Endocrine Abstracts

Myxedema coma has very high mortality and should be suspected in an acutely unwell patient presenting with depressed mental status who is hypothermic, bradycardic and or hypotensive. Myxedema coma may be the first presentation of people with undiagnosed hypothyroidism. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. There is no consensus about preferred ...

A 33-year-old lady presented to the surgeons with history of abdominal pain. CT scan abdomen done revealed massive adrenal enlargements reported as adrenal myelolipomas (left gland measuring 8.0×10.9×11.8 cm and multifocal lesions on the right with the larger one measuring 5.2×4.3×3.6 cm). She was referred to the endocrinology team where further history was elicited. She had been diagnosed as a child to have congenital adrenal hyperplasia (CAH) but was lost...

Introduction: Long-term repression of the HPA axis is a major side effect of chronic glucocorticoid administration, even after attempted withdrawal of therapy, and complicates management in patients. We have previously shown that the effect of chronic glucocorticoid treatment in vitro is in part mediated by inhibition of expression the POMC transcription factors Neuro D1 and Tpit, and that this is sustained on treatment withdrawal. We have now furth...

Background: Although hypocalcemia is common post thyroidectomy, no national guidelines pertain to its management.Long-term treatment with calcium and vitamin D replacement predispose patients to nephrocalcinosis and should be avoided in the absence of a clear indication.Aim: To identify the incidence and management of post-operative hypocalcemia following thyroidectomy in a UK teaching hospital with view to formulating management g...

Introduction: POMC is activated in ACTH-dependent Cushing’s Syndrome. We have previously shown that RNA interference (RNAi) targeting POMC coding and promoter sequences induces silencing of POMC and a reduction in ACTH. We have modified our most potent exonic sequence with locked nucleic acid (LNA) chemistry. This is purported to increase serum stability. Here we test whether the LNA confers stability without compromising siRNA silencing potency.<...

Introduction: Pro-opiomelanocortin (POMC) is a precursor polypeptide which is cleaved to make adrenocorticotrophic hormone (ACTH) in the anterior pituitary. It is activated in Cushing’s disease. Current therapies for Cushing’s disease are inadequate. RNA interference (RNAi) allows highly specific and effective suppression of gene expression by use of short interfering RNAs (siRNAs).Method: In the current study we employed custom designed siRNAs...

BackgroundPPAR-gamma agonists have been proposed as therapy to lower plasma ACTH in Cushing's disease. However, cyclical secretion may explain some of the 'responses' seen. In contrast, patients with Nelson's syndrome have continual high ACTH levels, and can present with pituitary mass effects and pigmentation. Since no established medical therapy exists, we assessed whether prolonged high-dose rosiglitazone therapy reduces circulating ACTH levels in Nel...

BackgroundPPAR-gamma agonists have been proposed as therapy to lower plasma ACTH in Cushing's disease. However, cyclical secretion may explain some of the 'responses' seen. In contrast, patients with Nelson's syndrome have continual high ACTH levels, and can present with pituitary mass effects and pigmentation. Since no established medical therapy exists, we assessed whether prolonged high-dose rosiglitazone therapy reduces circulating ACTH levels in Nel...

We present the case of 78-year-old female admitted to our hospital in January 2023 with recurrent hypoglycaemic episodes during fasting periods, particularly overnight and early morning. The patient had impaired hypoglycaemia awareness and cognitive decline. The only past medical history was of hypertension treated with bendroflumethiazide and amlodipine. During hospital stay, she experienced multiple hypoglycaemic episodes. Biochemical investigations revealed non-insulin-depe...

Background: Carcinoid Heart Disease (CHD) is a well-documented but devastating complication of metastatic neuroendocrine tumours (mNETs). Occurring in approximately 20% of patients with Carcinoid Syndrome (CS) the prognosis is poor, with a 3-year survival of 31% versus 68% in patients with mNETs without CHD1. Management of these patients requires a multidisciplinary approach to manage tumour load via medical and/or surgical options, alongside contro...