Searchable abstracts of presentations at key conferences in endocrinology
Previous issue | Volume 94 | SFEBES2023 | Next issue

Society for Endocrinology BES 2023

Glasgow, UK
13 Nov 2023 - 15 Nov 2023

Card image cap
SfE BES is the UK's leading endocrinology meeting. It will return to Glasgow in 2023.

Poster Presentations

Adrenal and Cardiovascular

ea0094p1 | Adrenal and Cardiovascular | SFEBES2023

Urinary steroid profiling by ultra-high-performance liquid-chromatography tandem mass spectrometry: Method Validation and comparison to GC-MS

Shaheen Fozia , Sayda Mariwan , Gilligan Lorna , Prete Alessandro , Arlt Wiebke , Taylor Angela

Gas chromatography mass spectrometry (GC-MS) is the gold standard for urinary steroid profiling. Our established GC-MS method quantifies mineralocorticoids, glucocorticoids, and androgens. GC-MS assays require chemical derivatisation and long run times, rendering them unsuitable for high-throughput analysis. Our aim was to develop and validate a high-throughput urinary steroid profiling method using ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-LC...

ea0094p2 | Adrenal and Cardiovascular | SFEBES2023

Comparison of aldosterone measurements during saline suppression tests by immunoassay and liquid chromatography tandem mass spectrometry methods

Frank Amy , Johnston Susan , Smith Karen

Background: Primary aldosteronism is an increasingly recognised cause of hypertension, caused by excess aldosterone secretion. Screening and confirmatory tests such as saline suppression tests (SST) require accurate measurements of aldosterone and use of appropriate cut-offs. Many laboratories have chosen liquid chromatography tandem mass spectrometry (LC-MSMS) methods as issues of poor specificity have been reported for immunoassay methods. During the validat...

ea0094p3 | Adrenal and Cardiovascular | SFEBES2023

Assessing the Impact of Residual Adrenal Function on the prevalence of adrenal crises and intercurrent infections

Lynch Julie , McLaren David , Cassidy Samantha , Kyriakakis Nikolaos , Seejore Khyatisha , Murray Robert

Objective: Determinants of why only a subset of patients with adrenal insufficiency (AI) experience recurrent adrenal crises (AC) and intercurrent illnesses are not well understood. This study aimed to identify whether residual adrenal function (RAF), defined by the peak response to a provocative test undertaken before commencing glucocorticoids, may help explain differences in prevalence.Design and Methods: Patients wit...

ea0094p4 | Adrenal and Cardiovascular | SFEBES2023

Implementation and impact of perioperative guidelines and the steroid emergency card for the management of adrenal insufficiency and prevention of adrenal crisis

Breen Louise , Simpson Helen , Shepherd Lisa

Background: Peri-operative guidelines (POG) published early 2020, were followed by the NHS National Patient Safety Alert (NatPSA) and launch of the NHS Steroid Emergency Card (SEC) in Aug 2020. The NatPSA was sent to all NHS health and care providers. This survey was undertaken to assess the implementation and impact of both.Methods: A pilot survey was undertaken at Endocrine Nurse Update 2022 and amended survey emailed ...

ea0094p5 | Adrenal and Cardiovascular | SFEBES2023

Salivary Steroid Profile: the simultaneous quantification of androgens, glucocorticoids, and mineralocorticoids in human saliva

Bain Joshua , Gilligan Lorna , Hawley James , Taylor Angela

Steroid profiling of biological fluids has been used for clinical and diagnostic research since the 1950s. Most methods focus on blood and urine, however, more recently saliva analysis has been employed as a non-invasive, simple to collect sample for the diagnosis of conditions such as Cushing’s and androgen excess. Despite its ease of collection, saliva remains an underutilised biofluid. To investigate the use of salivary steroid profiling for endocrine research, we aimed to ...

ea0094p6 | Adrenal and Cardiovascular | SFEBES2023

Initial impact of a virtual pathway to evaluate patients with evidence of mild autonomous cortisol secretion

Saadulla Agink , Sagar Rebecca , Wadsworth Charles , Cooke Heather , Abbas Afroze

Background: Adrenal incidentalomas (AI) are common, with approximately 40% of these demonstrating evidence of mild autonomous cortisol secretion (MACS). MACS has been associated with increased morbidity and mortality, and some patients with MACS may benefit from medical therapy or adrenalectomy, so all require further evaluation. Given the large numbers of patients involved, this has potentially significant resource implications for outpatient endocrinology se...

ea0094p7 | Adrenal and Cardiovascular | SFEBES2023

Presentation and management of adrenal tumours over time: a real-life experience from a UK tertiary care centre

Suntornlohanakul Onnicha , Mandal Sumedha , Saha Pratyusha , Ahmed Shadman , Parkin-Crawshaw Jessica , Asia Miriam , Arlt Wiebke , Elhassan Yasir , Prete Alessandro , Ronchi Cristina L.

Background: Adrenal tumours are found in 3-7% of adults. The European guidelines on management of adrenal incidentalomas (first published in 2016 and recently updated) have standardised the management of these patients, but evidence of guideline impact on clinical care is lacking.Methods: Retrospective review of the mode of presentation, radiological characteristics and final diagnosis of a large cohort of patients with ...

ea0094p8 | Adrenal and Cardiovascular | SFEBES2023

A conundrum of steroid absorption and metabolism in the treatment of diamond blackfan anaemia

Berry Simon , Bates Suzanne , Wright Josh , Samuelson Clare , Debono Miguel

Background: Diamond Blackfan anaemia (DBA) is a condition caused by mutations in ribosomal protein genes. After the first year of life, the mainstay of treatment is corticosteroids whilst red blood cell transfusions are used for patients who do not respond.Case: We present a case of a 20-year-old woman with a history of DBA (RPS19 mutation), initially treated with courses of prednisolone, who aged 3 developed steroid-ind...

ea0094p9 | Adrenal and Cardiovascular | SFEBES2023

Evidence of mild autonomous cortisol secretion in patients with adrenal incidentaloma is associated with increased cardiometabolic morbidity and relative risk of cardiovascular disease, compared to those with non-functional adrenal incidentalomas

Saadulla Agink , Abbas Afroze , Sagar Rebecca

Background: Mild autonomous cortisol secretion (MACS) is a common finding in patients who have an adrenal incidentaloma (AI). Evidence suggests patients with MACS are at risk of cardiovascular morbidity, but there is not yet a consensus on the management of this cohort. Our study assesses the cardiovascular risk of patients with MACS, compared to patients with non-functioning AIs.Methods: Data were collected retrospectiv...

ea0094p10 | Adrenal and Cardiovascular | SFEBES2023

Iatrogenic Cushing’s syndrome and Avascular necrosis of femoral heads following a drug to drug interaction of antiretrovirals and fluticasone inhaler

Bawden David , Jackson Portia , Pintilie Hannah , Swe Myint Khin , Ahmed Khaled

Background: Fluticasone is an inhaled steroid commonly used for asthma with low systemic bioavailability (~9%). We present a case of significant Iatrogenic Cushing’s syndrome when fluticasone was used simultaneously with antiretroviral therapy.Case: 27-year-old man was diagnosed with HIV in 2021. His antiretroviral therapy was simplified to GENVOYA (elvitegravir/cobicistat/tenofovir/alafenamide/emtricitabine) at the...

ea0094p11 | Adrenal and Cardiovascular | SFEBES2023

Healthcare professionals’ knowledge of adrenal insufficiency: a quantitative and qualitative study

Davies Sara-Louise

Objective: We sought to assess the knowledge of adrenal insufficiency among undergraduate healthcare students and pharmacy staff.Methods: We undertook a cross-sectional UK-wide survey of final year undergraduate student knowledge of AI before and after an online educational intervention. Universities were recruited through the Council of Medical Schools, Council of Pharmacy and Dean of Health Council, whereby surveys wer...

ea0094p12 | Adrenal and Cardiovascular | SFEBES2023

Service evaluation suggests variation in clinical care provision in adults with congenital adrenal hyperplasia in the UK and Ireland

Madden Doyle Lauren , Faisal Ahmed Syed , Elford Sue , Elhassan Yasir , James Lynette , Lawrence Neil , Llahana Sofia , Rees Aled , Tomlinson Jeremy , O'Reilly Michael , Krone Nils

Background: The Congenital adrenal Hyperplasia (CAH) Adult Study Executive (CaHASE) identified poor metabolic outcomes and reduced quality of life in CAH. CaHASE2 was recently established to examine the current status of CAH care. We surveyed clinical practice in the UK and Ireland, and awareness and use of the International CAH (I-CAH) Registry.Methods: We undertook an anonymised online survey targeting clinicians provi...

ea0094p13 | Adrenal and Cardiovascular | SFEBES2023

Hyponatraemia and falls in the elderly due to hypoaldosteronism

Tellier Genevieve , Berkeley Rhiannon , Wood Ffion , Searell Catrin , Head Simeon , Wilton Anthony

A third of people over the age of 65 and half of those over 85 fall at least once a year. Aside from the human cost, the cost to the NHS is an estimated £2 billion/year and 4 million bed days (2014 figures). Hyponatraemia in the elderly is associated with falls, fractures, morbidity and mortality. Previous studies have demonstrated decreased activity of renin-angiotensin-aldosterone system with increasing age. More recent studies have suggested dysregulation of aldosteron...

ea0094p14 | Adrenal and Cardiovascular | SFEBES2023

Evaluation of inpatient hyponatremia: if formal recognition (coding) of hyponatremia makes a difference in management and outcomes

Aung Ei Thuzar , Balafshan Tala , Bujawansa Sumudu , Narayanan Ram Prakash

Introduction: Hyponatremia is a common electrolyte disorder in clinical practice. We did a retrospective analysis of 100 patients admitted between Jan 2019 to June 2019 with moderate hyponatremia (Na-125-129 mmol/l) to see if there was a difference in management and outcome of the patients who were formally coded as hyponatremia and those who were not coded as such.Results: Mean age was 74 years in the coded group (n...

ea0094p15 | Adrenal and Cardiovascular | SFEBES2023

Genetic aetiology of primary adrenal insufficiency in Sudan

Smith Chris , Abdullah Mohamed , Hassan Samar , Fauzi Luqman , Qamar Younus , Hall Charlotte , Maitra Saptarshi , Maharaj Avinaash , Marroquin Ramirez Lucia , Read Jordan , Chan Li , Metherell Louise , Musa Salwa

Primary adrenal insufficiency (PAI) in children is usually congenital with more than 25 causal genes with overlapping phenotypes. Genetic diagnosis helps to guide management and genetic counselling but can be challenging in resource limited settings. The most common genetic aetiologies for PAI in Sudan are congenital adrenal hyperplasia (CAH; mostly CYP21A2) and Triple A syndrome (AAAS). Here we investigate other genetic aetiologies of PAI in a cohort of 43 Sudanese families (...

ea0094p17 | Adrenal and Cardiovascular | SFEBES2023

Weaning patients off long-term low dose (5mg) prednisolone: A national survey of current endocrine practice

Lazarus Katharine , Narula Kavita , Choudhury Sirazum , Martin Niamh , Wernig Florian , Papadopoulou Deborah , Tan Tricia , S Elhassan Yasir , L Mitchell Anna , Simpson Helen , Davies Jessica , Evans Roisin , Single Katherine , Meeran Karim

Background: Prolonged glucocorticoid use is associated with significant morbidity and mortality, including the development of glucocorticoid-induced adrenal insufficiency (GI-AI). There is no consensus regarding glucocorticoid weaning (<5mg prednisolone-equivalent dose) to alleviate withdrawal symptoms while promoting the quickest adrenal axis recovery. There is also limited research into understanding current practice and the barriers to weaning.<p cl...

ea0094p18 | Adrenal and Cardiovascular | SFEBES2023

Composite Pheochromocytoma with Adrenocortical Carcinoma - a rare coexistence

Sarwani Aysha , Morrin Martina , Naidoo Jarushka , O'Brien Odharnaith , Skordilis Kassiani , Ryan Cliona , Dugal Neal , Hill Arnold , Srinivasan Shari , Sherlock Mark , O'Reilly Michael

A 65-year-old man presenting with urinary symptoms was incidentally discovered to have an adrenal mass. Abdominal computed tomography (CT) revealed a 9.5x8cm heterogenous solid right adrenal tumor with no evidence of metastatic disease. The initial differential lay between adrenocortical carcinoma (ACC) or a phaeochromocytoma. The elevated plasma fractionated normetanephrine at 14439 pmol/l (0-1180), metanephrine 15202 pmol/l (0-510), 3-MT 415 pmol/l (0-180) led to a presumed ...

ea0094p19 | Adrenal and Cardiovascular | SFEBES2023

A case of functioning adrenal tissue post-bilateral adrenalectomy for Hereditary pheochromocytoma-paraganglioma syndrome

Olaogun Idowu , Chung Teng-Teng

Introduction: Endogenous cortisol secretion should cease after bilateral adrenalectomy (BAL) and steroid hormone replacement is life sustaining at the regular physiologic dosage. However, there are reports of occurrence of functioning adrenal tissue in the setting of BAL treatment for ACTH dependent Cushing’s syndrome and not the other known indications for BAL.Case report: A 44-year-old lady with functioning adrena...

ea0094p20 | Adrenal and Cardiovascular | SFEBES2023

Case of non-hodgkin lymphoma presenting as adrenal mass

Shehzad Muhammad Umair , Yee Sharlei , Abouglila Kamal

70-year-old male patient was referred by GP on account of low blood pressure and falling platelet levels. He reported persistent shortness of breath, lethargy and reduced exercise tolerance alongwith 2 stones weight loss with poor appetite in the last 4 months. He has a background history of corneal transplant and was on immunosuppressant therapy including mycophenolate mofetil which was tapered and then stopped few weeks ago when his GP first noticed the low platelet count. H...

ea0094p21 | Adrenal and Cardiovascular | SFEBES2023

Beware progressive unilateral adrenal haemorrhage

Holliday Rachel , Napier Catherine , Pearce Simon , Joshi Ashwin , Bishop David , Truran Peter

Background: Unilateral adrenal haemorrhage is usually asymptomatic and picked up incidentally on CT imaging. However, adrenal haemorrhage can cause flank pain and when bilateral, adrenal insufficiency or adrenal crisis. Biochemical changes include electrolyte imbalances, low platelet count and anaemia. We report a case of unilateral adrenal haemorrhage with devastating outcome.Case: A 45-year-old male smoker was incident...

ea0094p22 | Adrenal and Cardiovascular | SFEBES2023

Pathological fractures: Atypical first symptom of adrenal cushing’s in a young female

Roy Sabyasachi , Kurera Isuri

Cushing’s syndrome can lead to various complications, including pathological fracture. As an initial presenting symptom pathological fracture is not very common in Cushing’s syndrome. This abstract aims to present a case study of a female patient with multiple pathological fractures at a young age and subsequently diagnosed with Cushing’s syndrome. A 32-year-old female (at the time of referral) after a stress fracture of the right neck of the femur without any t...

ea0094p23 | Adrenal and Cardiovascular | SFEBES2023

A case of primary adrenal hydatid cyst

Ur Rehman Abaid , Ahsan Masato , Sule Zakary , Jones Max , Zaman Sajnin , Shafiq Shahriar , Morrison Amy , Levy Miles

Introduction: Hydatid disease (Cystic echinococcosis) is a zoonotic parasitic infection with the Echinococcus granulosus tapeworm resulting in cyst(s) within viscera. The predominant site for cyst formation is the live, with primary adrenal cyst accounting for less than 0.5% of presentation. We report a case of primary adrenal hydatid disease.Case report: A 62 year old female presented to the hospital with history of rig...

ea0094p24 | Adrenal and Cardiovascular | SFEBES2023

Unusual presentation of two patients with spontaneous pheochromocytoma

Hla Myat Mon , Praveena Vankayalapati , Sheharyar Qureshi

Here we present two interesting cases of pheochromocytoma with unusual presentation. Case1: A 61-year-old gentleman presented with syncope after noticing small amount of haematuria. His initial working diagnosis was vasovagal syncope but on further exploration, he reported previous history of palpitations and atypical chest pain. He was non-smoker with longstanding hypertension. His CT(urogram) showed incidental left adrenal nodule after...

ea0094p25 | Adrenal and Cardiovascular | SFEBES2023

Abiraterone related hyponatremia

Narayanan Mannath Sathia , Htwe Nyi , Fernandez James Cornelius

Introduction: Abiraterone acetate, potent selective irreversible inhibitor of CYP17A1, is increasingly used with prednisone to treat prostate cancer resistant to androgen deprivation therapy.Case Presentation: 64-year-old gentleman with BG of prostate cancer with widespread metastatic bone disease. He was on abiraterone since 2019. Admitted with generally unwell, aches/pains, headache, and dizziness. Euvolemic hyponatrem...

ea0094p26 | Adrenal and Cardiovascular | SFEBES2023

Withdrawal of glucocorticoid replacement in patients following treatment for Cushing’s: The importance of reassessing the need for long term replacement

Narula Kavita , Lazarus Katharine , Choudhury Sirazum , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...

ea0094p27 | Adrenal and Cardiovascular | SFEBES2023

Evaluation of the hounsfield unit approach for streamlining investigations for adrenal incidentalomas

Tam Trevor , Saada Louis , Joseph Neetha , Chipchase Allison , Swe Myint Khin , Ahluwalia Rupa

Background: Adrenal incidentalomas (AIs) detected on pre surgical scans often present a logistical challenge due to the pressing need for preoperative exclusion of a phaeochromocytoma. Our local guideline recommends endocrinology referral for all AIs for further investigations, including pre clinic 24-hr urine metadrenalines. This approach can be time-consuming, particularly for patients awaiting unrelated surgery.Methods:</stron...

ea0094p28 | Adrenal and Cardiovascular | SFEBES2023

Refractive hypokalemia due to Ogilvie’s syndrome

Narayanan Mannath Sathia , Sudarshanan Aditya , Fernandez James Cornelius

Introduction: Acute Colonic Pseudo-Obstruction (Ogilvie’s syndrome) is characterized by colonic distention in the absence of mechanical obstruction. Those without ischaemia/perforation is treated conservatively by withdrawing offending drugs, correcting electrolytes/underlying risk factors, neostigmine and colonic decompression.Case Presentation: 90-year-old frail lady from care home with HTN, CVA, and dementia, adm...

ea0094p29 | Adrenal and Cardiovascular | SFEBES2023

An unusual case of hypercalcemia in a patient with chronic hypoparathyroidism and mineralocorticoid insufficiency

Sirbu Anca , Pana Monica , Pascu Raluca , Fica Simona

Introduction: Hypercalcemia is a relatively common ionic imbalance, mostly due to primary hyperparathyroidism or neoplasia. Hypercalcemia rarely occurs in patients with acute adrenal insufficiency and establishing its etiology can be a challenge. Clinical presentation:We present the case of a 27-year-old patient, admitted in June 2023 with severe fatigue, recurrent diarrhea, vomiting and anorexia, symptoms that have progressively worsened in the last months. H...

ea0094p30 | Adrenal and Cardiovascular | SFEBES2023

Trials of therapy are subject to a placebo effect and should not be used

Bahowairath Fatima , Hag Sara , Oliver Nick , Meeran Karim

When patients with type 1 diabetes present with hyponatremia, Addison’s is an important condition to exclude. It is however important to consider other causes, and a trial of hydrocortisone is not part of the diagnostic test for adrenal failure. A 43-year-old lady, with a background of Type 1 Diabetes and depression, presented unwell with hyponatremia. Her basal cortisol was low 162 nmol/l along with an ACTH 16.2 ng/l. A short synacthen test (SST) revealed a baseline cort...

ea0094p156 | Adrenal and Cardiovascular | SFEBES2023

Glucocorticoid receptor and PARP-1 genomic binding changes in response to corticosterone excess in mice

Heaselgrave Samuel , Lavery Gareth , Doig Craig

Ligand binding of the glucocorticoid receptor (GR) initiates recruitment to GR Response Elements (GRREs). GR transcriptional activation of genes manifests many of the pleiotropic actions attributed to glucocorticoids. However, excessive exposure to GCs produces detrimental impacts, shifting GR behaviour and driving dysregulated metabolic states. Moreover, GR, its interacting partners, and influencing proteins remain ambiguous. Poly-(ADP-ribosyl) polymerase 1 (PARP1) is a chrom...

ea0094p157 | Adrenal and Cardiovascular | SFEBES2023

Identification of a novel constitutively active Gαs variant associated with cortisol-producing adrenocortical adenoma

Jamaluddin Aqfan , Wyatt Rachael , Pasaliu Andreea , Ruggles Oliver , Calebiro Davide , Gorvin Caroline , Ronchi Cristina L.

Adrenocortical adenomas are among the most commonly identified human neoplasias, with a prevalence of 2-3% in the population. In some cases they are associated with autonomous cortisol excess that leads to increased morbidity and mortality. Altered cAMP/protein kinase A (PKA) signalling is common in sporadic cortisol-producing adenomas (CPA), mostly caused by somatic mutations in the genes coding for the catalytic subunit α of PKA (PRKACA) or the stimulatory G-pr...

ea0094p158 | Adrenal and Cardiovascular | SFEBES2023

Development of PP-UHPLC-MS/MS workflow for the high-throughput and sensitive targeted steroid analysis of mouse plasma samples

Gazarkova Tatana , Plachka Katerina , Vlckova Hana Kocova , Svec Frantisek , Novakova Lucie

Stress is increasingly pervasive in modern society and an unavoidable stimulus to the human organism. Stressors, whether of social or physical type, activate the hypothalamic-pituitary-adrenal (HPA) axis, resulting in the upregulation of glucocorticoid levels and, in some cases, its de novo biosynthesis. Aside from HPA axis regulation, corticosteroids modulate the immune response to inflammation and affect whole-body metabolism. Despite numerous studies using traditional GC-MS...

ea0094p159 | Adrenal and Cardiovascular | SFEBES2023

A pragmatic approach to monitoring for adrenal axis recovery after a failed Short Synacthen Test (SST)

Harid Anes , Rowe Matthew , Patel Nishchil , Jeffery Jinny , Flannagan Daniel , McGovern Andrew

Background: The short Synacthen test (SST) is commonly used for assessing adrenal reserve. Depending on the cause, we often use serial SSTs in current practice, to assess whether people with adrenal insufficiency (AI) have adrenal axis recovery. We aimed to explore if baseline cortisol levels were a suitable screening test for recovery in people with AI rather than using serial SST in all cases.Methods: We retrospectivel...

ea0094p160 | Adrenal and Cardiovascular | SFEBES2023

Defining the basal serum cortisol cut-off for weaning patients off glucocorticoids in suspected tertiary adrenal insufficiency

Fahad Arshad Muhammad , Lawrence Neil , Elder Charlotte , Newell-Price John , Ross Richard , Debono Miguel

Background: Cut-offs for basal cortisol (early morning) have been determined to predict the 30-minute cortisol level post-synacthen, but not for determining when patients with suspected tertiary adrenal insufficiency (AI) are weaned off glucocorticoids.Aims: The aim of this study was to compare the predictive values of basal cortisol, basal ACTH and basal cortisol:ACTH ratio to determine appropriate thresholds to reduce ...

ea0094p161 | Adrenal and Cardiovascular | SFEBES2023

An international study of the association between local health care resources and acute adrenal insufficiency events in children with congenital adrenal hyperplasia

Tseretopoulou Xanthippi , R Ali Salma , Bryce Jillian , Nadia Amin , Atapattu Navoda , Bachega Tania , Baronio Federico , H Birkebaek Niels , Bonfig Walter , Claahsen-Van der Grinten L. Hedi , Cools Martine , de Sanctis Luisa , de Vries Liat , Elsedfy Heba , E Flueck Christa , Fu Antony , Guaragna-Filho Guilherme , Guran Tulay , Guven Ayla , E Hannema Sabine , Iotova Violeta , Konrad Daniel , Lenherr-Taube Nina , Korbonits Marta , P Krone Nils , Krone Ruth , Leka-Emiris Sofia , Lichiardopol R Corina , Luczay Andrea , L Markosyan Renata , Mazen Inas , Milenkovic Tatjana , Mohnike Klaus , Neumann Uta , Niedzela Marek , Nordenstrom Anna , Phan-Hug Franziska , Poyrazoglu Sukran , Probst Ursina , Randell Tabitha , Vieites Ana , Russo Gianni , Thankamony Ajay , van den Akker Erica , van Eck Judith , van der Kamp Hetty , G Wasniewska Malgorzata , Ahmed Syed Faisal

Background: The reported occurrence and management of acute adrenal insufficiency–related adverse events in children vary widely between centres and may depend on available resources.Methods: Real world data from the I-CAH Registry from 44 centres [32 from high income (HIC) and 12 from low/middle income (LMIC) countries] and a total number of 607 children were linked to the results of a health care survey of local r...

ea0094p162 | Adrenal and Cardiovascular | SFEBES2023

Hormonal secretion pattern in patients with adrenal tumours referred to a UK tertiary care centre

Mandal Sumedha , Saha Pratyusha , Suntornlohanakul Onnicha , Ahmed Shadman , Parkin-Crawshaw Jessica , Asia Miriam , Arlt Wiebke , Elhassan Yasir , Prete Alessandro , Ronchi Cristina

Introduction: Up to 3-7% of adults have an adrenal incidentaloma. These are most frequently non-functioning adenomas (NFA) but can be associated with adrenal hormone excess. According to the ESE-ENSAT guidelines on adrenal incidentalomas (2016), an accurate endocrine work-up is recommended.Methods: We provide an extensive retrospective analysis of patients with adrenal tumours referred to a large UK tertiary centre betwe...

ea0094p163 | Adrenal and Cardiovascular | SFEBES2023

Mild autonomous cortisol secretion in patients with adrenal incidentalomas – how common and what is the prevalence of co-morbidities?

San Yap Pui , Paterson Rachel , Philip Sam , Graveling Alex , Abraham Prakash

The widespread use of cross-sectional imaging has led to increased detection of adrenal masses in 2% of general population and over 7% of those above age 70. Although majority are benign, it is important to exclude hormonally active or malignant lesions. Mild autonomous cortisol secretion (MACS) is the most common and found in 30-50% of patients with adrenal mass. We reviewed our adrenal incidentaloma database for patients who attended the nurse-led pathway for biochemistry in...

ea0094p164 | Adrenal and Cardiovascular | SFEBES2023

MHRA steroid card for patients prescribed high dose steroids

Virdee Simran

Introduction: Steroids are used in an array of conditions, ranging from asthma through to haematological malignancies. When using steroids for prolonged periods patients are at risk of developing adrenal crisis with sudden withdrawal. To allow early recognition and support treatment of adrenal crisis patients prescribed high dose steroids should be issued with an MHRA steroid card. Our aim was to identify how many patients needed a steroid card, amongst those ...

ea0094p165 | Adrenal and Cardiovascular | SFEBES2023

Assess and improve (AAIM) implementation of corticosteroid sick day rules in transplant and oncology services. A single-centre steroid safety project

Naeem Ammara , Yousseif Ahmed , Khoo Bernard , Karra Efthimia , Armeni Eleni

Objective: The project was designed to Assess And IMprove (AAIM) the practice of healthcare professionals (HCPs) around the corticosteroid sick-day rule, involved in caring for transplant and oncology patients requiring treatment with corticosteroids long-term.Introduction: Corticosteroids are widely prescribed drugs in oncology and post-transplant patients. Long-term treatment with corticosteroids dose, which equals pre...

ea0094p166 | Adrenal and Cardiovascular | SFEBES2023

Malignant pheochromocytoma and paraganglioma – clinical course and outcomes from a tertiary care centre in India

Rajan Remya , Asha Hesarghatta , Pai Rekha , Kapoor Nitin , Cherian Kripa , Paul Thomas , Jebasingh Felix , Thomas Nihal , Sigamani Elanthenral , Sathanam Prisca , MJ Paul , Cherian Anish , Thomas Shawn , Sen Supriya , Chandramohan Anuradha , Singh Ashish , Hepzhibah Julie , Kumar Santhosh , Gowri Mahasampath

Objectives: To study the clinical, biochemical, imaging profile and treatment outcomes of patients with malignant pheochromocytoma and paraganglioma(PPGL). Also, to compare their characteristics with non-malignant PPGL to identify the factors that may predict metastasis.Methods: This retropsective cohort study included 212 patients with PPGL managed at our centre over a period of 10 years(2013-2022). Their clinical, bioc...

ea0094p167 | Adrenal and Cardiovascular | SFEBES2023

Improving Steroid prescribing in patients at risk of Adrenal Insufficiency: A Quality Improvement Project to enhance recognition and communication to patients at risk

Crockett Elin , James Charlotte , Roy Chowdhury Sharmistha , Lawrence Cozma Silviu

Background: Patient Safety Noticed issued by Welsh Government in June 2021 set out multiple action plans to be implemented by Welsh health boards to improve recognition and management of adrenal crisis. Hospitals were advised to review policies to ensure all patients at risk of Adrenal Crisis [(primary/secondary/tertiary adrenal insufficiency (AI)] were identified.Aim: In response, our hospital commenced a quality improv...

ea0094p168 | Adrenal and Cardiovascular | SFEBES2023

Developing a methodology to measure post-mortem hair hormone concentration to investigate causes of unexplained stillbirth – assessing cortisol, aldosterone, 17-hydoxyprogesterone and total bile acids

Ball Mia , Manna Luiza , Ovadia Caroline

Background: 3.8 per 1000 UK babies are stillborn, a large proportion of which are “unexplained”; aberrations in adrenal hormones and bile acids are possible contributors. In this study, we aimed to develop methodologies for simple laboratory measurement of adrenal hormone and bile acid concentrations that can be applied to postnatal samples from stillborn babies, using hair as a relatively stable medium, reflective of retrospective fetal hormone leve...

ea0094p169 | Adrenal and Cardiovascular | SFEBES2023

A comparison of hydrocortisone and prednisolone for the treatment of adrenal insufficiency

Miller Madelaine , Lazarus Katharine , Choudhury Sirazum , Peters Debbie , Tan Tricia , Meeran Karim

Background: Patients with adrenal insufficiency (AI) require glucocorticoid replacement therapy. Current Endocrine Society guidelines recommend thrice-daily hydrocortisone (15-25mg) or once-daily prednisolone (3-5mg). Concerns around prednisolone use have been based on evidence using higher doses. We have been using low-dose (2-4mg) once-daily prednisolone since 2014 for glucocorticoid replacement in adult patients with AI. This study aimed to compare the effe...

ea0094p170 | Adrenal and Cardiovascular | SFEBES2023

Aldosterone variability in patients with primary aldosteronism undergoing adrenal vein sampling

Pillai Syam Kaushal , Sharma Bhavna , Wernig Florian

Adrenal vein sampling (AVS) is used to differentiate between unilateral and bilateral subtypes of primary aldosteronism (PA). However, AVS results may be misinterpreted due to a procedural artefact resulting in low aldosterone levels at the inferior vena cava (IVC), thus making an interpretation of aldosterone to renin ratios difficult. We investigated whether this artefact was due to patients’ being supine before and during AVS, given aldosterone varies with posture, and...

ea0094p171 | Adrenal and Cardiovascular | SFEBES2023

A clinical case demonstrating the challenges in diagnosing and managing Paraneoplastic Cushing’s Syndrome

Iqbal Zohaib , Ho Jan , Walker Leanne , White Ann , Monaghan Philip , Thirkettle Sally , Gulamhusein Aziz , Keevil Brian , Mansoor Wasat , Adam Safwaan

We present a case of a 62-year-old lady with a grade 3 well-differentiated metastatic gastric-neuroendocrine tumour complicated by symptoms of CS (weight-gain, bruising, proximal weakness) which developed over 4 weeks. She had progressive disease after exhausting all conventional anti-neoplastic therapeutic options. Screening tests revealed raised 24-h urinary free cortisol (3460 nmol/24h[<165]), post-overnight dexamethasone suppression serum cortisol (serF) 1200 nmol/l(&#...

ea0094p172 | Adrenal and Cardiovascular | SFEBES2023

A case series of gastric diverticulum masquerading as adrenal adenoma

Morrison Amy , Gohil Shailesh , Bremner Emma , Barrowcliffe Mary , Reddy Narendra , Shah Vikas , Levy Miles

Case 1: A 57-year-old lady referred to the Endocrinology department due to a CT Abdomen, performed for abdominal pain, reporting the presence of an incidental left adrenal adenoma. Imaging was reviewed in the Adrenal MDT meeting and further CT Abdomen arranged. Images were reviewed before and after oral contrast. Pre-contrast images revealed a small volume of high-density material within a rounded structure in the left upper quadrant, immediately superior to t...

ea0094p173 | Adrenal and Cardiovascular | SFEBES2023

A rare case of hydatid cyst disease in the adrenal gland

Al Jumaah Ali , Levy Miles , Gohil Shailesh , Bhardwaj Neil , Wiselka Martin , Bremner Emma , Barrowcliffe Mary , Reddy Narendra

Introduction: Hydatid cysts disease (HSD) is a parasitic disease caused by echinococcus granulosus. It is common in areas where the parasite is endemic; North Africa, the Middle East, Central and Far Asia, Central America and Australia. Liver (44-77%) and lungs (10-50%) are the preferred locations for HSD. Here we report a rare case of HSD affecting the adrenal gland.Case report: A 62-year-old female complained of right ...

ea0094p174 | Adrenal and Cardiovascular | SFEBES2023

Case series of catecholamine-induced Takotsubo cardiomyopathy secondary to pheochromocytoma and discussion of relevant literature

Lin Zhimin , Soh Bennet , Lee James , Yuan Ngiam Kee , Parameswaran Rajeev

Catecholamine-induced cardiomyopathy is a rare presentation of pheochromocytoma (PCC) with typical and atypical subtypes. These patients are associated with worse rates of morbidity and mortality compared to patients with PCC that were incidentally found. Frequently, these patients would present in the emergency setting with cardiac symptoms that may be difficult to distinguish from ischemic cardiomyopathy, and hence patients may be prescribed cardiac treatment in the form of ...

ea0094p175 | Adrenal and Cardiovascular | SFEBES2023

Laparoscopic adrenalectomy for phaeochromocytoma in the context of acute coronary syndrome

Soruna Omolayo , Plowman Christina , Yu Thinn , Pittaway James , Goodchild Emily , Wragg Andrew , Fitchat Tracey , Parvanta Laila , Akker Scott

A 54-year-old man presented to the heart attack centre with cardiac chest pain, vomiting and collapse. Biochemistry (troponin incremented from 117 to 315ng/l) and electrocardiogram confirmed a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Past medical history included type 2 diabetes mellitus and hypertension (diagnosed 8 years previously), hypercholesterolaemia and a 20 pack year smoking history. Secondary prevention for MI was commenced and coronary angiograp...

ea0094p176 | Adrenal and Cardiovascular | SFEBES2023

Current perceptions and practices by general practitioners (GPs) in the management of resistant hypertension

Wong Wai Kit Clement , Rui Lee , Leong Kwong Fei Eugene , Lee James , Pruar Troy , Parameswaran Rajeev

Introduction: About 12% of patients present to the GPs with hypertension or related symptoms. The current practice of managing resistant hypertension in primary care is inconsistent and general practitioners (GP’s) do not have a criteria for referral to tertiary care.Methods: Quantitative anonymized online survey of 26 questions on the current prescribing practices and thresholds for referral of resistant hypertensi...

ea0094p177 | Adrenal and Cardiovascular | SFEBES2023

Adrenal Insufficiency is rare among patients referred to cardiac autonomic dysfunction clinics

Raja Touqeer , Fahad Arshad Muhammad , Ferrar Melloney , Lund Andrew , Debono Miguel

Background: Syncope and pre-syncope are well recognised symptoms of primary adrenal insufficiency (AI). Some guidelines(1) recommend screening for AI in all patients who present with symptoms of orthostatic intolerance. However, the incidence of AI in these patients is unknown.Aims: The aim of the study was to determine the incidence of AI in patients referred to a cardiac autonomic dysfunction clinic at a sin...

ea0094p178 | Adrenal and Cardiovascular | SFEBES2023

Glucocorticoid receptor resistance unmasked by bilateral adrenal histoplasmosis

Palani Raghavendar , Chung Teng-Teng

Background: Generalized glucocorticoid-resistance (GCR) is a broad spectrum and heterogeneous syndrome that may be familial or sporadic caused by mutations in glucocorticoid receptor function and signalling. These patients present with hypercortisolism with enlarged adrenals but no Cushing features. Identification of GCR requires extensive investigations.Case report: An 81-year-old thin-built man of South-East Asian orig...

ea0094p179 | Adrenal and Cardiovascular | SFEBES2023

Rare case of a giant Adrenal Schwannoma

Viswanath Aditya , Dales Jolyon , Levy Miles , Shah Vikas

Introduction: Adrenal schwannomas are rare but important causes of adrenal tumours which can often only be diagnosed histologically. We present an interesting case of an incidentally detected adrenal schwannoma.Case: A 67-year-old gentleman had an ultrasound imaging of the abdomen that incidentally revealed a large right adrenal mass prompting referral to the endocrinology service. His past medical history included myoca...

ea0094p180 | Adrenal and Cardiovascular | SFEBES2023

The golden ratio for cortisol replacement

Evans Rosemary , Gallagher Meurig , Smith David

Current cortisol dosing regimes for patients with adrenal insufficiency are unable to accurately replicate the physiological profile of healthy patients. This work is part of an interdisciplinary study with the aim of using mathematical approaches to understand the treatment strategies for patients with adrenal insufficiency. We also aim to then tailor treatments specific to an individual or situation. We present a simplified model of hydrocortisone delivery via intravenous bo...

ea0094p181 | Adrenal and Cardiovascular | SFEBES2023

Ectopic ACTH secretion (EAS) presenting with hypokalemia and succumbing to Covid-19

Narayanan Mannath Sathia , Sudarshanan Aditya , Fernandez James Cornelius

Introduction: EAS is an endocrine emergency requiring emergency diagnosis/treatment. Bronchial carcinoid is known to cause EAS and carcinoid syndrome (without liver involvement).Clinical features: 58-year-old lady with COPD and fibromyalgia referred as 2WW pathway with abdominal pain, diarrhoea, and weight loss. Investigated with CT-CAP: inflammatory looking 7mm lung nodule left upper lobe, enlarged left hilar, aorto-pul...

ea0094p182 | Adrenal and Cardiovascular | SFEBES2023

Clinical challenges in the biochemical evaluation of Pheochromocytoma: A case report of pseudo-pheochromocytoma in a patient with Obstructive Sleep Apnoea(OSA)

Nijith Lakshmi , Thong Lim Chung , Banerjee Ritwik

The diagnosis of Pheochromocytomas often poses a great challenge. We report a case of pseudo-pheochromocytoma causing challenges in the clinical diagnosis. A 35-year old gentleman with high BMI, was admitted with worsening headache, visual field defects and accelerated hypertension. MRI pituitary and biochemical profiling revealed a non-functioning pituitary macroadenoma with optic chiasm compression, warranting urgent surgical intervention, vindicating an endocrinology referr...

ea0094p183 | Adrenal and Cardiovascular | SFEBES2023

The management of adrenal incidentalomas referred to the adrenal radiology meeting at heartlands hospital in 2021

Matthews Alexandra , Ul-Hassan Naeem , Shepherd Lisa , Joseph Sonia , Hazlehurst Jonathan , Miller Ben , Rahim Asad , Juszczak Agata

Background: An adrenal incidentaloma (AI) is an adrenal lesion found on imaging performed for an indication other than adrenal disease. The current European Society of Endocrinology guidelines recommend that all AIs are discussed in a dedicated adrenal multidisciplinary meeting.Method: We evaluated the outcomes of AI cases referred to the Adrenal Radiology Meeting (ARM) at Heartlands Hospital between January 2021 and Dec...

ea0094p184 | Adrenal and Cardiovascular | SFEBES2023

Prednisolone replacement therapy is associated with significant weight loss in patients who switch from hydrocortisone with adrenal insufficiency

Lazarus Katharine , Choudhury Sirazum , Narula Kavita , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...

ea0094p303 | Adrenal and Cardiovascular | SFEBES2023

The hidden duo: phaeochromocytoma and primary peritoneal metastatic carcinoma unmasked

Akbar Shahzad , Taqi Muhammad , Karim Rehmat , Deshmukh Harshal , Aye Mo , Sathyapalan Thozhukat , Mongolu Shiva

A 71-year-old woman was referred to the urology department with macroscopic haematuria. An ultrasound scan revealed a suspicious solid mass measuring 6.6cm arising from the left kidney. Subsequent CT scan confirmed the presence of a left adrenal mass along with omental and peritoneal disease and small-volume ascites. The patient was referred to the adrenal surgeons for consideration of left adrenalectomy in view of suspected adrenal cancer. At the surgical outpatient departmen...

ea0094p304 | Adrenal and Cardiovascular | SFEBES2023

Assessment of adrenal incidentalomas: Benefits of a nurse-led clinic

Smith Robert , Marseden Louise , Delbene Leanne , Thomas Julia

Background: Adrenal incidentalomas (AI), the finding of asymptomatic adrenal lesion on unrelated imaging, represent an increasing number of endocrine referrals. In 2022, we introduced a nurse-led pathway to manage AI.Aim: To assess the cost savings and patient experience of a telephone nurse-led AI service at Musgrove Park Hospital.Methods: Records for patients seen in the AI clini...

ea0094p306 | Adrenal and Cardiovascular | SFEBES2023

The heterogeneous spectrum of adrenal ganglioneuromas: two interesting cases

Ntali Georgia , Kardalas Efstratios , Markou Maria , Mouchtouris Panagiotis , Partsalaki Eirini , Lavrentaki Aikaterini , Kyriakopoulos Georgios , Tzanela Marinella

Introduction: Ganglioneuromas (GNs) are rare, benign tumors, arising from neural crest cells. Their incidence amongst adrenal masses is 0.3%-6%. The majority are incidentalomas and hormonally inactive but a subset may cause compressive effects. Presentation in the context of genetic syndromes (NF1/NF2, RET, MAX, Von Hippel Lindau disease) has been reported. We present two cases of adrenal GNs: Case 1. A 31-year-old female patient who presented with a history o...

ea0094p307 | Adrenal and Cardiovascular | SFEBES2023

Unique case of pembrolizumab induced adrenal suppression

Amjad Wajiha , Venu Maya

We present a unique case of Pembrolizumab induced adrenal insufficiency. A 65 year old lady was admitted with septic shock secondary to chest infection. She was 3 weeks post neo adjuvant chemotherapy plus immunotherapy for triple receptor negative solitary Right sided breast cancer. She has Type II Diabetes mellitus, hypercholesterolemia and varicose veins. She takes Metformin and Atorvastatin. She is single, with no significant family history. On intravenous antibiotics her b...

ea0094p308 | Adrenal and Cardiovascular | SFEBES2023

Exploring the impact of unilateral adrenalectomy on health-related quality of life: a retrospective audit

Karkhanis Amol , Dinesh Athul , Yousseif Ahmed , Karra Efthimia , Armeni Eleni

Introduction: Laparoscopic unilateral adrenalectomy (UA) is a frequent approach in managing patients with structural and functional adrenal disorders. Suboptimal assessment post-operatively can result in multiple adverse consequences, including adrenal insufficiency. However, the optimal post-operative assessment and long-term effects on physical and mental health have not been sufficiently documented. This study aims to investigate the long-term effects of UA...

ea0094p309 | Adrenal and Cardiovascular | SFEBES2023

The diagnostic dilemma of discordance between cross-sectional imaging of an adrenal mass and adrenal vein sampling: a case report

Grundy Megan , Pasieka Janice , Chan Denise , So Benny , Kline Gregory

Introduction: We present a case of primary aldosteronism (PA) with adrenal mass, where lateralization of aldosterone production by adrenal-vein sampling (AVS) was discordant with cross-sectional imaging. We highlight an approach to investigation of PA using functional nuclear imaging, and show that subclinical cortisol excess may impact the reliability of AVS.Case: 70 year old female with 2.6 cm left-sided adrenal mass, ...

ea0094p310 | Adrenal and Cardiovascular | SFEBES2023

Unilateral nonhemorrhagic adrenal infarction presenting as acute abdomen in a pregnant woman

Muhammad Zubair Ullah Hafiz , Fisher Stephen , Littlewood Gail , Watson Wendy

Introduction: Diagnosing acute abdominal presentations in pregnant women poses challenges due to the physiological and anatomical changes during pregnancy. The differential diagnosis is broad, encompassing both obstetric and non-obstetric causes. Among the rare occurrences, nonhemorrhagic adrenal infarction presents a particularly unusual scenario, lacking established guidelines for management and follow-up. We discuss a case of nonhemorrhagic adrenal infarcti...

ea0094p311 | Adrenal and Cardiovascular | SFEBES2023

Autoimmune adrenal cortex insuffiency induced cardiomyopathy - A case report and literature Review

Abdelrahman Hiba , Azharuddin Mohammed , Jones Christopher

We are reporting a 33 years old female, known case of primary adrenal failure who presented to our emergency department feeling generally unwell, lethargic and short of breath, She found to be hypothermic, hypotensive and hypoglycaemic. ECG showed low voltage QRS complex with prolonged QT intervals and ECHO confirmed moderate to severe left ventricular dysfunction with features of ’broken heart’ and ballooning suggestive of Takusobo cardiomyopathy. In our case report...

ea0094p312 | Adrenal and Cardiovascular | SFEBES2023

The investigation and management of adrenal incidentalomas at guy’s and St Thomas’s NHS foundation trust

Desai Nirali , Gowrishankar Shravan , Hodson Alexander , Santucci Catherine , Demel Isabel , Zuckerman Benjamin , Armonis Panagiotis , Christodoulou Dimitra , Velusamy Anand , Carroll Paul , Saqib Aaisha

Background: Rapid improvements in imaging have led to a 10-fold increase in the incidence of adrenal incidentalomas (AIs) over the past two decades. Delays in the diagnostic evaluation of AIs are associated with patient anxiety and significant burden on medical resources. We retrospectively audited the investigation and management of AIs at Guy’s and St Thomas’s NHS Foundation Trust (GSTT).Methods: Patients wit...

ea0094p313 | Adrenal and Cardiovascular | SFEBES2023

An unusual cause of secondary HTN

Chirila-Berbentea Veronica , Bhattacharya Beas

We present the case of a 32-year-old gentleman who was reviewed in the endocrinology clinic for hypogonadotropic hypogonadism and he was investigated for persistent HTN. His only symptoms were anxiety and palpitations. We have controlled his blood pressure with doxazosin 10 mg BD and bisoprolol 1.25 mg OD. Investigations: bloods (Jan 23) normetanephrine:3,460 picomole/l, metanephrine:120 picomole/l, aldo/renin ratio: 92, TSH 2.3, prolactin 307, IGF-1: 26,6, testosterone: 5,9 n...

ea0094p314 | Adrenal and Cardiovascular | SFEBES2023

Case of insulinoma – non surgical therapy

Abdellatif Tarek , Kalaiah Yogesh

Background: The gold-standard therapeutic approach for benign insulinoma is surgery. If surgery is not feasible, minimally invasive ablative procedures by interventional radiology can lead to partial or complete remission of hormone hypersecretion and tumour control.Summary: 72-year-old woman, admitted with recurrent hypoglycaemia with whipple triad symptoms and presyncopal attacks for 5 weeks, relieved by eating carbohy...

ea0094p315 | Adrenal and Cardiovascular | SFEBES2023

New onset adrenal insufficiency post-astrazeneca vaccine

Hla Myat Mon , Praveena Vankayalapati , Sheharyar Qureshi

The COVID-19 vaccine plays an important role in managing the pandemic. Unfortunately, there are endocrine side effects also noted. The 36-year-old lady felt unwell 2 weeks post-AstraZeneca COVID-19 vaccine. She got admitted to the hospital after 6weeks with persistent vomiting and significant hyponatremia. She has a past history of well-controlled asthma and hypothyroidism. Random cortisol on admission was 31 nmol/l, and a short synacthen test(SST) confirmed adrenal insufficie...

ea0094p316 | Adrenal and Cardiovascular | SFEBES2023

Deciphering atherosclerosis: unravelling spatial lipid heterogeneity through advanced MALDI-MSI profiling in rabbit aortic and human carotid artery plaques

Ntshangase Sphamandla , Khan Shazia , Gazarkova Taťana , Bezuidenhout Louise , Kaczynski Jakub , Sellers Stephanie , Newby David , Hadoke Patrick , Andrew Ruth

Atherosclerosis, a multifaceted cardiovascular disease characterised by fatty plaque buildup in large and medium-sized arteries, is a leading cause of heart attacks, strokes and peripheral arterial disease. Its global impact on morbidity and mortality rates poses a significant health challenge. This study aimed to comprehensively understand its complex pathogenesis using histologically aided Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry Imaging (MALDI-MSI) to e...

ea0094p317 | Adrenal and Cardiovascular | SFEBES2023

Predictors of morbidity in autoimmune adrenal insufficiency

Dewdney Charlotte , Gibb Fraser , Lyall Marcus

Adrenal crisis (AC) is an acute life-threatening emergency contributing to excess mortality in patients with autoimmune adrenal insufficiency (AAI). Clinical, demographic and educational factors associated with high rates of AC admission remain unclear. We therefore examined the long-term clinical course of 91 patients with AAI.Methods: A retrospective observational study of 91 patients with AAI was performed. Electronic health records (...

ea0094p318 | Adrenal and Cardiovascular | SFEBES2023

LH-dependent female testosterone excess persisting after bilateral oophorectomy

Scotucci Jacopo , Gurnell Mark , Powlson Andrew

A 55-year-old post-menopausal female presented with hirsutism and increased libido. Testosterone was elevated at 9.7 (RR <1.8 nmol/l). LH/FSH were appropriate post-menopause (LH 28.8; FSH 54.1U/l). DHEAS, androstenedione and 17-hydroxyprogesterone were unremarkable. GnRH analogue suppression testing (GnST) appropriately suppressed LH/FSH and testosterone (testosterone 0.2 nmol/l), suggesting an LH-dependent source of testosterone. Pelvic MRI suggested a left ovarian tumour...

ea0094p319 | Adrenal and Cardiovascular | SFEBES2023

Selective non-lipogenic ABCA1 inducer, CL2-57, affects cholesterol efflux pathways and adrenocortical cancer cell migration in 2D and 3D spheroid models

Jarvis Sheba , Servin-Recio Renee , Varela-Carver Anabel , Reddy Velma Ganga , Thatcher Gregory , Bevan Charlotte

Adrenocortical carcinoma (ACC) is a rare tumour with a poor prognosis. There are a lack of successful targeted therapies and an urgent need to explore novel therapeutic avenues for ACC 1. In other cancer types, there has been some success in exploiting lipid metabolism. One example is manipulating intracellular cholesterol levels to starve cancer cells. 2 Another possibility is targeting the ligand-dependent nuclear receptors Liver-X receptors (LXRab), wh...

ea0094p320 | Adrenal and Cardiovascular | SFEBES2023

An audit of the use of plasma renin measurements to guide mineralocorticoid therapy in primary aldosteronism

Jacob Anu , Wu Xilin , Drake William

Introduction: Primary aldosteronism (PA) accounts for 5-10% of patients with hypertension. Approximately 40-50% of cases are bilateral, usually managed using mineralocorticoid receptor antagonists (MRAs). Recent literature suggests a higher risk of renovascular disease and cardiovascular events in PA patients treated medically, compared to those with essential hypertension. This excess risk is mitigated in individuals with unilateral disease managed surgically...

ea0094p321 | Adrenal and Cardiovascular | SFEBES2023

The dexamethasone assay as a useful tool to identify false positive dexamethasone screening test results

Humayun Khan Huma , Loo Helen , Pofi Riccardo , May Christine , Jafar-Mohammadi Bahram , Shine Brian , Pal Aparna

The dexamethasone suppression test (DST) is a common screening test in Cushing’s syndrome but associated with false positive result in 10-20%. One cause of false positivity is inadequate dexamethasone absorption. An assay to measure serum dexamethasone concentration can be used to validate the accuracy of the DST result.Aims: To audit 1) Use of the dexamethasone assay in DSTs 2) How frequently dexamethasone levels are inadequate 3) ...