Endocrine Abstracts

Prednisolone has been reported to have greater deleterious effects on bone turnover than other glucocorticoids, although the evidence for this is confounded by the effects of higher dose prednisolone, as used in conditions such as asthma. We hypothesise that a physiological replacement dose of prednisolone will have a less dramatic effect on bone than has previously been suggested, and might be safer than hydrocortisone for replacement in adrenal insufficiency. We investigated...

Mrs. M is a 66-year-old female who has had secondary adrenal insufficiency for many years following the withdrawal of prednisolone therapy for pulmonary eosinophilia. Synacthen tests revealed complete adrenal suppression when the dose of prednisolone was weaned to 5 mg in previous years. The dose was further reduced by switching to hydrocortisone three times daily, following a 10 mg-5 mg-5 mg regimen. Occasionally, a flare of eosinophilia required restarting high-dose predniso...

Phaeochromocytomas (PCC) and paragangliomas (PGL) are rare tumours derived from the sympathetic or parasympathetic paraganglia. They characteristically secrete catecholamines (noradrenaline/adrenaline/dopamine), which are metabolised to the metanephrines (normetadrenaline/metadrenaline/3-MT respectively). These tumour markers can be detected in acidified 24-h urine collections as first-line investigative tests. Plasma 3-MT has been characterised as a biomarker of metastatic PG...

A 31-year gentleman presented with a four day history of anxiety and confusion. Over several months, he had noticed red eyes and a ‘stomach-ache’. A collateral history revealed a previous episode of confusion and concern about excessive alcohol intake. He denied any current medication. On examination, he had bilateral conjunctivitis. Investigations demonstrated severe hypercalcaemia of 3.54 mmol/l (NR 2.15–2.6 mmol/l). He was treated with intravenous fluids and ...

Hyperaldosteronism is a significant cause of secondary hypertension, but there are often delays in obtaining the diagnosis. The recent BES publication of Guidelines for the investigation and management of this condition represent a move to standardise the work-up of these patients.We present an audit of cases, dating back to 2000, with confirmed biochemical hyperaldosteronism (on the basis of plasma aldosterone/renin activity ratio or lack of aldosterone...

Pancreatic polypeptide (PP) is a 36 amino acid peptide, secreted from the endocrine pancreas. Previous work has shown that peripheral administration of PP inhibits food intake in rodents and humans. However, PP has a short circulating half-life that limits its use as an anti-obesity agent. Determining the mechanisms involved in the physiological breakdown of PP will allow the rational design of long-acting analogues with greater clinical utility in the treatment of obesity. PP...

A 30-year-old lady was transferred to our hospital at 37 weeks of pregnancy. Hypertension was noted at 24 weeks of gestation and managed with methyldopa and labetalol. Despite treatment, BP was labile with a systolic of 90–220 and diastolic of 50–129 mmHg. She reported occasional palpitations but not chest pain or shortness of breath. The patient had a history of migrainous headaches but not hypertension prior to pregnancy. Her brother had previously had an operation...

Primary hyperparathyroidism (HPT) in pregnancy is an uncommon phenomenon, mostly occurring in the 2nd or 3rd trimester. HPT in pregnancy may cause complications affecting both the mother (renal stones, pancreatitis) and fetus (neonatal tetany, seizures, intra-uterine growth retardation and preterm labour). We report two recent cases that highlight the potential risks.Results: The patients, 37 and 35 years old at presentation respectively, both presented ...

Introduction: Phosphatase and tensin homolog gene (PTEN) gene encodes a lipid phosphatase that plays a central role in cell-cycle processes. PTEN hamartoma tumour syndrome (PHTS), caused by the mutation of the PTEN gene, is a diverse multi-system disorder. PHTS is characterised by the hamartomatous growths, increased risk of breast, thyroid, and renal cancers. In terms of thyroid presentation of PHTS, there is up to 75% risk of multinodular goitre and the life...

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual t...