Endocrine Abstracts

The hypothalamo-pituitary-adrenal (HPA) axis is essential component of the physiological stress response. Functional hypoadrenalism is a hypothetical contributor to mortality in the critically ill, though biochemical evidence for this is conflicting. Most studies have shown that 'high' random plasma cortisol in the first 24 hours of illness is associated with a high mortality. However, these data may be confounded by increased severity of illness in high mortality cohorts. Giv...

A gender-related bias in survival rates has been demonstrated in rodent models of critical illness. Sex steroids have differential effects on metabolic, immune and cardiovascular end points which may underlie these observations. The hypothalamo-pituitary-gonadal (HPG) axis response to critical illness in humans is poorly characterised. We have conducted a prospective study to characterise this response in the context of heterogeneous disease severity and disturbances in overal...

Maternal thyroxine (T4) deficiency is associated with adverse outcome for mother and infant such that selective screening has been advocated. Thyroid hormone production increases in pregnancy, T4-dependent patients requiring increased treatment. To highlight aspects of current service delivery and guide service development, we audited management of pregnant women requiring T4 in our city over one year.Cases were identified retrospectively through a data...

Since the observation in 1961, that phenytoin treatment caused a reduction in protein bound iodine, the effect of various anticonvulsants on the thyroid hormones and in causing sub clinical and overt hypothyroidism has been a matter of debate. There are no reports linking newer antiepileptics like lamotrignine to thyroid hormone abnormalities. We report three patients who developed overt hypothyroidism while on treatment with Primidone, Lamotrignine and Carbamazepine respectiv...

Familial hypopituitarism is a heterogeneous group of disorders with variable clinical, biochemical and genetic characteristics. X-linked forms have been described in rare kindreds, though clinical and molecular features are not well defined. We present a case of X-linked hypopituitarism in a young male.The patient, currently 39 years, had an early course complicated by neonatal jaundice, seizures and subsequent failure to thrive. Hypothyroidism was diagn...

Growth Hormone (GH) deficiency in the adult is associated with sub-optimal bone mineral density (BMD) and reduced bone turnover. GH replacement therapy results in increased bone turnover and new bone formation with biphasic changes in BMD: We report a case in which the anabolic effects of GH on bone precipitated profound Vitamin D (Vit D) deficiency.The patient 56-year-old man with panhypopituitarism following treatment for acromegaly commenced adult GH ...

An ovo-testis (a gonad showing aspects of both ovarian and testicular function) occurs in some 60% of true hermaphrodites. They may be located in the labio-scrotal folds, inguinal canal or abdomen and are often removed prior to or shortly after the onset of puberty. Though the potential for ovulatory function within such a gonad is acknowledged, it is rarely witnessed and there are few detailed descriptions of the phenomenon. We describe serial observations of this process in ...

Background: Sotos syndrome is an uncommon condition characterised by rapid growth, large body size and acromegaloid facies.There is limited data on metabolic abnormalities in Sotos syndrome.Aims: We investigated insulin sensitivity and secretion rates in a 22 year old girl with Sotos syndrome, prompted by the observation of a flat glucose response after an oral glucose challenge.Methods: Glucose tolerance was assessed with a 75g 2-h oral glucose tolerance test (OGTT), ...

Polycystic ovarian syndrome (PCOS) is the commonest cause of hyperandrogenism in women. Severe hyperandrogenism or virilisation, however, suggest the need to consider rarer causes e.g. Cushing's, congenital adrenal hyperplasia and androgen-secreting tumours. Here we present a case of PCOS where the remarkable response of severe hyperandrogenism with polycythaemia to metformin excluded these rarer causes without the need for complex or invasive investigation.<p class="abste...

Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH). Retrospective data suggests that the Syndrome of Inappropriate Antidiuresis (SIAD) is the most common cause, although glucocorticoid deficiency and rarely cerebral salt wasting may also cause hyponatraemia.We prospectively studied 100 patients (61% female, median age 53 (range 16–82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (p...