Endocrine Abstracts

Adrenal incidentalomas (AI) found on axial imaging are common. In ages <20 y the prevalence is <1%, but this increases around 10% of the population aged 70 y. Depending on definitions anything between 10–40% of these tumours exhibit low-grade cortisol excess, but patients are without the classic features of Cushing’s syndrome. This equates to 1–4% of the ageing population.Independent studies from our own group and others have demon...

Pancreatic neuroendocrine tumours (pNET) in patients with MEN1 pose a particular and challenging clinical problem. Whilst patients with a pNET and clear clinical and biochemical evidence of hormonal hypersecretion are usually candidates for some form of surgical or medical therapy, the decision-making is far harder for those who are found to have a non-functioning tumour on surveillance imaging. There is a lack of knowledge of the differing biological behaviour between pNETs i...

Pituitary radiotherapy plays an important role in the overall management of pituitary disease, but needs discussion at an expert regional pituitary MDT. Repeat surgical exploration is increasingly performed either as an alternative to radiotherapy or to further reduce tumour bulk ahead of radiotherapy. Careful discussion with the patient on the risks and benefits of radiotherapy, and all the other options, is essential. It is best to consider the control of tumour growth and a...

Background: Chromogranin A is an acidic 48 kDa glycoprotein originating from the chromaffin granules of most neuroendocrine cell types. In health chromogranin A is released as a pro-hormone together with other peptide hormones in response to stimulation. In disease larger quantities of Chromogranin A are produced by neuroendocrine derived tumours thus allowing its use as a tumour marker. Due to the different clinical scenarios for measuring Chromogranin A requesting practices ...

Steroid-dependent patients have a lifelong dependency on replacement therapy and a lifelong vulnerability to sudden death from under treated adrenal crisis. Yet evidence about the adequacy of medical response to adrenal crisis within the UK is largely anecdotal.We invited members of the main UK support groups representing steroid-dependent patients to complete an online questionnaire identifying the frequency, causes and location of their adrenal crises ...

Steroid-dependence is a life-long condition with a risk of premature mortality from undertreated adrenal crisis, hospital omission of steroids, or running out of maintenance drugs at home. We invited members of the main UK support groups representing steroid-dependent patients to complete an online questionnaire about their experiences of adrenal crisis. Respondents (n=1042) were asked to provide demographic information that explored predisposing factors, including co...

Aims: We aimed to assess the effectiveness of an insulin pump service for children, describe the demographics of the pump population and to review the change in glycaemic control following initiation of pump therapy. We also assessed patient and staff perceptions of the service.Method: Patients commenced on CSII from July 2013 to July 2014.Data collected included demographics, deprivation scores, HbA1c before and during pump therap...

Conventional hydrocortisone dosing does not mimic the normal cortisol circadian rhythm making treatment optimisation difficult in patients with adrenal insufficiency. We described the first use of a continuous variable subcutaneous hydrocortisone infusion (CSHI) via an insulin pump to replace cortisol in a patient with congenital adrenal hyperplasia (CAH) to mimic the normal plasma cortisol circadian rhythm. We report the long term experience of CSHI in seven patients with adr...

The aim of cortisol replacement in adrenal insufficiency is to mimic the normal cortisol circadian rhythm. Timing of the last dose varies. Paediatric practice doses as close to midnight or after as possible compared to no dose after 18.00 h in adults. Using a detailed questionnaire, we ascertained side effect prevalence in 226 patients with adrenal insufficiency (77 CAH, 82 Addison, 67 hypopituitarism) and compared frequency of problems with timing glucocorticoid replacement. ...

Introduction: Bowel preparation is known to cause minor electrolyte disturbances. There are only five reported cases of severe electrolyte disturbances following bowel preparation that have caused seizures. We report the case of a patient with severe hyponatraemia and hypokalaemia, resulting in a seizure, following the administration of picolax.Case report: A 60-year-old female patient with no significant past medical history and taking no regular medica...