Endocrine Abstracts

Insulin resistance is associated with a variety of cardiovascular disorders, including hypertension, non-insulin dependent diabetes mellitus, coronary artery disease and polycystic ovary syndrome. The mechanism of reduced insulin-stimulated glucose uptake in these conditions is unclear, but is likely to involve defects in cellular components of insulin signalling. All of the disorders above are characterised by abnormal vascular endothelial function, with reduced availability...

Von-Hippel-Lindau syndrome (VHL) is an autosomal-dominant disorder associated with CNS haemangioblastomas, phaeochromocytomas, renal carcinomas and retinal haemangiomas. We present the case of a 33-year-old woman with VHL who developed clinical progression of a CNS lesion during pregnancy. The patient had undergone removal of a cerebellar haemangioblastoma at age 18, and bilateral phaeochromocytomas were removed at age 27. The only other abnormality on regular review was a mix...

Autoimmune hypophysitis is a rare cause of pituitary failure. It’s aetiology and natural history are not well understood. We present a case of pituitary failure that showed spontaneous resolution of radiological and clinical features, consistent with autoimmune hypophysitis.Case report: An 18 year old male presented with a 7 month history of polyuria and headaches. No significant past medical history or family history were noted. A water deprivation...

Background: An elevated plasma aldosterone to renin ratio (ARR) is widely accepted as being important for the detection of primary hyperaldosteronism. The ability to measure renin at extremely low concentrations is the most critical factor in determining the diagnostic reliability of the ARR. We carried out this study to establish a reference interval for the ARR as part of an evaluation of a new automated platform for the simultaneous measurement of aldosterone (PAC) and dire...

Background: Recommendations for the diagnosis of phaeochromocytoma are based on individual institutional experience but have traditionally advocated concurrent measurement of urine and plasma catecholamines. However, reports of phaeochromocytoma presenting with normal catecholamines suggest that this practice is insufficiently sensitive. In phaeochromocytoma there is an increased output of metadrenaline metabolites with a disproprtionate increase in the unconjugated form and e...

BackgroundPatients with Growth Hormone Deficiency (GHD) are known to have an excess risk of vascular disease. Previous work has shown an increase in their arterial stiffness. The effect of GH on blood pressure is still unclear.Materials and Methods16 patients with GHD (6 males) and no history of existing vascular disease or hypertension, between the ages of 18 and 65 were recruited (mean 45.4 plus/minus 3.5 y...

Introduction. As for many minor metabolites of steroids, no authentic standard is commercially available for 18-OH-THA. This compound is the principal urinary metabolite of 18-hydroxycorticosterone, a putative intermediate in the synthesis of aldosterone and of diagnostic value in screening for hypermineralocorticoidism. Since de novo synthesis is time-consuming and expensive, we tested the possibility of using beta-cortol, which produces an ion at m/z 457 in common wit...

Thiazolidinediones and biguanides improve insulin resistance and are used in the management of type 2 diabetes. Use of biguanides is associated with a reduction in vascular complications in patients with diabetes. Pre-clinical studies with thiazolidinediones suggest improvements in vascular function and long-term clinical trials in type 2 diabetes are in progress. These effects are proposed to be mediated through inhibition of complex 1 in the mitochondrial respiratory chain a...

Hypopituitary patients receiving conventional hormonal therapy, excluding Growth Hormone, have an increased risk of vascular mortality. Significant endothelial dysfunction with impaired aortic distensibility has been demonstrated in these patients with some improvement in arterial stiffness after GH therapy. Inflammation is central in the pathophysiology of atherosclerosis and C-reactive protein is a validated marker for predicting cardiovascular risk.Fo...

A 33 year old male was referred with poorly controlled hypertension. He gave no other past medical or family history. Despite therapy with multiple agents blood pressure was poorly controlled at 200/130 mm/Hg. Initial investigations which included renal ultrasound, magnetic resonance angiography and urine catecholamine excretion were all negative. Plasma renin concentration was suppressed (1 mu/ml/L, normal range 5 to 50) and plasma aldosterone was raised at 650 pmol/L (normal...