Endocrine Abstracts

The term subclinical Cushing syndrome arose at the turn of the millennium with the description of large Italian study of adrenal incidentalomas. Of 1096 patients from 26 centres, 9.2% had ‘subclinical Cushing’s’ (JCEM, 2000; 85:637-644). Since then over 300 publications have detailed this newly discovered endocrine diagnosis, and herein lies the main issue. The definition of Cushing’s syndrome is not in doubt – a ‘constellation of symptoms and sig...

In an attempt to audit one aspect of the endocrine nurse's workload, all incoming telephone calls to our office were monitored over a two month period.Details recorded were the call source, the query raised and the time taken by the nurse to respond appropriately. We went on to analyse the information gathered to ascertain areas where improved clinical practice could alleviate the need for further calls.Calls totalled 200 in the ...

Debate surrounds the optimal biochemical assessment in the follow-up of patients withacromegaly, particularly with the introduction of GH receptor antagonists to the treatment algorithm. Consensus statements suggest target values for GH of < 1microgram per litre with normal age and sex matched IGF-1 values. A number of groups have reported on the correlation between IGF-1 and GH levels in small cohorts of acromegalic patients. We retrospectively<p...

IntroductionPrediction of the efficacy of antithyroid medication in Graves' disease would be of great value. There is no consensus if TSH levels at the end of treatment accurately predict relapse. Previous studies have not carefully defined Graves' disease nor used the same treatment protocol in all patients.AimTo study patients with Graves' disease treated with antithyroid medication to confirm or refute an ...

Introduction. We present a rare and unusual case of direct trauma to the pituitary region.History. A 22 year old female, 8 weeks post-partum, fell downstairs on to a metallic clothes drier. A metal spike 3mm wide and approximately 20cm long penetrated her right eyebrow. Computed tomography showed a haemorrhagic track involving the hypothalamic region, and extending to the left internal capsule. Irritability and instability of vital signs necessitated in...

Background: There is limited data on the use of Denosumab for hypercalcaemia in patients with primary hyperparathyroidism (PHPT). We describe a case of severe hypercalcaemia in a critically ill patient with COVID, on a background of mild PHPT prior to hospital admission.Case report: Seventy-seven-year-old gentleman with mild hypercalcaemia dating back to 2019, was referred to endocrinology with hypercalcaemia (adjusted calcium 4.02 mmol/l) and associated...

Endocrinologists focus on circulating and excreted cortisol for diagnosis of, and to assess severity and treatment response in, Cushing’s syndrome (Cs). However, in Cs, morbidity is mediated by excess cortisol binding to intracellular glucocorticoid (GC), mineralocorticoid (MC), and non-genomic receptors. We and others have demonstrated that 11b-hydroxysteroid dehydrogenase type 1 (HSD-1) is the source of about half of intrahepatocellular cortisol in healthy adults, patie...

Case history: 73-year-old woman recently commenced on oral diuretics for peripheral oedema was admitted with severe hypokalaemia and refractory hypertension. Conn’s syndrome was initially considered but admission of regular liquorice consumption made a diagnosis of hypokalaemic hypertension (pseudoaldosteronism) secondary to liquorice over-indulgence more likely. She went on to develop cardiomyopathy and had haematemesis from a bleeding duodenal ulcer (DU). Endocrine test...

Introduction: Acute adrenal insufficiency (adrenal crisis) is a life-threatening condition caused by glucocorticoid deficiency. Patient and carer education is key in the prevention, early identification and prompt management of this condition. We assessed the knowledge of adrenal insufficiency/crisis in patients with adrenal and pituitary disease to evaluate the strengths and weaknesses of local ‘sick day’ education processes.Methods: We utilis...

Continuous glucose monitoring (CGM) has highlighted the gap that exists between our expectations of tight metabolic control and the realities of actually achieving this, particularly during type 1 diabetes pregnancy. Longitudinal measurements indicate that despite overall ‘good’ HbA1c levels, pregnant women with type 1 diabetes spend 8 h/day with blood glucose levels above the recommended targets. New closed-loop (CL) or artificial pancreas approaches integrate insul...