Endocrine Abstracts

Introduction: Current clinical practice guidelines recognise that a calculated free testosterone (T) level is the single most-useful, clinically sensitive marker of androgen excess in women, but there is no clear guidance as to the best way to measure free T. Several equations have been proposed to calculate clinically useful estimates of free T including the free androgen index (FAI) and calculated free T (cFT). The FAI is not used in men but it is...

: We report on 4 patients who acutely presented to our unit and diagnosed with adrenal haemorrhage.Case 1: A 72 year old man presented with generalised abdominal pain, fever and raised CRP a week after hip replacement surgery. CT abdomen showed non-enhancing bilateral adrenal lesions consistent with adrenal haemorrhage. He was taking Apixaban for DVT following hip replacement. SST was performed which confirmed suboptimal cortisol response. Hence, Treated...

Introduction: Alternative biofluids such as sweat, which can be obtained non-invasively and present a simpler matrix composition than serum/plasma or urine, may be useful for monitoring biomarkers. The long-term sampling with patches either on the chest or back can be conveniently used under both rest and exercise conditions to provide an integrated response of free biomarkers over the course of a day. The smaller sample volumes generated by sweat collection can be convenientl...

: In community-dwelling men, salivary testosterone (Sal-T) concentrations are thought to represent tissue hormone levels and correlate strongly with serum free-T levels. Measurement of salivary glucocorticoid concentrations is a non-invasive and objective means of assessing cortisol exposure in users and non-users of hydrocortisone therapy. We assessed relationships of Sal-T with transdermal testosterone replacement therapy (TD-TRT) and with markers of testosterone exposure. I...

Background: Adrenal incidentalomas (AI) are being seen frequently in endocrine clinics due to increased cross-sectional imaging with a prevalence of 4% (7% in patients >70 years) of abdominal CT scans. The majority of these tumours are benign and non-functional, but identifying malignancy and functionality is important. Excess cortisol production is the commonest endocrinopathy associated with AI, with a reported prevalence of ~10%. The overnight 1 mg dexamethasone suppres...

Traditionally, oestradiol measurement is performed by immunoassay. The sensitivity of these assays is not sufficiently sensitive for certain patient groups such as males, post-menopausal females and children. There is also a potential for interference from structurally related compounds or heterophilic antibodies. LC–MS/MS is an attractive alternative as it has increased sensitivity and specificity.We reviewed the requests for LC–MS/MS analysis...

A 51-year-old obese lady was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. She was referred to the endocrine team because of newly-diagnosed type 2 diabetes mellitus. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis (BSAN) led to a clinical diagnosis of Cushing’s syndrome (CS); this was biochemically confirmed as follows: non-s...

Background: The overnight dexamethasone (DEX) suppression test is useful for the investigation of hypercortisolism, however several factors may influence its performance. Intestinal uptake of DEX, inactivation by conversion by CYP3A4 in the liver and renal clearance can all affect test variability. It is also known that several drugs can either reduce or accelerate CYP3A4 activity, thereby affecting blood DEX concentrations. Interpretation of the test would be greatly enhanced...

Introduction: Aldosterone is a potent adrenal steroid hormone which regulates renal sodium reabsorption and potassium secretion. Clinically, measurement of aldosterone is important to identify patients with primary hyperaldosteronism, and has traditionally been performed by immunoassay. The specificity of immunoassays is often poor due to antibody cross reactivity to other structurally related steroid hormones, resulting in falsely elevated concentrations. To overcome these li...

Introduction: We have developed a highly sensitive LC–MS assay in an attempt to improve the measurement of salivary testosterone in female samples.Methods: A 200 μl saliva sample, calibrators or QC were mixed with 10 μl working internal standard (0.1 μg/l) and 1 ml of methyl tert-butyl ether (MTBE). Vortex mixed for 4 min and frozen at −80 °C (1 h). Unfrozen organic layer was transferred to a glass tube and evaporated. The ...