Endocrine Abstracts

Background: Patients with adrenal insufficiency (AI) require glucocorticoid replacement therapy. Current Endocrine Society guidelines recommend thrice-daily hydrocortisone (15-25mg) or once-daily prednisolone (3-5mg). Concerns around prednisolone use have been based on evidence using higher doses. We have been using low-dose (2-4mg) once-daily prednisolone since 2014 for glucocorticoid replacement in adult patients with AI. This study aimed to compare the effe...

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...

Background: Bariatric surgery, dietary restriction and gut hormones treatment for obesity, lead to distinctive changes in weight-loss maintenance and glycaemia. We previously showed that Roux-en-Y Gastric Bypass (RYGB) and Very-Low-Calorie-Diet (VLCD) were superior in weight-loss, compared to a tripeptide hormone infusion of G lucagon-like Peptide-1, O xyntomodulin and P eptide-YY over a month (GOP, infused at doses to replicate their peak post-prandial concen...

Background: Dexamethasone significantly improved outcomes in patients requiring supplementary oxygen and in ventilated patients with COVID-19 in the RECOVERY trial. Consequently, dexamethasone is now routinely used in these patients. However, dysglycaemia is commonly associated with steroid use and is an established risk factor for poorer outcomes in COVID-19. In this study, we aimed to elucidate the effect of dexamethasone use in patients hospitalised with COVID-19 in a real-...

Background: Non-alcoholic fatty liver disease (NAFLD), encompasses hepatic steatosis alone (NAFL), steatohepatitis (NASH), NAFL/NASH with fibrosis and cirrhosis. Severe fibrosis and cirrhosis are associated with increased risk of morbidity and mortality (due to cardiovascular events, end-stage liver failure and cancer). Postmenopausal women are a high-risk group of patients that have worse outcomes, but the specific factors that place them at higher risk are incompletely under...

Introduction: Diabetes has been associated with poorer outcomes with COVID-19 infection, but precise predictors of mortality in patients with diabetes remain unclear. We assessed predictors of adverse outcomes in patients hospitalised with COVID-19 in Imperial College Healthcare NHS Trust (ICHNT) hospitals during the first and second waves of COVID-19 to determine if outcomes for patients with diabetes have evolved with new variants and treatments.Method...

Von Hippel-Lindau (VHL) disease is an inherited tumour syndrome, caused by a mutation in the VHL tumour suppressor gene encoding the VHL protein. Patients are prone to cysts and neuroendocrine tumours in the pancreas and other benign and malignant neoplasms. Pancreatic cysts occur in approximately 70% of VHL patients. We describe two cases of VHL disease with extensive multi-cystic changes affecting the whole pancreas, both patients had deletions of exon 2–3 of the VHL ge...

Background: An increasingly recognized complication of Roux-en-Y Gastric Bypass (RYGB) surgery is the development of postprandial hypoglycaemia (PPH). However, there remains no agreed standard on how to diagnose this condition. Commonly used tests include a prolonged oral glucose tolerance test (POGTT) and mixed meal tolerance test (MMTT). Little is known regarding how these tests compare in the post-bariatric population.Methods: Ten patients who had con...

Context: Hydrocortisone day curves (HCDC) are used to monitor hydrocortisone replacement by obtaining serum samples to measure cortisol levels throughout the day. Salivary measurement of free cortisol offers a non-invasive alternative to serum measurements.Objective: To validate salivary cortisol measurement as an alternative method to assess the adequacy of hydrocortisone replacement in patients with hypoadrenalism.Setting, patien...

We present the case of a 33-year-old woman diagnosed with congenital adrenal hyperplasia (CAH) due to classical 21-hydroxylase deficiency following a salt-losing crisis as a newborn. She had previously been controlled on dexamethasone 0.25 mg bd and fludrocortisone 100 mcg od, as evidenced by high-normal 17-hydroxyprogesterone (17-OHP) and low-normal testosterone levels (8.5 and 0.4 nmol/l respectively).However, she had experienced significant symptoms o...