Searchable abstracts of presentations at key conferences in endocrinology

ea0090s20.1 | Update on consequences of long-term exposure/treatment with glucocorticoids | ECE2023

Impairment of the HPA axis after treatment with glucocorticoids

Stewart Paul M

1% of western populations take chronic oral corticosteroids and this rises to 3% in subjects aged over 70 years old. When inhaled, topical and parenteral steroids are added to this burden, iatrogenic Cushing’s becomes a major health issue. High doses of medroxyprogesterone acetate can cause glucocorticoid effects and drug interactions may impair the metabolism of some glucocorticoids (eg fluticasone), thereby increasing their potency. Patients may develop the classical fe...

ea0041d4.2 | Are we ready for pharmacological therapy of obesity? | ECE2016

Should we treat subclinical Cushing’s syndrome?

Stewart Paul M

The term subclinical Cushing syndrome arose at the turn of the millennium with the description of large Italian study of adrenal incidentalomas. Of 1096 patients from 26 centres, 9.2% had ‘subclinical Cushing’s’ (JCEM, 2000; 85:637-644). Since then over 300 publications have detailed this newly discovered endocrine diagnosis, and herein lies the main issue. The definition of Cushing’s syndrome is not in doubt – a ‘constellation of symptoms and sig...

ea0041gp16 | Adrenal (1) | ECE2016

Increased morbidity and hospital admissions in patients with adrenal insufficiency

Stewart Paul M , Biller Beverly MK , Marelli Claudio , Gunnarsson Candace , Ryan Michael , Johannsson Gudmundur

Introduction: Patients with adrenal insufficiency (AI) (primary (PAI), secondary to pituitary disease (PIT) and congenital adrenal hyperplasia (CAH)) have reduced life expectancy with reported standardized mortality ratios of ~2:1 but given the rarity of AI, the underlying explanation remains largely unknown.Objective: To evaluate patient characteristics, prevalence of concomitant conditions and hospitalization incidence in patients with AI compared to a...

ea0019p243 | Pituitary | SFEBES2009

Growth hormone deficiency in adults: the NICE criteria do not discriminate an adverse cardiovascular phenotype

Aragon Alonso Aurora , Sherlock Mark , McGregor Elizabeth , Murray Robert , Stewart Paul M , Toogood Andrew A

Severe growth hormone (GH) deficiency in adults is associated with adverse changes in quality of life (QoL), body composition and cardiovascular risk profile. NICE guidance restricts GH replacement in the UK to those with impaired QoL, defined by a score of >11 in the QoL-AGHDA questionnaire.Aims: To assess whether the NICE guidance differentiates other clinical or biochemical features in GH deficient adults.Patients and...

ea0015oc30 | Pituitary, disease | SFEBES2008

Local cortisol generation by human macrophage subsets by 11β-hydroxysteroid dehydrogenase type 1 enzyme and its role in ocular immune privilege

Joganathan Varajini , Al-Hakami Ahmed , Rauz Saaeha , Stewart Paul M , Wallace Graham R , Bujalska Iwona J

The eye is an organ vulnerable to a variety of external and internal stimuli that can abolish its vital function to allow accurate vision of images for survival. Inflammation is the key mediator of immune protection but its consequence leads to the disruption of the visual axis integrity. Due to this precise reason, through adaptation and evolution, the eye has developed mechanisms of immune tolerance and privilege. Glucocorticoids have potent immunosuppressive and anti-inflam...

ea0015p274 | Pituitary | SFEBES2008

Use of the morning urinary cortisol to creatinine ratio in the diagnosis of mild Cushing’s disease in patients with discordant test results

Vassiliadi Dimitra A , Holder Geoff , Johnson Alan P , Arlt Wiebke , Stewart Paul M

The diagnosis of Cushing’s syndrome (CS) remains a major clinical challenge especially in a proportion of patients that have discordant results in the available tests. Although the measurement of 24-h urine free cortisol (UFC) is a useful test for the diagnosis of CS, 10–15% of patients have at least one measurement within the normal range and multiple measurements may be required in order to raise its sensitivity. In this study we sought to evaluate the value of the...

ea0015p322 | Steroids | SFEBES2008

Serine phosphorylation of IRS-1 as a mechanism of glucocorticoid induced insulin resistance in mouse C2C12 myotubes

Morgan Stuart A , Gathercole Laura L , Bujalska Iwona , Stewart Paul M , Smith David , Tomlinson Jeremy W

Glucocorticoid (GC) excess is characterized by increased adiposity, skeletal myopathy and insulin resistance. Despite the increasing use of GCs as therapeutic agents, the molecular mechanisms that underpin GC mediated changes in insulin signalling are not clear. Within skeletal muscle, the microsomal enzyme, 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) converts inactive GC, 11-dehydrocorticosterone (A) to active corticosterone (B) and thus regulates GC availabi...

ea0015p324 | Steroids | SFEBES2008

Adrenal function testing in 273 patients with severe sepsis reveals baseline cortisol as a reliable predictor of outcome

Mowatt Christopher J , Vassiliadi Dimitra A , Holder Geoff , Clark Penny , Bion Julian , Stewart Paul M , Arlt Wiebke

Stress results in activation of the hypothalamic–pituitary–adrenal axis with increased circulating cortisol. It has been argued that a syndrome of ‘relative adrenal insufficiency’ is common in critically ill patients. Patients who fail to increase their cortisol by >250 nmol/30 min following the administration of 250 μg ACTH in the short synacthen test (SST) have been reported to have a higher mortality (JAMA 2000, 283 1038–1045)...

ea0013oc7 | Society for Endocrinology/Clinical Endocrinology Trust Young Investigator Basic Prize winner | SFEBES2007

Differential effects of P450 oxidoreductase mutants on CYP17 activity provides evidence for an alternative pathway in human androgen biosynthesis

Dhir Vivek , Ivison Hannah E , Krone Nils , Stewart Paul M , Shackleton Cedric HL , Arlt Wiebke

Congenital adrenal hyperplasia (CAH) caused by mutations in the electron donor enzyme P450 oxidoreductase (POR) is unique amongst all CAH variants in that it can be associated with ambiguous genitalia (disordered sex differentiation, DSD) both in 46,XX and 46,XY individuals. POR has a pivotal role in facilitating electron transfer from NADPH to microsomal P450 enzymes, including CYP17, which catalyses a key step in human androgen synthesis, the conversion of 17-hydroxypregneno...