Endocrine Abstracts

Glucocorticoid (GC) production rates are elevated in obese, insulin resistant individuals. We and others have demonstrated decreased hepatic cortisol regeneration through reduced 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity that converts inactive cortisone to cortisol. In addition, there is enhanced cortisol clearance by A-ring reductases, (notably 5α-reductase). We have argued that these changes drive the hypothalamo-pituitary–adrenal axis a...

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 ...

Aim: In light of recent publications - could a lower cortisol cut off value of ~350 nmol/l be used to safely rule out adrenal insufficiency (AI) compared to current local guideline cutoff value of either a baseline or 9am cortisol of 420 nmol/l? If so could this potentially help reduce the number of Co-syntropin stimulation tests (CST) performed?Background: Current local guidelines recommend a cortisol cut value of 420 nmol/l to rule out adrenal insuffic...

Introduction: Water deprivation testing (WDT) is considered the gold standard test in differentiating between craniogenic diabetes insipidus (DI), nephrogenic DI and primary polydipsia. However, it requires day case admission for monitoring of sodium and osmolality. Copeptin, derived from pre-provasopressin, is secreted in an equimolar amount with arginine vasopressin and has a potential role in facilitating the diagnosis of DI and reducing the need for WDT. Copeptin was gradu...

Introduction: Between 5-10% of patients with hypothyroidism treated with levothyroxine (T4) continue to experience profound symptoms, despite achieving free T4/thyroid stimulating hormone concentrations within reference range. Liothyronine is sometimes added to levothyroxine, but its use is controversial due to uncertainties in clinical/cost effectiveness.Methods: An economic model was developed to estimate the incremental cost per quality-adjusted life ...

Background and Aim: Approximately 1500 people attend the Beacon Health Check Department annually involving a panel of blood tests being screened. Our aim was to compare what percentage of this asymptomatic population have diabetes or were pre-diabetic and what percentage of these were undiagnosed and therefore untreated conditions.Methodology: This audit was a retrospective review of data collected from patients attending the Beacon Hospital Health Check...

Background: Adrenocortical carcinoma (ACC) is a rare malignant tumour of the adrenal cortex with an incidence of 0.7-2.0 per million per year. The majority are steroid-producing with non-ACTH dependent hypercortisolism the most frequent biochemical abnormality. Around 10-15% of cases are picked up incidentally on abdominal imaging. Management of ACC during the covid-19 pandemic poses specific challenges. We present the case of a 69-year-old man who was found to have a massive ...

Introduction: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is documented as a pre-malignant condition by the World Health Organisation. Patients with pulmonary nodules typically undergo 5′-18fluoro-deoxy-D-glucose (FDG) positron emission tomography combined with computed tomography (PETCT) for further diagnostic investigation. DIPENCH is widely accepted as an FDG negative pathology. The purpose of this analysis was to a...

Introduction: We describe the case of a patient referred to Cardiology with an abnormal ECG & hypertension. Investigation led to the diagnosis of catecholamine induced cardiomyopathy caused by a pheochromocytoma. The case is unique as the cardiomyopathy was reversed with alpha and beta blockade prior to surgery.Case: A 56 year old female with 20 pack year smoking history, no regular medications and evidence of hypertension underwent CT AP for abdomin...

Introduction: Diamond Blackfan anaemia (DBA) is a rare disorder of red blood cell aplasia characterized by normocytic or macrocytic anaemia and reticulocytopaenia. Short stature, of multifactorial aetiology, is often present. Some patients are glucocorticoid-responsive, while others remain transfusion-dependent leading to iron overload.Case Report: Asymmetrical growth restriction was present at birth. Aged ten weeks, severe anaemia developed. Bone marrow...