Endocrine Abstracts

The National Service Framework (NSF) for Diabetes requires that type II diabetes patients are actively involved in their diabetes management. The use of patient-held, integrated care plans is envisaged to encourage patients to actively participate in their diabetes management and to facilitate the flow of information between primary and secondary care. However, the utility of such schemes may be limited by the current level of patient education regarding the data recorded in t...

Overt primary adrenocortical failure is preceded by several stages of subclinical hypoadrenocorticolism. Individuals with type 1 diabetes (T1D) or who have other autoimmune conditions are at risk for the development of Autoimmune Addison's disease (AAD). These at risk individuals can be identified by the detection of adrenal autoantibodies (AAb).The aim of this study was two fold: firstly, to evaluate the sensitivity of early morning cortisol: ACTH ratio...

A 26-year-old woman presented with vomiting and cortical blindness. CT scan of the brain confirmed a right-sided parietal-occipital infarct, She subsequently developed seizures and neurological extension resulting in global dysphasia. Serum and CSF lactate were elevated (4.4 and 4.3 mmol/l respectively, NR<1.8). MELAS syndrome was confirmed by mitochondrial DNA analysis, which revealed an A3243G mutation in muscle and serum (85% muscle, 63% urinary epithelial cells and 33%...

It is now well established that unilateral autonomous aldosterone secreting tumour (AST) in contrast to bilateral adrenal hyperplasia (BAH) - are corrected by surgery. The optimal method of pre-operatively defining a unilateral autonomous AST still remains controversial. There is agreement that adrenal scanning techniques are often unreliable or misleading. The aim of the current study was to analyse if a random aldosterone:renin (AR) ratio (after stopping anti-hypertensive me...

The glucagon stimulation test (GST) is used as a provocative test of the hypothalamic pituitary adrenal axis (HPAA) but the response to this test is variable and the mechanism of action remains unclear. The GST has never been studied in diabetic patients with autonomic neuropathy (AN). We illustrate the assessment of cortisol response in two diabetic patients with AN who were suspected of having adrenocortical deficiency. Case one: A 40 year old type 1 diabetic suffers from di...

Thyroid nodules are common in the general population. In 2006, we audited and discovered that primary care direct access to thyroid ultrasound (TUS) has limited value in detecting sinister thyroid pathology. To improve quality of thyroid nodule management, in May 2007, we introduced four changes (1) appointed a thyroid MDT coordinator, (2) produced a thyroid nodule proforma to guide primary care referrals, (3) established the rapid access one-stop thyroid ultrasound FNA clinic...

The National Service Framework (NSF) for Diabetes requires that type II diabetes patients are actively involved in their diabetes management. The use of patient-held, integrated care plans is envisaged to encourage patients to actively participate in their diabetes management and to facilitate the flow of information between primary and secondary care. However, the utility of such schemes may be limited by the current level of patient education regarding the data recorded in t...

Adult-onset Langerhans Cell Histiocytosis (LCH) is a rare disease characterised by the abnormal proliferation of Langerhans cells, and has a distinct phenotype to that of childhood-onset LCH. Diabetes Insipidus (DI) is a well-recognised manifestation of LCH, caused by infiltration of the hypothalamo-pituitary axis (HPA). Anterior pituitary dysfunction is an uncommon complication of LCH, which has been shown to be associated with DI. However, this association has previously onl...

Pre-operative localisation of insulinomas is essential prior to resection. Many imaging modalities have been used. Angiography is well described for localising neuroendocrine tumours and the use of selective intrarterial calcium injection to stimulate insulin release with simultaneous sampling of insulin levels in the hepatic vein has been shown to allow localisation of the tumour to particular vascular territories, even when other modalities have not been helpful.<p class...