Endocrine Abstracts

Background: The short Synacthen test (SST) is used primarily to diagnose adrenal insufficiency (AI), with hyponatraemia being among the commonest indications. Given the national shortage of tetracosactide and following cases of test mismanagement highlighted by our Biochemistry department, we investigated the indications, appropriate patient selection and performance of this test.Methods: A retrospective analysis of 117 cases identified to have a SST per...

Primary pigmented nodular adrenal disease (PPNAD) is a form of bilateral adrenocortical hyperplasia characterised by small to normal sized adrenal glands containing multiple small cortical pigmented nodules1. It may occur independently, but 90% of cases are a manifestation of the Carney complex. Most cases of PPNAD are diagnosed before age 30, and are the result of a germline mutation in PRKAR1A or PDE11A, leading to upregulation of cAMP signalling. It is a cause of...

Background: Bone mass is low and fracture risk is higher in obese children. We wished to ascertain the relationships of obesity-related changes in hormones with skeletal microstructure.Method: Children aged 8–15 years matched by gender and pubertal stage were recruited into lean and obese groups (18 pairs). We used high resolution peripheral quantitative computed tomography (HRpQCT – resolution-82 μm) to assess three-dimensional cortical a...

Tolvaptan (a selective V2 receptor antagonist) is licensed for the inpatient management of SIADH induced hyponatraemia, a common complication in patients with malignancy. Licensed daily doses start at 15 mg but there is evidence that some patients have a rise in serum sodium (Na) of >12 mmol/l per 24 h in response to this. Lower initial doses (7.5 mg) may therefore be appropriate1,2.Methods: A retrospective case note audit was performed. T...

Prolactin is associated with seasonal transitions into and out of anestrus in the mare. The earliest anestrous transitional changes are declining progesterone secretion and a concomitant prolactin decline. Ovarian changes include slowed follicular development and prolonged luteal activity. Dopamine antagonist administration during the autumnal transition prevented a seasonal progesterone decline, suggesting a cause-and-effect between prolactin and progesterone production. The ...

We present a 20-year-old lady who was known to have MEN-1 and had previously been treated for hyperparathyroidism at a different hospital in 2003 with excision of right upper and lower and left lower parathyroid glands and left thyroid lobectomy, resulting in normalisation of adjusted calcium (adjCa) levels.She presented to our department with persistently elevated adjusted calcium levels (adjCa 2.69 mmol/l) along with raised parathyroid hormone (PTH 16 ...

A 24-year-old Asian lady with no past medical history was admitted under the surgical team with right sided abdominal pain, nausea and vomiting, postural dizziness and weight loss. She was give trimethoprim for a possible urinary tract infection along with paracetamol, tramadol and diclofenac. Blood tests on admission demonstrated normal renal, liver and thyroid function, a normal C-reactive protein and full blood count and a low sodium of 131 mmol/l. An abdominal ultrasound w...

Primary hypothyroidism and hypoadrenalism may occur concomitantly as part of autoimmune endocrine syndromes. Thyroxine replacement without steroid replacement can precipitate fatal adrenal crisis in this subgroup of patients. We report two patients with autoimmune primary hypothyroidism presenting with acute adrenal crises after commencing thyroxine replacement.Case 1: A 36-year-old patient with type 1 diabetes for 15 years was admitted with vomiting, ab...

We recently demonstrated that fetal programming changes induced by a maternal low protein diet (MLP) that lead to the development of hypertension in the rat offspring were associated with increased expression of the AT1b angiotensin receptor (AT1b) and reduced methylation of its promoter in the adrenal gland. Previous findings have suggested that overactivity of the maternal pituitary–adrenal axis in pregnancy results in overexposure of the fetus to glucocorticoids which ...

Dumping syndrome is a common complication following gastric bypass surgery. Rapid gastric emptying in dumping syndrome triggers an inappropriate hyperinsulinaemic response which leads to hypoglycaemia. This can be very disabling and challenging to manage in clinical practice. Here we present a lady with dumping syndrome whose post meal hypoglycaemia improved with metformin.A 42-year-old female presented with eight months history of increasing mood swings...