Endocrine Abstracts

Obesity is a chronic disease with significant adverse implications for health. Guidelines recommend first line treatment with lifestyle interventions that include restriction of energy intake, increased physical activity and behavioural modification, but these only reduce body weight by 3–5% initial over 12 months, and weight regain is common. Bariatric surgery is effective, but most suitable for people with more severe obesity or with significant complications such as di...

Obesity is a chronic relapsing disease with significant adverse implications for current and future health. Whilst guidelines recommend first line treatment with lifestyle interventions that include restriction of energy intake, increased physical activity and behavioural modification, these only demonstrate an average decrease of 3–5% initial body weight over 12 months, and weight regain is common. Bariatric surgery is effective, but is generally only offered to people w...

Obesity poses a major threat to health, increasing the risk of degenerative diseases and the burden of health costs. Those with severe and complex obesity (often with a BMI > 40 kg/m2) have the greatest burden of co-morbidity and reduced life expectancy are now 2% of the UK population. These patients comprise the majority of referrals to tier 3 obesity services in primary and secondary care. Bariatric surgery is recognised as an effective intervention for approp...

Severe or morbid obesity is becoming more common and now affects about 2% of the UK population. Neuroendocrine disturbances are a common feature of morbid obesity and include male and female hypogonadism, deficiencies of the GH-IGF-1 axis and features suggestive of Cushing’s syndrome in some patients. Patients with neuroendocrine disturbance can broadly be considered in three main categories: 1. Those with genetic syndromes (eg Prader-Willi syndrome, leptin deficiency, MC...

The use of drugs for weight loss dates back to the first half of the 20th century. These older agents were mostly amfetamine-derived, centrally acting sympathomimetics, and although effective, their side-effect profile would not be acceptable today. A new generation of drugs, acting on brain serotoninergic pathways was developed in the 1960’s, including fenfluramine and later dexfenfluramine. In the 1990’s, a combination of fenfluramine with an older agent – phe...

Background: Severe obesity, BMI ≥40 kg/m2, confers a greater risk for graft loss and mortality among renal transplant patients. Transplantation provides a better survival and quality of life in overweight dialysis patients. Higher BMI is associated with progressively increased risk of CKD stages 4–5, hazard ratio of 3.10 (CI 2.95–3.25) for BMI ≥35 kg/m2. A recent meta-analysis found pre-transplant BMI <30 kg/m2 is asso...

Background: Adipose-tissue (AT)-derived cytokines contribute to systemic inflammation and insulin resistance. The systemic inflammation observed in obesity is thought to be mainly derived from the stroma–vascular fraction of adipose tissue due to macrophage-infiltration of AT in obesity. Macrophages are thought to be recruited and trapped in AT by release of chemoattractant-molecules such as monocyte-chemoattractant-protein-1 (MCP-1) and macrophage-migration-inhibitory-fa...

Background and aims: Adipose tissue (AT) secretes cytokines which contribute to systemic inflammation in obesity. Cytokines like monocyte-chemoattractant-protein-1 (MCP-1) have also been associated with macrophage infiltration of AT in obese mice. However, it is unknown whether visceral-AT (VAT) or subcutaneous-AT (SCAT) expression is related to serum levels of these cytokines in humans.Methods: Morbidly-obese non-diabetic subjects undergoing bariatric s...

Introduction: There are patients who remain symptomatic with hypothyroidism despite apparent adequate replacement on levothyroxine (LT4) therapy. We present an observation where monozygotic twins responded only to combination therapy with liothyroinine (LT3), and were found to have a genetic variation which may have clinical significance in thyroid metabolism.Case report: A 47-year-old female with polyglandular auto-immune syndrome (APS1) presented with ...

A male in his 40’s diagnosed with type 2 diabetes in 2011 (BMI:20.7kg/m2) was admitted with DKA (Dec 2018) after a period of poor glycaemic control on oral hypoglycaemic agents (Feb 2017: HbA1c-105mmol/mol, Nov 2018: HbA1c-115mmol/mol). There was dramatic improvement in glycaemic control after commencing him on subcutaneous insulin (April 2019: HbA1c-56mmol/mol). GAD65 antibodies were positive (24u/mL; normal<5u/mL) and a diagnosis of latent autoimmune diab...