Endocrine Abstracts

The glucocorticoid replacement therapy has been virtually unchanged since the invention of cortisone 60 years ago. Studies in patients with primary adrenal insufficiency have indicated increased mortality and unfavourable metabolic effects such as reduced bone mineral density, and evidence has accumulated that these patients suffer from reduced health-related quality of life (HRQoL). Although these endpoints possibly relate to inappropriate glucocorticoid therapy, the impact o...

Objective: Determine inflammatory and cardiometabolic biomarkers in patients with autonomous cortisol secretion (ACS), compared with healthy controls and patients with overt Cushing syndrome (CS).Method: Serum from prospectively included patients with ACS (n=65), overt CS (n=8), and healthy subjects (n=120) were analysed for 92 different inflammatory biomarkers using proximity extension assay.Results: ACS...

Background: We have previously shown that LC-MS/MS analyses of steroid hormones are superior to immunoassays monitoring 21OHD, due to better specificity and the possibility to multiplexing several steroid hormones in the same assay. This may lead to better understanding of the individual steroid hormone profile in patients with CAH. Here we present four patients cases with the same genotype in the CYP21A2 gene, and evaluate their steroid profile by LC-MS/MS analyses.<...

Background: Primary aldosteronism (PA) patients have increased left ventricular mass (LVM) and increased cardiovascular morbidity compared with those with essential hypertension. Echocardiographic studies have demonstrated that adrenalectomy or spironolactone decreases LVM. The aim of the present study was to use MRI to assess both LVM and cardiac function before and during stress testing, at baseline and after treatment with adrenalectomy or spironolactone, compared with heal...

Background: The Synachten test is used to diagnose for adrenal insufficiency (AI) and non-classical congenital adrenal hyperplasia (CAH). The cut-off levels for s-cortisol and s-17-hydroxyprogesterone are derived from immunoassays that were not well standardized and are no longer in use. Introduction of liquid chromatography tandem mass spectrometry (LCMSMS) could resolve the lack of standardization of steroid hormone assays and enable increased diagnostic accuracy.<p clas...

Objective: Immunoassays of steroids are still used in the diagnosis and biochemical monitoring of patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21 OHD). However, high levels of steroid intermediates can promote cross-reactivity between steroids giving rise to falsely elevated levels.Design: Fifty-nine patients with classic 21OHD (38 women) were studied. Blood samples were collected in the morning after overnight medicatio...

Pituitary and adrenal gland assessment, is one of the most important aspects of the management of a pituitary and adrenal adenoma.Clinical practice varies widely with regard to assessment of pituitary and adrenal status pre- and post-operative. Pre-operative testing includes dynamic testing to assess function which is not practical in the immediate post-operative period. Instead a single morning serum total hormones are measured while a more definitive a...

Background: 1-mg overnight dexamethasone-suppression test (DST) is commonly used to screen for hypercortisolism. Sensitivity is high (95%), but specificity is low (80%), leading to false positive results. Identifying individuals with abnormal dexamethasone absorption or metabolism could enhance diagnostic accuracy.Aim: Use serum dexamethasone (s-DXT) to increase diagnostic accuracy of DST.Methods: Prospective study of DST for clini...

The current conventional glucocorticoid (GC) replacement therapy in primary adrenal insufficiency (Addison’s disease) and congenital adrenal hyperplasia (CAH) renders the cortisol levels unphysiological, resulting in very high levels alternating with almost undetectable levels of cortisol over the day. This reduces not merely the patient’s quality of life but increases the patient’s morbidity and mortality. The HPA axis is characterised by a dynamic circadian va...

Background: Conventional glucocorticoid replacement therapies result in unphysiological variation in plasma cortisol levels; concern has been raised regarding long-term metabolic consequences. Glucocorticoid replacement is technically feasible by continuous subcutaneous hydrocortisone infusion (CSHI), which can mimic the normal diurnal cortisol rhythm. The aim of this study was to compare insulin sensitivity in patients with Addison’s disease (AD) on CSHI vs three daily d...