Endocrine Abstracts

There is limited evidence for the role of screening for Cushing’s syndrome (CS). Patients referred to the specialist medical weight management service at Musgrove Park Hospital have routinely been screened for CS with either an overnight dexamethasone suppression test (ODST) or two 24hour urinary free cortisol (UFC) if evidence of dysglycaemia. We retrospectively analysed the results of all patients referred to the service between 2013–2016. 794 patients were seen as...

A 51 year old woman presented with severe Cushing’s syndrome. In addition to a typically Cushingoid appearance she demonstrated increased cutaneous pigmentation in her face and upper chest. Biochemical investigation confirmed elevated serum cortisol levels with loss of circadian variation, and failure to suppress with low dose dexamethasone (0.5 mg 6 hourly for 48 hours). Serum ACTH levels were undetectable. Cross-sectional imaging revealed bilateral macronodular adrenal ...

Primary aldosteronism (PA) accounts for the largest proportion of cases of secondary hypertension worldwide. The majority of PA cases are a result of a unilateral aldosterone-producing adenoma (APA). The pathogenesis of APAs, the most curable form of hypertension, has been the focus of worldwide clinical interest, and is associated with mutations in four genes: KCNJ5, ATP1A1, ATP2B3, and CACNA1D. Investigation into these mutations may lead t...

Background: The human adrenal cortex is composed of different zones, namely the zona glomerulosa (ZG), zona fasciculata (ZF), zona reticularis, and the recently proposed undifferentiated zone (UZ). The adrenal cortex synthesises and secretes steroids, mainly aldosterone and cortisol, both responsible for essential physiological and metabolic functions. Adrenal cortex disorders can be life threatening and current treatment involves life-long steroid replacement, which is not id...

Introduction: The Sonic hedgehog (Shh) pathway is an evolutionarily conserved signalling pathway, playing an essential role during embryonic development. Murine studies have shown the importance of Shh in the growth of the adrenocortical primordium. Shh expression has previously been described in relatively undifferentiated sub-capsular cells in the developing rodent adrenal, however the organisation of the human foetal adrenal (HFA) is unique. This novel study aimed to descri...

Background: The diagnosis of central diabetes insipidus (DI) relies on indirect measurement of serum/urine sodium and osmolality. Since the diagnosis can only be made when an inappropriately dilute urine is paired with a significantly concentrated serum, the process is tedious for the clinician and uncomfortable for the patient. Copeptin is the C-terminal portion of the anti-diuretic hormone (ADH) prohormone which correlates with the less stable ADH, therefore providing a dire...

Background: Gonadotroph adenomas usually present as non-functioning pituitary adenomas.We describe a patient with a functioning gonadotroph adenoma presenting with ovarian hyperstimulation syndrome: an exceptionally rare presentation of pituitary disease.Case history: A 26-year-old female presented with a 10-year history of worsening lower abdominal pain, bloating, dysmenorrhea and irregular periods in 2006. She was found by ultrasound to have multiple o...

Background: Familial Glucocorticoid Deficiency is an autosomal recessive disorder characterised by ACTH resistance of the adrenal cortex, leading to isolated glucocorticoid deficiency. Causative genes include MC2R, its accessory protein MRAP and StAR which account for 50% of cases. Recently nicotinamide nucleotide transhydrogenase (NNT) has been associated with a further 10% of cases. NNT generates the high concentrations of NADPH in mitochondria necessary for detoxification o...

In the pancreas, PYY is expressed in a subpopulation of non-beta cells in the islets of Langerhans. The role of PYY-expressing cells in the adult pancreas is unknown. We generated a mouse model in which administration of diphtheria toxin (DT) produced specific ablation of PYY-expressing cells in the colon, pancreas and brainstem. Interestingly, DT administration to adult mice resulted in severe hyperglycaemia associated with significant loss of pancreatic insulin and disrupted...

The adrenogonadal primordium develops from a thickening of the coelomic epithelium covering the urogenital ridge. After segregation of the primordium into the bipotential gonad and the adrenocortical primordium, the cortex is encapsulated by mesenchymal cells and infiltrated by migrating sympathoadrenal cells, which form the medulla. We have shown that the cell fate regulator sonic hedgehog (Shh) is not required for the formation of the adrenocortical primordium but is require...