Searchable abstracts of presentations at key conferences in endocrinology

ea0094p129 | Thyroid | SFEBES2023

A case for caution: Paediatric reference intervals for thyroid function tests

Chipchase Allison

Background: Thyroid stimulating hormone (TSH) and free T4 (fT4) were requested on a neonate, on Day 1 after birth. fT4 was flagged as below range, TSH was insufficient for analysis. Day 5-8 newborn bloodspot screening flagged a high TSH, hypothyroidism was confirmed, and thyroxine treatment commenced. Internal investigation into the incident, and the potential impact on the baby of delayed onset of treatment, raised the question of the relevance of our referen...

ea0086p8 | Adrenal and Cardiovascular | SFEBES2022

Gender-Related Analytical Bias in Biochemistry - Under-Recovery in a Serum Cortisol Immunoassay

Chipchase Allison , Hall Sebastian

Background: The displacement of cortisol from its binding globulin (CBG) in the Abbott Alinity immunoassay assumes an average concentration of CBG in all individuals. Displacement buffer volume, and/or composition, is frequently insufficient to displace cortisol where higher concentrations of CBG are present (e.g. with higher oestrogen concentrations). To address this bias, the Eastern Pathology Alliance (EPA) introduced a 1:2 dilution step on all serum cortisol specimens in D...

ea0082wc5 | Workshop C: Disorders of the thyroid gland | SFEEU2022

Two case reports of suspected thyroid assay interference

Miler Emma , Chipchase Allison , Ahluwalia Rupa

Case 1: A 17-year-old female was referred to the endocrinology outpatients due to abnormal thyroid function tests (TFTs) (as below) detected on routine monitoring for Thyroxine replacement therapy. Following exclusion of pregnancy, possibilities of assay interference due to heterophilic antibodies as well as thyroid hormone resistance were considered. Repeat analysis was arranged at two laboratories using different methods. Results were concordant, excluding assay interference...

ea0086p245 | Neuroendocrinology and Pituitary | SFEBES2022

An investigation into discrepancies between serum insulin-like growth factor 1 (IGF-1) concentrations and clinical presentation in the assessment of acromegaly

Miler Emma , McMurray Susanne , McArdle Nicholas , Ahluwalia Rupa , Chipchase Allison

Background: The suitability of serum insulin-like growth factor 1 (IGF-1) reference ranges (RR) used locally (manufacturer-derived), were raised as a clinical concern. IGF-1 levels above the RR were reported in patients displaying no clinical signs or symptoms of acromegaly, and in whom growth hormone suppression tests were negative. No analytical issue was evident, and quality performance indicators were satisfactory.Methods: A review of all serum IGF-1...

ea0094p118 | Reproductive Endocrinology | SFEBES2023

An audit of elevated serum testosterone in females with discrepant results

Miler Emma , Tam Trevor , Amjad Wajiha , Ahluwalia Rupa , Chipchase Allison

Background: While investigating hyperandrogenism in women, local laboratory policy dictates adult females with a serum testosterone of >3.5 nmol/l should be confirmed with an alternative method to exclude interference by cross-reacting substances. Patients who were on testosterone replacement or had a previous result in the same year were excluded. We explore the biochemical investigation of discrepant testosterone in females.<strong...

ea0077oc5.3 | Bone and Calcium | SFEBES2021

Role of Intact and C-Terminal FGF-23 Assays in the Investigation of Metabolic Bone Disease.

Jethwa Kishan , Bhatti Sumbal , Chipchase Allison , Piec Isabelle , Fraser William , Turner Jeremy

Fibroblast growth factor 23 (FGF-23) is a phosphatonin produced by osteocytes in response to serum phosphate concentration. Immunoassays are widely employed to detect C-terminal fragments of FGF-23 (cFGF-23). Quantitative assays for intact FGF-23 (iFGF-23) measurement are also available. Causes of increased FGF-23 include Tumour Induced Osteomalacia (TIO), X-linked hypophosphataemic rickets (XLH) and end stage renal disease (ESRD). We observed that some individuals, with no id...

ea0044p61 | Bone and Calcium | SFEBES2016

FGF23, iron and vitamin D metabolism in chronic kidney disease

Piec Isabelle , Chipchase Allison , Nicholls Holly , Tang Jonathan , Washbourne Christopher , Fraser William D

Introduction: In CKD, net effects of declining kidney function and increasing FGF23 (and PTH) concentrations on vitamin D catabolism and iron metabolism are not clear.Objectives: Compare the Biomedica to the Immutopics’ immunoassay for measurement of cFGF23. Determine the relationship between iron status; vitamin D and intact FGF23 (iFGF23) and c-terminal (cFGF23) concentrations in blood.Method: Samples from routine care and a...

ea0059p024 | Adrenal and steroids | SFEBES2018

Current management of adrenal incidentalomas- a United Kingdom single centre experience

Allsop Daniel , Burgess Neil , Saada Janak , Ahluwalia Rupa , Chipchase Allison , Myint KhinSwe

Background: Adrenal incidentalomas (AI) are asymptomatic adrenal lesions found on imaging not primarily performed to detect adrenal disease. We conducted a retrospective audit of management of AI following European Society of Endocrinology recommendation (2016).Methods: This was a retrospective review of incidentaloma referrals over 9 months (June 2017–March 2018). Cases were identified using criterion search of the referral console. Additional data...

ea0059p029 | Adrenal and steroids | SFEBES2018

Management outcome of phaeochromocytoma over 10 years (2008–2018) in a Tertiary Centre, UK

Waife Eunice , Gaur Smriti , Burgess Neil , O'Hare Debbie , Saada Janak , Chipchase Allison , Swords Francesca , Myint KhinSwe

Introduction: Pheochromocytomas (adrenal and extra- adrenal/Paragangliomas) are rare catecholamine producing tumors and required complex dedicated MDTintervention. We preliminarily reported our service in a tertiary referral centre over 10 years (2008–2018).Method: A retrospectively review of confirmed phaeochromocytoma were carried out by reviewing clinical correspondences and ICE investigation-result system (laboratory, radiology and histology.)</...

ea0094op6.2 | Bone and Calcium | SFEBES2023

Measuring FGF23 in patients treated with burosumab

Piec Isabelle , Chipchase Allison , Miler Emma , Ramachandran Hari , Webb Emma , Fraser William D

Burosumab has become available as a treatment for children with X-linked hypophosphatemia (XLH) and is a recombinant fully human IgG1 against FGF23. By binding to the active FGF23, burosumab inhibits its effect and symptoms (growth retardation, rickets, enthesiopathy, low phosphate) may improve, however, not in all children. Concomitantly paediatricians are keen to measure FGF23, in treated children, to avoid overtreatment with burosumab, associated with potential calcificatio...