Endocrine Abstracts

Introduction: In a recent 16-week Phase II study in patients with de novo, persistent or recurrent acromegaly, pasireotide effectively controlled GH and/or IGF-I levels in 56% of patients, and reduced tumor volume by >20% in 39% of patients. We present preliminary 6-month results from the ongoing extension phase of this study.Methods: This extension study enrolled patients who achieved biochemical control (GH ≤2.5 μg/l and normalize...

Children diagnosed with either Growth Hormone deficiency (GHD) or Turner syndrome (TS) are both treated with GH titrated against either weight or area. The response to such treatment however, is highly variable and, at least in part, diagnosis dependent. The precise mechanisms underlying this variability are unknown. As basal GH levels differ between GHD and TS and, as GH elicits its effects through changes in gene expression, the basal gene expression profiles of GHD and TS s...

A 30-year-old woman with long standing type 1 diabetes presented with recurrent severe hypoglycaemia. One month earlier she had given birth to her first child. Before pregnancy her HbA1c had been 7.8 to 9.2 percent (RR 3.1 to 5.0 percent) but improved by the third trimester to 6.8 percent. Before pregnancy her total daily insulin dose was 50 units and by the third trimester it had only increased by 25 percent to 60 units. The pregnancy and birth were uneventful with no hypogly...

A 22 years old woman presented with a few days history of nausea, vomiting and general lethargy. She was not on any treatment except the oral contraceptive pill (OCP). She was apyrexial, tachycardic at 140/min with a regular pulse and her blood pressure was 110/70. She was not pigmented. Her plasma sodium was 131 mmol/l, with normal potassium, creatinine and urea. Her arterial blood gas analysis showed a pH of 7.22 and bicarbonate of 12mmol/L. Her TFTs showed a thyrotoxic pict...

11β-Hydroxysteroid dehydrogenase type one (11β-HSD1) converts inert glucocorticoids to active forms, amplifying intracellular glucocorticoid action. 11β-HSD1 also catalyses the reduction of seven-ketocholesterol (7KC) to 7β-hydroxycholesterol (7βHC). 7KC may inhibit cholesterol biosynthesis (Brown et al. 2002). Alteration of cholesterol homeostasis is a major atherosclerotic risk factor. 11β-HSD1 deficiency/inhibition is atheroprotective ...

A 34-year-old woman was referred by her GP in 2000 with thyrotoxicosis (TSH undetectable, free T4 36.4 pica moles per litre, reference range 10-25). She had no ophthalmic symptoms or signs and no goitre. There was no family history of thyroid disease. Her thyroid peroxidase antibodies were undetectable but thyrotropin-binding inhibitory immunoglobulin was 30 (Reference range 0-15) confirming Graves' disease. Carbimazole was initiated but changed to propylthiouracil after a pre...

A 54-year-old man with long standing coeliac disease and moderate dietary compliance was admitted with lethargy and feeling unwell. His blood pressure was 129 mmHg systolic, 91mmHg diastolic and serum sodium 112 millimoles per litre (RR 136 to 145). He was otherwise well with normal visual fields. A 250-microgram Synacthen test demonstrated a basal cortisol of 630 nanomoles per litre rising to 983 nanomoles per litre after 30 minutes. His TSH was undetectable, Ft4 9.6 picomole...

A 77 year old man developed a severe progressive polyneuropathy associated with significant disability. He was also found to have type 2 diabetes mellitus and antibody-negative primary hypothyroidism and was treated with gliclazide and thyroxine to good effect. Nerve conduction studies showed a demyelinating type neuropathy that was not typical of diabetic neuropathy. Two years later he was admitted with an episode of severe hypoglycaemia accompanied by low blood pressure, hyp...

A 42 year old gentleman presented for a second opinion regarding management of Congenital Adrenal Hyperplasia (CAH) of the salt losing variety. The patient had been under long term follow up elsewhere but had discontinued his medication of his own accord 14 months prior to seeking consultation. Examination revealed a heavily pigmented male patient with protuberant belly. He had easily palpable masses in both flanks. An abdominal CT showed bilateral massive adrenal enlargement ...

An 18 year old young man was first seen in the ENT department with bilateral swelling of the supraclavicular fossae. A clinical diagnosis of Cushing's syndrome was made and the patient was referred to the Endocrine team. Examination showed a BP of 150/100 and clinical features of gross Cushing's syndrome. Initial investigations revealed normal electrolytes, fT4 8.7 pmol/L, TSH 0.69 mIU/L and a basal prolactin of 68280 mIU/ml. A 24 hr urinary free cortisol (UFC) was 3860 nmol/L...