Endocrine Abstracts

Clinical guidance recommends titrating the dose of metyrapone against serum cortisol concentrations. These serum samples are usually measured by immunoassays; however it has been well documented that there are interferences in these assays in patients with altered steroid metabolism due to a pathological process or drug treatment. The increasing availability of mass spectrometry (MS) assays for steroid hormones may circumvent this issue and assays that measure multiple steroid...

Androsterone glucuronide (ADG) is a major metabolite of the androgen dihydrotestosterone and has also been shown to arise from the intracrine conversion of other adrenal androgens such as androstenedione and androsterone. ADG has been shown to be raised in some women with clinical signs of hyperandrogenism such as acne and hirsutism, even when levels of androgens, e.g. testosterone or DHEA-S are normal. This indicates that raised ADG levels may be an early indication of hypera...

Testosterone, androstenedione and DHEAS are commonly measured by immunoassays. Variations in antibody specificity and calibration of assays results in non-commutability of measurements. Even more specific mass spectrometry (LC–MS/MS) assays still exhibit differences in calibration. As the use of mass spectrometry for measuring steroids is becoming more common in the clinical laboratory, the development of LC–MS/MS reference ranges for these analytes is essential to h...

Before the use of potent acid suppressing drugs and in particular proton pump inhibiters (PPI), most patients with gastrinoma presented with Zollinger–Ellison syndrome and diagnosis was problematic in only a few. In recent years, the syndrome is rarely seen and gastrinoma patients present with less overt symptoms and hypergastrinaemia which may be mild. Increasingly patients present later.In the population, hypergastrinaemia most commonly occurs bec...

This 52-year-old lady presented in 2001 at a GI clinic complaining of occasional abdominal cramps, which could be severe and prolonged. Her symptoms were not associated with diarrhoea or constipation. Weight loss of 4.5 kg over 4 months was noted. Coeliac disease was excluded and a diagnosis of severe irritable bowel was made.In January 2002 she returned to the clinic with further weight loss (total 8 kg), cyclical symptoms of diarrhoea lasting 3–5 ...

Cortisol is regenerated from cortisone by 11βHSD1 reductase in cells from VAT. Mice overexpressing 11βHSD1 in adipocytes have more glucocorticoids in the portal vein (PV) and hepatic insulin resistance. In humans, hepatic vein (HV) sampling during D4-cortisol tracer infusion confirmed substantial splanchnic cortisol generation, and indirect modelling suggested major contributions from both liver and VAT. PV sampling in dogs, however, did not reveal cortisol release f...

A 46-year-old male presented in 1981 with a 2 year history of profuse watery diarrhoea, three stone weight loss and fatigue. On examination he appeared gaunt with diffuse muscle weakness. Investigations revealed hypokalaemia (2.5 mmol/l; NR 3.5–4.5), achlorhydria and a raised vasoactive intestinal polypeptide (VIP) (1500ng/L; NR 0–100). Abdominal CT showed a 5 cm pancreatic mass but with no focal liver pathology. A distal pancreatectomy was performed. Histology confi...

Salivary cortisol (SalC) potentially has advantages over serum cortisol (SerC) as it is easier to collect and possibly reflects unbound (free) cortisol. SalC levels are approximately 10 times lower than SerC and require high measurement precision best addressed by liquid chromatography–tandem mass spectrometry (LC-MS/MS), which in contrast to previously used radioimmunoassays eliminates cross-reactivity by other steroids. We describe the use of LC-MS/MS to evaluate the po...

Introduction: Adult Growth Hormone Deficiency (AGHD) is associated with osteoporosis. Underlying mechanisms involved in the pathogenesis include reduced target-organ sensitivity to the effect of PTH. Growth Hormone Replacement (GHR) in AGHD leads to increased PTH target-organ sensitivity and consequently increased bone turnover and bone mineral density (BMD).Aims: We determined the effect of alendronate, given in addition to GHR, on PTH target-organ sens...

Insulinoma is a rare tumour, but is the commonest cause of hyperinsulinaemic hypoglycaemia in adults. It is characterised by symptomatic hypoglycaemia with inappropriately elevated plasma insulin and C-peptide levels. 10% of insulinomas are malignant. The coexistence of insulinoma with diabetes mellitus is extremely rare with only 20 previously reported cases. This can therefore pose a diagnostic challenge.An 83 year old man, who developed Type 2 diabete...