Endocrine Abstracts

Several alterations of the metabolic processes develop during sepsis. Adiponectin and resistin are amongst the main adipokines that may contribute to the metabolic adaptations observed in the context of critical illness. However, there is scarce data on the circulating pattern of these adipokines in human sepsis. Therefore we aimed to describe the variation in circulating levels of resistin and adiponectin during the course of sepsis and examine whether they are related to the...

The role of endogenous glucocorticoid (GC) production and metabolism in the pathogenesis of obesity, insulin resistance and type 2 diabetes remains unclear. Patients with Cushing’s syndrome develop central obesity, insulin resistance and in some cases type 2 diabetes (T2DM), yet circulating cortisol levels are not elevated in simple obesity. Alterations in GC metabolism, including 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) that generates active cortisol ...

The diagnosis of Cushing’s syndrome (CS) remains a major clinical challenge especially in a proportion of patients that have discordant results in the available tests. Although the measurement of 24-h urine free cortisol (UFC) is a useful test for the diagnosis of CS, 10–15% of patients have at least one measurement within the normal range and multiple measurements may be required in order to raise its sensitivity. In this study we sought to evaluate the value of the...

Stress results in activation of the hypothalamic–pituitary–adrenal axis with increased circulating cortisol. It has been argued that a syndrome of ‘relative adrenal insufficiency’ is common in critically ill patients. Patients who fail to increase their cortisol by >250 nmol/30 min following the administration of 250 μg ACTH in the short synacthen test (SST) have been reported to have a higher mortality (JAMA 2000, 283 1038–1045)...

Aberrant hormone receptors have been demonstrated in macronodular adrenal hyperplasia or, rarely, unilateral adenomas causing Cushing’s syndrome but their prevalence in adrenal incidentalomas (AI) remains uncertain. Therefore we evaluated patients with bilateral AI for evidence of abnormal response to physiological stimuli. We also compared their biochemical characteristics with those of patients with unilateral AI.Assessment of adrenal function was...

Although bilateral inferior petrosal sinus sampling (BIPSS) is the most accurate procedure for the differential diagnosis of ACTH-dependent Cushing’s syndrome, a false-negative rate of 4–15% has been reported. An even lower sensitivity has been shown in patients with equivocal responses to CRH and/or high-dose dexamethasone suppression test (HDST). In the present study we investigated whether the administration of CRH plus desmopressin (DDAVP) during BIPPS, which is ...

A 61-year-old woman was admitted to the Emergency Department with generalized seizures. She reported general malaise, anorexia, headache and multiple episodes of vomiting that started about 12 h before admission. She had a history of recent thyroidectomy, and she was on oral calcium carbonate (3 gr/day) and alpha calcidol (3 mg/day). Non-contrast head CT scan was negative for major findings. Laboratory work up revealed hypercalcemia (corrected calcium 14,4 mg/dl), renal impair...

Purpose: Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-I) are currently the principal biomarkers used to assess disease activity in acromegaly and any discrepancy between them renders interpretation of results inconclusive. The purpose of this study was to assess the frequency of discrepant results and identify parameters that might affect the emergence of this phenomenon.Methods: A systematic review of Medline and Scopus was performed (1987&...

Introduction: Cushing’s disease (CD) is associated with significant morbidity and mortality due to cerebro-cardiovascular, thrombotic or infectious complications. However, there is significant variation in the clinical presentation and consequences of hypercortisolism, resulting in a wide clinical spectrum, ranging from mild to severe or even life-threatening disease requiring immediate treatment.Aim: The description of patients with severe CD in c...

Introduction: Critical illness, and sepsis in particular, drives adipose tissue lipolysis up (with triglycerides (TG) being split to free fatty acids (FFA) and glycerol (GLYC)) to meet increased energy demands. Few studies have addressed lipolysis with tissue microdialysis (MD).Aim: To assess indexes of lipolysis in septic patients with and without shock.Subjects and methods: The study included 110 men and 73 women (mean age+<small...