Endocrine Abstracts

Aims: The lowest licensed dose of tolvaptan for treatment of hyponatraemia is 15 mg. There is little data on lower doses. Our study aimed to evaluate the safety of an initial dose of 7.5 mg tolvaptan.Methods: We retrospectively reviewed data from a London teaching hospital over a 6-year period. All adults administered a first dose of 7.5 mg tolvaptan were included. Three different timeframes were reviewed: 4-12, 12-18 and 18-30 hours. We analysed respons...

Case: A 29-year-old gentleman with HIV was self-administering anabolic steroids. The abrupt discontinuation of the exogenous anabolic steroids resulted in fatigue and abdominal pain. A short synacthen test confirmed adrenal insufficiency.His past medical history comprised of HIV which was stable on anti-retroviral therapy. He was commenced on Hydrocortisone 10 mg in twice daily.Over 1 year he developed clinical Cushings. Discontinu...

Introduction: Severe hypercalcaemia is a medical emergency which can result in severe cardiovascular and neurological dysfunction. Pathophysiological mechanisms of hypercalcaemia include increased osteoclastic activity, osteolytic bone metastasis, extra-renal activation/production of 1,25 hydroxyvitamin D and decreased urinary calcium excretion. Understanding these mechanisms is important to guide the diagnostic process and the long-term management of hypercalcaemia.<p cla...

Objective: Growth hormone (GH) deficiency in adult patients is associated with poor quality of life and increased cardiovascular morbidity and mortality. We studied the effects of GH replacement on the lipid profile in adult patients with GH deficiency treated over a 3-year period.Method: A retrospective analysis of 70 adult patients, who had completed 3 years of GH therapy. Growth hormone is initiated at a dose of 0.3 mg/day and titrated to 0.5 mg/day o...

Background: Patients with hypoparathyroidism may present acutely with hypocalcaemia and these patients may have multiple admissions; however, data on the incidence of acute and recurrent acute hypoparathyroidism are scarce in the literature.Aim: We wished to determine: (1) the causes of severe hypocalcaemia amongst A&E attendances (2) the incidence of acute hypocalcaemia due to hypoparathyroidism amongst A&E attendances, and (3) the incidence of ...

Background: Patients with hypoparathyroidism may present acutely with hypocalcaemia and these patients may have multiple admissions; however, data on the incidence of acute and recurrent acute hypoparathyroidism are scarce in the literature.Aim: We wished to determine: (1) the causes of severe hypocalcaemia amongst A&E attendances (2) the incidence of acute hypocalcaemia due to hypoparathyroidism amongst A&E attendances, and (3) the incidence of ...

Context: Better, reproducible and structured methods of assessing care provided to endocrine patients are needed. Similarly, access to regional units and referral pathways could be improved with nationally agreed standards for waiting times.Objective: To gain views on the current level of patient care and how services might be improved using a 360-degree assessment process.Method: Three web based surveys were created using SurveyMo...

Context: Adrenocortical carcinoma is a rare cancer with an annual incidence of 0.7-2 cases per million population and 5-year survival of 31.2%. Adrenal insufficiency is a common and life shortening complication of ACC and little is understood about how it impacts on patients.Objective: To understand patients’ experience of the condition, its treatment, care process, impact of AI on ACC wellbeing, self-care needs and support.De...

Introduction: Cranial Diabetes Insipidus (DI) presenting in children beyond infancy is most commonly associated with sellar/suprasellar tumours and severe traumatic brain injury or haemorrhage. Less frequent causes may be genetic or idiopathic. Exceptional cases may be associated with minor head injury. We present a case of post-concussive head injury with DI, and anterior pituitary hormone deficits.Case: 15 year old malesustained a concussive head injur...

Introduction: Primary aldosteronism (PA) is the most common endocrine cause of hypertension affecting up-to 10% of hypertensives. Saline suppression, a confirmatory test for PA helps avoiding patients undergoing invasive lateralisation procedures due to a false positive aldosterone-to-renin ratio (ARR). The proposed cut-off to exclude PA is post-saline aldosterone suppression to <140 pmol/l. We reviewed our biochemical work-up in order to optimise laboratory assessment.</p...