Endocrine Abstracts

Background: The hypothalamic-pituitary-adrenal (HPA) axis can be suppressed by long-term exogenous glucocorticoids, resulting in tertiary adrenal insufficiency (AI). International expert consensus suggests that during weaning, prednisolone be converted to hydrocortisone to allow HPA axis reactivation(1). There is, however, little evidence to support this practice.Aim: To compare HPA axis recovery during treatment with prednisolone and immediat...

Background: Bone is constantly remodelling and an imbalance between bone resorption and formation can predispose to osteoporosis. Bone turnover markers (BMTs) are biochemical markers that reflect the dynamics of bone formation and resorption. Carboxy-terminal collagen crosslinks (CTx) is a bone resorption marker measured in serum which is used to monitor treatment response.Aims: The aims of the study were to determine how CTx has been used to monitor pat...

Case history: A 26 year old lady presented in 1999 with a 3 year history of worsening headache, increased sweating, excessive tiredness and progressive enlargement of hands and feet. She was otherwise well and had no family history of pituitary tumors, hypercalcaemia or renal stones. On examination she had typical facial features of acromegaly and acral enlargement. Her blood pressure was normal and visual fields were full.Investigations: Oral Glucose To...

Background: Life expectancy of cancer survivors has doubled in the past four decades; however, death due to cardiovascular disease is more prevalent in survivors than the general population.Objective, design and methods: We evaluated novel and traditional cardiometabolic risk factors in young male cancer survivors in a cross-sectional study of male cancer survivors aged 25–45 years compared with age-matched non-cancer controls. Demographic and anthr...

Background: In men there is a strong relationship between androgens and erythropoiesis; however this has not been shown in women. Patients with congenital adrenal hyperplasia (CAH) if uncontrolled may have high androgen levels and if over treated with glucocorticoids low androgen levels. Therefore CAH provides a potential model to examine the relationship between androgens and erythropoiesis in women.Aim: To investigate the relationship between androgens...

Introduction: Measuring serum cortisol to evaluate the normal circadian rhythm and adequacy of hydrocortisone replacement levels requires multiple readings; an expensive, cumbersome process. Conversely, salivary cortisone, a surrogate marker for free cortisol levels is non-invasive and well suited for out-patient settings. We hypothesised that salivary cortisone predicts circulating cortisol levels and can be used as an alternative marker of serum cortisol in a physiological s...

Background: Current standard treatment for adrenal insufficiency in neonates and infants is unsatisfactory as unlicensed adult dosage formulations are used. These are generally difficult to administer and may give rise to inconsistencies in dose as the content uniformity of the dosage form cannot be verified.Methods: Infacort is a newly-developed immediate release formulation of hydrocortisone that is provided in appropriate unit dosage units (0.5, 1, 2,...

Introduction: The management of type 1 diabetes (T1D) in young children can be extremely challenging due to high insulin sensitivity, unpredictable eating and activity and difficulty recognizing symptoms of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) therapy is beneficial in managing young children, however the small insulin doses required challenge the accuracy of standard concentration (100 IU/ml) CSII.Case report and literature revi...

Background: Excess glucocorticoids are well recognised as a cause of osteoporosis; they inhibit osteoblast function and increase osteoblast and osteocyte apoptosis resulting in thinning of the trabeculae. The circadian rhythm of bone turnover, which is linked to cortisol rhythm, is abnormal in osteoporosis. Furthermore, some studies show abnormal cortisol metabolism in osteoporosis. The aim of our study was to evaluate the day–night rhythm of cortisol and to relate cortis...

Background: Replacing physiological cortisol levels is important for the long-term health of patients with adrenal insufficiency and congenital adrenal hyperplasia (CAH). Modified-release formulations of hydrocortisone are one strategy being used to replace the cortisol circadian rhythm in adult patients but there is no data in children. Physiologically based pharmacokinetic (PBPK) modelling is a valuable tool for paediatric drug development1; however, there are no ...