Endocrine Abstracts

Background: Leptin has multiple functions including modulating energy homeostasis and the immune response. Leptin is an important target for therapy to modulate the immune response in several autoimmune diseases. Although the structure of leptin is known, that of its receptor remains unsolved. The aim of this project was to express and purify the extracellular domain the leptin receptor (ObR) in order to carry out functional and crystallisation studies to elucidate the mechani...

Background: Cut-offs for basal cortisol (early morning) have been determined to predict the 30-minute cortisol level post-synacthen, but not for determining when patients with suspected tertiary adrenal insufficiency (AI) are weaned off glucocorticoids.Aims: The aim of this study was to compare the predictive values of basal cortisol, basal ACTH and basal cortisol:ACTH ratio to determine appropriate thresholds to reduce ...

Background: The current screening test for adrenal insufficiency (AI) involves patients attending hospital for an “early” morning serum cortisol sample, generally taken some considerable time after the child has woken. This risks missing the morning cortisol peak, leading to false positive results. It requires venepuncture, which is unpleasant for children. Saliva collection is non-invasive, simple and can be undertaken on waking at home, providing a...

Background: Long-term glucocorticoids can result in iatrogenic Cushing’s syndrome with adrenal suppression. Most patients reactivate their hypothalamic-pituitary-adrenal axis once they’re weaned off glucocorticoids. During glucocorticoid withdrawal, many clinicians switch patients to hydrocortisone to benefit from its short half-life1. However, in some patients, hypothalamic-pituitary-adrenal axis recovery is delayed despite the above. It is unclear whethe...

The granulation pattern of somatotroph adenoma is well known to be associated with differing clinical and biochemical characteristics and it has been shown that sparsely granulated tumors respond poorly to commonly used somatostatin analogs. We report a challenging case of acromegaly with a sparsely granulated tumor, resistant to multiple modalities of treatment given over several years and ultimately achieving biochemical control with pasireotide. A 26-year-old lady presented...

Introduction: Children with adrenal insufficiency requiring hydrocortisone rely on compounded adult medication. This study aimed to evaluate the absorption, palatability and safety of Alkindi® (hydrocortisone granules in capsules for opening).Methods: The phase 3 study was an open-label, single-dose study in a total of 24 children (aged 0–6 years) with adrenal insufficiency. Fasted children were given a single dose of Alkindi&#1...

Background: Treatment of congenital adrenal hyperplasia (CAH) in childhood focuses on growth and development; however the relationship of childhood treatment with adult health outcomes is not established. We explored this by examining relationships between final height (FH) and cardiometabolic risk in CAH adults.Methods: Cross-sectional analysis of 65 men (80% salt wasting (SW) and 20% non-SW) and 134 women (74% SW and 26% non-SW), aged 18–69 years....

Introduction: In many endocrine centres the 250μg Short Synacthen (Cosyntropin) Test (SST) is the reference standard for the diagnosis of adrenal insufficiency (AI) 1, but it is time consuming, expensive, and requires hospital attendance and venepuncture. The morning physiological peak of cortisol shortly after waking is a good predictor for a negative SST; however, a morning serum cortisol requires venepuncture. Serum cortisol and salivary cortisone correlate ...

Introduction: The 250µg Short Synacthen test (SST) is the reference standard for a diagnosis of adrenal insufficiency (AI) in most endocrine centres. The test is expensive and time consuming, requiring clinic attendance. We hypothesised that a cheaper home waking salivary cortisone (WSC) is predictive of the SST 30-minute cortisol >430 nmol/l cut-off and carried out a diagnostic accuracy study to assess the predictive value of the WSC in diagnosing and excluding AI. W...

Clinical Endocrinology, 2018, 88(1): 21–29 (DOI: https://doi.org/10.1111/cen.13447)...