Endocrine Abstracts

Obesity surgery is not a scalable solution for obesity and diabetes. Options for pharmacotherapy are sorely required because there will be patients who cannot and will not have surgery, or perhaps will require a ‘bridge’ to surgery. Although oral agents such as Orlistat and Bupropion/Naltrexone are marketed in Europe, these treatments suffer from considerable side effects that limit their appeal and efficacy. Gut hormone treatments, exemplified by high-dose Liragluti...

Bariatric or metabolic surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy are becoming increasingly prevalent as these treatments are now recommended as treatment choices for obesity and type 2 diabetes. Post-bariatric hypoglycaemia (PBH), typically a post-prandial hyperinsulinaemic hypoglycaemia occurring 1-3 hr after ingestion of food, is now more commonly encountered in practice, presenting either to endocrine/metabolic outpatient clinics or during medical on-...

Very low calorie diets (VLCD) have been a time-honored means of losing weight for many decades. The DiRECT trial has put VLCD back in the limelight and now NHS England and Scotland have committed resources to piloting VLCD as an intervention for Type 2 diabetes. Is this premature, or is it the solution for the tsunami of Type 2 diabetes that we face? Prof Tricia Tan and Dr Abd Tahrani will debate the utility of VLCD in the treatment paradigm of Type 2 diabetes....

Post–bariatric surgery hypoglycaemia (PBH) is a metabolic complication of bariatric surgery. Symptoms of post-bariatric hyperinsulinaemic hypoglycaemia may develop from 6 months to years after surgery, and typically present 1 to 3 hours after a meal. The incidence of post bariatric hypoglycaemia is estimated to be 0.2–11%,1,4 but the actual incidence is unknown due to the vague symptoms and lack of diagnostic criteria for the diagnosis of post-bariatric hy...

Background: Increased endogenous post-prandial GLP-1 release is a key mediator of improved glycaemic control following Roux-en-Y gastric bypass (RYGB) surgery. GLP-1 receptor agonists (GLP-1 RA) augment glucose-stimulated-insulin-release and suppress glucagon release, and do not usually cause hypoglycaemia. The use of GLP-1 RA have been shown to be safe for patients requiring additional glycaemic control following RYGB. We present a case of severe recurrent fasting nocturnal h...

Africo Caribbean gentleman was referred to our endocrine department for management of secondary hypertension. He initially presented to his doctor with headache and he was found to be hypertensive with systolic BP of 200 mmHg and hypokalaemia. A renal MRI showed a right adrenal mass, 2.9×2.4 cm, and echocardiogram showed moderate left ventricular hypertrophy and diastolic dysfunction. He had normal 24 h excretion of metanephrines and free cortisol. An aldosterone renin ra...

Introduction: Misdiagnosis of secondary hypocortisolaemia can have profound consequences on a patient’s life. Due to contraindications the gold standard dynamic diagnostic test of cortisol reserve – the insulin tolerance test (ITT) – may not always be suitable. Here we examine the diagnostic accuracy of the second line dynamic tests: the overnight metyrapone test (OMT), short synacthen test (SST) and glucagon stimulation test (GST).Patient...

Background: Hyperprolactinaemia is common in patients presenting with polycystic ovary syndrome (PCOS). Recent studies suggest that each condition has an independent aetiology, hence appropriate investigation of hyperprolactinaemia in the context of PCOS is required, for which separate treatment may then be provided. Appropriate investigation includes a serum macroprolactin screen, a specific drug history for drug-induced hyperprolactinaemia (DIH), blood tests to exclude secon...

Patients with acromegaly have characteristic clinical features of soft tissue overgrowth. Both somatic and metabolic features of acromegaly are secondary to excess GH secretion and high circulating levels of insulin-like growth factor 1 (IGF1). However, an acromegaloid phenotype associated with severe insulin resistance is occasionally seen in the absence of biochemical hallmarks of acromegaly (insulin-mediated pseudoacromegaly). Here we present a case of ‘insulin-mediate...

Background: Short Synacthen Tests (SSTs) are integral to the diagnosis of Adrenal Insufficiency (AI). A 30-minute stimulated cortisol value is assessed against local assay dependent thresholds to ascertain or exclude the diagnosis. A diagnosis of AI is a life changing event requiring the initiation of life long glucocorticoid replacement therapy for survival. Glucocorticoid replacement is associated with long term morbidity and mortality, including an increased risk of diabete...