Endocrine Abstracts

It is less than a decade since the nuclear receptor peroxisome proliferator-activated receptor gamma (PPARg) was first cloned, yet it has become one of the most extensively studied family members, implicated in a wide array of physiological and pathological processes ranging from adipocyte differentiation to lipid trafficking in macrophages and thyroid neoplasia. This receptor is therefore considered a key target for therapeutic modulation, as exemplified by the novel antidiab...

A 39 yr-old female with a past medical history of a non-metastatic ductal breast carcinoma, presented to hospital with a two-week history of vomiting and dizziness. Clinical examination was essentially normal apart from pigmentation of her mastectomy scar, palmar creases and buccal mucosa. Investigations revealed a plasma sodium (Na) 102 mmol/l, potassium 4.9 mmol/l, plasma osmolality 219 mOsm/kg, urine osmolality 173 mOsm/kg and urine Na 36 mmol/kg. She was treated with fluid...

Whilst surgery and external beam radiotherapy remain cornerstones of the management of acromegaly, recent guidelines have emphasised the importance of adjunctive medical therapy [e.g. with somatostatin receptor ligands (SRLs), dopamine agonists, growth hormone (GH) receptor antagonists] in attaining 'safe' GH and insulin like growth factor 1 (IGF-1) levels, especially in patients who are not 'cured' following primary intervention. Several studies have established the efficacy ...

Corepressors and coactivators mediate thyroid hormone receptor-dependent repression and transactivation of positively-regulated target genes respectively, but their role in negative regulation is not understood.A 4 years old boy was born at 31 weeks. He was jittery at birth, with neonatal respiratory distress. Childhood features included poor weight gain, heat intolerance, tachycardia and hyperactivity. Ongoing problems are low frequency hearing loss, po...

A 64-year-old lady presented with weight gain, tiredness, palpitations and tremor. She had no goitre and no other extra thyroidal manifestations. Both TSH and thyroid peroxidase antibodies (>1300) were elevated and she was treated by her GP with Thyroxine 50 mcg daily. She felt a lot worse on this, so it was discontinued and a full thyroid hormone profile was checked (see Table 1) which prompted referral; to Endocrinology.Other pituitary hormone leve...

Background: Insulin resistance (IR) commonly manifests in acromegaly leading to impaired glucose tolerance (IGT) and diabetes mellitus (DM). Studies have shown that ‘control’ of growth hormone (GH) and insulin-like growth factor 1 (IGF1) hypersecretion typically ameliorates glucose homeostasis. However, suppression of beta-cell function by somatostatin analogues may potentially attenuate glycaemic benefits of reduced IR. Effects on insulin’s other pleiotropic ef...

We report a rare case of acute myeloid leukaemia (AML) with high risk cytogenetics and associated hypothalamic diabetes insipidus (HDI).A 48-year-old female presented to her GP with a 3-month history of tiredness and lethargy. Full blood count revealed haemoglobin 7.0 g/dl (MCV 103fl), white cell count 12.1×109/l (neutrophils 1.33×109/l), platelets 91×109/l; circulating blast cells were evident on the perip...

Guidelines for the use of Growth Hormone (GH) replacement in adults with GH deficiency (GHD) were published by the National Institute for Clinical Excellence (NICE) in 2003. We undertook an audit to ensure that patients attending our adult endocrinology clinic were being prescribed GH in accordance with NICE guidelines.Patients commenced on GH replacement between June 2004 and June 2005 were included in the audit. Data was collected from medical notes, a...

Radioiodine (RAI) is widely used for the treatment of thyrotoxicosis. The efficacy and hypothyroidism rate following a single dose of RAI is variable and the optimum administered dose – sufficient to achieve remission but with an acceptable low hypothyroidism rate, is still debated.Our audit sought to compare the results of local practice with published rates of success and hypothyroidism following RAI. We also examined the relationship between trea...

Multiple Endocrine Neoplasia Type 2B is a dominantly inherited disorder characterised by mucosal neuromas, medullary thyroid carcinoma (MTC), phaeochromocytoma, and intestinal ganglioneuromatosis. We report the case of a 34-year-old woman who presented with chronic diarrhoea. She had a longstanding history of gastrointestinal symptoms including diarrhoea since the age of 7 and had been investigated extensively for over 20 years at three different centres, but no definitive dia...