneous hydrocortisone (HC) infusion using continuous (CSHI) and pulsatile (PSHI) regimes are treatment options for adrenal insufficiency. It is an off-labelled treatment in UK for patients with adrenal insufficiency (AI). We surveyed 8 cohorts via Cortisol Pump UK support group in Facebook to capture their data in the following area: Quality of Life AddiQoL scores 24 h infusion doses & type of...

ea0065p60 | Adrenal and Cardiovascular | SFEBES2019

Transient diabetes insipidus following aortic valve replacement

Nana Melanie , Ravindran Ravi , Witczak Justyna , Rees Aled

Background: Postoperative diabetes insipidus (DI) occurs predominantly following pituitary surgery. Here we present a case of transient DI developing after coronary artery bypass surgery (CABG) and aortic valve replacement and discuss the potential mechanisms.Case Presentation: A 69-year-old female with a past medical history of atrial fibrillation, hypertension and stroke was admitted for elective aortic valve replacement for severe aortic stenosis. The...

ea0065p61 | Adrenal and Cardiovascular | SFEBES2019

Retrospective audit of adrenal incidentaloma

Dyer Henry , Majeed MS , Ahmed Fahad Wali

Background: The incidental adrenal lesion, coined ‘incidentaloma’, is a common radiological finding, necessary of further investigation and diagnosisAims: This is a retrospective observational study which aims to identify the prevalence of incidentaloma in CT scans of the abdomen and pelvis in the Brighton & Sussex University Hospital’s Trust. Our additional objective is to assess the adequacy of incidentaloma management throu...

ea0065p62 | Adrenal and Cardiovascular | SFEBES2019

A service evaluation for patients with adrenal incidentalomas

Greene Alexander , Umme Rubab , Sharma Dushyant , Purewal Tejpal , Hegde Pallavi

Introduction: Adrenal incidentalomas are increasingly found in patients imaged for investigation. A service evaluation was undertaken to standardise care for these patients in line with the European Society of Endocrinology Guidelines.Aim: Standardise the care for patients with adrenal adenomas at Royal Liverpool University Hospital.Method: Retrospective review of 70 patients with adrenal incidentalomas over 2 years (January 2016&#...

ea0065p63 | Adrenal and Cardiovascular | SFEBES2019

Adrenal medullary hyperplasia mimicking phaeochromocytoma – a case report

Montebello Annalisa , Vella Sandro

Introduction: Adrenal medullary hyperplasia (AMH) is a rare syndrome of catecholamine excess.Case: A 59 year old lady known to suffer from hypertension underwent a computed tomography scan of the abdomen as further investigation for unprovoked deep vein thrombosis. This showed a 37 mm right adrenal mass which enhancedheterogeneously with contrast on the porto-venous phase and became homogenously hyperdense on the delayed phase. Findings were not typical ...

ea0065p64 | Adrenal and Cardiovascular | SFEBES2019

Primary aldosteronism (PA) – clinical and hormonal characteristics of a series of patients

Vladan Andreea , Baranga Iuliana , Dumitrascu Anda , Hortopan Dan , Poiana Catalina , Radian Serban

Background: PA is a frequent cause (5–13%) of secondary hypertension (HT), yet diagnostic work-up of PA remains challenging.Aim: To describe the characteristics of hypertensive patients diagnosed with PA, biochemical screening (aldosterone:renin ratio/ARR), confirmatory tests, and adrenal CT results.Methods: Clinical, hormonal and imaging evaluation.Results: 13 patients (7M/6F) with PA were 45 yrs (40&#1...

ea0065p65 | Adrenal and Cardiovascular | SFEBES2019

Maturity onset diabetes of the young: a first case description of PAX4 mutation in the UAE

Boharoon Hessa , El-Houni Ali

Introduction: Maturity-onset diabetes of the young (MODY) is a genetically and clinically heterogeneous type of diabetes mellitus, characterized by early onset (often before 25 years of age) and absence of pancreatic autoimmunity markers.Case: We report a 20 years old female diagnosed with type 1 diabetes at age 18, with positive glutamic acid decarboxylase antibodies and low C peptide level. She had no history of diabetic ketoacidosis or hypoglycemia. H...

ea0065p66 | Adrenal and Cardiovascular | SFEBES2019

Waterhouse–Friderichsen syndrome: an endocrine emergency

Gatdula Erneda Reyes , Cho Sanda , Rao Ranganatha , Murthy Narasimha

Waterhouse–Friderichsen Syndrome is adrenal gland failure due to adrenal haemorrhage. It is an uncommon but usually life-threatening condition, which can be one of the serious complications of severe sepsis. Clinical manifestations of adrenal haemorrhage can vary widely depending on the degree and rate of haemorrhage. Adrenal haemorrhage may result from trauma, sepsis, anticoagulation medication, coagulopathy, autoimmune conditions, underlying tumour or idiopathic disease...

ea0065p67 | Adrenal and Cardiovascular | SFEBES2019

New onset paranoid psychosis associated with ‘incidental’ pheochromocytoma

Knysak Alicja , Bujanova Jana , Lockyer Richard

We present a case of 70 year-old-man, who was referred to the endocrine clinic with incidentally detected 26 mm lesion arising from the left adrenal gland suspicious of pheochromocytoma. This was detected during investigations for asymptomatic microscopic haematuria. He did not describe the typical symptoms of pheochromocytoma (episodic headaches, sweating, tachycardia), but interestingly 4–5 months previously was diagnosed with an acute onset of psychosis with paranoid d...

ea0065p68 | Adrenal and Cardiovascular | SFEBES2019

Unusual case of aldosterone and cortisol co-secreting adrenal adenoma

Rathi Manjusha

72 year old female presented with lower abdominal pain and was incidentally noted to have right adrenal adenoma. On further evaluation, she was noted to be experiencing excessive weight gain despite healthy lifestyle, low trauma fracture right wrist 3 yrs ago and uncontrolled hypertension despite taking 3 anti-hypertensive medications. She had no overt clinical features of Cushing’s such as striae, proximal myopathy, thinning of skin or easy bruising. Screening biochemist...

ea0065p69 | Adrenal and Cardiovascular | SFEBES2019

Adrenal incidentaloma multi-disciplinary investigation and management at University Hospitals of Derby and Burton Foundation Trust

Morrison Amy , Ko Ye Lynn , Agha Adnan , Kirke Rathy , Sugunendran Suma , Hughes David

Introduction: Incidental indeterminate adrenal nodules discovered on imaging in patients under the care of University Hospitals of Derby and Burton Foundation Trust are discussed in Urology MDT. MDT cases were reviewed for a 12 month period before an endocrinologist joined the MDT in January 2018 and 12 months afterwards, to review the compliance of local practice with European Society of Endocrinology (ESE) Guidelines for the management of adrenal incidentalomas.<p class=...

ea0065p70 | Adrenal and Cardiovascular | SFEBES2019

Comparison of adrenal incidentalomas management in single Trust with reference of European society of endocrinology guidelines

Kethireddi KM , Majeed MS , Till D A

Aim: This audit aims to access the compliance in management of adrenal incidentalomas with reference of European society of endocrinology guidelines.Background: An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered on radiological examination. It is important to determine its malignant potential and functional status. European society of Endocrinology (ESE) has published its guidelines in 2016 for management ...

ea0065p71 | Adrenal and Cardiovascular | SFEBES2019

Autonomous cortisol secretion in adrenal incidentalomas

Greene Alexander , Sharma Dushyant , Purewal Tejpal , Hegde Pallavi

Introduction: Adrenal incidentalomas are common occurrence with up to 3–10% of the general population who have imaging. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to biochemical evidence of excess cortisol, but without the overt cushing’s syndrome.Aim: Prevalence of ACS in our cohort of patients with adrenal incidentalomas and review their care.Method: Retrospective review of 70 pat...

ea0065p72 | Adrenal and Cardiovascular | SFEBES2019

Management of adrenal incidentaloma: a DGH experience

Shah Vinit Kirankumar , Roche Oran , Banerjee Ritwik

Incidental adrenal masses is a common finding on abdominal imaging completed for other reasons. Majority of these masses are benign non-functioning adenomas. Investigations are required to ensure they are benign and do not have autonomous hormonal secretion.Aim: We completed an audit to review current practice in the assessment of adrenal incidentaloma at our organisation, a mid-size acute DGH, and compared it with European Society of Endocrinology (ESE)...

ea0065p73 | Adrenal and Cardiovascular | SFEBES2019

Heparin-induced hypo-aldosteronism and hyperkalemia

Alizadeh Katrin , Qurehsi Sheharyar , Hadjinicolaou Andreas , Hadjittofi Christopher

We present an interesting case of Heparin induced hypoaldosteronism associated hyperkalemia in a 69 year old man with a prosthetic heart valve requiring a right sided nephrectomy for a liposarcoma. His persistent hyperkalaemia failed to respond to conventional treatment initially but a switch to Warfarin and use of oral Fludrocortisone was effective in normalisation of observed high renin and low aldosterone levels. Early and timely recognition of Heparin induced hypoaldostero...

ea0065p74 | Adrenal and Cardiovascular | SFEBES2019

Symptomatic hyponatraemia due to valerian extract use

Tzanninis Stamatios

A middle aged woman was admitted to Salisbury District Hospital after she was found to be severely hyponatraemic by her GP. She had been suffering from lightheadedness, headaches and tiredness for a few weeks before her admission but there was no obvious aetiology. Her past medical history included hypertension but she was not on diuretics or any other medication that could affect her sodium levels. Her serum sodium at the GP surgery was 123 and when she was admitted in the Ac...

ea0065p75 | Adrenal and Cardiovascular | SFEBES2019

Review of the adrenal surgeries at East Sussex Hospitals Trust over 2 years

Kumar Sathis , Lewis-Morris Timothy , Rimington Peter

Introduction: Prior to 2015 there was no pathway for adrenal masses. An Adrenal MDT was started to discuss all the adrenal nodules (except for suspected phaechromocytoma and adrenal carcinoma) to improve the service for this cohort of patients. This audit is a review of the impact of this intervention.Methods: Data was collected between April 2016 and March 2016 for all adrenalectomies performed at East Sussex Hospitals Trust. Data was collected from the...

ea0065p76 | Adrenal and Cardiovascular | SFEBES2019

Factitious Addison’s disease in a young adolescent with type 1 diabetes

Bahowairath Fatima , Mateen Abdul Jamil , Jones Bryony , Ogilvie Arla , Pokrajac Ana

Hypoglycaemia is a common side effect of insulin treatment in patients with type 1 diabetes mellitus (T1DM). A 16-year old girl with T1DM presented with a recurrent hypoglycaemia, despite insulin dose reduction. Differential diagnosis included: overdose of insulin, Addison’s disease, hyperthyroidism, insulinoma and anti-insulin antibodies. She was admitted to the hospital for observation and investigations. She had a low random cortisol level, leading us to start steroids...

ea0065p77 | Adrenal and Cardiovascular | SFEBES2019

Impacts and quality of life for people with adrenal insufficiency using Medical Detection Dogs before and after initiation of continuous subcutaneous hydrocortisone infusion (CSHI)

Yeoh Phillip

Use of medical detection dog to improve hypoglycaemia awareness has been documented. However the data remain limited for people with adrenal insufficiency. We collected data retrospectively and prospectively on the episodes of low cortisol events initiated by medical detection dog and quality of life of 3 people with adrenal insufficiency before and started on continuous subcutaneous hydrocortisone infusion (CSHI) to correlate it with our Addison’s Quality of Life scores....

ea0065p78 | Adrenal and Cardiovascular | SFEBES2019

The frustration of endocrine practice in a resource poor, developing country

Akinlade Akinyele

Background: The practice of endocrinology requires the support of good laboratory services in order to make accurate diagnosis of many endocrine disease. Many endocrine disorders appear rare in our country because of lack of reliable laboratory services. The following cases illustrate this frustration.Case 1: A 39-year old caterer, known hypertensive but diagnosed diabetic recently when she developed a non-healing left foot ulcer and subsequent gangrene ...