Endocrine Abstracts

Introduction: The provision of out-of-hours (OOH) care for hospital inpatients is currently a hot political topic with aspirations for ‘seven day working’ and earlier specialist involvement. Care for patients with diabetes or endocrine problems OOH (which accounts for 75% of each week) is variable and often falls as a default to the general medical team. Our centre (over 1000 beds, all major specialities) has, for many years, provided a 24/7 service for GPs and hospi...

Background: Endocrine Society guidelines classify macroprolactinomas as ‘resistant’ if there is failure to normalise prolactin, or to achieve radiological tumour shrinkage of >50%, on standard doses of dopamine agonist. In this context, escalation of treatment to maximal tolerable doses and/or referral for surgery is advised. However, we have recently observed several ‘discordant responders’, where tumour shrinkage lags significantly (>6 months) beh...

Primary aldosteronism (PA) is an important cause of hypertension which confers significant cardiometabolic risk. In approximately half of cases, the cause is a surgically resectable unilateral aldosterone-producing adrenal adenoma, making PA the most common potentially curable form of hypertension. Despite this, long-term data on surgical outcomes that could be used to guide discussions with patients are sparse. Here, we report on clinical outcomes several years post-adrenalec...

Background: The low dose dexamethasone suppression test (LDDST) is an important investigation for suspected Cushing’s syndrome (CS). The traditional definition of normal suppression of serum cortisol to ≤50 nmol/l (0.5 mg 6 hrly × 48 hrs) comes from a time when biochemical auto analysers did not routinely detect very low values. Previous studies reported 5.1–8.3% of patients with Cushing’s disease (CD) suppressed to <50 nmol/l at 48 hrs. Many clin...

Hypertension is a common risk factor for cardiovascular disease and up to 15% of hypertensive patients are now known to have primary aldosteronism (PA), where the adrenal glands secrete inappropriately high levels of the steroid hormone aldosterone. Of these cases, almost half are due to the presence of unilateral aldosterone-producing adenoma (APA). Aldosterone is synthesised in the zona glomerulosa of the adrenal cortex, with the final stages of production catalysed by aldos...

Peptide long-acting somatostatin receptor ligands (SRLs) are a first line medical treatment for acromegaly but are not efficiently absorbed when delivered orally. Years of injections with SRLs are associated with variable dose delivery, injection site reactions, and excessive life burden. Paltusotine (CRN00808) is a nonpeptide small molecule somatostatin type 2 (sst2) receptor agonist with high oral bioavailability (70%) and a 42–50 hour terminal elimination half-life in...

Background: Liver fibrosis in cirrhosis is characterized by accumulation of extracellular matrix from activated hepatic stellate cells (HSCs). Glucocorticoids (GCs) limit HSC activation in vitro. Local GC levels are regulated by 11β-hydroxysteroid dehydrogenase-1 (11βHSD1) which converts inactive GCs (11-dehydrocorticosterone) into active GCs (corticosterone). In this study we hypothesized that 11βHSD1 could potentially inhibit liver fibrosis.<p cla...

Non-invasive methods to measure enzyme activity in vivo can provide a useful tool for the development of selective inhibitors. Tissue-specific dysregulation of 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1), a reductase enzyme that amplifies active intracellular glucocorticoid levels, has been shown in obese patients using invasive tools (biopsy, microdialysis and arteriovenous sampling with stable isotope tracers). 11β-HSD1 inhibitors are efficacious in...

Fetal Leydig cell (LC) dysfunction leads to human male reproductive disorders (‘testicular dysgenesis syndrome’; TDS) that manifest at birth (cryptorchidism, hypospadias) or in young adulthood (low sperm count, testicular germ cell cancer). The factors regulating fetal LC function in early gestation are unknown, but can be disrupted in rats by environmental chemicals (e.g. dibutyl phthalate (DBP)). We identify a novel repressor mechanism that explains this vulnerabil...

Mutations in the co-chaperone molecule AIP account for a predisposition to pituitary tumours in some families with familial isolated pituitary adenomas (FIPA). We now report on four apparently-unrelated families with the same mutation and originating from the same geographical area, suggesting a possible founder mutation.The index patient had gigantism (19 years, 208 cm) and had a female 4th cousin, once removed (13 years, 191 cm) with a large pituitary ...