Endocrine Abstracts

A 40-year-old woman was admitted for investigation of severe fatigue, abdominal pain, anorexia and myalgia over the preceding year. Past medical history included vitiligo, coeliac disease and depression. Initial investigations revealed hyperkalaemia, normocytic anaemia and hypercalcaemia with an inappropriately normal parathyroid hormone level. Low TSH with normal free T4 and T3 (0.02 milliunits per litre, 17.1 picomoles per litre and 6.3 picomoles per litre respectively) were...

Abstract for Society for Endocrinology Conference 2003Category: Clinical case report (Young Endocrinologist)AbstractTitle: A CASE OF HYPERTHYROIDISM PRESENTING AS HAEMATOLOGICAL MALIGNANCYAuthors: K.M. Evans, D.E. Flanagan; Dept. of Endocrinology and Diabetes, Derriford Hospital, Plymouth, PL6 8DHA 30 yr old man was referred to the Haematology department with axil...

Introduction: The insulin stress test (IST) used to assess the hypothalamic–pituitary–adrenal (HPA) and growth hormone axes requires blood glucose to fall below 2.5 mmol/l. This level of hypoglycaemia is considered safe for selected patients but blood glucose levels below this are associated with increasing risk. We reviewed the depth and length of hypoglycaemia in a cohort of patients undergoing IST.Method: Between October 2004 and 2008, 138 I...

Graves' disease appears to be the clinical result of an autoimmune attack on thyroid tissue however the immune defect and triggering events remain unclear. The inflammatory process in multiple sclerosis (MS) is mediated by CD4 T lymphocytes. Campath-1H, a monoclonal antibody against the CD52 antigen of CD4 T cells, improves disease activity in MS and is associated with development of Graves' disease in one-third of patients. Thus Campath-1H provides an interesting insight into...

Background: Stress-related illness is commonly referred to the endocrine clinic, and often becomes a diagnosis of exclusion after extensive investigation. We provide evidence that a positive clinical diagnosis can be made without risk of missing organic illness.Methods: 101 consecutive and unselected referrals for ‘fatigue ?endocrine’ between 1/4/95 and 30/3/99 were identified from an endocrine clinic database (81 female, 20 male; mean age 41...

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...

Classical congenital adrenal hyperplasia (CAH) usually presents at birth with ambiguous genitalia or adrenal failure. Non-classical forms can present later with precocious puberty or may only present, in early adult life, with hyperandrogenism and amenorrhoea.An 86 year old lady presented with a toxic confusional state, male pattern balding and hirsuitism. Little history was available. The provisional diagnosis was an androgen secreting tumour, however, a history taken fro...

The cortisol day curve has been advocated in the assessment of glucocorticoid replacement therapy in adrenal failure but remains controversial.Objective: To determine the validity of this test within our practice.Method: A retrospective analysis using endocrine laboratory dataset.Results: 102 inpatient cortisol day curves from 76 patients were analysed. The serum cortisol was checked at 5 time points (pre and 1 hour post morning dose, before midday dose, pre and po...

Ghrelin is a novel peptide that acts on the growth hormone segratagogue receptor in the pituitary and hypothalamus. It functions as a third physiological regulator of GH secretion along with GHRH and somatostatin. In addition to the action of ghrelin on the GH axis it appears to have a role in the determination of energy homeostasis. Whilst feeding suppresses ghrelin production and fasting stimulates ghrelin release the underlying mechanisms controlling this process remain unc...

Leptin is a crucial hormone in the regulation of body weight. It is produced by adipose tissue and acts centrally decreasing appetite and increasing energy expenditure. Leptin has been shown to stimulate sympathetic nervous system activity in vitro although the physiological relevance of this remains unclear. Increased sympathetic nervous system (SNS) activity has been implicated in the pathogenesis of insulin resistance and a greatly increased cardiovascular risk. We have the...