Endocrine Abstracts

Introduction: Corticosteroid Binding Globulin (CBG) binds >85% of plasma cortisol and modulates free cortisol levels. Observations in vitro show that CBG is cleaved by neutrophil elastase (NE), a mechanism proposed to reduce CBG binding affinity and increase free cortisol availability to inflamed tissues. However, detection of cleaved CBG in vivo in human plasma is controversial, and any influence of NE on CBG cleavage has not been tested in vivo...

Variation in endogenous glucocorticoid (GC) activity during inflammation has been linked to susceptibility to developing rheumatoid arthritis (RA). It has been shown that in patients with RA inflamed synovial tissue can generate active GCs through the expression of the 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1), which converts cortisone to cortisol. We examined whether the total body activity of 11β-HSD1 or its expression within synovium was assoc...

Introduction: Vitamin D insufficiency is common in subjects with type 2 diabetes. Observational studies suggest that vitamin D plays a role in the pathogenesis of type 2 diabetes. However, results of intervention studies have been inconsistent. We investigated the effects of improving vitamin D status on insulin sensitivity and inflammatory markers in type 2 diabetic patients with vitamin D insufficiency.Methods: A double blind, randomized, placebo contr...

Case history: A 38-year-old man was referred with a 12-month history of recurrent bouts of transient hyponatraemia (serum sodium ranging from 115 to 125 mmol/l). Citalopram, which he was taking for depression, was discontinued, but the episodes continued.Initial investigations: Whilst symptomatic, and clinically euvolaemic, his biochemical profile was consistent with a syndrome of inappropriate antidiuresis (SIAD): sodium 124 mmol/l, potassium 4.5 mmol/l...

Introduction: In August 2015, a revision of the BSPED-recommended guideline for the management of diabetic ketoacidosis (DKA) was published. A key difference from the previous guideline was a reduction in maintenance fluid rates, with the aim of reducing the incidence of cerebral oedema. Since implementation of these national guidelines, there have been reports within regional networks of an increased incidence in mild acute renal impairment and hypokalaemia. This retrospectiv...

Fifty postmenopausal hypothyroid women (age 71.7±5.1 year) had been under replacement L-T4 therapy for 4.4±2.0 years before adding calcium carbonate (CC) (taken 1–2 h after L-T4). CC and tablet L-T4 were taken for the subsequent 2.3±1.1 years. Because serum TSH increased compared to L-T4 taken alone (3.33±1.0 vs 2.0±0.5 mU/l (baseline), P<0.001), with 9/50 having TSH values >4.12 mU/l, we instructed all 50 women to postpone CC aft...

Case: A 22-year-old lady was referred with marked hirsutism for 12 months and secondary amenorrhoea for 4 years. She has a complex medical background including persistent hyperinsulinaemic hypoglycaemia of infancy (PHII) necessitating subtotal pancreatectomy with subsequent diabetes. Perhaps a result of PHII, she also has learning difficulties and epilepsy. Other problems include myopathy and mild chronic thrombocytopaenia.Medications: insulins glargine ...

It is generally considered that sight-threatening retinopathy is most unlikely within 5 years of diagnosis in a young patient with acute onset diabetes. We present the case of a 27 year old who developed severe bilateral proliferative retinopathy within 6 months of diagnosis.She consulted her about GP about long standing irregular periods. As she was overweight the GP checked a random blood sugar which was16. HBAIC was 9.2%. There was a family history of...

Introduction: Testosterone therapy for hypogonadal men has been used for decades. However, there are still concerns regarding the safety of this treatment, particularly in elderly men.Methods: Prospective registry study of 252 men (mean age 60.6±8.0 years), with testosterone levels between ≤3.5 ng/ml. They received parenteral testosterone undecanoate 1000 mg at day 1, week 6 and every 12 weeks thereafter for up to 66 months.<p class="abst...

Generalised resistance to glucocorticoid is a rare familial or sporadic disease with partial target tissue insensitivity to glucocorticoids. Compensatory activation of the hypothalamo–pituitary–adrenal axis occurs with raised andrenocorticotrophic (ACTH) hormone levels and increased synthesis of adrenal steroids. The phenotype varies from asymptomatic to excess glucocorticoid, mineralocorticoid and androgenic effects.A 20-year-old female was fo...