Endocrine Abstracts

A 62-year-old male was referred by his GP querying acromegaly. His past medical history included sleep apnoea, hypertension, dislipidaemia and gout. Serum IGF1 was elevated at 827 ug/l (normal range 100–300 ug/l). Prolonged oral glucose tolerance did not show suppression of GH with a nadir of 9.0 mu/l. A pituitary MRI demonstrated a 5x6mm microadenoma. There were no visual field defects. The patient was pre-treated with somatostatin analogues and proceeded to transphenoid...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

Mrs SP was a 50-year old patient who presented with typical features of Cushing’s syndrome in 2003 and proceeded to pituitary surgery. Following this she was not cured, and elected to have a bilateral adrenalectomy. Following this, she was initially commenced on hydrocortisone 30 mg daily taken as 15 mg in the morning, 10 mg at noon and 5 mg at 1600 h, and fludrocortisone 100 μg daily. She continued on this for 10 years, but switched her glucocorticoid replacement to...

A 33 year-old male bus driver with long standing pemphigus requiring high dose prednisolone, presented with acromegaly in 2001. MRI pituitary revealed a 2×2×0.5 cm pituitary adenoma and his GH levels of 14.8–16.4 nmo/L throughout and were not suppressible with glucose. His IGF1 was 191 nmol/l (normal range: 13–64 nmol/L), Prolactin 6,557 milliunit/L, testosterone 2 nmol/L and cortisol uninterpretable as he was on prednisolone. Trans-sphenoidal hypophysectom...

Objective: To investigate a selection of novel bone or immunomarkers which may act as indicators for steroid replacement in Adrenal Insufficiency (AI).Introduction: AI is a condition where individuals are not able to produce sufficient steroids for their body’s requirement. Although mortality rates have improved since the introduction of exogenous steroid replacement, this condition is still associated with increased mortality and morbidity. This co...

Alterations in thyroid hormone levels are commonly observed in critical illness with thyroxine replacement remaining a controversial issue. We undertook a prospective observational cohort study in medical intensive care unit of Gauhati Medical College to evaluate whether thyroid hormone levels at admission could be used to predict mortality and compared it to the well established APACHE II scoring system for ICU patients. Serum T3, T4 and TSH were estimat...

Introduction: The understanding and approach to management of DSDs has undergone rapid changes in recent years with focus on early diagnosis followed by disclosure and decision making with family members. However in certain regions specially in developing countries, lack of awareness and the social environment contribute to late diagnosis and problems in management. The present study was done to assess the clinical presentation of DSDs attending an endocrine clinic at a tertia...