Endocrine Abstracts

Background: Replacing physiological cortisol levels is important for the long-term health of patients with adrenal insufficiency and congenital adrenal hyperplasia (CAH). Modified-release formulations of hydrocortisone are one strategy being used to replace the cortisol circadian rhythm in adult patients but there is no data in children. Physiologically based pharmacokinetic (PBPK) modelling is a valuable tool for paediatric drug development1; however, there are no ...

Background: Effective management of diabetic ketoacidosis (DKA) improves clinical outcomes. Regular auditing and performance feedback are key to achieving sustained and significant improvement in the management of DKA. One of the major limitations for maximal impact of an audit is the delay from initiation to results as the latter may not be applicable to the then current practice. In order to overcome this, we created an automated auditing system called Digital Evaluation of ...

Patients with primary hyperparathyroidism (PHP) should have assessment of urinary calcium excretion as part of routine work up. This helps in the differential diagnosis of PHP in that urine calcium is low in familial benign hypocalciuric hypercalcaemia. Possible measures of calcium excretion include 24 h urine collection, spot sample for urine for urine calcium concentration and calcium/creatinine ratio (UCa/creat), and fractional excretion of calcium (FrExCa=urine calcium&#21...

The HIV protease inhibitor (PI) ritonavir is used in conjunction with other antiretroviral treatments as a pharmacokinetic booster due to its potent inhibition of hepatic cytochrome P450 3A4 (CYP3A4). Co-administration of glucocorticoids metabolized by CYP3A4, with ritonavir leads to accumulation of these glucocorticoids, markedly increasing the risk of iatrogenic Cushing’s syndrome and suppression of the Hypothalamic-Pituitary-Adrenal axis. We present 11 patients receivi...

The guidelines for management of prolactinomas (PRLoma) during pregnancy are mostly based on retrospective evidence or expert opinion. We conducted a survey of four Canadian provinces (NS, NB, PEI and BC) to assess the current trends in management of PRLoma during pregnancy. A case-based electronic questionnaire was sent to all practicing endocrinologists, with 3 cases of varying severity ranging from a micro PRLoma to a large macroPRLoma compressing the optic chiasm. A total ...

Objective: The past 2 decades have seen advances in the surgical management of Cushing’s disease (CD). Our aim was to meet the need for current data on clinical features, long-term outcomes, and prognostic indicators.Patients and methods: We conducted a retrospective study of 71 patients treated by trans-sphenoidal surgery (TSS) for CD. All patients were operated on by the same surgeon in a single centre between 1988–2009. Diagnosis was confirm...

Context: Bariatric surgery can lead to vitamin deficiencies.Objective: To assess changes in blood vitamin concentrations after gastric bypass surgery.Design: Twenty-nine patients underwent gastric bypass and 24 unmatched controls underwent lifestyle intervention in a prospective, non-randomised trial. Patients in the surgical group received multivitamin, iron, calcium, vitamin D, and vitamin B-12 supplements. No supplements were pr...

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...

A 44-year-old man referred with erectile dysfunction was found to have hypogonadotrophic hypogonadism (HH), but otherwise apparently normal anterior pituitary function (LH 1.6 & FSH 2.7 IU/l; T 3.4 & cortisol 516 nmol/l; PRL 103, GH 5.5 & TSH 2.8 mU/l; f-T4 13, f-T3 4.8 & f-T 128 pmol/l; ferritin 103 ug/l). He appeared normally virilised, with central obesity (BMI 36 kg.m−2, collar size 46 cm) and symptomatic sleep apnoea (SA). MRI showed a rig...

Adrenocortical carcinoma (ACC) is a rare and highly malignant tumour with a poor prognosis with an incidence of 1 – 2 per million population per year. We report 2 cases of functioning ACC.Case 1: An 80 yr old with a history of hypertension, paroxysmal atrial fibrillation and cerebrovascular disease presented with leg ulcers, peripheral oedema, tiredness, weight gain, plethora and proximal myopathy. ACTH-independent Cushing’s syndrome was confir...