Endocrine Abstracts

Objectives: Insulin pumps were introduced in the late 1970s. Their use has continued to grow and the technology has continued to improve along with the development of insulin substrates. They are however a costly therapy, thus NICE recommend pump therapy in the following circumstances; when patients are undergoing regular episodes of severe and sometimes unpredictable episodes of hypoglycaemia, have HbA1c levels over 8.5% despite attempts to lower it, difficult control during ...

Objective: We reported 3 patients with primary aldosteronism who presented at times of high plasma LH, and had somatic CTNNB1 mutations causing ˜100-fold elevation of LHCGR in their APAs (Teo et al. NEJM 2015). Subsequently we identified 4 further patients, but the association with pregnancy was not found by others. Whole exome sequencing (WES) of an APA diagnosed at onset of puberty suggests an explanation.Method: WES of tumour and blood w...

Primary aldosteronism (PA) is the cause of 5–10% of hypertension, surgically curable in patients with unilateral aldosterone-producing adenomas (APAs). However <1% of patients are currently diagnosed and cured. Newer and simpler modalities of diagnosis and treatment are required. The aim of FABULAS (a feasibility study of endoscopic ultrasound-guided ablation as a non-surgical, adrenal sparing treatment for aldosterone-producing adenomas) is to determine in 30 patient...

A 65-year-old Afro-Caribbean gentleman, with a >10-year history of hypertension, frequently recorded blood pressures of >160/80 mmHg. His serum electrolytes showed Na+ 145 mmol/l and K+ 3.2 mmol/l. MRI demonstrated 13 mm left medial-limb adrenal adenoma. His hypertension was uncontrolled on treatment with amlodipine 10 mg OD, spironolactone 50 mg OD, losartan100 mg OD and doxazosin 16 mg OD. Although his quality of life was reduced, and he dislike...

Introduction: Adrenal venous sampling (AVS) is the criterion standard method of lateralisation in primary aldosteronism (PA). Despite this pivotal role, there is limited consensus and significant variability between centres related to many of the technical aspects of AVS. In this study, we sought to address whether variations in two different technical aspects of AVS altered parameters and interpretation, namely: 1. Peripheral sample site 2. Method of adrenal vein (AV) venesec...

Background: After adrenalectomy (ADX) for primary aldosteronism (PA), approximately 30% of patients achieve clinical success (normalisation of home BP); many additional patients report feeling subjectively better. We used the non-randomised MATCH study1 to further assess quality of life (QoL) changes in participants.Objective: Assess QoL using the 36-item Short Form Health Survey (SF-36) after surgical treatment of unilateral PA and medical treatment of ...

Primary aldosteronism (PA) is the potentially curable cause of high-risk hypertension in 5-10% of unselected patients. Diagnosis and lateralisation of PA is challenging and complex. Outcomes post total adrenalectomy, the standard treatment for unilateral aldosterone producing adenomas (APAs), are variable. Between 30-60% are cured (1), but prediction of outcome is unreliable, and some patients are reluctant to have abdominal surgery to remove a whole adrenal gland. Endoscopic ...

Most aldosterone-producing adenomas (APAs) have gain-of-function somatic mutations of ion channels or transporters. However, their frequency in aldosterone-producing cell-clusters of normal adrenals could suggest the existence of co-driver mutations which influence the development or phenotype of APAs [1]. Gain-of-function mutations in both CTNNB1 and the G-protein coupled receptor GNA11 were found by whole exome sequencing in 3/10 APAs. Further sequencing of...

Introduction: Our MATCH study demonstrated 11-C ligand MTO was non-inferior to adrenal vein sampling in predicting surgical outcomes of adrenalectomy in patients with PA. The 20-min half-life of 11-C imposes logistic constraints. We investigated an 18-F ligand, CETO; its 2h half-life permits use in any facility with fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan capability.Objective: To compare the detection of aldosterone-producing ade...

Primary aldosteronism (PA) is considered the sole, often curable, cause of hypertension in 5–10% of patients. Yet there has been only one RCT, and practice has changed little since the advent of CT scanning. Adrenal vein sampling (AVS) and adrenalectomy remain the standard, invasive interventions, leading to a 50% reduction in pill count as the average clinical improvement.Study DesignIn MATCH (Is Metomidate PET-CT superior t...