Endocrine Abstracts

Some 50 years on from the originally published description of gestational diabetes mellitus, debates continues as to the significance of minor degrees of glucose intolerance for maternal/fetal outcome. Confusion has been compounded by different diagnostic practices and the likelihood that there is a continuum of risk. A fundamental lack of robust evidence is reflected in the lack of consensus among published guidelines. The picture has been further complicated by the current s...

Background: A re-emergence of mild iodine deficiency in the United Kingdom (UK) has been reported. A recent UK study suggested a dose dependent relationship between mild maternal deficiency and a number of childhood cognitive scores. The World Health Organisation defines sufficiency in a population as a median urinary iodine concentration (UIC) of ≥100 μg/l in non-pregnant women and infants and ≥150 μg/l during pregnancy. It also recommends a daily intake...

Pneumocystis jirovecii pneumonia (PJP) is well recognised in HIV infected and transplant recipient populations and prophylaxis is standard practice. PJP may also occur in rarer cases of immunodeficiency. We report 2 cases of Cushing’s syndrome complicated by PJP. Patient 1 was a 30 year old Indian male who presented with 2 weeks of bloody diarrhoea, abdominal pain and lethargy. He was cushingoid and investigations showed severe hypercortisolism (urinary cortisol >266,...

We measured chromogranin A (CgA) and chromogranin B (CgB) in 36 patients, recently confirmed to have a midgut carcinoid tumour (MGC), prior to the commencement of octreotide treatment. Blood samples were taken before and after a bolus injection of 50 μg octreotide. There were 21 males, 15 females, age range 28–76 median 61 years.Basal CgA, expressed as times the upper limit of normal (ULN) ranged from 333.3 to 0.5 ULN. Basal CgB ranged from 33....

There is limited evidence on the effect of potassium (K+) supplementation on endothelial function. Three studies suggest a beneficial effect in healthy volunteers and mild hypertensives. However potassium increases aldosterone due to a direct effect on the adrenal gland and there is evidence that aldosterone excess is detrimental to cardiovascular health. We therefore aimed to determine the effect of potassium supplementation on endothelial function in patients with...

Aberrant and upregulated eutopic receptors have been identified in vitro in patients with primary aldosteronism (PA). We previously identified an exaggerated aldosterone response to synacthen in patients with PA versus healthy controls. In this study we aimed to evaluate whether the synacthen test differentiates between patients with PA and essential hypertension (EH). The 250 mcg intramuscular synacthen test was performed after 30 minutes recumbency in the morning and off int...

Before the use of potent acid suppressing drugs and in particular proton pump inhibiters (PPI), most patients with gastrinoma presented with Zollinger–Ellison syndrome and diagnosis was problematic in only a few. In recent years, the syndrome is rarely seen and gastrinoma patients present with less overt symptoms and hypergastrinaemia which may be mild. Increasingly patients present later.In the population, hypergastrinaemia most commonly occurs bec...

This 52-year-old lady presented in 2001 at a GI clinic complaining of occasional abdominal cramps, which could be severe and prolonged. Her symptoms were not associated with diarrhoea or constipation. Weight loss of 4.5 kg over 4 months was noted. Coeliac disease was excluded and a diagnosis of severe irritable bowel was made.In January 2002 she returned to the clinic with further weight loss (total 8 kg), cyclical symptoms of diarrhoea lasting 3–5 ...

We present a 66 year old man with a metastatic small bowel neuroendocrine tumour managed with resection of primary in 2011 and subsequent somatostatin analogue therapy. In 2018 disease progressed requiring right ureteric stenting due to extrinsic nodal compression. Three weeks later he presented with sweats, pyrexia and elevated inflammatory markers. Multiple blood and urinary cultures were clear. CT imaging, MRI spine and echocardiogram did not identify a source of sepsis. Ur...

Nocturnal salivary cortisol (NSC), urinary free cortisol (UFC) and overnight dexamethasone suppression testing (ODS) are recommended screening tests for Cushing’s syndrome (CS). Individual centers differ in their screening approach; UFC being the test of choice in Northern Ireland with ODS in patients with adrenal incidentalomas. NSC, which measures free cortisol, is not routinely used. The aims of this study were to 1. Evaluate the utility of NSC in the diagnosis of CS; ...