Endocrine Abstracts

A 35 year old woman was referred to Endocrinology after imaging investigating unexplained pyrexia demonstrated an absent uterus. She was of Pakistani origin and was born phenotypically female with reported normal female genitalia. During late teenage years she experienced virilisation with deepening voice, increased pubic and axillary hair and clitoromegaly. She had absent breast development. Her parents were first cousins and siblings were unaffected. Investigations in Pakist...

Traditionally, oestradiol measurement is performed by immunoassay. The sensitivity of these assays is not sufficiently sensitive for certain patient groups such as males, post-menopausal females and children. There is also a potential for interference from structurally related compounds or heterophilic antibodies. LC–MS/MS is an attractive alternative as it has increased sensitivity and specificity.We reviewed the requests for LC–MS/MS analysis...

Background: Elevated morning plasma cortisol is associated with multiple cardiovascular risk factors in metabolic syndrome. Epidemiological studies have also reported a positive association between plasma cortisol and coronary heart disease (CHD), although not all estimates are statistically significant (OR 1.10 (95% CI 0.97 to 1.25)) (Davey Smith et al. Circulation 2005). Importantly, observational studies are unable to infer causality and results may be confounded.<...

Background: Vascular impairment, most commonly due to endothelial dysfunction, is associated with cardiovascular risk in humans with obesity, insulin resistance or Cushing’s syndrome. Similar endocrine disorders in horses, resulting in insulin resistance, are associated with laminitis, a dysfunction of the vasculature supplying the hooves, the mechanism of which is unclear. We hypothesised that horses with insulin resistance have both local and systemic evidence of vascul...

Canrenone and mifepristone (RU486) are respectively mineralocorticoid receptor (MR) and glucocorticoid receptor (GR) antagonists commonly used to block or displace steroid for clinical pharmacological or research purposes. The aim of this study was to develop and validate a sensitive, quantitative assay for the combined analysis of glucocorticoids (cortisol, cortisone, corticosterone, and 11-dehydrocorticosterone), mineralocorticoids (aldosterone), canrenoate, and mifepristone...

We measured chromogranin A (CgA) and chromogranin B (CgB) in 36 patients, recently confirmed to have a midgut carcinoid tumour (MGC), prior to the commencement of octreotide treatment. Blood samples were taken before and after a bolus injection of 50 μg octreotide. There were 21 males, 15 females, age range 28–76 median 61 years.Basal CgA, expressed as times the upper limit of normal (ULN) ranged from 333.3 to 0.5 ULN. Basal CgB ranged from 33....

A 51-year-old obese lady was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. She was referred to the endocrine team because of newly-diagnosed type 2 diabetes mellitus. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis (BSAN) led to a clinical diagnosis of Cushing’s syndrome (CS); this was biochemically confirmed as follows: non-s...

Background: The overnight dexamethasone (DEX) suppression test is useful for the investigation of hypercortisolism, however several factors may influence its performance. Intestinal uptake of DEX, inactivation by conversion by CYP3A4 in the liver and renal clearance can all affect test variability. It is also known that several drugs can either reduce or accelerate CYP3A4 activity, thereby affecting blood DEX concentrations. Interpretation of the test would be greatly enhanced...

Activation of the hypothalamic–pituitary–adrenal (HPA) axis and altered tissue glucocorticoid action in obesity and metabolic syndrome has been attributed to altered peripheral cortisol metabolism. In human obesity, cortisol clearance is increased with up-regulation of A-ring reductases and down-regulation of cortisol-regenerating 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) in liver, while in adipose tissue 11β-HSD1 is up-regulated. Rodent studi...

Canrenone is a mineralocorticoid receptor antagonist used as a diuretic agent to treat hypertension. It is the major active metabolite of spironolactone and may be quantified in clinical studies either to ensure compliance or to gain information about pharmacokinetic-pharmacodynamic interactions.The aim of this study was to develop and validate a sensitive, quantitative assay for the analysis of canrenone in plasma.HPLC mass spectr...