Endocrine Abstracts

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

A 41 year old Emirati man was reviewed in January 2016 for hypercholesterolaemia managed on diet alone, but direct questioning revealed gradual onset erectile dysfunction over 2 years, treated by a urologist elsewhere. Initial response to Cialis had waned over 18 months. Testosterone replacement (Nebido) had been initiated in June 2015 on the basis of one low morning total testosterone of 3.89 nmol/L (normal range 8.64 – 29). SHBG and prolactin...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

A 41 year old Emirati man was reviewed in January 2016 for hypercholesterolaemia managed on diet alone, but direct questioning revealed gradual onset erectile dysfunction over 2 years, treated by a urologist elsewhere. Initial response to Cialis had waned over 18 months. Testosterone replacement (Nebido) had been initiated in June 2015 on the basis of one low morning total testosterone of 3.89 nmol/L (normal range 8.64 – 29). SHBG and prolactin...

Case history: A 66 year old lady presented with abdominal pain, new onset diabetes and hypertension. She was diagnosed with Cushing’s syndrome and was found to have a large heterogeneous left adrenal mass of 11.4 × 9.3 cm in size with no disease elsewhere. She underwent a left open adrenalectomy and the histology confirmed an adrenocortical carcinoma (Weiss score of 7) with focal vascular invasion, no extra-capsular spread and clear resection margins. Following surge...

Mrs SP was a 50-year old patient who presented with typical features of Cushing’s syndrome in 2003 and proceeded to pituitary surgery. Following this she was not cured, and elected to have a bilateral adrenalectomy. Following this, she was initially commenced on hydrocortisone 30 mg daily taken as 15 mg in the morning, 10 mg at noon and 5 mg at 1600 h, and fludrocortisone 100 μg daily. She continued on this for 10 years, but switched her glucocorticoid replacement to...

A 33 year-old male bus driver with long standing pemphigus requiring high dose prednisolone, presented with acromegaly in 2001. MRI pituitary revealed a 2×2×0.5 cm pituitary adenoma and his GH levels of 14.8–16.4 nmo/L throughout and were not suppressible with glucose. His IGF1 was 191 nmol/l (normal range: 13–64 nmol/L), Prolactin 6,557 milliunit/L, testosterone 2 nmol/L and cortisol uninterpretable as he was on prednisolone. Trans-sphenoidal hypophysectom...

Objective: To investigate a selection of novel bone or immunomarkers which may act as indicators for steroid replacement in Adrenal Insufficiency (AI).Introduction: AI is a condition where individuals are not able to produce sufficient steroids for their body’s requirement. Although mortality rates have improved since the introduction of exogenous steroid replacement, this condition is still associated with increased mortality and morbidity. This co...

A 70 year old Afro-Caribbean gentleman was referred for investigation of hypercalcaemia. He had a past medical history of prostate cancer treated 10 years previously with radical prostatectomy and radiotherapy, type 2 diabetes and hypertension. There was no family history of note. At the time of his operation, his calcium was noted to be high 2.87 mmol /L (nr 2.15–2.6) and his creatinine was 87 but this was not investigated further. At the first clinic visit, his correcte...