Endocrine Abstracts

Case history: We report a 56-year-old man who was referred to the Endocrinology Clinic with hypokalaemic hypertension. He had a history of bladder cancer 9-years previously, treated with surgery, chemotherapy and BCG therapy. At referral, he was taking Amlodipine 10 mg and Doxazosin 8 mg twice daily with average home blood pressure readings of 160/90 mmHg.Investigations: Aldosterone to renin ratio (ARR), taken on Doxazosin with potassium 3.6 mmol/l was 3...

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...

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....

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...

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...

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...

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...

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,...

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...

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 ...