Endocrine Abstracts

Case History: A 69-year-old lady was admitted to her local district general hospital with a history of confusion, memory disturbance and focal twitching affecting her upper limbs and face. She had a past medical history of type 2 diabetes mellitus, hypertension, hypercholesterolaemia and ischaemic heart disease. Her medications included gliclazide, pioglitazone, atorvastatin, bisoprolol, aspirin and omeprazole. She had never smoked and was teetotal. Neurological examination on...

Background: It is apparent that COVID-19 may cause persistent symptoms beyond 12 weeks (‘long COVID’). However its underlying pathophysiology is unclear. Several symptoms of long COVID draw similarities to that of endocrine diagnoses. We recently observed that adrenal and thyroid function were normal in survivors of COVID-19 at follow-up. Here we assess additional endocrine axes that could plausibly have a role in long COVID to determine their relationship to ongoing...

Kisspeptin is integral to hypothalamo-pituitary-gonadal (HPG) axis function and overall fertility. Functional deficiency of GnRH/lH secretion in the central reproductive disease, hypothalamic amenorrhoea (HA), indicates diminished kisspeptin signalling. Clinical trials have shown kisspeptin to be a viable therapeutic intervention. However, repeated administration led to the development of tachyphylaxis and so is likely a problem for future implementation. Indeed, elevated LH r...

Introduction: Free ionised calcium is the biologically active component of total circulating calcium but is infrequently measured due to sampling requirements. Therefore, total calcium is ‘adjusted’ for albumin to provide a closer estimate of the biologically active ionised calcium level (e.g. James, Orell, Payne and Berry formulae). Here, we aim to derive a novel equation to estimate ionised calcium from readily available biochemical parameters and compare its perfo...

Background: Due to practical limitations, the diagnosis of hypogonadism is predominantly based on a single measure of reproductive hormones, often with confirmation on a second occasion. Factors associated with reproductive hormone variation include: pulsatile secretion, diurnal rhythm, and food intake, which can affect the accuracy of diagnosis of reproductive disorders. There is limited data quantitatively estimating the variability of reproductive hormone levels over the da...

Section 1: Case history: A 19-year-old British-Asian man presented with a two-year history of gynaecomastia. He had no other symptoms of hypogonadism. He had an unremarkable past medical history, did not take any regular medications and denied the use of any illicit drugs. There was a family history of consanguinity, with his parents being first cousins. On examination, his BMI was 28 kg/m2 and he had post-pubertal-sized testes (20 ml) with normal secondary sexual c...

Case: A 19-year-old British-Asian man presented with a two-year history of gynaecomastia. He had no other symptoms of hypogonadism. On examination, BMI was 28 kg/m2 and he had post-pubertal-sized testes (20 ml) with normal secondary sexual characteristics. Hypogonadism was confirmed by two morning fasting total testosterone levels of 4.7 and 5.2 (RR 9.2–31.6 nmol/l). Haemoglobin was normal (152 g/l) and serum oestradiol was <100 pmol/l. He had inappropriate...

Background: During IVF treatment, a pharmacological dose of recombinant FSH (rFSH) is used to induce multi-follicular growth (controlled ovarian stimulation; COS). An insufficient dose of rFSH negatively impacts the number of oocytes retrieved, whereas an excessive dose risks the potentially life-threatening complication ‘ovarian hyperstimulation syndrome’. Hence, appropriate rFSH dosing is regarded as a key treatment decision affecting both the success and safety of...

Introduction: Kallmann syndrome (KS) is a rare genetic disorder typically due to defective migration of olfactory-axons and GnRH-neurons. KS results in congenital hypogonadotrophic hypogonadism (CHH) typically associated with absent (anosmia) or reduced (microsmia) sense of smell. Unilateral hypoplastic/absent olfactory bulbs on MRI are reported, although disturbance in smell is usually bilateral. Here, we present an unusual case of KS with unilateral anosmia....

Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual health complaint worldwide, affecting 1-in-10 women. It is characterised by a persistent lack of desire for sexual activity and sexual fantasies, causing distress or interpersonal difficulties. Treatment options are limited, however, melanocortin-4 receptor (MC4R) agonists have emerged as a promising therapy for HSDD, through unclear mechanisms. Investigating the pathways involved is crucial for our u...