Endocrine Abstracts

The Endocrine Society recommends urinary or plasma metanephrines as first choice screening tests for phaeochromocytoma due to their high sensitivity. Test specificity is limited by the influence of many commonly prescribed medications resulting in false positive results and additional investigations. The aims of this retrospective study were to (1) Determine the diagnostic accuracy of urinary metanephrines using current cut-off values and (2) Evaluat...

The Endocrine Society recommends urinary or plasma metanephrines as first choice screening tests for phaeochromocytoma due to their high sensitivity. Test specificity is limited by the influence of many commonly prescribed medications resulting in false positive results and additional investigations. The aims of this retrospective study were to (1) Determine the diagnostic accuracy of urinary metanephrines using current cut-off values and (2) Evaluat...

Case history: A 47 year old male presented to his GP with non-specific symptoms of fatigue and weight gain. Thyroid function tests revealed elevated TSH (28.4 mU/l) with normal Free T4 (14.3 pmol/l). Anti-TPO antibodies were undetectable. A presumptive diagnosis of subclinical hypothyroidism was made and he was commenced on Levothyroxine which was titrated over 9 months to 150 mcg/d given a persistently elevated TSH. The patient was unable to tolerate this dose due to the deve...

Cyclical Cushing’s syndrome is typically detected by collecting sequential daily early morning urine (EMU) samples for cortisol to creatinine ratio over a 28 day period. More recently nocturnal salivary cortisol (NSC) measurement has been shown to be a sensitive means of screening for Cushing’s syndrome. The Endocrine Society have suggested that NSC may be used to assess patients for cyclical Cushing’s however there is limited evidence that it correlates with th...

First line screening for pheochromocytoma, as recommend by Endocrine Society guidelines, is to determine plasma free or urinary fractionated metanephrines. We routinely offer the latter. Although negative results rule out pheochromocytoma, it is not uncommon to see borderline results which require further investigation. In this situation we have historically relied on the measurement of plasma catecholamines in the clonidine suppression test (CST). Plasma metanephrines, howeve...

In Northern Ireland hypopaks (contains samples for glucose, lactate, hydroxybutyrate, insulin, growth hormone (GH), cortisol, amino acids, organic acids and acylcarnitines) are used to investigate hypoglycaemia in children. We aimed to assess the appropriateness of hypopak requests, to determine their usefulness in diagnosing endocrine and metabolic conditions and to determine if GH is helpful. Data for hypopaks received between 01 April 17 and 31 March 18 was analysed. Hypopa...

Introduction: When hypoglycaemia (blood glucose <2.6 mmol/l) is detected in a child a ‘Hypopak’ is sent, which tests for blood glucose, lactate, hydroxybutyrate, insulin, growth hormone, cortisol, amino acids, acylcarnitines, and urine organic acids. We aimed to determine whether samples were sent appropriately and completely, and whether a diagnosis ensued.Methods: All Hypopak samples received by the laboratory between 1/4/17 and 31/3/18 w...

The Endocrine Society guidelines recommend initial testing for Cushing’s syndrome (CS) can be based on non-invasive late-night salivary cortisol measurement (NSC). In the BHSCT NSC (11pm), measured using the IBL ELISA kit has been found to be highly discriminative in identifying patients with CS. However it is a labour intensive test and the need for analysing samples in batches delays turnaround time, limiting its use in the routine work-up for CS. Roche provide an autom...