Endocrine Abstracts

Context: Premature ovarian insufficiency (POI) affects approximately 1-3% of women. Clinical presentations are heterogeneous and the underlying etiologies remain unknown in the majority of cases.Objective/aim: To characterize presentations of POI and to evaluate the distribution of underlying etiologies in women with newly diagnosed POI of unknown cause.Design: Prospective study of 100 women with newly diagnosed POI. Autoimmunity w...

Background: The Synachten test is used to diagnose for adrenal insufficiency (AI) and non-classical congenital adrenal hyperplasia (CAH). The cut-off levels for s-cortisol and s-17-hydroxyprogesterone are derived from immunoassays that were not well standardized and are no longer in use. Introduction of liquid chromatography tandem mass spectrometry (LCMSMS) could resolve the lack of standardization of steroid hormone assays and enable increased diagnostic accuracy.<p clas...

The current conventional glucocorticoid (GC) replacement therapy in primary adrenal insufficiency (Addison’s disease) and congenital adrenal hyperplasia (CAH) renders the cortisol levels unphysiological, resulting in very high levels alternating with almost undetectable levels of cortisol over the day. This reduces not merely the patient’s quality of life but increases the patient’s morbidity and mortality. The HPA axis is characterised by a dynamic circadian va...

Objective: In acromegaly, high GH/IGF1 levels are associated with abnormal glucose metabolism. Treatment with somatostatin analogues (SSAs) reduces the GH and IFG-1 levels. However, SSAs may worsen glucose homeostasis despite this, due to concomitant inhibition of insulin secretion. We studied the possible association between biochemical cure and glucose homeostasis in de novo patients with acromegaly.Design: Post hoc analysis from a ra...

Objective: Early postoperative results for the Preoperative Octreotide Treatment of Acromegaly (POTA) study has been published, and like later randomized studies we demonstrated a beneficial effect of presurgical treatment with somatostatin analogues (SSA) in GH-secreting macroadenomas when evaluated 3–4 months postoperatively. However, concerns about a potential lingering effect of SSA and thereby potential false positive results have been raised. The objective of this s...

Background: Conventional glucocorticoid replacement therapies result in unphysiological variation in plasma cortisol levels; concern has been raised regarding long-term metabolic consequences. Glucocorticoid replacement is technically feasible by continuous subcutaneous hydrocortisone infusion (CSHI), which can mimic the normal diurnal cortisol rhythm. The aim of this study was to compare insulin sensitivity in patients with Addison’s disease (AD) on CSHI vs three daily d...

Patients on long term glucocorticoid replacement therapy have higher rates of morbidity and mortality. One causative factor may be non-physiological cortisol replacement. We have developed as part of the ULTRADIAN consortium (https://www.uib.no/en/ultradian) the U-RHYTHM, an ambulatory bio-sampling device that can collect clinical samples using in-vivo microdialysis every 20 minutes over the 24hour day whilst individuals continue with their normal everyday activities....

Many patients with primary adrenal insufficiency (Addison’s disease) take extra doses of glucocorticoids before or during stressful events, but benefit has not been demonstrated. We aimed to test the effect of an extra dose of glucocorticoids on cardiorespiratory, hormonal and metabolic parameters in response to physical activity in a randomised placebo-controlled, 2-weeks cross-over, clinical trial (clinicaltrials.gov NTC01847690). Ten women with Addison’s disease a...

Background: Conventional glucocorticoid replacement therapy in patients with Addison’s disease (AD) is unphysiological with possible adverse effects on mortality, morbidity and quality of life. Physiological amounts of glucocorticoids are required for normal GH production and release and a chronically raised cortisol level, suppresses the secretion of GH with possible metabolic and cardiovascular consequences. The diurnal cortisol profile can likely be restored by continu...

Adrenal hormones possess both circadian and ultradian rhythms, making interpretation of single time point measurements difficult, particularly in the context of suspected endocrine disease. Attempting to capture either normal or pathological rhythms in detail by traditional measurement of blood is impractical and generally unfeasible. However, minimally invasive microdialysis sampling of free tissue hormones coupled with a portable fraction collector (U-RHYTHM), and a targeted...