Endocrine Abstracts

The interest in replacing testosterone, the most important male hormone, dates to back to antiquity. Ancient Roman and later in the Middle Ages European, Arabic and Chinese physicians prescribed the ingestion of animal testes to restore male virility. Fast forward through an interesting and questionable history of organotherapy that includes various concoctions of questionable sources for xenotransplantation of testes to modern attempts to replace testosterone. Modern testoste...

Ghrelin is a brain-gut peptide originally identified in the stomach. It binds to and stimulates the growth hormone secretagogue receptor type 1a (GHS-R). The presence of ghrelin in hypothalamic tissue was studied. It has been previously established that neither the synthetic GHSs, nor the endogenous hormone ghrelin, is specific for GH stimulation: they generally also stimulate the HPA axis as well as prolactin release. Since there is no direct stimulatory effect on ACTH releas...

Background: The short synacthen test (SST) is commonly used to evaluate the integrity of the hypothalamic–pituitary–adrenal (HPA) axis in children. However, this test is time-consuming, requiring cannulation, several blood samples, and medical observation. Studies in adults have suggested an early morning serum cortisol level could be used to rule out or confirm adrenal insufficiency, reducing reliance on SSTs, however, few studies have evaluated thi...

Background: The Insulin Tolerance Test (ITT) is the gold standard for assessing pituitary function in adults, but used variably in paediatrics due to concerns of serious adverse events. Our aim was to assess the safety of ITT and identify factors associated with the hypoglycaemic response.Methods: We retrospectively collected the following data from patients who underwent ITT (n=122) under Paediatric Endocrinology from 2019-2021: demography, ant...

Introduction: Hydrocortisone is the main treatment for congenital adrenal hyperplasia (CAH) in children. The optimal biochemical monitoring and replacement regimen of these children continues to be debated. We explored variations in blood spot 17α-hydroxyprogesterone (17-OHP) levels.Methods: Single centre retrospective cross-sectional study of children with 21-hydroxylase deficiency aged <18 years. Patients treated with hydrocortisone who had dr...

Introduction: The management of type 1 diabetes (T1D) in young children can be extremely challenging due to high insulin sensitivity, unpredictable eating and activity and difficulty recognizing symptoms of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) therapy is beneficial in managing young children, however the small insulin doses required challenge the accuracy of standard concentration (100 IU/ml) CSII.Case report and literature revi...

Synthetic glucocorticoids bind to the glucocorticoid receptor (GR) and have been used for nearly 70 years to treat inflammatory diseases. However, their use is limited by adverse effects such as diabetes, muscle wasting and osteoporosis. High throughput screening identified a novel non-steroidal scaffold with great potential for chemical optimization. Through rational design we developed the indazole ether series which combines high potency with structural motifs that provide ...

Introduction: Thyroid function tests are frequently undertaken in children with non-specific symptoms suggestive of thyroid dysfunction. Infrequently, susceptibility of automated thyroid hormone assays to interference may generate misleading results, with the potential for inappropriate diagnosis and management. We report an unusual case with apparent subclinical hyperthyroidism, due to negative interference in particular TSH assay platforms, with an underlying genetic basis.<...

Introduction: The hypothalomo-pituitary response to the loss of ovarian function due to ageing is an increase in GnRH induced gonadothropic activity: FSH. It is thought that the pituitary gives maximum endogenous stimulation leading to FSH levels above the ovarian threshold to develop follicular growth and it is a matter of debate whether exogenous FSH (r-FSH) will or will not improve ovarian response. In intrauterine insemination (IUI) treatment r-FSH is used to induce multif...

Introduction: With IVF stimulation a premature pituitary LH surge can ruin the whole procedure. Traditionally prevention of this event is done by administering a GnRH antagonist against endogenous hypothalamic GnRH. The obvious consequence is low LH levels, one of the two gonadotrophines usually not given for ovarian stimulation since for adequate action FSH suffices. However there are indications that LH levels may render too low, in particular in older women. The aim of this...