Searchable abstracts of presentations at key conferences in endocrinology

ea0086hdi2.1 | How do I...? 2 | SFEBES2022

Outstanding clinical practioner award: how do i wean patients who have had pituitary or adrenal cushings syndrome off glucocorticoids once they are in remission?

Meeran Karim

Following pituitary or adrenal surgery, an undetectable morning cortisol suggests remission, and the patient needs to be discharged on replacement glucocorticoid, either thrice-daily hydrocortisone (commonly 10mg in the morning, 5 mg at noon and 2.5mg at 4pm) or once-daily prednisolone (commonly 3mg to 4mg)1. Low-dose once-daily prednisolone is seven times more potent than hydrocortisone2. Weaning prednisolone is easier than weaning hydrocortisone3</...

ea0086hdi2.2 | How do I...? 2 | SFEBES2022

Outstanding clinical practioner award: how do i rationalise withdrawal of liothyronine (T3) in a symptomatic tired, depressed and vulnerable patient with chronic fatigue syndrome or long COVID who may or may not have hypothyroidism?

Meeran Karim

Patients on thyroxine have lower psychological well-being than controls using the GHQ12 questionnaire, which gives patients a score between 0 (very happy and well) and 36 (profoundly exhausted and feeling worthless). Average GHQ was 11.39 in controls and 12.09 in patients optimised on thyroxine(P=0.028)1. Liothyronine has a large and sustained placebo effect with the GHQ improving from 13.5 to 11.0 in the WATTS study2. This placebo effect needs c...

ea0044fut1.1 | Futures 1: My future career in endocrinology? | SFEBES2016

This house believes that prednisolone should be the first line for glucocorticoid replacement in adrenal insufficiency: The case FOR…

Meeran Karim

Natural hormones are continuously secreted and metabolised and thus have a short half-life. When administered exogenously, either the natural hormone needs to be administered often, or analogues with longer half-lives are given. For insulin, slow release (zinc suspensions) have been used, and more recently, the molecule has been extensively modified to give longer lasting insulins. Similarly, hydrocortisone can be given as a slow release or modified release preparation, or the...

ea0034ew1.1 | Teaching and learning in Endocrinology | SFEBES2014

Endocrinologists as teachers: integrating teaching and practice in the real world

Meeran Karim

Endocrinologists are ideal teachers of physiology and biochemistry, major aspects of the underpinning of the science behind clinical practice. There are many methods that are successful in imparting this core knowledge to our medical students. Patients with endocrine disease also display symptoms and signs that that give clues to diagnoses, and the subject is ideal to serve as a broad general medical education.Evidence that teachers are effective comes f...

ea0034n1.1 | Cushing's Syndrome | SFEBES2014

Investigating and diagnosing Cushing’s syndrome: not as straightforward as it seems?

Meeran Karim

Cushing’s syndrome is rare at about 20 per million of population each year. Patients with Cushing’s syndrome complain of increased weight, high blood pressure and diabetes. Obesity not caused by Cushing’s is becoming very much more common, and obesity itself can also cause high blood pressure and diabetes. Distinguishing common simple obesity from rare Cushing’s disease can be difficult. Patients with simple obesity are now able to surf the internet, and fi...

ea0028mte3 | (1) | SFEBES2012

Preventing and managing long term complications of acromegaly

Meeran Karim

The treatment of Acromegaly includes radiotherapy, surgery, and medical treatment to reduce GH levels. The aim of treatment is to reduce GH levels to a “safe” level. The secretion of GH in normal individuals is pulsatile, so that most normal people have concentrations of GH close to zero for most of the time, with concentrations rising to about 6 ng/ml three or ten times per day (approx 20 mU/l). The height and frequency of these GH peaks is variable. However because...

ea0059p132 | Neuroendocrinology and pituitary | SFEBES2018

Cannulated prolactin is useful to confirm hyperprolactinemia and to minimize inappropriate imaging

Almazrouei Raya , Meeran Karim

Background: Current Endocrine Society guideline recommends a single prolactin level to confirm the diagnosis of hyperprolactinemia. This may lead to over diagnosis and inappropriate imaging. Our institution protocol is to repeat the prolactin and measure macroprolactin. If the second prolactin is elevated, then a cannulated prolactin to role out venipuncture stress effect is undertaken.Methods: Data were collected for 49 patients between January 2017 to ...

ea0059ep86 | Neuroendocrinology and pituitary | SFEBES2018

Sheehan’s syndrome in a man

Almazrouei Raya , Meeran Karim

Background: The blood supply of the pituitary gland comes via a portal circulation from the hypothalamus. During pregnancy, the anterior pituitary gland enlarges but the blood supply cannot increase, as it is derived from a capillary plexus. The pituitary is thus vulnerable to arterial pressure changes and infarction secondary to hypotension. We describe a case of a male patient with large pituitary adenoma who developed Sheehan’s like syndrome due to adenoma infarction s...

ea0094p75 | Metabolism, Obesity and Diabetes | SFEBES2023

Severe non-diabetic hypoglycemia unawareness, explained by a large fibrous tumor

Alshamsi Shamma , Meeran Karim

Background: Hypoglycaemia unawareness is thought to be due to very tight control of diabetes but may also be due to very longstanding slowly progressive hypoglycaemia. We describe a patient who had no warning of very severe hypoinsulinaemic hypoglycaemia.Case Presentation: A 65-year-old gentleman presented with recurrent hypoglycemia that responded to IV glucose. A chest X-ray revealed a space occupying lesion and furthe...

ea00100we2.3 | Workshop E: Disorders of the gonads | SFEEU2024

Follicular harmony: triumph over hirsutism with the symphonic intervention of gnrh antagonists

Mohamed Einas , Meeran Karim

Gonadotropin-releasing hormone (GnRH) antagonists, primarily used in prostate cancer treatment, have found application in androgen-secreting ovarian tumors. Among these, degarelix, a pure GnRH antagonist was found to rapidly suppress testosterone levels within 24 h. Testosterone fell from 14 nM to 1.5 nM within 24 h and to less than 1 nM within 48 h. A 77-year-old woman presented with hirsutism and voice deepening over the past few months. Elevated serum testosterone levels wi...