Endocrine Abstracts

Introduction: Minimally invasive surgical treatment of primary hyperparathyroidism (PHPT) requires optimal preoperative localisation imaging. Parathyroid four-dimensional CT (4D-CT) has been reported to provide greater sensitivity than MIBI-SPECT/CT in localizing parathyroid adenomas. We analysed the additional value of 4D-CT in our cohort of PHPT patients.Materials and methods: Patients who attended our parathyroid clinic between February 2016 and April...

Introduction: Following treatment of Graves’ disease (GD), levels of thyrotropin receptor autoantibodies (TRAb) tend to decrease depending on treatment modality and length of follow up. We have assessed TRAb biological activity at follow up, years after GD treatment.Subjects and methods: TRAb concentration and biological activity were measured in 69 GD patients (59 females; 10 males; median age 59 years; TRAb positive at diagnosis), with follow up r...

Background: Diabetes insipidus (DI) is a recognised complication of pituitary surgery, with current diagnosis requiring clinical observation aided by plasma and urine electrolytes and osmolalities. Copeptin, a 39 amino acid glycopeptide secreted in equimolar quantities to ADH, is a stable surrogate marker of ADH release and has potential to facilitate prompt diagnosis of post-operative DI. This assay has been shown to accurately predict which patients are likely to develop DI ...

Tumour localisation in Cushing’s disease (CD) can be challenging; most are microadenomas and 50% are <5 mm in diameter. They are, therefore, often difficult to detect by conventional MRI. Volumetric MRI (3D-SGE, spoiled-gradient echo 3D sequence) is a high spatial resolution scanning technique which uses very thin slices (1 mm). Theoretically, this increases the probability of finding small pituitary lesions when compared to conventional (spin-echo, SE) MRI techniques...

Introduction: Germline aryl hydrocarbon receptor-interacting protein (AIP) mutations are responsible for 15–30% of familial isolated pituitary adenomas (FIPA). We report a 4-generation FIPA kindred with a heterozygous AIP gene deletion in exon 2, highlighting the benefits of genetic screening and management challenges in affected subjects and asymptomatic carriers.Patients: A 45y woman died of a spinal ependymoma (obligate carrier)...

Non-alcoholic fatty liver disease is the hepatic manifestation of the global epidemic of metabolic disease. Steroid hormones, including glucocorticoids and sex steroids, regulate metabolic phenotype, and in addition, bile acids have recently been identified as potent metabolic regulators. 5β-reductase (AKR1D1) is predominantly expressed in the liver and is a crucial regulator of steroid hormone clearance as well as bile acid synthesis. Its role in pathogenesis of metaboli...

Introduction: Patients with Cystic fibrosis are now living longer due to advances in nutritional and medical care. As a consequence a larger number are developing related co-morbidities such as cystic fibrosis related diabetes (CFRD). CFRD is the most common co-morbidity in CF, with the prevalence being up to 50% by the age of 30.Aims: To assess current practice in relation to the UK CF Trust guidelines 2004 – Screening for CFRD should begin at age ...

Rathke’s cleft cysts (RCC) arise from the embryonic remnants of Rathke’s pouch in the anterior pituitary gland. The majority are asymptomatic and incidentally diagnosed when the pituitary is imaged for other reasons. RCCs can progress to requiring surgical intervention for hormonal and structural effects. It is unclear what factors determine RCC enlargement and over what period this occurs, hence need for long term follow-up is uncertain. We analysed our conservative...

A 57-year-old woman with poorly controlled type 2 diabetes (HbA1c 148 mmol/mol) presented acutely with lower back pain, in the absence of trauma. Her WHO performance status score was 2. 18 months earlier she had developed a left fifth toe ulcer, resulting in left forefoot amputation six months later which had not healed. She had also developed a neuropathic ulcer in her right hallux, complicated by osteomyelitis. Despite excellent peripheral vasculature, conservative therapy w...

Non-alcoholic fatty liver disease is the hepatic manifestation of the global epidemic of metabolic disease. It is tightly associated with obesity and type 2 diabetes, yet the precise mechanisms that drive its aetiology are not fully defined. Steroid hormones, including glucocorticoids and sex steroids, regulate metabolic phenotype, and in addition, bile acids have recently been identified as potent metabolic regulators. AKR1D1 (5β-reductase), is predominantly expressed in...