Endocrine Abstracts

Background: Type 2 diabetes (T2D) and hypercortisolism associated with Cushing’s syndrome (CS) share clinical characteristics such as hypertension, dyslipidaemia, hyperglycaemia, and obesity. Several studies have recorded a relatively high prevalence of hypercortisolism in T2D, which may have therapeutic implications. The aim of this systematic review and meta-analysis was to assess the prevalence of hypercortisolism in T2D patients.Methods: Origina...

Background: Pegvisomant has demonstrated efficacy in attaining IGF1 normalisation in previously uncontrolled acromegalic patients. A home care programme improves treatment compliance.Aims: Evaluation of home educational program and quality of life (Qol).Methods: Multicentre observational study involving eight Flemish centres. Uncontrolled acromegalic out-patients were trained for daily subcutaneous pegvisomant injection at home by ...

Introduction: The short Synacthen test (SST) is a popular diagnostic investigation for adrenal insufficiency (AI). Cannulation and blood sampling are required making it invasive, time-consuming and resource-intensive. Salivary cortisol is a well-established alternative to serum sampling. We have developed a non-invasive alternative to the 1 μg SST, using a novel formulation of Synacthen (with a nasal drug enhancer, chitosan) given nasally and utilising saliva to measure t...

Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, with time,...

Background: Treatment outcome with hydrocortisone for congenital adrenal hyperplasia (CAH) in neonates and children is highly variable. As there is no licensed formulation for children <6 years hydrocortisone capsules individually have to be compounded by local pharmacies (dose strength: 0.5–9.5 mg). The aim of this study was to characterise mass and content of these capsules in order to assess medication safety for effective and nontoxic dosing in terms of precision ...

Background: Paediatric diabetes is predominantly an outpatient based specialty, limiting the training opportunities available to paediatric trainees. At our centre, out of hours diabetes advice calls are managed by paediatric specialty trainees working on the middle grade rota, with 24 hour support from an oncall paediatric diabetes consultant. Feedback locally from families has highlighted the quality of out of hours advice as an area of concern. We aimed to assess the knowle...

Introduction: Phytoestrogens are derived from plants that are structurally and functionally similar to oestrogens. Their health benefits are widely extolled, although excessive consumption in children may cause adverse effects.Case 1: A 5.7-year old female presented with a one-month history of breast development and a 3-day history of vaginal bleeding. Prior to presentation, she was taking a health drink containing fennel and sesame seeds, in addition to...

Hyponatraemia is associated with an increase in morbidity and mortality, prolonged hospital stays and poor assessment and management. Two audits were performed looking at acute medical unit (AMU) admissions with sodium <130 mmol/l, before and after the introduction of a protocol and regular endocrine nurse specialist ward visits, 3 months apart (58 patients in April and 99 in July 2013).Hyponatraemic patients were older than the AMU population (>...

Introduction: A 2009 BSPED survey revealed that 90% use a low dose Synacthen test (LDST) and 44% had noticed increased referrals of asthmatic children prescribed inhaled corticosteroids (ICS). Approximately 21% of UK children have asthma of whom 70% are prescribed ICS (10% at ‘high dose’). There is an increasing need for a simple, less invasive, alternative to the LDST to evaluate their adrenal function. We are developing a non-invasive LDST, with Synacthen administe...

A 65-year-old female, with a 4 month history of left upper quadrant discomfort, was identified as having a multi-loculated para-renal ‘cyst’ on ultrasound scanning. CT identified a 13×11×10 cm heterogeneous mass arising from the left adrenal. An enlarged ill-defined left retro-crural ‘lymph node’ was also noted. There was no history of weight loss. Past medical history was unremarkable. She was no medication. Examination was unremarkable apart fro...