Endocrine Abstracts

Background: Management of adrenal insufficiency (AI) with glucocorticoid replacement is associated with increased mortality and morbidity. There is growing evidence that this is because of excess, non-physiological steroid exposure. Low dose prednisolone (2-4 mg) is a once-daily alternative to standard hydrocortisone regimens that more closely mimics the circadian rhythm and may translate to better outcomes. There is however a paucity of studies comparing the two treatments.</...

Background: Adrenal insufficiency (AI) is a life-threatening condition if left unmanaged. Despite treatment patients can expect a life expectancy that is shortened by 12 years secondary to probable inherent over-replacement associated with oral glucocorticoid regimens. Thrice-daily hydrocortisone is the most common regimen used. Very low-dose prednisolone (2-4 mg) is an alternative with lower uptake due to the absence of evidence for its use. This study fills this literature g...

Introduction: Glucocorticoid replacement in adrenal insufficiency may be achieved by administering thrice- daily hydrocortisone or once-daily very low dose (2-4 mg) prednisolone. Prednisolone’s longer half-life enables once-daily dosing, improving patient satisfaction and compliance. At very low doses, it has shown no difference in most markers of metabolic risk when compared with hydrocortisone. At Imperial College Healthcare NHS Trust (ICHNT), use of an eight-hour troug...

Introduction: Liberal glucocorticoid replacement therapy prevents Addisonian crises in individuals with adrenal insufficiency (AI). Prednisolone is six to eight times more potent than hydrocortisone. There is inter-individual variation in glucocorticoid metabolism wherein 5 mg prednisolone once-daily may result in over-replacement in most individuals, with subsequent long-term morbidity and mortality.Methods: Data from individuals on established predniso...

Background: Adrenal insufficiency (AI) is a life-threatening condition which requires long term glucocorticoid (GC) replacement. Patient misdiagnosis results in inappropriate GC use, which has significant adverse effects and is associated with an increased mortality risk. The insulin tolerance test (ITT) is the gold standard test for diagnosis, but the widely accepted cut-off value of ≤550 nmol/l used to diagnose AI is founded on outdated immunoassays. Use of this cut-of...

A 26-year-old woman presented to the Endocrine clinic with features of Cushing’s syndrome (CS). Investigations revealed a non-suppressible cortisol in low dose Dexamethasone suppression test with a suppressed ACTH, and two positive 24-hour urine cortisol collections, indicating CS. CT imaging revealed a left adrenal adenoma of 3.4 cm. Following a left adrenalectomy, she was discharged on once daily Prednisolone 3 mg. She was well for a year except for one occasion where s...

Case history: A 51 year old gentleman presented to ED with severe right thigh pain, a 6 month history of weight loss, and 2 weeks of polyuria. He had no medical history and took no regular medications. He worked as a postman, was a non-smoker and non-drinker.Investigations: Bloods showed adjusted calcium of 5.04 mmol/l, parathyroid hormone (PTH) 1.4 pmol/l, and alkaline phosphatase 438 IU/l. Vitamin D was reported one week later as 37 nmol/l. His haemogl...

We report 2 patients with Graves’ thyrotoxicosis complicated by jaundice.Case 1 - A 36 year old referred to the gastroenterologists with a 3-month history of general malaise, myalgia, jaundice, 4 stone weight loss and diarrhoea. A hepatitis and autoimmune liver screen were negative, bilirubin elevated at 200 umol/l, coagulation screen and ultrasound scan were normal and a liver biopsy showed cholestasis. Thyroid function tests (TFT’s) demonstra...

The presence of thyroid peroxidase antibodies (TPOAb) is a marker of autoimmune thyroid disease and, when present in early pregnancy, is predictive of postpartum thyroiditis. In the course of undertaking the Controlled Antenatal Thyroid Screening Study we have taken the opportunity to measure TPOAb in a large number of samples from 11–16 weeks gestation by 3 different assays.The assays were (1) an in-house ELISA; (2) Bayer ADVIA Centaur anti-TPO ass...

Prednisolone is widely prescribed in the UK, whereas prednisone is used instead for the same indications in the United States. Both have utility as anti-inflammatory agents and for use as glucocorticoid replacement therapy at lower doses. Oral prednisone is converted to prednisolone by first pass hepatic metabolism by 11 beta HSD-1. This study was undertaken to compare the bioavailability of prednisone against prednisolone. To determine the conversion of prednisone to predniso...