Endocrine Abstracts

Glucocorticoids (Gc) act through the glucocorticoid receptor (GR) to regulate immunity, energy metabolism, and tissue repair. The inactive GR is held in the cytoplasm in a multi-protein complex, which upon ligand binding undergoes a conformational change. Activated GR translocates to the nucleus to regulate gene expression (over hours), but some effects occur more rapidly. Gc inhibit cell migration through an uncertain mechanism. We now show a very rapid effect, and surprising...

Glucocorticoids (Gc) act through the glucocorticoid receptor (GR) to regulate immunity, energy metabolism, and tissue repair. The inactive GR is held in the cytoplasm in a multi-protein complex, which upon ligand binding undergoes a conformational change. Activated GR translocates to the nucleus to regulate gene expression (over hours), but some effects occur more rapidly. Gc inhibit cell migration through an uncertain mechanism. We now show a very rapid effect, and surprising...

Introduction: National audits suggest significant variation in experience of individual surgeons performing adrenalectomies. A 2016 cross specialty consensus statement recommended that adrenal surgeons perform a minimum of six adrenalectomies per year given improved outcomes with higher volume surgeons. Patients in the Scottish Highlands requiring adrenalectomy are referred to a single Consultant Urologist with a specialist interest in retroperitoneal surgery based in Raigmore...

A 56-year-old woman presented with progressive swelling of her face and fatigability. Investigating for Cushing’s, her 24-hour Urine Free Cortisol was negative at 43 and 70nmol/24hr (Reference interval or R.I. < 146 nmol/24hr) with overnight dexamethasone suppression test showing full suppression of cortisol to 34nmol/l. Her short synacthen test was normal at 30-minute cortisol of 753nmol/l (R.I.>420); on Zumenon. Other pituitary function tests were unremarkable b...

Introduction: Cinacalcet is an allosteric modulator of the calcium sensing receptor which lowers parathyroid hormone (PTH) secretion. However, it is expensive and there is limited evidence of benefit in reducing complications of primary hyperparathyroidism (PHPT). In 2019 the National Institute for Health and Care Excellence (NICE) guidelines suggested that cinacalcet could be considered in individuals with PHPT if surgery has been unsuccessful or is unsuitable and if adjCa<su...

An anonymised online survey was created to evaluate junior doctor’s competency and confidence with decision-making scenarios in managing patients with diabetes at the end-of-life. 26 doctors working at the Beacon Hospital completed the online survey. A structured education programme was then delivered to the junior doctors where the critical information pertaining to the management of diabetes at the end-of-life was discussed, based on the ABCD 2011 and Diabetes UK 2013 a...

Case history: A 39-year-old lady first presented to our endocrine outpatient clinic in September 2014 when blood tests at her GP surgery showed serum cortisol of 65 nmol/l. She had been having chronic back pain which is treated with Buprenorphine patches for many years. A Short Synacthen test (SST) showed an inadequate response. A low ACTH suggest secondary adrenal insufficiency. Other pituitary function tests and MRI of the pituitary were normal. After staying off buprenorphi...

A 31 year-old woman is referred into the Endocrine clinic with a palpable mass in her right anterior neck that was found incidentally by her GP. She had no known past medical history, did not take any medications and had not noticed any dysphagia, neck pain, or compressive symptoms. On clinical exam, there was an enlarged thyroid with a 1.5-cm left-sided thyroid nodule that moved on swallowing. There was no palpable cervical lymphadenopathy. TSH was 2.5 mIU/l (0.29–5.1 mI...

Neonatal Diabetes Mellitus (NDM) occurs in the neonatal period and has a very high burden of morbidity and mortality. The incidence is approximately 1:100,000 but reports range from between 1 in 25,000 to 1:500,000 live births. A genetic cause can be found in over 80% of cases. At present, patients with NDM are unrecognised as being seriously ill until hyperglycaemia is at a life-threatening level. An effective method for measuring blood glucose concentrations from Guthrie car...

Gestational Diabetes (GDM) complicates 3–5% of all UK pregnancies but prevalence is increasing with rising rates of maternal obesity. Adaptions to the GDM screening protocol within NHS Lothian in August 2016 to screen high-risk women including women with obesity (BMI≥30 kg/m2) during early pregnancy (approximately 10 weeks gestation) allowed us to test the hypothesis that early screening of obese pregnant women would be associated with improved maternal a...