Searchable abstracts of presentations at key conferences in endocrinology

ea0048cb10 | Additional Cases | SFEEU2017

A challenging case of dual endocrine pathology

Ramli Rozana , Steer Keith , Hatfield Emma , Mehta Amrish , Jones Brynn , Mendoza Nigel , Meeran Karim , Martin Niamh

A 39-year-old man presented with thyrotoxicosis and was diagnosed with Graves’ disease. Despite high doses of anti-thyroid medication for 18 months, he remained biochemically and clinically hyperthyroid. Therefore, a thyroidectomy was planned. Four days before surgery, he developed double vision and was referred for urgent Neurosurgical review at our centre. On further questioning, he reported a 12-month history of lethargy and low libido. On examination, he had right 6th...

ea0044p23 | Adrenal and Steroids | SFEBES2016

The pharmacokinetic profile of prednisolone is not affected by ingestion of food – how should patients be advised?

Choudhury Sirazum M , Williams Emma L , Tan Tricia M , Meeran Karim

Background: Prednisolone is used for glucocorticoid replacement therapy in Adrenal Insufficiency. Package inserts indicate that prednisolone should be administered with or after food as there is a belief that prednisolone causes stomach ulcers. We have investigated the impact of various fasted and non-fasted states on its pharmacokinetic profile.Method: A healthy volunteer provided three 4 mg prednisolone profiles. The first was a fasted reference curve....

ea0044p26 | Adrenal and Steroids | SFEBES2016

Could modified release prednisone hold the key to closer reproduction of the glucocorticoid circadian rhythm in Adrenal Insufficiency?

Choudhury Sirazum M , Leckey Adam , Williams Emma L , Tan Tricia M , Meeran Karim

Background: The cortisol circadian rhythm has an early morning peak with an increase before awakening, and a second lunchtime peak. Using a UPLC-MS/MS technique to measure prednisolone, the active metabolite of prednisone, we investigated the suitability of modified release (MR) prednisone (Lodotra) as a replacement therapy.Method: Blood samples were taken at fixed time points after the administration of MR-prednisone. Concentrations of the active metabo...

ea0044p65 | Clinical biochemistry | SFEBES2016

Osteoporosis and low-dose prednisolone: Is there a link? Insights from bone turnover markers

Ang Yvette , Leckey Adam , Choudhury Sirazum , Courtney Alan , Tan Tricia , Meeran Karim

Prednisolone has been reported to have greater deleterious effects on bone turnover than other glucocorticoids, although the evidence for this is confounded by the effects of higher dose prednisolone, as used in conditions such as asthma. We hypothesise that a physiological replacement dose of prednisolone will have a less dramatic effect on bone than has previously been suggested, and might be safer than hydrocortisone for replacement in adrenal insufficiency. We investigated...

ea0044p239 | Thyroid | SFEBES2016

Optimising the medical treatment of Graves’ Disease through developing a novel carbimazole dosing-algorithm

Brewster Rosalind , Abbara Ali , Clarke Sophie , Comninos Alexander , Peters Deborah , Sam Amir , Meeran Karim , Dhillo Waljit

Introduction: Graves’ disease is the commonest cause of hyperthyroidism accounting for 80% of all cases. The first line treatment for Graves’ disease in the UK is medical therapy, most frequently using a ‘dose-titration’ regimen. Currently, there is a lack of guidance to aid clinicians in carrying out optimal dose-titration of carbimazole, resulting in a risk of under- or over-treatment. Thus, we aimed to develop a carbimazole dosing-algorithm for the medic...

ea0044ep26 | (1) | SFEBES2016

Osteocalcin suppression may be a useful marker of steroid exposure

Ang Yvette , Leckey Adam , Choudhury Sirazum , Courtney Alan , Tan Tricia , Meeran Karim

Mrs. M is a 66-year-old female who has had secondary adrenal insufficiency for many years following the withdrawal of prednisolone therapy for pulmonary eosinophilia. Synacthen tests revealed complete adrenal suppression when the dose of prednisolone was weaned to 5 mg in previous years. The dose was further reduced by switching to hydrocortisone three times daily, following a 10 mg-5 mg-5 mg regimen. Occasionally, a flare of eosinophilia required restarting high-dose predniso...

ea0059p058 | Clinical biochemistry | SFEBES2018

A cross-sectional study of sensitivity and specificity of late-night salivary cortisol in a single-centre heterogenous population

Barker Sally , Prabhudev Hemanth , Martin Nimah , Todd Jeannie , Meeran Karim , Agha-Jaffar Rochan , Wernig Florian

Endogenous Cushing’s syndrome poses considerable diagnostic challenges. It is recommended to use two screening tests to confirm hypercortisolaemia. While late-night salivary cortisol assessment (LNSC) is reported to have good specificity and sensitivity and deemed to be cost-effective, it is the least widely biochemical tool used both nationally and in Europe. We aim to compare the specificity and sensitivity of LNSC against and in combination with other diagnostic tests,...

ea0059ep88 | Reproduction | SFEBES2018

An Unusual but Important Cause of Hyperandrogenism in Women

Alkaabi Fatima , Haboosh Sara , Abbara Ali , Meeran Karim , Todd Jeannie , Fotopoulou Christina , Comninos Alexander N

A 61 year-old woman presented with a two year history of facial hirsutism and frontal balding. She did not report voice change or acne. Menarche was at age 14 with regular menses until a hysterectomy (with ovarian preservation) for menorrhagia aged 29. She had a past medical history of T2DM and gastric bypass surgery. She was not on androgenic medication. Examination revealed clinical hyperandrogenism with androgenic alopecia and hirsutism (FG score 20) but no cliteromegaly. T...

ea0038p95 | Clinical practice/governance and case reports | SFEBES2015

Diaphoresis: an unusual initial presenting complaint of Cushing’s syndrome

Ali Sabreen , Abbara Ali , Comninos Alexander , Ramli Rozana , Martin Niamh , Hatfield Emma , Sam Amir , Meeran Karim

Introduction: Diaphoresis, or excessive sweating, is well recognised as a presenting complaint for endocrine disorders such as hyperthyroidism, acromegaly, and phaeochromocytoma. However, diaphoresis is an unusual presenting complaint for Cushing’s syndrome.Case: We present the case of a 35-year-old lady who first presented to health services for symptoms of excessive sweating, and feeling hot most of the time. Whilst initial investigations such as ...

ea0038p124 | Clinical practice/governance and case reports | SFEBES2015

A case of Graves’ disease occurring following cessation of the oral combined contraceptive pill

Ali Sabreen , Abbara Ali , Comninos Alexander , Ramli Rozana , Martin Niamh , Hatfield Emma , Sam Amir , Meeran Karim

Introduction: Graves’ disease is an autoimmune disorder which may lead to thyroid overactivity and eye disease. Oestrogen and progesterone are thought to be immunomodulatory and have been postulated to play an important role in the difference in prevalence of autoimmune disorders between men and women. Autoimmune disorders, including autoimmune thyroid disease, are often quiescent during pregnancy with an increased prevalence postpartum. The increase in immune mediated th...