Endocrine Abstracts

Continuous Glucose Monitoring and Flash Glucose Sensing are exciting new technologies popular with many patients and their parents who are keen to have access to such technologies. However such technologies are costly and it is important that clinicians identify patients who are most likely to benefit and ensure that families have appropriate training in order to optimise their use. The aims of this overview are firstly to review the evidence underpinning CGMS and to discuss t...

Background: Non-type 1 diabetes mellitus (T1DM) and T2DM accounts for up to 4% of cases of paediatric diabetes. The most common form is maturity-onset diabetes of the young, however rarer forms exist.This case highlights a number of important points to be considered when investigating patients with ketoacidosis that is not typical of T1DM. An understanding of the ketogenic pathway and knowledge of differential diagnoses for ketoacidosis and their appropr...

Background: Peutz Jegher’s syndrome is a rare condition with substantial cancer risk. Testicular cancer risk is 9%, the commonest being pre-pubertal large cell Sertoli cell tumour (LCST) which usually presents with bilateral gynecomastia. Here we present a case of Peutz Jegher’s syndrome with LCST who presented with unilateral gynecomastia.Case: A 5-year-old boy was referred to our endocrine service with unilateral gynecomastia. He had right si...

Introduction: To maintain an average HbA1c of less than 48 mmol/mol requires good diabetes control throughout the year. School holidays take on average 13 weeks (25%) of the year in the UK, therefore good control in holidays as well as term-time is paramount. Little work has been done in this area but it has been suggested diabetes control may be worse during holidays. This study aimed to retrospectively compare diabetes control between term time and the school holidays.<p...

Introduction: The NPDA presents data on management, treatment, and complications for all diabetes units in the country. This acts as a driver for quality improvement and aims to improve standards of diabetes care. The 2019 report identified a relatively high proportion of children with hypertension locally. An audit aimed to identify the proportion of local diabetes patients with ‘hypertension’ or ‘pre-hypertension’, and their clinical identification. The s...

Introduction: In the majority of patients presenting to A&E with hypoglycaemia it is secondary to infection or stress and individuals exhibit a ketogenic response. A minority who first present with hypoglycaemia may have endocrine or metabolic disorders. For this reason a full ‘hypoglycaemia screen’ is undertaken. It is recommended by metbionet that before glucose administration, the following are measured: intermediary metabolites (glucose, b-OHB, free fatty aci...

Introduction: The National Paediatric Diabetes Audit (NPDA) provides a benchmark of performance for paediatric diabetic services across the UK. Whether intentional or not, a league table is created comparing units based on their mean HbA1c. Although the coordinators suggest submitting the patients’ most recent HbA1c, this may not necessarily be a universally adopted phenomenon. We examined the effect of selecting patient’s best, yearly average, and latest HbA1c on ou...

Background: Over the last two decades, supported by two metanalyses, the low-dose Synacthen Test (LDST) has gained in popularity, with many believing it to be more sensitive than the supra-physiological Standard (250 microgram) Short Synacthen Test (SSST). The literature reveals lack of consensus about its specific clinical applications, what is considered “low-dose” and how that dose is made up.Methods: To ascertain current UK practice,...

Introduction: Individuals with cystic fibrosis (CF) frequently exhibit altered insulin and glucose metabolism and many develop cystic fibrosis related diabetes (CFRD). Lung function is influenced by glucose metabolism with changes in glucose metabolism resulting in deterioration in lung function. Recommendations suggest CF patients should have an OGTT annually to screen for the development of CFRD. We examined the OGTT profiles to ascertain whether simpler fasting measures of ...

Background: The low-dose short synacthen test (LDSST) is the most popular diagnostic test for adrenal insufficiency in UK. Although various dosing strategies exist 1 μg is most commonly employed but not commercially available. A BSPED survey revealed 14 different methods for diluting the 250 μg/ml ampoules. We investigated whether differing dilution strategies, made up using standard ward not laboratory equipment, result in differences in Synacthen dose administered....