Endocrine Abstracts

Dr Rachel Besser BSc MBBS (Hons) MRCPCH PhD, is a consultant in paediatric endocrinology at Oxford Children’s Hospital, and Honorary senior clinical lecturer at the University of Oxford, working with both the NIHR Oxford Biomedical Research Centre and the Wellcome Centre for Human Genetics. She came to Oxford in 2016 and was Clinical Lead between 2016–2018, and is now Research and Audit lead for the department. Rachel splits her job between clinical diabetes and diab...

Alkaline phosphatase is a widely-ordered test from the clinical laboratory. This brief clinical overview will cover the considerations an endocrinologist should make when assessing a patient referred with an incidental finding of either low or elevated alkaline phosphatase. Some discussion from a laboratory perspective will be included, with a clinic visit and the many caveats for interpretation of alkaline phosphatase in mind, as well as the patient f...

2021 is an important year for diabetes. It is 100 years since insulin was discovered and the first child had their life saved by insulin, turning a death sentence into a chronic condition. Since then, insulin has remained the mainstay of treatment for type 1 diabetes. Outcomes have improved with advances in technology, but outcomes remain suboptimal and, in the UK, around 25% children still present late, in a state of life-threatening diabetic ketoacidosis (DKA). DKA rates hav...

Introduction: Early detection of congenital hypothyroidism (CHT), and treatment with oral thyroxine, supports the critical period of early brain development, improves growth and prevents the metabolic effects of adult hypothyroidism. Screening for CHT, involving an assay for thyroid-stimulating hormone (TSH), has been included in the UK newborn blood spot screening programme since 1981. Since the introduction of screening, the number of CHT cases has increased, although the re...

Severe insulin resistance (SIR) is an umbrella term which encompasses a number of clinical conditions, all of them rare. This talk will use a case based approach to demonstrate a practical approach to the investigation and management of severe insulin resistance and will include severe insulin resistance secondary to insulin signalling defects and to different forms of lipodystrophy. The aim of the talk will be to provide clinicians with a useful framework to approach the clin...

The experience of patients with craniopharyngioma is not benign; these patients are subject to increased mortality compared to age- and gender-matched peers and increased morbidity from hypopituitarism, obesity, thirst and electrolyte disorders and sleep disturbance. This talk will explore the challenges specific to management of this patient cohort, how they differ from other patients with tumoural hypopituitarism, strategies to minimize hypothalamic damage and how to assess ...

Exogenous administration of the gut hormone peptide YY3-36 (PYY3-36) reduces food intake in obese humans and rodents. New lines of evidence support a role for endogenous PYY3-36 in regulating energy homeostasis. The NPY-Y2 receptor mediates the anorectic actions of PYY3-36 with rodent studies implicating the hypothalamus, vagus and brainstem as key target sites. Functional imaging in humans has confirmed that PYY3-36 activates brainstem and hypothalamic regions. The greatest e...

Complex interrelated neuronal circuits have developed in the mammalian brain to regulate many aspects of feeding behaviour. An increased understanding of how peripheral energy signals act upon these circuits to regulate food intake is essential for effective treatment of the current obesity crisis.In response to meal ingestion, several hormones are released from the gastrointestinal tract, which play a role in the regulation of energy homeostasis. Peptid...

A 28 year old female was referred to endocrinology after routine bloods during first trimester of pregnancy demonstrated a low alkaline phosphatase (ALP) of 14U/l (range 30-130U/l). Calcium, phosphate and vitamin D were normal. There is no past medical history, no fragility fractures, no dental concerns and height was normal (157.5cm). Her only family history was her mother lost her teeth prematurely. Biochemical testing showed a raised copper level of 26.0µmol/l (range 1...

Type 1 diabetes (T1D) can be identified pre-symptomatically, by measuring islet associated autoantibodies (IAb). In an analysis from multiple prospective cohort studies, >80% children with two or more IAbs developed clinical T1D over 15 years of follow up. The reasons for identifying children presymptomatically include reducing the risk of diabetic ketoacidosis at diagnosis and the related morbidity and mortality, reducing the need for hospitalisation, providing time to al...