Endocrine Abstracts

Adequate iodine intake during pregnancy is required for the production of thyroid hormones and brain development in the foetus. Recent evidence has suggested re-emergence of mild iodine deficiency in the UK but there are few studies that have specifically looked at iodine intake in pregnant women. Current World Health Organisation recommendation is for 250 μg per day intake of iodine in pregnancy and the following are good sources of dietary iodine: 1 pint milk (~140&#150...

Iodine deficiency is the most common cause of preventable mental impairment worldwide. Recent evidence suggests the re-emergence of mild iodine deficiency in the UK possibly due to changing farming practice. A recent multicentre survey in the UK reported that 68% of school girls were iodine deficient with the lowest levels seen in Northern Ireland (NI). Unlike many countries, the UK does not have a salt or food iodination programme. A cross-sectional survey of 264 schoolgirls,...

A 39-year-old female presented with an 18-month history of borderline hypertension, headaches, palpitations and some anxiety symptoms. Both parents also had hypertension. Blood pressure was 160/102 on no medications. She had a large single cafe au lait spot but no neurofibromata. Urinary dopamine levels were repeatedly elevated (5398–8653 nmol/24 h (n<3900)) with normal noradrenaline and adrenaline levels. Serum calcium was also elevated at 2.83 mmol/l (n...

There is limited evidence on the effect of potassium (K+) supplementation on endothelial function. Three studies suggest a beneficial effect in healthy volunteers and mild hypertensives. However potassium increases aldosterone due to a direct effect on the adrenal gland and there is evidence that aldosterone excess is detrimental to cardiovascular health. We therefore aimed to determine the effect of potassium supplementation on endothelial function in patients with...

Cyclical Cushing’s syndrome is typically detected by collecting sequential daily early morning urine (EMU) samples for cortisol to creatinine ratio over a 28 day period. More recently nocturnal salivary cortisol (NSC) measurement has been shown to be a sensitive means of screening for Cushing’s syndrome. The Endocrine Society have suggested that NSC may be used to assess patients for cyclical Cushing’s however there is limited evidence that it correlates with th...

Aberrant and upregulated eutopic receptors have been identified in vitro in patients with primary aldosteronism (PA). We previously identified an exaggerated aldosterone response to synacthen in patients with PA versus healthy controls. In this study we aimed to evaluate whether the synacthen test differentiates between patients with PA and essential hypertension (EH). The 250 mcg intramuscular synacthen test was performed after 30 minutes recumbency in the morning and off int...

A 27 years old girl presented with weight gain, hirsutism, fatigue, bruising and striae. On examination she was Cushingoid. On initial assessment, 3 out of 4 24 h urinary free cortisol collections were elevated. 0800 h serum cortisol was 280 nmol/l after 1mg dexamethasone given at 2300 h. After formal 48 h low and high dose dexamethasone suppression tests cortisols were 164 and 34 nmol/l respectively. Basal 0800 h ACTH was 33 ng/l. Given the clinical features and the discrepan...

Nocturnal salivary cortisol (NSC), urinary free cortisol (UFC) and overnight dexamethasone suppression testing (ODS) are recommended screening tests for Cushing’s syndrome (CS). Individual centers differ in their screening approach; UFC being the test of choice in Northern Ireland with ODS in patients with adrenal incidentalomas. NSC, which measures free cortisol, is not routinely used. The aims of this study were to 1. Evaluate the utility of NSC in the diagnosis of CS; ...

First line screening for pheochromocytoma, as recommend by Endocrine Society guidelines, is to determine plasma free or urinary fractionated metanephrines. We routinely offer the latter. Although negative results rule out pheochromocytoma, it is not uncommon to see borderline results which require further investigation. In this situation we have historically relied on the measurement of plasma catecholamines in the clonidine suppression test (CST). Plasma metanephrines, howeve...

An adrenal incidentaloma is defined as an adrenal mass >1 cm diameter, discovered serendipitously on radiological imaging done for another reason. They are important because a percentage will turn out to be malignant or secrete excess hormones. The aim of the current study was to ascertain if these lesions were being investigated and followed appropriately compared to American Association of Clinical Endocrinologists guidelines. All imaging reports for the calendar year 20...