Endocrine Abstracts

Adrenal suppression and iatrogenic Cushing’s secondary to concomitant inhaled steroid and itraconazole is a potentially common and serious drug interaction. A 55 year old patient with bronchiectasis and asthma developed an exacerbation of allergic bronchopulmonary aspergillosis (ABPA). He had been on inhaled fluticasone for over 2 years. He was commenced on itraconazole. The patient was on holiday 6 weeks after itraconazole was commenced when he noted that his face had be...

Paragangliomas are rare tumours that arise from extra-adrenal chromaffin cells within the sympathetic paraganglionic axis. While neoplasms of the adrenal medulla, (phaeochromocytomas) are normally characterized by catecholamine (CA) hypersecretion, paragangliomas can be nonfunctional. We report our findings from 5 patients (4 males, 1 female) with paragangliomas. In 4 out of 5 patients the initial presentation was related to the space-occupying effect of the tumour. Episodic s...

Permanent hypoparathyroidism is rare after total thyroidectomy. However, our experience is that often patients remain on alfacalcidol and calcium supplements long-term after thyroidectomy.A study was initiated in our centre in 2004, whereby all patients on alfacalcidol or calcium supplements post thyroidectomy underwent a gradual alfacalcidol and calcium reduction programme. Of 57 patients thus enrolled, we report on 22 who were initially on alfacalcidol...

Thyroid associated orbitopathy affects approximately a third of patients with Graves’ disease. It is responsible for significant symptoms, poor quality of life, and if neglected can cause blindness. Early diagnosis of Graves’ ophthalmopathy is paramount as is early detection of sight-threatening disease. All but the mildest cases are best referred to centres who provide multidisciplinary care and have the experience and expertise on managing this condition. Treatment...

The majority of patients with thyroid eye disease (TED) improve spontaneously without any specific intervention. Some have acute sight-threatening complications and most are left with significant disfigurement. Numerous medical treatments have been tried and most do not work. Steroids and orbital irradiation are helpful in some cases, but neither has a major impact on appearance. All patients with TED deserve consideration for rehabilitative reconstructive surgery. The role of...

Radioidine (RI) has been implicated as an adverse factor causing deterioration of Thyroid-Associated Ophthalmopathy (TAO). Oral steroids administered after RI appear to protect patients' eyes, and this practice is now widespread. Two factors may confound the controversy surrounding the effects of RI on TAO. Firstly hypothyroidism, which is common after RI and is independently detrimental to the eyes, and secondly studying patients who are in different phases of the natural his...

Thyroid nodule is a potential thyroid cancer and hence prompt assessment of all cases is mandatory. Fine needle aspiration (FNA) is a simple and reliable test in the management of thyroid nodule.This is a prospective audit of all new patients with thyroid nodules referred to our endocrine unit in the period between November 2000 to March 2002. 64 patients were identified, 57(89%) of which were females. The mean average age was 49. Thyroid function test w...

High dose intravenous methylprednisolone therapy is used in patients with severe thyroid-associated ophthalmopathy (TAO) and other inflammatory disorders. Although in the short-term it appears to be safe, the acute metabolic effects of this regimen have not been studied in detail.We studied 15 patients with severe TAO, aged 59 ± 10 (mean ± SD) years. One patient was known to have type 2 diabetes. Each patient received 500 mg of iv methyprednisolone daily on t...

IntroductionLeukocyte recruitment is a key feature in (I/R)-induced tissue injury. We have developed and validated a novel method to study molecular mechanisms of leukocyte-endothelium interactions in the colonic microcirculation in vivo by use of inverted intravital fluorescence microscopy.Methods & ResultsIn male C57/BL6 mice the superior mesenteric artery was occluded 30 min and leukocyte rolling and ...

The TSH B/I ratio is normally reduced overnight and is substantially reduced in patients with overt central hypothyroidism due to h-p axis tumours before and after treatment. It is unknown if similar changes in the TSH B/I ratio in the absence of overt central hypothyroidism contribute to the increased TSH levels seen in cancer survivors who undergo h-p axis irradiation. Thus, we selected 9 patients with the highest TSH levels out of a previously reported cohort of 37 euthyroi...