Endocrine Abstracts

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...

Pegvisomant is a specific GH antagonist developed for the treatment of acromegaly. Pegvisomant is a GH antagonist molecule with an amino acid substitution that blocks the conformational change necessary for signal transduction and polyethylene glycol (PEG) moieties to improve clinical efficacy. Pegvisomant has a long plasma half-life and its mode of clearance has not been established. We hypothesised that GHR mediated internalisation of Pegvisomant might be one mechanism for i...

Introduction: Leptin modulates immune activation in relation to nutritional state and there is gender difference in body composition and the immune response. Leptin induces the release of pro-inflammatory cytokines, including TNF-alpha, from human peripheral blood mononuclear cells (PBMCs). We hypothesised that estrogen may modulate the immune actions of leptin. Aim: To test the effect of estrogen on leptin signalling and leptin-induced TNF-alpha production. Materials and Meth...

Background: The introduction of somatostatin analogues for the treatment of acromegaly has relegated dopamine agonists, once a mainstay of treatment, down the therapeutic ladder. Dopamine agonists are, however, added to somatostatin analogues to control active disease in some patients, in an attempt to achieve biochemical control. There are no reports, however, assessing this practise.Aim: To assess the effectiveness of adding dopamine agonist therapy to...

Background: Leptin, the satiety hormone that is produced by adipose tissue appears to act as a link between nutritional status and immune function, and it has been shown to elicit a number of immunoregulatory effects, including the promotion of T cell proliferative responses, and the elicitation of pro-inflammatory cytokines from T cells and monocytes. Given that leptin deficiency is associated with an increased susceptibility to infection, and that polymorphonuclear neutrophi...

The adrenal steroid dehydroepiandrosterone (DHEA) is the most prominent circulating steroid in humans and is also a precursor for sex steroids in peripheral tissues. In prostate, DHEA is a substrate for two major metabolic pathways that produce antagonistic sex steroids. In one pathway, DHEA is converted into potent 5alpha-reduced androgens such as 5alpha-dihydrotestoterone (DHT) and thus shares with testicular androgens the control of prostate growth and functions in both nor...

Background: The COVID-19 pandemic led to major changes in the pattern of presentation to Emergency Departments. This prompted concern within Paediatrics that this altered behaviour could lead to delays in the diagnosis of life-threatening conditions such as type 1 diabetes. A multicentre study was conducted to determine the incidence, referral patterns and severity of disease at presentation of this condition. Methods: This was a U.K.-based multi-centre ...

Background: The Short Synacthen Test (SST) is the most popular test of adrenal insufficiency (AI) worldwide. The current SST protocol at Sheffield Children’s Hospital (SCH) recommends measurement of serum cortisol at baseline, then 30- and 60-minutes post stimulation. A peak cortisol of >429nmol/l constitutes a pass. Our practise has evolved to consider results between 350 and 429nmol/l as “borderline” and these patients may be treated with stress dosing ste...

A case is reported of a man with stage IV grade 2 pancreatic VIPoma. At diagnosis he had several features which may have expedited the diagnosis including refractory diarrhoea containing undigested foodstuffs, alcohol-related flushing, electrolyte abnormalities and intestinal oedema on imaging. Symptom control was challenging. There was no benefit from creon, loperamide or codeine and escalation to both short and long acting somatostatin analogues was futile. Consistent with a...

Background: Measurement of salivary glucocorticoids is gaining popularity as it offers a non-invasive collection technique, enabling sampling in the community or home environment, allowing tailored capture of steroid circadian rhythm and improved patient experience. Current popular salivary collection methods cannot be used in very young children due to choking and the requirement for active participation. There is little data on saliva stability during home collection.<p ...