Adrenal and Cardiovascular

Background: Autoimmune Addisons disease (AAD) is a rare endocrinopathy arising from a complex interplay between multiple genetic susceptibility polymorphisms and environmental factors. Several variants in immune pathways have been identified through hypothesis-driven candidate gene analysis, though these associations can prove difficult to replicate. The first genome wide association study (GWAS) with patients from Scandinavian Addisons registries identified associ...

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ea0086p2 | Adrenal and Cardiovascular | SFEBES2022

Radiological and biochemical assessment of adrenal incidentalomas need improving to prevent unnecessary follow up

Bhola Shalini , Yin Yin , Virgo Elena , Liu Sky , Joseph Stonny

Background: Adrenal incidentalomas often pose a clinical conundrum when identified radiologically. The direction of management is often based on findings on imaging and biochemistry. To aid management, the European society for Endocrinology (ESE) recently published guidelines. Aims and Methods: We conducted a retrospective analysis of 142 patients with identified adrenal incidentalomas between April 2020 and April 2021 in East Kent Hospitals University N...

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ea0086p3 | Adrenal and Cardiovascular | SFEBES2022

Identification and characterization of a receptor for N-terminal pro-opiomelanocortin peptide

Alshammari Fatema , Bicknell Andrew , Lander Elizabeth

Background: Numerous studies have reported the role of the N-terminal of pro-opiomelanocortin (N-POMC1-76) and its smaller fragments; 1-28 and 1-49, in adrenal steroidogenesis and mitogenesis. A full understanding of this area will help to understand the pathophysiology of certain adrenal tumours but exactly how these peptides elicit this effect is unclear. We have recently identified an orphan G protein-coupled receptor (GPCR) as a possible N-POMC receptor. Preliminary data s...

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ea0086p4 | Adrenal and Cardiovascular | SFEBES2022

Bone health optimisation and patient education in adult congenital adrenal hyperplasia patients

Zaman Sajnin , Riaz Afifa , Bremner Emma , Barrowcliffe Marry , Robinson Carole , Pathi Jawahar , Gohil Shailesh , Bhake Ragini , Levy Miles J , Reddy Narendra L

Introduction: Decreased bone mineral density (BMD) is a concern in Congenital adrenal hyperplasia (CAH) given life-long glucocorticoid treatment. We undertook a quality improvement project (QIP) to optimise bone health for all adult CAH patients under our care in line with Endocrine Society CAH Guidelines.Method: Retrospective case notes and electronic records review was undertaken to identify CAH patients in University Hospitals of Leicester (UHL)...

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ea0086p5 | Adrenal and Cardiovascular | SFEBES2022

Abstract Unavailable...

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ea0086p6 | Adrenal and Cardiovascular | SFEBES2022

Evaluation of fracture risk in patients with mild autonomous cortisol secretion and adrenal incidentaloma

Eyadeh Ahmad , Sagar Rebecca , Htwe Nang , Abbas Afroze

Background: Patients with adrenal incidentaloma (AI) and cortisol levels of 50-138 nmol/l on overnight dexamethasone suppression tests (ONDST) may have mild autonomous cortisol secretion (MACS). MACS is associated with increased morbidity, including osteoporosis, but this is infrequently systematically evaluated. We compared fracture risk and fracture prevalence in patients with AI, both with and without MACS.Methods: Data were collected retr...

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ea0086p7 | Adrenal and Cardiovascular | SFEBES2022

Adrenalectomy for unilateral primary aldosteronism improves quality of life: prospective analyses in the MATCH trial

Blackstone Brittany , Goodchild Emily , Tooze Oliver , Salsbury Jackie , Wu Xilin , Ronaldson Amy , Senanayake Russell , Bashari Waiel , Argentesi Giulia , O'Toole Samuel M. , Parvanta Laila , Sahdev Anju , Laycock Kate , Cruickshank Kennedy , Gurnell Mark , M. Drake William , Brown Morris J.

Background: After adrenalectomy (ADX) for primary aldosteronism (PA), approximately 30% of patients achieve clinical success (normalisation of home BP); many additional patients report feeling subjectively better. We used the non-randomised MATCH study1 to further assess quality of life (QoL) changes in participants.Objective: Assess QoL using the 36-item Short Form Health Survey (SF-36) after surgical treatment of unilateral PA and medical treatment of ...

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ea0086p8 | Adrenal and Cardiovascular | SFEBES2022

Gender-Related Analytical Bias in Biochemistry - Under-Recovery in a Serum Cortisol Immunoassay

Chipchase Allison , Hall Sebastian

Background: The displacement of cortisol from its binding globulin (CBG) in the Abbott Alinity immunoassay assumes an average concentration of CBG in all individuals. Displacement buffer volume, and/or composition, is frequently insufficient to displace cortisol where higher concentrations of CBG are present (e.g. with higher oestrogen concentrations). To address this bias, the Eastern Pathology Alliance (EPA) introduced a 1:2 dilution step on all serum cortisol specimens in D...

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ea0086p9 | Adrenal and Cardiovascular | SFEBES2022

Inflammation-Based Scores as Predictors of Treatment Response in Advanced Adrenocortical Carcinoma

Mangone Alessandra , S. Elhassan Yasir , Prete Alessandro , Asia Miriam , Detomas Mario , Altieri Barbara , Mantovani Giovanna , Ronchi Cristina L.

Background: Standard treatment for advanced adrenocortical carcinoma (ACC) is mitotane in monotherapy or combined with etoposide, doxorubicin and cisplatin (EDP), yet biomarkers predictive of treatment response are lacking. Inflammation-based scores were proposed as predictors for gemcitabine+capecitabine efficacy, used as second-line in progressive ACC. We investigated the role of inflammation-based scores in predicting response to first-line treatment in advanced ACC.<p ...

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ea0086p10 | Adrenal and Cardiovascular | SFEBES2022

Practices in perioperative management of patients with pheochromocytoma and paraganglioma: a Scoping Review

Bojoga Andreea , Narula Harveer , Balasubramanian Sabapathy

Introduction: There is variation in practice with regards to preoperative optimization protocols and postoperative management in pheocromocytoma and related paraganglioma (PPGL). We aimed to review the literature on perioperative strategies to reduce morbidity and mortality following surgery for PPGL and enhance understanding of optimal approaches.Methods: Two databases were systematically searched in January 2020 for terms related to perioperative manag...

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ea0086p11 | Adrenal and Cardiovascular | SFEBES2022

Development of novel immunoassays for pro-opiomelanocortin (POMC)-derived peptides as surrogate markers of adrenocorticotrophin levels for use in the diagnosis of Cushing’s syndrome

Donnelly Megan , Lowry Philip , Gibbins Jon , Bicknell Andrew

Plasma adrenocorticotrophin (ACTH) is extremely labile and far from an ideal analyte for use in the diagnosis of Cushings syndrome. Processing of ACTH by some ectopic tumours releases high levels of smaller ACTH-like fragments, α-MSH and CLIP, which can interfere with individual antibodies in current diagnostic immunoassays. Furthermore, cross-reactivity with the precursor of ACTH, pro-opiomelanocortin (POMC), increases the likelihood of erroneous interpretations an...

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ea0086p12 | Adrenal and Cardiovascular | SFEBES2022

Phaeochromocytomas Most Commonly Present As Adrenal Incidentalomas – A Large Tertiary Centre Experience

Aggarwal Sunil , Prete Alessandro , Asia Miriam , Arlt Wiebke , Ronchi Cristina , Sutcliffe Robert , Karavitaki Niki , Ayuk John , Elhassan Yasir

Background: The detection of phaeochromocytomas evolved from autopsy finding to presentation in symptomatic/hypertensive, and genetically-predisposed individuals. Increasingly, phaeochromocytomas are diagnosed in incidental adrenal masses and the impact on the clinical, biochemical, and radiological features is unclear.Methods: Retrospective review of patients with phaeochromocytomas seen at a large tertiary referral centre between January 2010 and May 2...

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ea0086p13 | Adrenal and Cardiovascular | SFEBES2022

Counselling for adrenal insufficiency for patients on long term steroids amongst physicians and patients

Marie Hannon Anne , Rose Frances , Singh Andev Rajinder , Loo Helen , Marland Ann , Pal Aparna

Patients with adrenal insufficiency (AI) should be informed about sick day rules and risk of a life-threatening adrenal crisis if corticosteroids are abruptly stopped or if the steroid dose is inadequate.Aims and Methods: To assess current practice with regard to steroid advice given across medical specialties at Oxford University Hospital Trust. To assess patient knowledge both in a specialist Endocrine department and in a medical specialty ...

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ea0086p14 | Adrenal and Cardiovascular | SFEBES2022

Factors which contribute to LDL-C target attainment in familial hypercholesterolaemia

Vineall Owen , Jones Ben , Cegla Jaimini , David Alessia

Background: In the UK, NICE guidelines for familial hypercholesterolaemia (FH) recommend a greater than 50% reduction in low-density lipoprotein-cholesterol (LDL-C) as the therapeutic target. However, despite the availability of a range of lipid lowering medication, this target is often difficult to achieve and, more importantly, maintain life-long. Understanding factors that affect LDL-C target achievement is key to reducing cardiovascular disease (CVD) risk. Currently, there...

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ea0086p15 | Adrenal and Cardiovascular | SFEBES2022

Involvement of the adrenal gland in post-bariatric surgery Type 2 Diabetes remission

Doria Durazzo Isabella , F. Brisnovali Niki , Akalestou Elina

Currently, most Type 2 Diabetes (T2D) treatments are targeted for the mitigation of the disease rather than remission. It has been previously demonstrated that T2D remission post-bariatric surgery in mice is independent of weight loss, indicating a metabolic mechanism. One avenue that remains largely unexplored is the role of cortisol, a hormone secreted from the adrenal cortex, dysregulation of which is linked to insulin resistance and obesity. The enzyme 11β-Hydroxyster...

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ea0086p16 | Adrenal and Cardiovascular | SFEBES2022

Can we use swabs to collect samples for salivary androgen analysis?

Adaway Joanne

Salivary androgens (testosterone, androstenedione, 17-hydroxyprogesterone, 11-ketotestosterone and 11-hydroxyandrostenedione) are currently analysed on samples collected by passive drool. Other saliva analyses such as cortisol are often collected using swabs such as Sarstedt Salivettes, therefore multiple samples are required if both cortisol and androgen analysis is requested. The aim of this study was to determine whether salivary androgen analysis could be performed on samp...

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ea0086p17 | Adrenal and Cardiovascular | SFEBES2022

Adrenal insufficiency caused by herbal remedies - a case presentation

Elhelw Omar , Ragavan Sharanniyan , Elkhenini Hanaa

Case Presentation: A 35-year-old Caucasian male presented to our endocrine clinic with a right pituitary lesion. This was found incidentally on MRI nine months previously after admission with head injury. He was asymptomatic apart from intermittent pain in his left wrist and right knee. He has a history of epilepsy. He was on paracetamol for analgesia, levetiracetam for epilepsy, and was not on any oral, topical, inhaled or injectable steroids. On assessment, he had central ob...

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ea0086p18 | Adrenal and Cardiovascular | SFEBES2022

Adrenal reserve and glucocorticoid requirements post unilateral adrenalectomy for primary aldosteronism

Bakaya Kaushiki , Bharadwaj Aniket , Chung Teng-Teng

Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension that can be cured by surgery. Mild autonomous cortisol co-secretion is a recognised feature of PA, which is associated with an increased cardiometabolic penalty and the possibility of adrenal insufficiency postoperatively. There have also been case reports of adrenal crisis post adrenalectomy for this patient subtype. We report our experience of adrenal insufficiency post adrenalectomy ...

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ea0086p19 | Adrenal and Cardiovascular | SFEBES2022

An Audit of Adrenal Vein Sampling in a large teaching hospital in Leeds

Lim Joyce , Sagar Rebecca , Abbas Afroze

Introduction: Primary hyperaldosteronism (PA) can affect up to 10% of patients with hypertension. Adrenal vein sampling (AVS) is used to distinguish between unilateral and bilateral aldosterone production. However, it is invasive, technically challenging and is only performed in a limited number of centres. This audit aimed to evaluate the effectiveness of AVS in informing the management of PA in a large teaching hospital.Methods: A retrospective audit o...

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ea0086p20 | Adrenal and Cardiovascular | SFEBES2022

Cortisol/cortisone measurement in sweat samples

Keevil Brian , Marshall David , Adaway Jo , Hawley James

Introduction: Alternative biofluids such as sweat, which can be obtained non-invasively and present a simpler matrix composition than serum/plasma or urine, may be useful for monitoring biomarkers. The long-term sampling with patches either on the chest or back can be conveniently used under both rest and exercise conditions to provide an integrated response of free biomarkers over the course of a day. The smaller sample volumes generated by sweat collection can be convenientl...

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ea0086p21 | Adrenal and Cardiovascular | SFEBES2022

Adrenal function in patients with extrapulmonary tuberculosis using serum and salivary cortisol

Ramalan Mansur , Gezawa Ibrahim , Muhammad Fakhradeen

Background: Adrenal insufficiency has been well established in patients with pulmonary tuberculosis in Nigeria. It has however not been well documented in patients with extra pulmonary TB. This study compared the adrenal function in patients with pulmonary TB vs those with extra pulmonary TB.Methods: We randomized 100 cases of pulmonary TB and 50 cases of diagnosed extra pulmonary TB, with the aim of assessing the adreno-cortical functions using both ser...

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ea0086p22 | Adrenal and Cardiovascular | SFEBES2022

Hyperaldosteronism caused by sertraline

Landin-Olsson Mona , Bliding Lena , Reis Margareta , Borg Julia

Introduction: Antidepressants especially SSRI are widely used in all ages. Increase in serotonin level is not supposed to give side effects in other hormonal systems. Here we present a case with serotonergic like symptoms, elevated aldosterone levels and hypertension due to sertraline treatment.Clinical Case: A 37-year-old woman with previous PCÓs was admitted due to hypertension and high aldosterone. She had undergone two pregnancies after letrozol...

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ea0086p23 | Adrenal and Cardiovascular | SFEBES2022

Endocrine Complications and Metabolic Risk in Sleep Apnoea

Bawden David , Stratos Efstratios , Cordell Christopher , Swe Myint Khin

Introduction: Within our single centre, the referral rate from the endocrine hypertension clinic to the sleep clinic is high. We have also observed a particular metabolic profile of those patients including raised normetanephrines which subsequently improve after treatment for sleep apnoea.Illustrative cases: 56 year old man with a BMI of 33 kg/m2 and multiple complications of obesity including NAFLD, gallstones and loss of libido. He was rare...

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ea0086p24 | Adrenal and Cardiovascular | SFEBES2022

A Case of Pheochromocytoma with Haematuria

Nair Vidya , Silveira Maria

Introduction: Pheochromocytomas are rare neuroendocrine tumours from catecholamine producing chromaffin tissue of adrenal medulla that typically present with headache, palpitations, diaphoresis, and paroxysmal hypertension. Here we describe a case of pheochromocytoma presenting as haematuria. There are case reports of paraganglioma of urinary bladder with haematuria. In our case no bladder lesion was identified but close follow up is needed for recurrence and bladder involveme...

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ea0086p25 | Adrenal and Cardiovascular | SFEBES2022

Coincidence of Primary Adrenocortical Carcinoma and Melanoma: Three Case Reports

Lynn Ko Ye , Kumar Vaishnavi , Lippert Juliane , Diaz-Cano Salvador , Skordilis Kassiani , Kimpel Otilia , Kircher Stefan , Asia Miriam , S. Elhassan Yasir , Altieri Barbara , L. Ronchi Cristina

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy. ACC may rarely occur as part of familial cancer syndromes, but the majority of the cases occur sporadically. A significant proportion of sporadic ACC cases may be preceded by other malignancies and adrenal metastasis from these primary tumours may frequently occur. Herein we present three cases where sporadic ACC was identified in patients with coexistent or previous history of melanoma.Case ...

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ea0086p26 | Adrenal and Cardiovascular | SFEBES2022

Primary adrenal lymphoma as the culprit of fever of unknown origin and adrenal insufficiency

Martin Sorina , Mustata Theodor , Dumitru Parfeni Ovidiu , Ciobanu Carla , Fica Simona

Introduction: Primary adrenal lymphoma is a rare cause of adrenal insufficiency, with most cases being of B-cell lymphoma.Case report: We present the case of a 51 yo man with a 1.5-month history of recurrent fever, nausea, vomiting, anorexia, weight loss of 12 kg, fatigue, polyarthalgia, hypotensive episodes (70/40 mmHg) and singultus. Before admission in our clinic he had a thoracic CT scan, which showed a 5.5 cm right adrenal mass and hyperplasia of th...

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ea0086p27 | Adrenal and Cardiovascular | SFEBES2022

Sulfasalazine as a cause of false positive elevation of normetanephrine in patients with adrenal mass – A diagnostic challenge

Ter Zuling Eunice , Balasubramanian Sabapathy

In clinical settings, when biochemical screening revealed grossly elevated urinary normetanephrine and metanephrine in the presence of an adrenal mass, there is a high clinical suspicion of a pheochromocytoma. However, sulfasalazine, an anti-inflammatory drug can cause analytical drug interference, leading to falsely positive elevation of urinary normetanephrine and a misdiagnosis of phantom pheochromocytoma. This report illustrates two patients with adrenal mass who had false...

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ea0086p152 | Adrenal and Cardiovascular | SFEBES2022

Utility of point of care ultrasound (POCUS) as an adjunct investigation for guiding fluid management in severe hyponatraemia

Reddy Narendra , Rahman Latif , Shafiq Shahriar , Al-Alousi Salam , Rahman Faizanur , Sardar Muhammad , Aijaz Faizal , Gohil Shailesh , Bhake Ragini , Levy Miles

Background: The main dilemma in hyponatraemia management is that of fluid restriction vs fluid administration. Inappropriate fluid management may result in either cerebral oedema/death or permanent neurologic disability due to rapid sodium correction. Objective: We explore the utility of point of care ultrasound (POCUS) as an adjunct tool for assessing 3-volume groups (Hypovolaemia, Euvolaemia & Hypervolaemia) in severe hyponatraemia (Na<120 mmol...

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ea0086p153 | Adrenal and Cardiovascular | SFEBES2022

Preliminary data from FABULAS: a Feasibility study of RadioFrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone producing adenomas

Argentesi Giulia , Wu Xilin , Goodchild Emily , Laycock Kate , Ney Alexander , Senanayake Russell , MacFarlane James , Goodchild George , Wilson Patrick , Godfrey Ed , Gurnell Mark , Cheow Heok , P Pereira Stephen , M Drake William , J Brown Morris

Primary aldosteronism (PA) is the potentially curable cause of high-risk hypertension in 5-10% of unselected patients. Diagnosis and lateralisation of PA is challenging and complex. Outcomes post total adrenalectomy, the standard treatment for unilateral aldosterone producing adenomas (APAs), are variable. Between 30-60% are cured (1), but prediction of outcome is unreliable, and some patients are reluctant to have abdominal surgery to remove a whole adrenal gland. Endoscopic ...

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ea0086p154 | Adrenal and Cardiovascular | SFEBES2022

HLA-DRB1*0404 is associated with the deletion of the 21-hydroxylase pseudogene in AAD patients

Mavridou Maria , Mitchell Anna , Allinson Kath , Lane Laura , Pearce Simon

Background: HLA-DRB1*04 is one of the MHC alleles which is associated with several autoimmune endocrinopathies, including autoimmune Addisons disease (AAD). The two versions of the gene which encodes the main target of the autoimmune attack in AAD, steroid 21-hydroxylase, are encoded in a gene cluster, called RCCX module, which is a copy number variation located in the MHC class III locus. Previous data from our group showed that AAD patients are more likely to have no c...

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ea0086p155 | Adrenal and Cardiovascular | SFEBES2022

Glucocorticoid Excess Disrupts the NAD+ Metabolome Within Skeletal Muscle in Male and Female C57BL/6J Mice

Heising Silke , Heaselgrave Samuel , Morgan Stuart , Kabli Ali , Doig Craig , Tsintzas Kostas , Lavery Gareth

Introduction: Glucocorticoid excess (GE) causes severe metabolic dysfunction within skeletal muscle (SM) which includes reduced muscle accrual and increased proteolysis. The NAD+ metabolome is crucial for SM health and metabolic function, however, whether this is disrupted by GE remains unknown.Methods: Male and female C57BL/6J mice (n=12) were treated with a vehicle control or corticosterone (100 mg/l) ad libitum via drinking water for 3 weeks ...

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ea0086p156 | Adrenal and Cardiovascular | SFEBES2022

Whole genome sequencing and Sanger sequencing to identify novel mutations in adrenal tumours from cats with primary hyperaldosteronism

Watson Alice , Syme Harriet , Brown Morris

Primary Hyperaldosteronism (PA) is caused by adrenal tumours or bilateral adrenal hyperplasia (Djajadiningrat-Laanen et al., 2011) causing constitutive aldosterone production. Both germline and somatic mutations have been identified in human PA (Scholl, 2022). The commonest somatic mutations in benign tumours causing PA in humans include KCNJ5, CACNA1D, ATP1A1 and ATP2B3 (Williams et al., 2015). It is hypothesized that analogous somatic mutations arise in fel...

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ea0086p157 | Adrenal and Cardiovascular | SFEBES2022

Depleting NAD+ pools specifically in the endoplasmic reticulum lumen impairs 11β-hydroxysteroid dehydrogenase activity

Kabli Ali , Heising Silke , Heaselgrave Samuel , Elhassan Yasir , Hardy Rowan , Stromland Oyvind , Ziegler Mathias , Morgan Stuart , Hodson David , Lavery Gareth

Introduction: The endoplasmic reticulum (ER) lumen enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) obtains NADPH from hexose-6-phosphate dehydrogenase to reduce cortisone to the active glucocorticoid cortisol. Cells depleted in NAD+ (parent molecule of NADPH) have impaired 11β -HSD1 activity, which can be rapidly rescued with supplementation of the NAD+ precursor nicotinamide riboside. This suggests the existence of an ER-specific pathway to NAD(P)(H)....

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ea0086p158 | Adrenal and Cardiovascular | SFEBES2022

Salivary dexamethasone and 11-dehydrodexamethasone analysis post overnight dexamethasone suppression test

Marshall David , Keevil Brian , Issa Basil

Background: The 1 mg overnight dexamethasone suppression test (ONDST) is recommended as a first-line test for the investigation of Cushing Syndrome. Measurement of dexamethasone alongside cortisol in a 9am serum sample has been credited with improving diagnostic sensitivity of the test. Previous studies have also looked at the utility of salivary dexamethasone and have observed poor correlation with serum dexamethasone. Herein we introduce the concept of measuring 11-dehydrode...

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ea0086p159 | Adrenal and Cardiovascular | SFEBES2022

An audit of the clinical utility of urine steroid profiling for endocrine disorder diagnosis in a routine clinical laboratory in 2021

Taylor David , Churchus Richard , Collins Heather , Ajaj Nicola , Ekundayo Susan , Alramadhi Ulfat , Rayner Oliver , Ghataore Lea

Measurement of steroid metabolites in urine by gas chromatography-mass spectrometry remains the gold standard for biochemical diagnosis of steroidogenic disorders. In the UK, three laboratories offer steroid profiling for routine clinical testing, with the Supraregional Assay Service at Kings College Hospital being the largest and experiencing increased demand year-on-year for testing. In this study, we used our profiling database to audit 2021 workload. By direct compar...

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ea0086p160 | Adrenal and Cardiovascular | SFEBES2022

Mapping the chromatin-associated-lncRNAs and their enhancer regions between lymphatic and endothelial cells

Mitic Tijana , Chaloner Emma , Zhang Chenyun , Dudnakova Tatiana , Dunn-Davies Hywel

Blood vessels supply nutrients, oxygen and other key molecules necessary for the function of all organs in the body. The endothelial cell (EC) repair and response to injury or hypoxia is also regulated by the interplay of chromatin-modifying enzymes. Likewise, dysregulation of the lymphatic system underlies the development of the metabolic syndrome. New technologies using omics approaches have now allowed the detection of chromatin and RNA molecules that directly interact in n...

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ea0086p161 | Adrenal and Cardiovascular | SFEBES2022

Prednisolone replacement therapy in Adrenal Insufficiency: Defining target ranges and timing for optimum Prednisolone level sampling

Sharma Angelica , Lazarus Katharine , Choudhury Sirazum , Meeran Karim

Introduction: Glucocorticoid replacement in adrenal insufficiency may be achieved by administering thrice- daily hydrocortisone or once-daily very low dose (2-4 mg) prednisolone. Prednisolones longer half-life enables once-daily dosing, improving patient satisfaction and compliance. At very low doses, it has shown no difference in most markers of metabolic risk when compared with hydrocortisone. At Imperial College Healthcare NHS Trust (ICHNT), use of an eight-hour troug...

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ea0086p162 | Adrenal and Cardiovascular | SFEBES2022

5mg of Prednisolone results in over-replacement in individuals with Adrenal Insufficiency

Sharma Angelica , Lazarus Katharine , Choudhury Sirazum , Meeran Karim

Introduction: Liberal glucocorticoid replacement therapy prevents Addisonian crises in individuals with adrenal insufficiency (AI). Prednisolone is six to eight times more potent than hydrocortisone. There is inter-individual variation in glucocorticoid metabolism wherein 5 mg prednisolone once-daily may result in over-replacement in most individuals, with subsequent long-term morbidity and mortality.Methods: Data from individuals on established predniso...

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ea0086p163 | Adrenal and Cardiovascular | SFEBES2022

Validating the cholesterol-year-score as a predictor of major cardiovascular events in familial hypercholesterolaemia

Vineall Owen , Jones Ben , David Alessia , Cegla Jaimini

Background: Cardiovascular disease (CVD) risk in familial hypercholesterolaemia (FH) is driven by cumulative exposure to high low-density lipoprotein cholesterol (LDL-C) levels. Previously, LDL-C burden has been loosely approximated using the cholesterol year score (CYS) based on two LDL-C readings only. We aimed to determine whether a more sophisticated LDL-C burden score based on serial LDL-C measurements, could more accurately predict major atherosclerotic cardiovascular ev...

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ea0086p164 | Adrenal and Cardiovascular | SFEBES2022

Review of clinical and biochemical characteristics, perioperative management and surgical outcomes in patients undergoing surgery for primary hyperaldosteronism (PHA) at The University Hospital Southampton NHSFT (UHS)

Bray Diane , Bujanova Jana , Richard W Lockyer C , Al-Mrayat Ma'en , Brown Beata , Zarif Nadia

Objective: We reviewed clinical and biochemical characteristics and post-operative outcomes in patients undergoing surgery for PHA in UHS between January 2014 and June 2022 (8.5-year period).Results: 17 patients (41% female, mean age 45y) underwent adrenalectomy for PHA during this period. 5/17 (29%) required admissions related to PHA, 7/17 had blood pressure (BP) of ≥ 200 mmol/Hg, 11/17 (65%) potassium ≤3 mmol/l, 5/17 required ≥ 4 BP a...

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ea0086p165 | Adrenal and Cardiovascular | SFEBES2022

Oral itraconazole augments iatrogenic Cushing’s syndrome and adrenal insufficiency after medication withdrawal

Maarouf Amro , Joseph Sonia , Juszczak Agata

A 37-year-old woman was referred to the endocrine team for the assessment of her adrenal axis, as she had been taking high dose prednisolone (20-40 mg) for several years for the management of her brittle asthma. Drug history included inhaled Symbicort 200/6 (SMART regime), tiotropium and montelukast. Her respiratory symptoms improved with the introduction of theophylline, thus enabling her prednisolone to be switched to oral hydrocortisone, with appropriate sick- day&#14...

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ea0086p166 | Adrenal and Cardiovascular | SFEBES2022

Review of multidisciplinary perioperative management of functioning and non-functioning adrenal lesions at The University Hospital Southampton NHSFT (UHS)

Bujanova Jana , Bray Diane , Richard W Lockyer C , C Hayes Matthew , Douglas James , Crabb Simon , Chance Thomas , Al-Mrayat Ma'en

Objective: We reviewed perioperative management of patients undergoing adrenal surgery at UHS between 1/12/2020 to 1/6/2022 (19-month period) since formalisation of its regional adrenal MDT.Results: 45 adrenalectomies were performed during this period with all cases being discussed at the adrenal MDT, of which 24 (53%) were referred from peripheral hospitals. Laparoscopic surgery was performed in 35/45 (78%) (median length of stay (LOS): 3d), open in 10/...

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ea0086p167 | Adrenal and Cardiovascular | SFEBES2022

The Value of Baseline Cortisol in Predicting a Preserved Cortisol Response to Synacthen

Suh Sarah , Agha-Jaffar Rochan , Choa Dri , Bravis Vassiliki , Vakilgilani Tannaz , Yee Michael , N Comninos Alexander , Cox Jeremy , Robinson Stephen

Background: Adrenal Insufficiency (AI) presents a diagnostic and clinical challenge. While short Synacthen Tests (SSTs) are most commonly utilised to diagnose AI, the value of a baseline cortisol is being explored. We aimed to review indications for performing an SST and to determine the baseline cortisol that predicted a preserved cortisol response to Synacthen.Methods: Eight hundred and sixty SSTs performed in 621 individuals at a tertiary endocrinolog...

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ea0086p168 | Adrenal and Cardiovascular | SFEBES2022

Inclisiran for the treatment of hypercholesterolemia in clinical settings

Iqbal Sajid , Sabbour Hani , Ashraf Tanveer , Buckley Adam

Background: Inclisiran is the first clinically available small interfering RNA (siRNA)-based treatment, has been shown to reduce pro-atherogenic lipoproteins in patients with or without familial hypercholesterolemia (FH), diabetes mellitus (DM), or atherosclerotic cardiovascular disease (ASCVD), but has not been evaluated in Middle Eastern populations.Methods: Retrospective review of patients initiating inclisiran treatment for any indication at our cent...

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ea0086p169 | Adrenal and Cardiovascular | SFEBES2022

Adrenal Incidentaloma Service in a DGH; Role of an endocrine pharmacist

Smurthwaite Hannah , Mani Hamid

An endocrine specialist pharmacist has been running an adrenal incidentaloma clinic since September 2020. As of Jun-22 258 patients have been seen in clinic and managed using a local protocol. Adrenal incidentaloma patient referrals are screened as per current guidelines on receipt; those measuring <1 cm are declined, suspected adrenocortical carcinomas are seen by a consultant and referred elsewhere if needed. All others are seen by the endocrine pharmacist within 4 weeks...

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ea0086p170 | Adrenal and Cardiovascular | SFEBES2022

Audit of adrenal lesions incidentally found on imaging in a London hospital: What is the clinical outcome?

Htut Zin , Vainieri Erika , Nge Thida Nge , Remedios Denise , Seetho Ian

Background: We have seen an increased referrals to endocrinology because of adrenal lesions that are discovered on imaging performed for other clinical indications. This is largely driven by the increased use of, technological advancement in imaging modalities, and increasing prevalence of chronic disease. We performed an audit to determine the incidence of adrenal incidentalomas at a large general hospital and to assess management of adrenal incidentalomas in relation to the ...

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ea0086p171 | Adrenal and Cardiovascular | SFEBES2022

Myriad Complications of Cushing’s syndrome

Shaikh Sheeba , Komlosy Nicci , Gibson Christine , Lewis Alexander

Introduction: Ectopic Cushings syndrome constitutes the second most common paraneoplastic syndrome and has been seen in 1-5 % of small cell lung cancers. It has a poor prognosis and can present with life-threatening complications.Case: We present a 66-year-old lady who attended with peripheral oedema, bruising and visual blurring. Past medical history included bronchiectasis, oesophageal web, ischemic colitis, Ehlers Danlos syndrome, and hypoxic br...

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ea0086p172 | Adrenal and Cardiovascular | SFEBES2022

Silent clinical picture at diagnosis in incidentally discovered large pheochromocytomas

Arbunea-Ghenoiu Sandra , Căpăţină Cristina , Poiană Cătălina

Introduction: Pheochromocytoma is an adrenal medullary tumor which typically involves nonspecific symptoms like arterial blood hypertension, tachycardia, headache or sweating. In some cases, patients may be completely asymptomatic at onset and exceptionally develop symptoms after surgery.Case presentation: We present two cases, first one of a 36 years old male, in which an MRI scan for evaluation of the spine revealed an oval, well-contoured heterogeneou...

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ea0086p173 | Adrenal and Cardiovascular | SFEBES2022

Adrenal adenomas: an atypical case

Thu Winmyat , Ragavan Sharanniyan , Elhelw Omar , Elkhenini Hanaa

Case Presentation: A 69-year-old female was found unconscious on the floor at her home. She was unable to provide a reliable history due to a GCS of 8. On examination there were no Cushingoid features and normal BMI (20 kg/m2). She was previously fit and well with no significant history. Investigations revealed a hyperosmolar metabolic acidosis (pH 6.9) with a high serum sodium (174 mmol/l) and high glucose (70.5 mmol/l). Chest X-ray revealed left middle zone consol...

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ea0086p174 | Adrenal and Cardiovascular | SFEBES2022

Detection rate and management of adrenal incidentalomas at Gozo General Hospital (GGH)

Zoaka Mercy , Bigeni Josephine , Abela Janice , Oguntuase Temitayo

Background: Adrenal tumours are often benign and non-functioning. However, there can be underlying phaeochromocytoma, Conns, adrenal Cushing or even malignancy in some cases. It is therefore imperative that these incidentalomas are promptly investigated once detected and managed accordingly.Aim: 1. To determine the incidence of adrenal incidentaloma at Gozo General Hospital. 2. To determine the adherence of management of incidentalomas to guidelines reco...

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ea0086p175 | Adrenal and Cardiovascular | SFEBES2022

Neonatal salt wasting: A rare case of X-linked adrenal hypoplasia congenita

Frank Amy R , Longmuir Sophie , McNeilly Jane , McGowan Ruth , Faisal Ahmed S , Smith Karen

Neonatal salt wasting can present in neonates with a life-threatening state of hyponatraemia, hyperkalaemia, dehydration and metabolic acidosis. The differential diagnosis of neonatal salt wasting includes congenital adrenal hyperplasia (CAH) most commonly due to 21-hydroxylase deficiency, pseudohypoaldosteronism (PHA), X-linked adrenal hypoplasia congenital (AHC) and aldosterone synthase defects. Diagnostic work up should include serum measurement of ACTH, Cortisol, 17OH-prog...

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ea0086p176 | Adrenal and Cardiovascular | SFEBES2022

Type 1 Diabetes in remission following adrenalectomy for sporadic phaeochromocytoma

Idampitiya Chandima

Phaeochromocytoma is a rare adrenal tumour and patients usually present with palpitations, headaches, labile blood pressure and uncontrolled hypertension. Diabetes mellitus can occasionally be the presenting feature of pheochromocytoma due to catecholamine induced hyperglycaemia. We report a patient who presented with headaches and dizziness to the emergency department who was diagnosed with Type 1 diabetes incidentally following a random venous glucose of 41.6 mmol/l, capilla...

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ea0086p177 | Adrenal and Cardiovascular | SFEBES2022

A case of 17-alpha-hydroxylase deficiency congenital adrenal hyperplasia presenting with delayed puberty

Frank Amy R , Longmuir Sophie , McNeilly Jane , McGowan Ruth , Faisal Ahmed S , Smith Karen

A 13 year old female presented with a two day history of abdominal pain and vomiting which responded to analgesia. Pelvic ultrasound showed complex ovarian cysts and a pre-pubertal uterus. Initial blood tests were consistent with hypergonadotrophic hypogonadism (LH 31.5 U/l, FSH 14.3 U/l and oestradiol <70 pmol/l) and karyotype was 46 XX. Bone age was slightly delayed (measured 12.4 years, chronological age 13.7 years). On referral to paediatric endocrinology, the patient ...

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ea0086p298 | Adrenal and Cardiovascular | SFEBES2022

Mapping corticosteroids in mouse kidney following changes in dietary salt intake using mass spectrometry imaging

Stasinopoulos Ioannis , Khan Shazia , MacKay Logan , Brown Roger , Bailey Matthew , Andrew Ruth

Blood pressure homeostasis is regulated via renal sodium reabsorption by aldosterone and glucocorticoids, although the role of glucocorticoids is less clear. High-salt diets lead to suppression of aldosterone in plasma, but changes in available ligands for the mineralocorticoid and glucocorticoid receptors in kidney subregions are unknown. Hypothetically, high-salt intake modifies aldosterone and corticosterone amounts in specific kidney subregions. Kidney cryosections from ma...

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ea0086p299 | Adrenal and Cardiovascular | SFEBES2022

Screening for adrenal insufficiency using home waking salivary cortisone is accurate and lowers NHS costs

Debono Miguel , Elder Charlotte , Lewis Jen , Jacques Richard , Caunt Sharon , Fearnside Jane , Dixon Simon , Newell-Price John , Whitaker Martin , Keevil Brian , Ross Richard

Introduction: The 250µg Short Synacthen test (SST) is the reference standard for a diagnosis of adrenal insufficiency (AI) in most endocrine centres. The test is expensive and time consuming, requiring clinic attendance. We hypothesised that a cheaper home waking salivary cortisone (WSC) is predictive of the SST 30-minute cortisol >430 nmol/l cut-off and carried out a diagnostic accuracy study to assess the predictive value of the WSC in diagnosing and excluding AI. W...

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ea0086p300 | Adrenal and Cardiovascular | SFEBES2022

Using mass spectrometry imaging to study the lipidome of atherosclerotic plaques

Ntshangase Sphamandla , Khan Shazia , Kaczynski Jakub , Newby David , Hadoke Patrick , Andrew Ruth

Atherosclerotic cardiovascular disease (ASCVD) is a chronic inflammatory disorder characterised by the gradual build-up of plaques in the arterial wall. Unstable plaques are more dangerous than stable plaques as they are prone to rupture and obstruct blood flow, resulting in heart attacks and strokes. Lipids play a key role in plaque progression, yet their exact involvement remains elusive. We hypothesise that stable or unstable plaques will have distinct spatial lipid phenoty...

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ea0086p301 | Adrenal and Cardiovascular | SFEBES2022

Feasibility of primary aldosteronism screening in primary care – prevalence and concordance with secondary care assessment

Marie Hannon Anne , Dissanayake Harsha , Warner Bronwen , Mihai Radu , James Tim , Ray David , Shine Brian , Pal Aparna

Background: Primary aldosteronism (PA) is the commonest cause of secondary hypertension. Reported prevalence is about 30% in hypertensive population. Success of screening for PA in general practice (GP) is unknown. Expected challenges include laboratory access, transport issues and interfering medications.Aims: We aimed to report prevalence of PA in a large primary care cohort, the correlation between GP and in-hospital ARR and to assess if a change in r...

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ea0086p302 | Adrenal and Cardiovascular | SFEBES2022

The importance of questioning the ACTH result in Cushing’s and potential need for a two-site assay

Hart Dulciana , Arya Aditi , Levy Miles J

This case shows the potential unreliability of a single ACTH assay in the context of Cushings syndrome and need for better ways of measuring ACTH and precursors. A 35 year-old lady presented with severe abdominal pain and cushingoid features. CT scan showed a 2.9 cm right adrenal nodule. Investigations: 24-hour UFC 446 nmol/l, post-dexamethasone cortisol level of 572 nmol/l. The referring hospital found a suppressed ACTH < 0.1ng/l consistent with ACTH-independent Cus...

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ea0086p303 | Adrenal and Cardiovascular | SFEBES2022

Prednisone is 100% converted to Prednisolone by first pass metabolism

Chia Eng Pei , Lazarus Kate , Narula Kavita , Choudhury Sirazum , Tan Tricia , Meeran Karim

Prednisolone is widely prescribed in the UK, whereas prednisone is used instead for the same indications in the United States. Both have utility as anti-inflammatory agents and for use as glucocorticoid replacement therapy at lower doses. Oral prednisone is converted to prednisolone by first pass hepatic metabolism by 11 beta HSD-1. This study was undertaken to compare the bioavailability of prednisone against prednisolone. To determine the conversion of prednisone to predniso...

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ea0086p304 | Adrenal and Cardiovascular | SFEBES2022

Prolonged adrenal suppression does not always need additional glucocorticoid therapy

Narula Kavita , Lararus Kate , Meeran Karim , Tan Tricia

A 53 year old female weighing 117 kg was thought to be slightly cushingoid by her GP who checked a morning cortisol. This was surprisingly undetectable (<28nM) on 13th June 2022. The patient was urgently referred for a medical opinion. A repeat cortisol in A&E was 29nM with an undetectable ACTH. Given the lack of clinical features of adrenal failure, further history was obtained. The patient appeared well on examination, and denied any inhaled, oral/ topical steroid us...

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ea0086p305 | Adrenal and Cardiovascular | SFEBES2022

The utility value of genetic testing in endocrine syndromes

Yin Yin , Grigoras Eliza

A 51-year-old gentleman who has been diagnosed with bilateral pheochromocytoma at the age of 11 after developing classical symptoms of catecholamine excess and had bilateral adrenalectomy. At the age of 37, he underwent total thyroidectomy with preservation of the parathyroid glands for C-cell hyperplasia. Over the course of the years, it was presumed he had MEN2A syndrome, although no formal genetic testing was done. He does not have a family history of MEN syndrome and does ...

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ea0086p306 | Adrenal and Cardiovascular | SFEBES2022

Appropriateness of aldosterone renin ratio (ARR) testing: A retrospective multicentre audit

Williams David M , Shaikh Ayesha , Williams Ellen , Maroof Aiman , Michael Therese , Boregowda Kusuma

Introduction: Clinical practice guidelines advocate testing the aldosterone-renin ratio (ARR) in specific circumstances only. Tests should be taken following abstinence from drugs associated with false results. We aimed to determine the appropriateness of testing locally and any associated wasted healthcare costs.Methods: We retrospectively evaluated ARR requests taken July-October 2019 and July-October 2021 in Swansea Bay University Health Board to dete...

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ea0086p307 | Adrenal and Cardiovascular | SFEBES2022

Pheochromocytoma in patient with Neurofibromatosis 1 (NF1) radiologically mimicking Neurofibroma

Tahir Chohan Muhammad , Pye So , Iqbal Khan Irfan

Introduction: NF1 or Von-Recklinghausens disease, an autosomal dominant neuro-cutaneous disorder results from NF1 (a tumour-suppressor gene) mutation, predisposing to neoplasms mainly affecting eye, skin and nervous system but rarely pheochromocytoma (0.1-5.7%). The incidence increases to 20-50% if NF1 is associated with hypertension.Case history: 30 years female, known NF1 since 2005 and multiple laparotomies for intra-abdominal neurofibromas pres...

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ea0086p308 | Adrenal and Cardiovascular | SFEBES2022

Severe Tiredness in patient treated with itraconazole in Aspergilloma and Type 1 Diabetes

Abdelrahim Tarig , Abouglila Kamal , Abdalaziz Altayeb

Introduction: Adrenal insufficiency is characterized by inadequate ¬glucocorticoid production owing to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation. Patients can present with an insidious onset of symptoms, or acutely in adrenal crisis, which requires prompt recognition and treatment. Chronic glucocorticoid therapy is the most common cause of adrenal insufficiency. We present a case with an adrenal insufficiency caused by Itraconazo...

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ea0086p309 | Adrenal and Cardiovascular | SFEBES2022

Case of herbal tea causing severe hypokalaemia and hypertension

Nizami Atif , Bilal Aziz Mohammed , Hasan Ahmed Ikram , Baig Irfan

Liquorice intake is an uncommon but familiar cause of hypokalaemia and hypertension. Liquorice tea is available over the counter as herbal tea to promote general wellbeing. This case report describes a 64-year-old male patient who presented to hospital with severe hypokalaemia and hypertension. During the in-patient stay, patient was managed with potassium replacement and anti-hypertensives (avoiding medications that interfere with endocrine investigations), investigations wer...

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ea0086p310 | Adrenal and Cardiovascular | SFEBES2022

Pheochromocytoma masquerading as acute coronary syndrome

Awadelkareem Abuzar , Elsaify Wael , Nag Sath , Ashwell Simon , Mohammed Azmi

Pheochromocytoma is a rare catecholamine-secreting tumor. It is potentially curable but can cause life-threatening hypertension or cardiac arrhythmias. We report a 58- years- old woman with no significant past medical history who was admitted through the emergency department with complaints of chest pain, palpitation, and nausea. She reported six months history of episodic palpitation and throbbing headaches, sometimes associated with light-headedness and dizziness. Hence, she...

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Society for Endocrinology BES 2022

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