Searchable abstracts of presentations at key conferences in endocrinology

ea0077p3 | Adrenal and Cardiovascular | SFEBES2021

Improving outcomes from SSTS: Redefining Cortisol Cut-Offs

Choudhury Sirazum , Ramadoss Vijay , Lazarus Katharine , Tan Tricia , Meeran Karim

Background: Short Synacthen Tests (SSTs) are integral to the diagnosis of Adrenal Insufficiency (AI). A 30-minute stimulated cortisol value is assessed against local assay dependent thresholds to ascertain or exclude the diagnosis. A diagnosis of AI is a life changing event requiring the initiation of life long glucocorticoid replacement therapy for survival. Glucocorticoid replacement is associated with long term morbidity and mortality, including an increased risk of diabete...

ea0077p19 | Adrenal and Cardiovascular | SFEBES2021

Prednisolone versus Hydrocortisone in Adrenal Insufficiency: A positive and negative control cross-sectional study

Choudhury Sirazum , Lazarus Katharine , Thaventhiran Thilipan , Tan Tricia , Meeran Karim

Background: Management of adrenal insufficiency (AI) with glucocorticoid replacement is associated with increased mortality and morbidity. There is growing evidence that this is because of excess, non-physiological steroid exposure. Low dose prednisolone (2-4 mg) is a once-daily alternative to standard hydrocortisone regimens that more closely mimics the circadian rhythm and may translate to better outcomes. There is however a paucity of studies comparing the two treatments.</...

ea0081p530 | Adrenal and Cardiovascular Endocrinology | ECE2022

Objective markers and new indicators in adrenal insufficiency- findings from the omni-aid study comparing hydrocortisone and prednisolone replacement therapy

Choudhury Sirazum , Thaventhiran Thilipan , Lazarus Katharine , Tan Tricia , Meeran Karim

Background: Adrenal insufficiency (AI) is a life-threatening condition if left unmanaged. Despite treatment patients can expect a life expectancy that is shortened by 12 years secondary to probable inherent over-replacement associated with oral glucocorticoid regimens. Thrice-daily hydrocortisone is the most common regimen used. Very low-dose prednisolone (2-4 mg) is an alternative with lower uptake due to the absence of evidence for its use. This study fills this literature g...

ea0086p161 | Adrenal and Cardiovascular | SFEBES2022

Prednisolone replacement therapy in Adrenal Insufficiency: Defining target ranges and timing for optimum Prednisolone level sampling

Sharma Angelica , Lazarus Katharine , Choudhury Sirazum , Meeran Karim

Introduction: Glucocorticoid replacement in adrenal insufficiency may be achieved by administering thrice- daily hydrocortisone or once-daily very low dose (2-4 mg) prednisolone. Prednisolone’s longer half-life enables once-daily dosing, improving patient satisfaction and compliance. At very low doses, it has shown no difference in most markers of metabolic risk when compared with hydrocortisone. At Imperial College Healthcare NHS Trust (ICHNT), use of an eight-hour troug...

ea0086p162 | Adrenal and Cardiovascular | SFEBES2022

5mg of Prednisolone results in over-replacement in individuals with Adrenal Insufficiency

Sharma Angelica , Lazarus Katharine , Choudhury Sirazum , Meeran Karim

Introduction: Liberal glucocorticoid replacement therapy prevents Addisonian crises in individuals with adrenal insufficiency (AI). Prednisolone is six to eight times more potent than hydrocortisone. There is inter-individual variation in glucocorticoid metabolism wherein 5 mg prednisolone once-daily may result in over-replacement in most individuals, with subsequent long-term morbidity and mortality.Methods: Data from individuals on established predniso...

ea0086p95 | Neuroendocrinology and Pituitary | SFEBES2022

Optimising the Insulin Tolerance Test: Cortisol Thresholds on Abbott Platforms should be lowered to 416 nmol/L

Hayes Annabel , Choudhury Sirazum , Lazarus Katharine , Meeran Karim

Background: Adrenal insufficiency (AI) is a life-threatening condition which requires long term glucocorticoid (GC) replacement. Patient misdiagnosis results in inappropriate GC use, which has significant adverse effects and is associated with an increased mortality risk. The insulin tolerance test (ITT) is the gold standard test for diagnosis, but the widely accepted cut-off value of ≤550 nmol/l used to diagnose AI is founded on outdated immunoassays. Use of this cut-of...

ea0069oc8 | Oral Communications | SFENCC2020

Bones, Moans and Groans: A Calcium Conundrum

Esdaile Harriet , Lazarus Katharine , Saliu David , Sartori Giulia , Qureshi Asjid

Case history: A 51 year old gentleman presented to ED with severe right thigh pain, a 6 month history of weight loss, and 2 weeks of polyuria. He had no medical history and took no regular medications. He worked as a postman, was a non-smoker and non-drinker.Investigations: Bloods showed adjusted calcium of 5.04 mmol/l, parathyroid hormone (PTH) 1.4 pmol/l, and alkaline phosphatase 438 IU/l. Vitamin D was reported one week later as 37 nmol/l. His haemogl...

ea0094p26 | Adrenal and Cardiovascular | SFEBES2023

Withdrawal of glucocorticoid replacement in patients following treatment for Cushing’s: The importance of reassessing the need for long term replacement

Narula Kavita , Lazarus Katharine , Choudhury Sirazum , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...

ea0094p169 | Adrenal and Cardiovascular | SFEBES2023

A comparison of hydrocortisone and prednisolone for the treatment of adrenal insufficiency

Miller Madelaine , Lazarus Katharine , Choudhury Sirazum , Peters Debbie , Tan Tricia , Meeran Karim

Background: Patients with adrenal insufficiency (AI) require glucocorticoid replacement therapy. Current Endocrine Society guidelines recommend thrice-daily hydrocortisone (15-25mg) or once-daily prednisolone (3-5mg). Concerns around prednisolone use have been based on evidence using higher doses. We have been using low-dose (2-4mg) once-daily prednisolone since 2014 for glucocorticoid replacement in adult patients with AI. This study aimed to compare the effe...

ea0094p184 | Adrenal and Cardiovascular | SFEBES2023

Prednisolone replacement therapy is associated with significant weight loss in patients who switch from hydrocortisone with adrenal insufficiency

Lazarus Katharine , Choudhury Sirazum , Narula Kavita , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...