Searchable abstracts of presentations at key conferences in endocrinology

ea0086p304 | Adrenal and Cardiovascular | SFEBES2022

Prolonged adrenal suppression does not always need additional glucocorticoid therapy

Narula Kavita , Lararus Kate , Meeran Karim , Tan Tricia

A 53 year old female weighing 117 kg was thought to be slightly cushingoid by her GP who checked a morning cortisol. This was surprisingly undetectable (<28nM) on 13th June 2022. The patient was urgently referred for a medical opinion. A repeat cortisol in A&E was 29nM with an undetectable ACTH. Given the lack of clinical features of adrenal failure, further history was obtained. The patient appeared well on examination, and denied any inhaled, oral/ topical steroid us...

ea0090ep114 | Adrenal and Cardiovascular Endocrinology | ECE2023

The importance of under-treating adrenal failure in order to allow normal adrenal function following unilateral adrenalectomy for Cushing’s syndrome

Narula Kavita , Lazarus Kate , Qureshi Asjid , Palazzo Fausto , Meeran Karim

A 26-year-old woman presented to the Endocrine clinic with features of Cushing’s syndrome (CS). Investigations revealed a non-suppressible cortisol in low dose Dexamethasone suppression test with a suppressed ACTH, and two positive 24-hour urine cortisol collections, indicating CS. CT imaging revealed a left adrenal adenoma of 3.4 cm. Following a left adrenalectomy, she was discharged on once daily Prednisolone 3 mg. She was well for a year except for one occasion where s...

ea0062p13 | Poster Presentations | EU2019

Extensive intracranial calcification in a patient with hypoparathyroidism

Chok Yin Ling , Larsen Niels , Baburaj Rajee , Narula Kavita

Case history: A 74 years old gentleman with no medical illness presented with loss of consciousness in March 2018. CT head did not show acute cortical infarct but there was florid symmetrical calcification involving the basal ganglia, thalami, cerebellar lobes and subcortical white matter within the parietal-occipital lobes bilaterally. Fahr’s disease was suspected and an outpatient MRI was requested.Investigation and Results: 2 weeks later, a routi...

ea0082oc6 | Oral Communications | SFEEU2022

Treatment with Selective RET inhibitors in Medullary Thyroid Cancer – A Case series

Sharma Aditi , Sairam Shwetha , Narula Kavita , Newbold Kate , Di Marco Aimee , Wernig Florian

Case history: A 54-year-old lady was diagnosed with primary hypoparathyroidism in 2005, after being referred by her Rheumatologist as her father and brother had familial hypoparathyroidism and sensorineural deafness. She was followed up in endocrine clinic for management of primary hypoparathyroidism. Her hypocalcaemia is well managed with calcium supplementation, with no specific symptoms of hypocalcaemia. She has recurrent urinary tract infections with known borderline chron...

ea0086p303 | Adrenal and Cardiovascular | SFEBES2022

Prednisone is 100% converted to Prednisolone by first pass metabolism

Chia Eng Pei , Lazarus Kate , Narula Kavita , Choudhury Sirazum , Tan Tricia , Meeran Karim

Prednisolone is widely prescribed in the UK, whereas prednisone is used instead for the same indications in the United States. Both have utility as anti-inflammatory agents and for use as glucocorticoid replacement therapy at lower doses. Oral prednisone is converted to prednisolone by first pass hepatic metabolism by 11 beta HSD-1. This study was undertaken to compare the bioavailability of prednisone against prednisolone. To determine the conversion of prednisone to predniso...

ea0090ep719 | Pituitary and Neuroendocrinology | ECE2023

Polyuria after steroid replacement in a patient with adrenal insufficiency – not always vasopressin deficiency

Narula Kavita , Nyunt Sandhi , Sharma Aditi , Lazarus Kate , Falinska Agnieszka , Russell-Jones David , Meeran Karim

A 54-year-old man with a recurrent non-functioning pituitary gonadotroph adenoma previously treated with transphenoidal surgery (TSS) in 2015, presented to Charing Cross hospital for repeat transsphenoidal surgery in May 2022. Since his initial surgery, he remained on Levothyroxine 50 μg once daily only. There was no evidence of adrenal insufficiency (0900 h cortisol 333 nmol/l at day 6 following initial TSS). In February 2022, his electrolytes, FSH, LH, testosterone, pro...

ea0094p26 | Adrenal and Cardiovascular | SFEBES2023

Withdrawal of glucocorticoid replacement in patients following treatment for Cushing’s: The importance of reassessing the need for long term replacement

Narula Kavita , Lazarus Katharine , Choudhury Sirazum , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...

ea0094p184 | Adrenal and Cardiovascular | SFEBES2023

Prednisolone replacement therapy is associated with significant weight loss in patients who switch from hydrocortisone with adrenal insufficiency

Lazarus Katharine , Choudhury Sirazum , Narula Kavita , Papadopoulou Deborah , Tan Tricia , Meeran Karim

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...

ea0099ep287 | Adrenal and Cardiovascular Endocrinology | ECE2024

Redefining diagnostic cut-offs for the indirect water deprivation test

Akkara Yash , Lazarus Kate , Narula Kavita , Choudhury Sirazum , Papadopoulou Debbie , Martin Niamh , Meeran Karim

Background: The water deprivation test serves as a key diagnostic test to differentiate between Arginine Vasopressin Deficiency (AVP-D), Arginine Vasopressin Resistance (AVP-R), and Psychogenic Polydipsia (PP) in patients presenting with symptoms of polydipsia and polyuria, when common causes such as diabetes mellitus have been excluded. This study evaluated the established diagnostic values for serum osmolality, serum sodium, and urine osmolality.Method...

ea0086p352 | Neuroendocrinology and Pituitary | SFEBES2022

The heart bleeds – complex management of a patient with acromegaly, cardiomyopathy and mechanical mitral valve

Sharma Aditi , Nyunt Sandhi , Narula Kavita , Mitchell Catherine , Mendoza Nigel , Yong Yong , Hatfield Emma , Meeran Karim , Martin Niamh

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...