Endocrine Abstracts

Salivary cortisol (SalC) potentially has advantages over serum cortisol (SerC) as it is easier to collect and possibly reflects unbound (free) cortisol. SalC levels are approximately 10 times lower than SerC and require high measurement precision best addressed by liquid chromatography–tandem mass spectrometry (LC-MS/MS), which in contrast to previously used radioimmunoassays eliminates cross-reactivity by other steroids. We describe the use of LC-MS/MS to evaluate the po...

Itraconazole increases glucocorticoid levels through inhibition of CYP3A4 in the liver. Recent case-reports have shown that the co-administration of itraconazole with inhaled glucocorticoids in asthmatics may result in suppression of their HPA axis and a Cushing’s phenotype. We have evaluated the impact of this interaction on the cortisol axis in a double-blind randomised placebo-controlled study.Twenty-seven patients with severe asthma (17 women; m...

The GH receptor antagonist pegvisomant entered clinical trials in 1997 and was (UK) marketed in 2005. There is little long-term experience with this novel drug. We report the experience from two centres that used common protocols to manage 58 patients (36 male, median age 53, range 27 78) since 1997. Before commencing pegvisomant, patients had IGF-I above the upper limit of normal (ULN) of age-related reference ranges (median 1.8 xULN, range 1.2–4.1 xULN) and were uncontr...

In patients with pituitary disease stimulation tests, such as the insulin tolerance test, are performed as tests of the HPA axis and widely used as the basis for commencing hydrocortisone replacement therapy.We conducted a pilot study to investigate the relationship between the peak cortisol response to insulin-induced hypoglycaemia and daily CPR. Isotopic CPRs were studied in 10 patients (5 male, mean age 44±13 years) with pituitary disease and a s...

Patients with acromegaly die prematurely from CVD. Hypertension is more prevalent with increased peripheral vascular resistance thought to be due to structural remodelling of resistance vessels.We investigated structural properties and reactivity of small arteries in 20 healthy controls(55±11 years, 10 m) and 43 patients with acromegaly (55±14 years, 29 m), split into active disease (AD, n=17, 56±15 years, 13 m) or remission (CD, <i...

Introduction: Catheterisation of the right adrenal vein when performing adrenal vein sampling (AVS) is challenging. The AVS Accuracy Kit (AAK) (Trust Medical, Kasai, Japan) enables point-of-care confirmation of accuracy of AVS by rapid cortisol assay. We investigated whether use of AAK during AVS would impact upon procedural success, number of venous samples taken, radiation dose and screening time.Methods: 0.5 ml of each venous blood sample was centrifu...

Background: Hyponatraemia (most commonly secondary to SIADH) is very common in cancer patients; it is associated with delays to oncology treatment and mortality.Aim: To evaluate the number of patients with hyponatraemia at a tertiary referral cancer centre and assess adherence to national recommendations for investigations and treatment.Methods: All biochemistry results (in-patient and outpatient) analys...

Introduction: Catheterisation of the right adrenal vein when performing adrenal vein sampling (AVS) is challenging. The AVS Accuracy Kit (AAK) (Trust Medical, Kasai, Japan) enables point-of-care confirmation of accuracy of AVS by rapid cortisol assay. We investigated whether use of AAK during AVS would impact upon procedural success, number of venous samples taken, radiation dose and screening time.Methods: 0.5 ml of each venous blood sample was centrifu...

Background: Hyponatraemia (most commonly secondary to SIADH) is very common in cancer patients; it is associated with delays to oncology treatment and mortality.Aim: To evaluate the number of patients with hyponatraemia at a tertiary referral cancer centre and assess adherence to national recommendations for investigations and treatment.Methods: All biochemistry results (in-patient and outpatient) analys...

Case history: A 53-year-old male with melanoma who had a previous surgical excision of his skin lesion in December 2018 was being treated with adjuvant pembrolizumab. In June 2019 his treatment changed to combination immune checkpoint inhibitor therapy (ICPi) with ipilimumab and nivolumab due to radiological recurrence.Investigations: There were no pre-ICPi endocrine investigations available. In July 2019, thyroid function tests (TFTs) showed thyroid-sti...