Endocrine Abstracts

Background: Corticosteroid Binding Globulin (CBG) binds >85% of plasma cortisol and controls the circulating free cortisol pool. Proteolytic cleavage by neutrophil elastase is proposed to reduce CBG binding affinity and increase free cortisol availability to inflamed tissues. The CORtisol NETwork (CORNET) consortium found that genetic variation at a locus spanning SERPINA1 (encoding alpha-1 antitrypsin, A1AT, the endogenous inhibitor of neutrophil elastase) and SE...

Introduction: Hydrocortisone therapy in adrenal insufficiency and medical management of Cushing’s syndrome requires accurate monitoring of glucocorticoid status. Currently, this necessitates admitting patients to hospital for serial measurements of serum cortisol. From previous studies in Cushing’s, the goal of medical therapy is a mean (based on five samples) serum cortisol of 150–300 nmol/l, which is known to equate to a normal cortisol production rate. Saliva...

Background: Endocrinology is well-established as an outpatient specialty. However, virtually no data exist on the volume, nature, management and disposal of inpatient referrals to inform the design and delivery of a quality-assured service.Methods: We undertook an audit of all activity of the Inpatient Endocrine Service at University Hospitals Birmingham NHSFT (IES@UHB) between January 2010 and December 2015. Referrals received electronically via the Pat...

Glucocorticoids (GCs) are widely prescribed to treat a number of inflammatory and autoimmune conditions. However, patients receiving GCs often develop adverse metabolic effects such as hyperphagia leading to weight gain and hyperglycaemia. Little is known about the central effects of GCs; however they can act in the hypothalamic arcuate nucleus (ARC), a region involved in the integration of other energy regulatory hormones such as leptin, insulin and ghrelin. Therefore, the ai...

Abstract: Inflammation plays a contributing role in the pathogenesis of several metabolic disorders, including type 2 diabetes and obesity. Intriguingly, obesogenic diets induce markers of hypothalamic inflammation and neuronal injury in both rodents and humans, suggesting that targeting inflammatory pathways in the hypothalamus might represent a novel strategy to control energy metabolism. Unfortunately, the majority of steroid-based anti-inflammatory drugs are fraught with a...

Excess action of glucocorticoid hormones is implicated in metabolic disease and cognitive decline, 11β-hydroxysteroid dehydrogenase 1 (11βHSD1) catalysing generation of active glucocorticoid hormones in tissues. The penetration rates and tissue-specific contribution of 11βHSD1 to glucocorticoid turnover were assessed using tracer kinetics. 9,11,12,12-d4-Cortisol (d4F) was infused (1.75 mg/day, 7 days) into C57Bl6/J male mice and mice lacking 11βHSD1 (n<...

Background: NEQAS data demonstrate a divergence in bias of cortisol immunoassays over the last 10 years. Despite this, a serum cortisol of 50 nmol/l has been universally applied as the cut-off for the overnight dexamethasone suppression test (ONDST), the commonest screening test for Cushing’s syndrome.Aims: To assess the effect of assay bias on interpretation of the ONDST and determine the necessity for a method-specific cut-off.<p class="abstex...

Aims: The aim of this paper is to report on the outcomes of a clinical trial investigating the clinical effectiveness of universal screening for gestational diabetes mellitus (GDM) in primary care vs secondary care.Design and methods: A parallel group randomised controlled trial of universal screening for GDM in primary vs secondary care. The primary outcome – uptake of screening in primary vs secondary care is reported elsewhere. In this article we...

Aim: The aim of this paper is to report on the outcomes of a randomized controlled trial designed to evaluate the effectiveness of a group-based lifestyle intervention programme for reducing the risk factors associated with diabetes in women with pre diabetes following gestational diabetes. We expected that the group based intervention through its educational and supportive approach would enable improvements in psychosocial health, health behaviours, anthropometry, and glucose...

Background: Treatment of congenital adrenal hyperplasia (CAH) in childhood focuses on growth and development; however the relationship of childhood treatment with adult health outcomes is not established. We explored this by examining relationships between final height (FH) and cardiometabolic risk in CAH adults.Methods: Cross-sectional analysis of 65 men (80% salt wasting (SW) and 20% non-SW) and 134 women (74% SW and 26% non-SW), aged 18–69 years....