Endocrine Abstracts

Background: Patients with adrenal insufficiency (AI) require glucocorticoid replacement therapy. Current Endocrine Society guidelines recommend thrice-daily hydrocortisone (15-25mg) or once-daily prednisolone (3-5mg). Concerns around prednisolone use have been based on evidence using higher doses. We have been using low-dose (2-4mg) once-daily prednisolone since 2014 for glucocorticoid replacement in adult patients with AI. This study aimed to compare the effe...

Background: Adrenal Insufficiency (AI) is a life-threatening disorder caused by dysfunction of the adrenal axis (primary AI) or of the hypothalamic-pituitary-adrenal axis (secondary AI). Both result in glucocorticoid deficiency, requiring life-long replacement, with additional mineralocorticoid replacement required in primary AI. However, accurately reproducing the endogenous circadian and ultradian rhythm of cortisol secretion is challenging. Current Endocrin...

β-Caryophyllene, a dietary CB2 receptor selective cannabinoid mitigates myocardial fibrosis in a mice model of diabetic cardiomyopathyBackground and aim: Diabetic cardiomyopathy (DCM), a cardiac complication in diabetes is characterized by abnormal cardiac function accompanied with myocardial fibrosis. In recent years, the cannabinoid type 2 receptors (CB2) emerged as a crucial therapeutic target for diabetes and its complications. The downregulatio...

Introduction: Prolactinomas are the commonest type of secretory pituitary tumours. In current practice, dopamine agonists (DA) remain the mainstay treatment. However, treating physicians are increasingly aware of DA-associated impulse control disorders (ICD) in their patients. We describe 4 individuals with prolactinomas, who either developed ICD on DA or deemed at ‘high risk’, successfully managed surgically with preservation of pituitary function. All decisions for...

A 44 year old gentleman presented to his local hospital with a two week history of fevers and rigors. Blood cultures were positive for Streptococcus oralis, and an echocardiogram confirmed new diagnosis of hypertrophic cardiomyopathy (HCM) complicated by mitral valve infective endocarditis (IE). Unfortunately, this required a mechanical mitral valve replacement (MVR) and he started warfarin (INR target 2.5-3.5). During his admission, he reported chronic headaches. An MRI brain...

A 44-year-old gentleman presented to the Emergency Department with a 2-week history of fever and rigors. Past medical history was unremarkable other than an earlier diagnosis of hypertension. He was noted to have new onset atrial fibrillation with rapid ventricular response; a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) was made on echocardiography. In addition, a vegetation was identified on the mitral valve. Treatment for infective endocarditis (Streptoco...

Case history : A 44-year-old female presented with 6-week history of gradual deterioration in her left vision associated with eye pain. She saw an ophthalmologist who noted that she had reduced visual acuity (6/24) and colour vision (Ishihara colour vision score 3/15) in her left eye with left relative afferent pupillary defect (RAPD). It was thought that she may have a left retrobulbar neuritis so she was advised to attend A&E for an urgent neurology assessment. On examin...

A 30-year-old female presented to her general practitioner with a three-month history of fatigue, visual disturbance, polydipsia and dizziness. She was treated for iron deficiency anaemia, but re-presented two-months later with new-onset headache and worsening visual disturbance. Previously, she had childhood leukaemia, treated in Brazil with no cranial irradiation. On examination there was left eye loss of light/dark perception and right temporal vision loss. She was referred...

Purpose: There are sporadic reports illustrating more severe TED and complications in those with diabetes mellitus (DM) and from local experience these patients have poorer outcomes as seen in other diseases, such as cardiovascular disease. However, the relationship between glycaemia and clinical activity/severity and disease course are not well described.Methods: A multi-centre retrospective patient-cohort study of 236 patients referred to three TED mul...

Purpose: There is increasing evidence that a multidisciplinary (MDT) approach optimises diagnosis and management in active Thyroid Eye Disease (TED) and is recommended by current TEAMeD-5 guidelines1. Here we aim to describe the clinical and endocrine characteristics of a large cohorts of patients with TED seen in 3 MDT clinics in London.Methods: A retrospective patient-cohort study of 236 patients with suspected TED referred to these services...