Endocrine Abstracts

Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard investigation in Cushing’s disease for identifying the pituitary as the ACTH source. This technique aims to demonstrate a gradient of central:peripheral ACTH levels of >2:1 in such patients, or >3:1 after CRH stimulation. In patients without significant pituitary MRI abnormalities this facilitates neurosurgical exploration.The test is limited by difficulties in achieving...

Background: Intramuscular long acting testosterone injections are widely used, convenient form of androgen replacement in patients with hypogonadism.Aims: To evaluate the long term effects of parenteral long acting testosterone replacement on patients commenced on treatment in years 2006–2014 and adherence to monitoring undertaken by primary care after discharge from specialist service.Method: We reviewed the results of 64 pat...

A 69-year-old lady with a history of autoimmune diabetes mellitus and primary autoimmune hypothyroidism presented to the Specialist Diabetes Clinic with a significant inexplicable variation in her capillary blood glucose. She had been undergoing investigations with the gastroenterologists for nausea, vomiting, and weight loss. Despite extensive investigations including: oesophageal–gastro-duodenoscopy, CT–thorax, abdomen, pelvis scanning, and gastric emptying studies...

Introduction: Increased oxidative stress is associated with endothelial dysfunction in atherosclerosis and cardiovascular diseases (CVD). Evidence suggests that tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), a member of the tumour necrosis factor (TNF) superfamily, may also be involved in the pathogenesis of CVD. Observational studies have demonstrated that serum levels of TRAIL are inversely correlated with severity of coronary artery disease. This concurs ...

Introduction: We present the contrasting cases of two siblings diagnosed with Wolfram’s syndrome aged 2 and 10 years old. We discuss several family factors which have made management of this rare condition even more complex, emphasising the importance of holistic medicine.Case: The older sibling was diagnosed with diabetes mellitus age 4. Parents struggled to cope with the diagnosis, however, and emotional and psychological support was offered. She ...

Although TIH is a well-established complication of this drug class, the extent of this problem and the serious morbidity that can result is often not appreciated. At our centre, we became aware of three serious cases of TIH over a 2-week period during the ‘heat wave’ in July 2013. In at least one of these cases excessive water drinking was a clear precipitant. We therefore determined the incidence of TIH at our hospital and in particular whether there is a seasonal e...

Introduction: PWS children have higher body fat content and lower lean muscle mass as compared to normal population. Bioelectrical impedance analysis (BIA) estimates lean muscle mass and total fat content separately and thus is more useful than BMI. Continued weight gain despite treatment, can be distressing to patients and parents. We hoped to resolve this dilemma through serial body composition measurements.Materials and methods: Patients and families ...

Background: Oral corticosteroids are a known risk factor for developing osteoporosis and subsequent fracture at higher bone mineral density than post menopausal osteoporosis. Bone loss is thought to be most pronounced in the first 12 weeks of steroid use, and existing guidelines recommend a fracture risk assessment and appropriate osteoporosis prophylaxis with calcium and vitamin D supplements and bisphosphonates. There is also a recognized role for FRAX scoring to help strati...

One in 11 women develop breast cancer before the age of 75, and mortality is significant. Estrogens and progesterone (PROG) are mediators of breast cancer aetiology and progression, and are targets for both diagnostics and therapy. The actions of estrogens via estrogen receptor alpha (ERα) have been extensively studied, but the genomic actions of PROG via the progesterone receptor (PGR) are still not fully understood. This study investigates the genomic actions of PGR in ...

Aims and Objectives: We conducted a study of 71 patients with Primary Hyperparathyroidism being managed in a single site Joint Endocrine Service. We sought to review the adherence to current international guidelines in managing these cases, and the effectiveness of pre-operative localization to inform surgical options.Results: A total of 71 cases were reviewed, of whom 35 were managed conservatively and 36 underwent surgery. Every patient undergoing surg...