Endocrine Abstracts

Langerhans cell histiocytosis (LCH) is a rare disease often involving the hypothalamo-pituitary axis. Extreme obesity is frequent, but effective treatment is not. Malabsorptive bariatric surgery techniques are effective for weight loss in hypothalamic dysfunction. Laparoscopic sleeve gastrectomy (LSG) has recently emerged as a restrictive bariatric procedure to be used before biliopancreatic diversion or gastric bypass, thus reducing surgery-associated morbidity in particularl...

Introduction: Hypoaldosteronism is characterized by the development of hyperkalemia, but can also induce hypovolemic hyponatremia. Trimethroprim can cause hypoaldosteronism through mineralocorticoid resistance. That hypoaldosteronism can induce hyponatremia in absence of Addison’s disease has been questioned. We studied the electrolyte disturbances found following initiation of trimetroprim therapy.Material and methods: Retrospective, analytical. La...

Introduction: Primary hyperparathyroidism (PHP) has been postulated to be a cause of primary hyperaldosteronism (PHA). In fact, PTH receptors have been detected in aldosteronoma tissue. Hyperaldosteronism can also induce elevation of PTH levels, as increased circulating volume increases calciuria, with secondary elevation of PTH levels as serum calcium levels rise. We studied the prevalence of PHP in a group of patients diagnosed with PHA either following or simultaneously wit...

Inroduction: Polydipsia -excessive oral intake of liquids, with/without thirst- can induce euvolemic hyponatremia. Adequate inhibition of AVP secretion induced by low plasma osmolality (POsm) is reflected in a urinary osmolality (UOsm) ≤100 mOsm/kg. However, increased fluid intake can also reveal underlying non-osmotic AVP secretion, induced by pain, nausea, and/or SIADH, with UOsm >100. Iatrogenic polydipsia is characterized by increased liquid intake without thirst...

Introduction: Primary hyperaldosteronism (PH) is characterized by autonomous adrenal aldosterone (A) hypersecretion. Unilateral adrenalectomy is the treatment of choice, when adrenal vein sampling (AVS) indicates lateralization of A secretion. To assure that each adrenal vein (AV) has been correctly sampled, cortisol levels in each adrenal vein must be higher than in the inferior vena cava. The adrenal gland cortisol/vena cava cortisol ratio is referred to as the selectivity i...

Introduction: Euvolemic hyponatremia (HN) caused by the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) can predate a diagnosis of malignancy. It is thus essential to accurately diagnose the etiology of HN/SIADH when detected.Methods: Retrospective, descriptive study of all 52 oncological/hematological malignancy patients diagnosed with SIADH in our Department between January 2011 and December 2016. HN was detected via computerized Prima...

Introduction: Hypoaldosteronism (HA), a cause of hypovolemic hyponatremia (HN) with urinary(U) sodium(Na) loss, is often underdiagnosed. We studied 28 patients with an episode of HA-induced moderate/severe hyponatremia.Methods: Retrospective 2012–2015. In all patients, Nadir(N) serum(S) Na <130 mmol/l (corrected for total proteins and glycemia), low internal yugular venous pressure, low ocular pressure. Addison’s Disease ruled (ACTH, cortis...

Context: Fluid restriction (FR) is recommended as first line therapy for SIAD by both the European1 and the American guidelines2 for management of SIAD. Not all patients respond to FR however, and the American guidelines have identified clinical predictors of failure to respond to FR. These include 1.Urine osmolality (UOsm) >500 mOsm/Kg 2. Furst formula (ratio UNa+UK/pNa) > 1, and 3. 24 hour-urine volume<1500 mlObjective...

Introduction: ESE guidelines state a risk for overcorrection of serum sodium levels (SNa) with vaptans. We present the results of our protocol for initiation of tolvaptan(TV) therapy in SIADH.Methods: Retrospective (2011–15). 86 patients with SIADH-induced mild/moderate hyponatremia received TV:7.5 mg day 1, ad-libitum liquids, no other Na-raising therapies. Conventional hospitalization (CH):66/86, day hospital (DH):20/86. Glycemia-corrected SNa det...

Introduction: Some authors consider aldosteronism to be a spectrum, ranging from aldosterone-associated (or low-renin) hypertension (AAH) to primary hyperaldosteronism (PHA) due to bilateral adrenal hyperplasia. Thus, blood pressure (BP) response to mineralocorticoid-receptor blockade (MRB) could be similar.Methods: Retrospective analysis of 60 patients. Screening per Endocrine Society guidelines, positive screening: aldosterone (pg/ml) to direct-renin (...