Endocrine Abstracts

Muscle wasting remains a significant complication in patients with inflammatory disease where it contributes to disability, risk of falls and early mortality. Interestingly, muscle wasting in patients with glucocorticoid excess mirrors that observed in patients with inflammatory disease. We have previously reported that the glucocorticoid activating enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) is potently up-regulated within mesenchymal derived cell popu...

Synovial fibroblasts (SFs) form a substantial component of inflamed rheumatoid synovium and generate endogenous glucocorticoids (GCs) during inflammation. Recently, production of DKK-1 (a Wnt signalling inhibitor that reduces bone formation) by SFs in response to TNFα has been proposed to be the master regulator of inflammatory osteoporosis. We have identified that in addition to TNFα, GCs potently induce DKK-1 secretion. This may provide a novel mechanism whereby lo...

We have previously proposed a central role for locally generated glucocorticoids in the periarticular and systemic osteoporosis seen in rheumatoid arthritis (RA). Synovial fibroblasts (SFs) express the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme and this expression increases dramatically with inflammation. Recently, production of DKK-1 (a Wnt signalling inhibitor known to inhibit bone formation) by SFs in response to inflammation has been proposed to ex...

High dose glucocorticoids are effective in suppressing inflammatory synovitis but have adverse effects on other connective tissues. In inflammatory arthritis glucocorticoids suppress the capacity of synovial fibroblasts (SFs) to recruit leukocytes to the joint whereas poor skin healing is due to impaired dermal fibroblast (DF) function. It is unknown whether these clinical differences are due to similar or distinct effects of glucocorticoids on fibroblast function.<p class...

Microsomal glucose-6-phosphatase (G6Pase) and glucose-6-phosphate transporter (G6PT) are key enzymes in regulation of blood glucose concentration. Deficiency of G6Pase gives rise to glycogen storage disease type Ia (GSDIa) whilst mutations in G6PT cause GSDIb. Both are characterized by growth retardation, hypoglycemia, hepatomegaly, nephromegaly. G6Pase shares its substrate (G6P) with hexose-6-phosphate-dehydrogenase (H6PDH), an ER enzyme functionally coupled with, and which c...

Our previous studies of the gene responsible for the expression of pituitary GH (GH1 gene) have identified 13 novel missense mutations in 52 children with short stature and 154 controls, which occurred more frequently in patients than controls. These mutations result in expression of variant forms of GH with a single amino acid alteration that could lead to conformational changes within the protein, possibly resulting in cleavage sites hidden in wild-type GH becoming ex...

Growth hormone (GH) has profound anabolic effects on bone, but its use as a treatment for patients with osteoporosis has only resulted in small increases in BMD. The low serum IGF-I demonstrated in men with idiopathic osteoporosis may be important in the aetiology of this disease and has been attributed to GH hypo-secretion, though there are conflicting reports of this. Insensitivity to the actions of GH has also been suggested. We studied the GH-IGF-I axis in otherwise health...

A child with short stature having height greater than 2 standard deviations below the mean for age and bone age delay of two years but with normal growth hormone secretion tests was identified. Since there was no known clinical cause of the short stature, it was decided to sequence both alleles of the patient's GH1 gene that encodes pituitary GH to determine whether there was a genetic defect responsible for the observed phenotype (with local ethical approval). A 3.2kb fragmen...

Background: There are several good practices to improve DKA management across hospitals. However, the lack of a unified system limits comparisons and learning from each other.Objectives: To establish a DKA registry to identify best practices across centres in the West Midlands.Methods: All people admitted with DKA at four hospitals in the West Midlands (named A, B, C, D for anonymity) from 1st January 2020 to 31st December 2020 wer...

Background: Hyperosmolar hyperglycaemic state (HHS) is an acute metabolic complication of diabetes that can lead to significant morbidity and mortality if managed incorrectly. With <1% prevalence, there is limited published literature available on HHS and most management guidelines worldwide are based solely on expert advice and opinions.Aims: To study the precipitating causes and identify baseline practises of HHS management, to highlight areas for ...