Endocrine Abstracts

Aim: To determine the association between recorded inpatient glycaemic variability and long-term mortality in patients with diabetes mellitus.Methods: Inpatient capillary blood glucose (CBG) readings from eight acute hospitals were included. Data was analysed from first admission within the dataset with >4 measured CBGs. 28 353 admissions were identified (24 181 type 2 DM, 4,172 type 1 DM). Matching parameters were: age, diabetes duration, admission ...

A 16 year old previously healthy boy from Manipur, India was admitted with rapid onset quadraparesis, vomiting and diarrhoea, on a background 3 month history of increasing facial puffiness and progressive widespread rash. Investigations revealed hyperglycaemia, hypokalaemia and a raised ESR. The basal serum cortisol was 103 μg/dl (n=7–22 μg/dl) at 0800 h. 24-h urinary free cortisol failed to suppress with 8 mg of dexamethasone. Plasma ACTH and serum ald...

Vitamin B12 (B12) is an essential micronutrient required for optimal hematopoietic, neurologic and other several metabolic reactions. Longitudinal studies and animal models showed that low maternal vitamin B12 deficiency is associated with the maternal obesity, development of insulin resistance and metabolic syndrome phenotype suggesting the crucial role of B12 in adipose tissue function. Although the mechanisms underpinning metabolic disorders remain poorly defined, the patho...

Vitamin B12 (B12) is an essential micronutrient required for two key metabolic reactions. Longitudinal studies and animal models showed that B12-deficiency during pregnancy is associated with the maternal obesity, development of insulin resistance and metabolic syndrome phenotype. Although the mechanisms underpinning low B12 and metabolic disorders remain poorly defined, it’s becoming increasingly clear that lipid dysregulation is associated with obesity and co-morbiditie...

Background: The liver stores 10 μg cobalamin per gram protein and able to hold 50% (1–1.5 mg) of body’s B12. Making up the bulk of the liver, hepatocytes express receptors regulating cellular uptake of B12 in the liver. However, relationship between circulating and intracellular B12 levels as well as regulation of hepatic uptake of B12 is unexplored.Objective: To assess the regulation of cellular uptake and storage of B12 in hepatocytes in...

Background: Metformin is utilized in clinical trials for treatment of non-alcoholic fatty liver disease (NAFLD) and obesity. Metformin increases AMP:ATP ratio activating AMP activated protein kinase-alpha (AMPKα), a mediator of fatty acid oxidation (FAO) in the liver. Meanwhile, prolonged oral metformin therapy in T2DM decreases vitamin B12(B12) in patients and evidence shows that low B12 dysregulates lipid levels. We therefore investigated whether low B12 impairs FAO ind...

Pneumocystis jirovecii pneumonia (PJP) is well recognised in HIV infected and transplant recipient populations and prophylaxis is standard practice. PJP may also occur in rarer cases of immunodeficiency. We report 2 cases of Cushing’s syndrome complicated by PJP. Patient 1 was a 30 year old Indian male who presented with 2 weeks of bloody diarrhoea, abdominal pain and lethargy. He was cushingoid and investigations showed severe hypercortisolism (urinary cortisol >266,...

Background: Hyperosmolar hyperglycaemic state (HHS) is a life-threatening condition that can be the initial presentation of type 2 diabetes mellitus. This condition is characterized by severe hyperglycaemia, a high serum osmolality and dehydration without accumulation of ketoacids. We report two patients who presented with mixed features of HHS and DKA.Case 1: An 11-year-old Afro-Caribbean boy with severe developmental delay presented with a 4-week histo...

Introduction: Atopic dermatitis can cause significant exudative fluid loss from a large body surface area in an infant leading to severe hyponatraemia.Case report: A 5-month-old boy was referred to the paediatric team from dermatology with severe cradle cap, eczema and fever. He also had faltering growth (weight: 4.95 kg, well below 0.4th centile) and moderate developmental delay. On examination, he had severe infected eczema over a large area of the sca...

Widespread use of CT and MRI scan has led to the identification of incidental adrenal tumours. The need to determine functionality often results in a battery of investigations that are a drain to scarce resources and are frequently normal. Studies to identify tumour radiological features that suggest functionality and hence enable targeted investigations are few in the literature. To this effect we set out to analyse which features on imaging that are best predictive of functi...