Endocrine Abstracts

Background: ‘Glycaemic tracking’ describes the stability of HbA1c over time commonly observed in individuals with type 1 diabetes (T1DM). Preliminary studies have noted the relationship between early metabolic control and long-term outcomes, while recent evidence has been presented for glycaemic tracking in a large number of newly diagnosed individuals with T1DM. The benefits of tight glycaemic control, in terms of reducing microvascular complications and lowering Hb...

A 23-year-old Rwandan lady was 27 weeks pregnant and reported feeling non-specifically unwell for 3 days followed by 24 h of diarrhoea and vomiting. She denied fever, rash, polyuria, polydipsia, weight loss or foreign travel. She has sickle cell trait with no other past medical history. Laboratory glucose at 16 weeks gestation was 5.1 mmol/l.On admission she looked unwell and was tachycardic and dehydrated. Her capillary blood glucose was 17.9 mmol/l and...

When patients with type 1 diabetes present with hyponatremia, Addison’s is an important condition to exclude. It is however important to consider other causes, and a trial of hydrocortisone is not part of the diagnostic test for adrenal failure. A 43-year-old lady, with a background of Type 1 Diabetes and depression, presented unwell with hyponatremia. Her basal cortisol was low 162 nmol/l along with an ACTH 16.2 ng/l. A short synacthen test (SST) revealed a baseline cort...

Prohormone convertase 1/3 (PC1/3), encoded by protein convertase subtilisin kexin type 1 (PCSK1), converts inactive prohormones such as pro-opiomelanocortin, proinsulin, proglucagon into biologically active peptides. Inherited genomic mutations of PCSK1 present with malabsorptive diarrhoea, hyperinsulinemic hypoglycaemia, central adrenal and thyroid defects and severe obesity. Somatic mutations of insulinomas are associated with genetic defects interfering with insulin secreti...

A 65-year-old lady presented to the emergency department with breathlessness due to an exacerbation of chronic airways disease. Her past medical history included laryngeal carcinoma treated with total-laryngectomy, thyroidectomy and adjuvant radiotherapy in 2003. She remained on stable post-operative replacement doses of 125mcg of levothyroxine and 1mcg 1-Alfacalcidol/1g Sandocal TDS for hypoparathyroidism for several years. Three days prior to her admission, strontium ranelat...

A 31-year-old male presented to A&E with confusion, lethargy, polyuria and blurred vision. The previous month he had been diagnosed with diabetes and started on metformin by his GP. On examination he was cachectic (BMI 17 kg/m2), dehydrated and hypotensive (88/56). Baseline investigations revealed a metabolic acidosis (pH 7.30), with capillary glucose 20 mmol/l and moderate ketonuria. Treatment for diabetic ketoacidosis was commenced. Further results revealed he...

BackgroundWhilst hydrocortisone is standard glucocorticoid replacement therapy in patients with adrenal insufficiency, some have considered prednisolone an alternative. Some data have shown diabetes and osteoporosis risk. Mortality of patients using prednisolone in relation with those using hydrocortisone is not known. We compared all-cause mortality risk compared to matched controls in patients with primary or secondary adrenal insufficiency using predn...

BackgroundIncreased mortality risk of patients with adrenal insufficiency has been inconsistently reported. This might have resulted from the disparity of time and place of clinical care between the study patients and reference population. Also, data of patients with secondary adrenal insufficiency was limited as majority focused on other types of pituitary disorders. Therefore, we compared all-cause mortality of patients with primary and secondary adren...