Endocrine Abstracts

Background: X-rays of the left hand and wrist are used to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides a framework for calculating bone age but specifies exact hand position. We noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, resulting in additional time, cost and radiation exposure. We in...

Introduction: The short Synacthen test (SST) is a popular diagnostic investigation for adrenal insufficiency (AI). Cannulation and blood sampling are required making it invasive, time-consuming and resource-intensive. Salivary cortisol is a well-established alternative to serum sampling. We have developed a non-invasive alternative to the 1 μg SST, using a novel formulation of Synacthen (with a nasal drug enhancer, chitosan) given nasally and utilising saliva to measure t...

Introduction: Ovotesticular disorders of sexual development (DSD) are a rare form of DSD with co-existence of both ovarian and testicular tissue in one or both gonads.Case report: A term infant (weight+1.38 SDS) presented at birth with severe penoscrotal hypospadias, a small phallus and a right hemiscrotum with descended gonad (external masculinization score 1.5). Pelvic ultrasound revealed no mullerian structures, a small right gonad with probable epidi...

Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, with time,...

Rationale: Although many adolescents meet the NICE criteria for bariatric surgery there is a reluctance to undertake or commission such irreversible procedures in young people. Balloons are temporary, reversible, safer and more acceptable and in adults have been shown to promote a clinically significant change in BMI of 4.0–9.0 kg/m2 But due to subsequent weight regain, bypass surgery is preferred.This is a feasibility study of endocsopic...

Background: Children presenting with diabetic keto-acidosis (DKA) as an initial presentation of diabetes mellitus are often unwell, with associated increases in mortality and morbidity. While electrolyte imbalances such as hypokalaemia and hypophosphataemia are well recognised, the incidence of hypercalcaemia is less well documented.Case: A previously healthy 12-year-old boy presented to hospital with a history suggestive of new onset diabetes. Initial b...

Introduction: A 2009 BSPED survey revealed that 90% use a low dose Synacthen test (LDST) and 44% had noticed increased referrals of asthmatic children prescribed inhaled corticosteroids (ICS). Approximately 21% of UK children have asthma of whom 70% are prescribed ICS (10% at ‘high dose’). There is an increasing need for a simple, less invasive, alternative to the LDST to evaluate their adrenal function. We are developing a non-invasive LDST, with Synacthen administe...

Background: Adrenal suppression is a well recognised complication of inhaled corticosteroids. Committee for Safety of Medicines (CSM) guidelines (2006) recommend that children taking high dose inhaled corticosteroids (HDICS) are tested for adrenal insufficiency. Patients requiring steroid replacement require a steroid card and written advice on steroid replacement in acute illness.Aims: To determine the impact of CSM guidelines on the use of short synact...

Background: Type 1 diabetes is a chronic condition with significant implications on the child, the family and the health services. Management of this condition in a refugee child is fraught with further challenges.Methods: In this observational case report, we discuss the challenges in the management of a 10-year-old Somalian boy, with type 1 diabetes for the past few years, who presented with Diabetic ketoacidosis.Table 1 illustra...

Background: The effect of profound weight loss following obesity surgery on skeletal microarchitecture and strength in adolescents has not been studied. Obese children are at an increased risk of fracture and childhood obesity leads to reconfiguration of trabecular bone without augmenting bone strength.Objectives: To examine the impact of weight loss following 6 months treatment with an intragastric balloon supported by a lifestyle intervention programme...