Endocrine Abstracts

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</...

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...

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...

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...

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...

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...

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 ...

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...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...