Endocrine Abstracts

A 33 year old male was referred with poorly controlled hypertension. He gave no other past medical or family history. Despite therapy with multiple agents blood pressure was poorly controlled at 200/130 mm/Hg. Initial investigations which included renal ultrasound, magnetic resonance angiography and urine catecholamine excretion were all negative. Plasma renin concentration was suppressed (1 mu/ml/L, normal range 5 to 50) and plasma aldosterone was raised at 650 pmol/L (normal...

The discovery of the fundamental involvement of receptor activator for nuclear factor-KB ligand (RANKL) in osteoclast (OC) formation, has enabled the routine generation of human OCs in vitro from human peripheral blood mononuclear cells (PBMCs). Beta C-terminal telopeptide (beta-CTx) is a specific resorption marker for degradation of bone type I collagen by OCs. We have evaluated the correlation between beta-CTx released from dentine wafers on which OC were c...

The key enzymes in the terminal stages of human adrenal gland corticosteroid biosynthesis are aldosterone synthase (AS) and 11-beta hydroxylase (11beta-OHase). Their amino acid sequences differ by only 7% but they exhibit markedly different enzymatic activities. AS is expressed solely in the zona glomerulosa and converts 11-deoxycorticosterone (DOC) to aldosterone whereas 11beta-OHase is expressed mainly in the zona fasciculata and produces cortisol from 11-deoxycortisol. The ...

The key enzymes in the terminal stages of human adrenal gland corticosteroid biosynthesis are aldosterone synthase (AS) and 11beta-hydroxylase (11beta-OHase). Their amino acid sequences differ by only 7% but they exhibit markedly different enzymatic activities. AS is expressed solely in the zona glomerulosa and converts 11-deoxycorticosterone (DOC) to aldosterone whereas 11beta-OHase is expressed mainly in the zona fasciculata and produces cortisol from 11-deoxycortisol. The 3...

Fibroblast growth factor 23 (FGF-23) is a phosphatonin produced by osteocytes in response to serum phosphate concentration. Immunoassays are widely employed to detect C-terminal fragments of FGF-23 (cFGF-23). Quantitative assays for intact FGF-23 (iFGF-23) measurement are also available. Causes of increased FGF-23 include Tumour Induced Osteomalacia (TIO), X-linked hypophosphataemic rickets (XLH) and end stage renal disease (ESRD). We observed that some individuals, with no id...

Individuals with chronic hypoparathyroidism sometimes receive suboptimal care with high frequency of unplanned hospitalisation and iatrogenic harm. In 2015 the European Society for Endocrinology published evidence base consensus guidelines on the management of chronic hypoparathyroidism. Using these consensus recommendations as audit standards we worked with the Society for Endocrinology and Parathyroid UK to conduct a national audit of management of chronic hypoparathyroidism...

Background: Adrenal incidentalomas are common and require investigation to exclude malignancy and evidence of hormone overproduction. Clinical guidelines recommend overnight dexamethasone suppression tests (ONDST) to assess for cortisol hypersecretion with cortisol levels of 50-138 nmol/l termed “mild autonomous cortisol secretion” (MACS). MACS may be associated with both cardiovascular and metabolic morbidity. We assessed cardiovascular risk in patients with MACS us...

Background: Adrenal incidentalomas are common amongst the general population, incidence increases with age. Radiological and biochemical assessment of all lesions >1 cm is standard practice to determine appropriate future management, as per current European guidelines. We report the experiences of a recently formalised adrenal multi-disciplinary pathway in a large UK teaching hospital, where all adrenal incidentalomas are referred and systematically assessed.<p cl...

Introduction: Copeptin is the C-terminal fragment of proAVP and provides an alternative measure of AVP secretion. While direct measurement of AVP during hypertonic saline infusion has been recommended as a diagnostic test for diabetes insipidus (DI), the number of reports examining the utility of copeptin in this context is limited. Here we describe a series of cases where measurement of copeptin during saline infusion has contributed to ...

Introduction: Copeptin is the C-terminal fragment of proAVP and provides an alternative measure of AVP secretion. While direct measurement of AVP during hypertonic saline infusion has been recommended as a diagnostic test for diabetes insipidus (DI), the number of reports examining the utility of copeptin in this context is limited. Here we describe a series of cases where measurement of copeptin during saline infusion has contributed to ...