Endocrine Abstracts

A central tenet in medicine is that disruption of homeostatic mechanisms leads to disease and effective therapy must re-establish normal physiology. The sun imposes a 24-hour periodicity to life and circadian rhythms have evolved to maintain homeostasis through the 24-hour day/night cycle. In humans, there is a central clock that controls the sleep/wake cycle which metabolically is a fast/feed cycle. The clock maintains homeostasis by synchronising metabolism to the time of fe...

The critical contribution of deficient insulin secretion to the pathogenesis of type 2 diabetes is beyond doubt. The normal beta-cell response to obesity-associated insulin resistance is hypersecretion of insulin that maintains blood glucose levels within the normal range. This is associated with both expansion of beta-cell mass and enhanced beta-cell function. Type 2 diabetes only develops in subjects that are unable to sustain the beta-cell compensatory response. This is ass...

Congenital adrenal hyperplasia (CAH) is a genetic disorder arising from defective steroidogenesis resulting in glucocorticoid deficiency; the commonest mutation is in the gene encoding 21-hydroxylase. Lifesaving glucocorticoid treatment was introduced in the 1950s and there is now an enlarging cohort of adult patients; however, there is no consensus on management. To address this issue, the Congenital adrenal Hyperplasia Adult Study Executive (CaHASE) was formed in 2003 to stu...

The multidisciplinary diabetes team consists of health care professionals (HCP) each with a profession specific role who are required to be competent to a basic level in all aspects of diabetes care. Working together, teams provide all the education required to manage this condition to children and families as they grow up. The amount and complexity of information is increasing making it difficult to deliver to all individually. Group education is a solution but introduces a r...

CAH is the commonest inborn endocrine disorder and associated with significant morbidity. The health status of CAH adult patients has recently been reported by the UK Congenital adrenal Hyperplasia Adult Study Executive, CaHASE (Arlt et al. JCEM 2010 95 5110–5121). Compared to the health survey for England, metabolic abnormalities were common in adult patients with CAH: obesity (41%), hypercholesterolemia (46%), insulin resistance (29%),...

Cortisol is an essential stress hormone and replacement with oral hydrocortisone is lifesaving in patients with adrenal insufficiency. Cortisol has a diurnal rhythm regulated by the central body clock and this rhythm is a metabolic signal for peripheral tissue clocks. Loss of cortisol rhythmicity is associated with fatigue, depression and insulin resistance. A general principle in endocrinology is to replace hormones to replicate physiological concentrations; however the pharm...

CAH is the commonest inborn endocrine disorder and associated with significant morbidity. The health status of CAH adult patients has recently been reported by the United Kingdom Congenital Adrenal Hyperplasia Adult Study Executive, CaHASE (Arlt et al. JCEM 2010 95 5110–21). Compared to the health survey for England, metabolic abnormalities were common in adult patients with CAH: obesity (41%), hypercholesterolemia (46%), insulin resistance (29%), ost...

Growth hormone (GH) is a potent anabolic hormone; deficiency results in extreme short stature and excess in gigantism and acromegaly. It is just over 50 years since Raben first demonstrated the dramatic impact of GH replacement on linear growth in a young boy with pituitary infantilism. Since then milestones in GH research have included identification of the GH binding protein (1986), the crystal structure of GH (1987), cloning of the GH receptor (1987) and the discovery of a ...

One in eight hundred young adults is now a survivor of childhood cancer as a result of tremendous advances in cancer therapy. However, this success now brings with it the challenge that both the cancer and its therapy may have late effects. In a recent review of 10 397 young adult survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with...

Replication of physiology is a basic tenet of endocrinology but this is rarely achieved. We developed a modified-release hydrocortisone to provide circadian cortisol. The adrenal glucocorticoid, cortisol, is an essential stress hormone and its secretion follows a distinct rhythm regulated by the central circadian oscillator in the suprachiasmatic nucleus. Circulating cortisol levels are low at sleep onset, rise between 0200 and 0400 h, peak within an hour of waking and then de...